Warli Syah Mirsya, Prapiska Fauriski Febrian, Siregar Dewi Indah Sari, Seja Ilham Ari
Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara - Haji Adam Malik General Hospital, Medan, Indonesia.
Department of Urology, Faculty of Medicine, Universitas Sumatera Utara Hospital - Universitas Sumatera Utara, Medan, Indonesia.
World J Oncol. 2023 Oct;14(5):423-429. doi: 10.14740/wjon1676. Epub 2023 Sep 20.
Bladder cancer, as one of types of cancers within the urinary tract, is associated with a greater risk of acute kidney injury (AKI), resulting in a poorer prognosis, discontinuation of effective oncological treatments, longer hospitalization, and higher expenses. There is no discussion yet on tumor markers in bladder cancer. With the revolutionary advances in bladder cancer molecular subtyping over the past decade, the presence of tumor markers to assess the staging of bladder cancer has yet to be discussed. In this study, we intended to assess the relationship between tumor markers and incidence of AKI, also between tumor markers and the cancer staging.
This retrospective cross-sectional study utilized secondary data from 26 medical records of patients diagnosed with bladder cancer at the Adam Malik and Universitas Sumatera Utara Hospital between 2021and 2022. This study included all patients with bladder cancer who met the inclusion criteria. Continuous variables were reported as mean (standard deviation (SD)) and examined using an independent -test. Categorical variables were reported as proportions, examined using Chi-square or Fisher's exact test. Pre- and post-tumor marker data were evaluated with dependent sample -test for normal variance data, and Wilcoxon test for data with atypical distribution. P values were set at 0.05.
CD44 (P = 0.003) and programmed cell death 1 (PD-1) (P = 0.030) were the only significant markers in their pre- and post-chemoradiation states among the four investigated tumor markers in this study. Meanwhile, PD-1 tumor marker levels were only found to be significant between AKI and pre-chemoradiation (P = 0.011). Even though the multivariate study of tumor staging did not show any statistical significance, both tumor markers CD44 and PD-1 showed a significant effect on the incidence of acute renal damage (P = 0.034).
Pre-chemoradiation PD-1 tumor markers showed promise as good predictive indicators for staging and AKI incidence in muscle-invasive bladder cancer patients undergoing chemoradiation therapy.
膀胱癌作为泌尿系统癌症的一种，与急性肾损伤（AKI）的风险增加相关，导致预后较差、有效肿瘤治疗中断、住院时间延长和费用增加。目前尚未对膀胱癌中的肿瘤标志物进行讨论。在过去十年中，膀胱癌分子亚型取得了革命性进展，但用于评估膀胱癌分期的肿瘤标志物的存在情况仍有待探讨。在本研究中，我们旨在评估肿瘤标志物与AKI发生率之间的关系，以及肿瘤标志物与癌症分期之间的关系。
这项回顾性横断面研究利用了2021年至2022年期间在亚当·马利克和北苏门答腊大学医院确诊为膀胱癌的26例患者的医疗记录中的二次数据。本研究纳入了所有符合纳入标准的膀胱癌患者。连续变量以均值（标准差（SD））报告，并使用独立t检验进行检验。分类变量以比例报告，使用卡方检验或费舍尔精确检验进行检验。肿瘤标志物前后数据采用方差正常的数据的相关样本t检验和非典型分布数据的威尔科克森检验进行评估。P值设定为0.05。
在本研究调查的四种肿瘤标志物中，CD44（P = 0.003）和程序性细胞死亡蛋白1（PD-1）（P = 0.030）是其放化疗前后状态中唯一具有显著意义的标志物。同时，仅发现PD-1肿瘤标志物水平在AKI与放化疗前之间具有显著意义（P = 0.011）。尽管肿瘤分期的多变量研究未显示任何统计学意义，但肿瘤标志物CD44和PD-1均对急性肾损伤的发生率有显著影响（P = 0.034）。
放化疗前的PD-1肿瘤标志物有望成为接受放化疗的肌层浸润性膀胱癌患者分期和AKI发生率的良好预测指标。
