Friedman G D, Carroll P R, Cattolica E V, Hiatt R A
Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94611, USA.
Cancer Epidemiol Biomarkers Prev. 1996 Dec;5(12):993-6.
In a case-control study of urinalysis screening in the prevention of death from bladder cancer, hematuria was present in a higher proportion of cases than controls as long as five or six years before the diagnostic evaluation that led to the diagnosis of bladder cancer. In a separate cohort study data base that permitted the follow-up of 1046 persons with a physician's diagnosis of hematuria, 11 cases of bladder cancer were diagnosed more than two (mean 7.4) years after the hematuria diagnosis (4.3 cases expected; age-sex standardized morbidity ratio, 2.5; 95% confidence interval, 1.3-4.5). Bladder cancer was ruled out initially by cystoscopy in 8 of the 11 cases. Although we cannot be certain that preexisting bladder cancer or bladder cancer risk factors did not cause the bleeding, we hypothesize that hematuria can be a predictor as well as a manifestation of bladder cancer, based on a tendency for bladder mucosa with premalignant changes to bleed. The implications for screening and clinical practice remain to be determined.
在一项关于尿液分析筛查预防膀胱癌死亡的病例对照研究中，在导致膀胱癌诊断的诊断评估前长达五六年的时间里，病例组中血尿出现的比例高于对照组。在另一项队列研究数据库中，对1046名经医生诊断为血尿的患者进行了随访，在血尿诊断后两年多（平均7.4年）诊断出11例膀胱癌（预期4.3例；年龄性别标准化发病率比为2.5；95%置信区间为1.3 - 4.5）。11例病例中有8例最初经膀胱镜检查排除了膀胱癌。尽管我们不能确定先前存在的膀胱癌或膀胱癌危险因素是否未导致出血，但基于癌前病变的膀胱黏膜有出血倾向，我们推测血尿可能是膀胱癌的一个预测指标以及一种表现形式。其对筛查和临床实践的影响仍有待确定。
