Thrasher J B, Frazier H A, Robertson J E, Dodge R K, Paulson D F
Division of Urology, Duke University Medical Center, Durham, NC 27710.
Cancer. 1994 Mar 15;73(6):1708-15. doi: 10.1002/1097-0142(19940315)73:6<1708::aid-cncr2820730626>3.0.co;2-j.
Studies have demonstrated conclusively that the stage and grade of transitional cell tumors at presentation are major determinants of survival for those with the disease in the bladder and prostate. The authors initiated a review of 531 patients with transitional cell carcinoma of the bladder and prostate treated with radical cystectomy between 1969 and 1990 to identify other clinical features predictive of cancer-specific survival.
Inpatient and clinical medical records were analyzed for age, race, gender, clinical T stage, medical history, and presenting symptoms and signs, and admission laboratory values were correlated with the patient's cancer-specific outcome. Both univariate and multivariate analyses of the various clinical factors were performed to identify variables predictive of cancer-specific survival.
Univariate analysis indicated that clinical T classification, preoperative hemoglobin, tumor grade, irritative voiding symptoms, age, preoperative creatinine, obstructive hydronephrosis on preoperative excretory urography, a history of bladder tumors or nephrouretectomy for transitional cell cancer, prior urinary tract infections, prior pelvic irradiation, and obstructive symptoms were all predictive of poor cancer-specific survival. Multivariate analysis demonstrated that higher clinical T classification (T2, T3a, T3b, T4 versus Ta, Tis, T1) (P < 0.001), increasing age (< 65 years versus > or = 65 years) (P < 0.001), the presence of irritative voiding symptoms (P = 0.01), higher tumor grade, lower preoperative hemoglobin level (< or = 12 gm/dl versus > 12 gm/dl) (P < 0.001), higher preoperative creatinine level (> or = 1.5 mg/dl versus < 1.5 mg/dl) (P = 0.002), a history of nephroureterectomy for transitional cell cancer (P = 0.016), and a history of pelvic irradiation (P = 0.002) were all predictive of poor cancer-specific survival.
Although clinical T classification and tumor grade remain the best predictors of survival in patients with transitional cell carcinoma of the bladder or prostate, clinical variables such as age, preoperative creatinine and hemoglobin levels, a history of nephroureterectomy or pelvic irradiation, and irritative voiding symptoms at presentation may provide additional prognostic information independent of tumor grade and stage.
研究已确凿证明，膀胱和前列腺移行细胞肿瘤初诊时的分期和分级是这些疾病患者生存的主要决定因素。作者对1969年至1990年间接受根治性膀胱切除术治疗的531例膀胱和前列腺移行细胞癌患者进行了回顾，以确定其他预测癌症特异性生存的临床特征。
分析住院和临床病历中的年龄、种族、性别、临床T分期、病史、症状和体征，并将入院实验室值与患者的癌症特异性结局相关联。对各种临床因素进行单变量和多变量分析，以确定预测癌症特异性生存的变量。
单变量分析表明，临床T分类、术前血红蛋白、肿瘤分级、刺激性排尿症状、年龄、术前肌酐、术前排泄性尿路造影显示的梗阻性肾积水、膀胱肿瘤病史或因移行细胞癌行肾输尿管切除术史、既往尿路感染、既往盆腔放疗以及梗阻症状均预测癌症特异性生存较差。多变量分析表明，较高的临床T分类（T2、T3a、T3b、T4与Ta、Tis、T1相比）（P < 0.001）、年龄增加（< 65岁与≥65岁相比）（P < 0.001）、存在刺激性排尿症状（P = 0.01）、较高的肿瘤分级、较低的术前血红蛋白水平（≤12 g/dl与> 12 g/dl相比）（P < 0.001）、较高的术前肌酐水平（≥1.5 mg/dl与< 1.5 mg/dl相比）（P = 0.002）、因移行细胞癌行肾输尿管切除术史（P = 0.016）以及盆腔放疗史（P = 0.002）均预测癌症特异性生存较差。
虽然临床T分类和肿瘤分级仍然是膀胱或前列腺移行细胞癌患者生存的最佳预测指标，但年龄术前肌酐和血红蛋白水平、肾输尿管切除术或盆腔放疗史以及初诊时的刺激性排尿症状等临床变量可能提供独立于肿瘤分级和分期的额外预后信息。
