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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (6): 1056-1061. doi: 10.19723/j.issn.1671-167X.2019.06.014

• 论著 • 上一篇    下一篇

术前贫血对上尿路尿路上皮癌预后的影响: 单中心686例患者回顾性研究

关豹1,翁迈2,凡航2,彭鼎1,方冬1,熊耕砚1,李学松1,△(),周利群1   

  1. 1. 北京大学第一医院泌尿外科,北京　100034
    2. 武警北京总队医院泌尿外科,北京　100039
  • 收稿日期:2017-10-12 出版日期:2019-12-18 发布日期:2019-12-19
  • 通讯作者: 李学松 E-mail:pineneedle@sina.com
  • 基金资助:
    北京市自然科学基金(7152146);北京市科学技术委员会“首都临床特色应用研究项目”(151100004015173)

Evaluating the impact of preoperative anemia on the prognosis of upper tract urothelial carcinoma following radical nephroureterectomy: A single-center retrospective study of 686 patients

Bao GUAN1,Mai WENG2,Hang FAN2,Ding PENG1,Dong FANG1,Geng-yan XIONG1,Xue-song LI1,△(),Li-qun ZHOU1   

  1. 1. Department of Urology, Peking University First Hospital, Beijing 100034, China
    2. Department of Urology, Beijing Armed Police Corps Hospital, Beijing 100039, China
  • Received:2017-10-12 Online:2019-12-18 Published:2019-12-19
  • Contact: Xue-song LI E-mail:pineneedle@sina.com
  • Supported by:
    Supported by the Natural Science Foundation of Beijing(7152146);the Clinical Features Research of Capital(151100004015173)

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摘要：

目的 评估术前血红蛋白水平与上尿路尿路上皮癌(upper tract urothelial carcinoma, UTUC)患者临床病理特征的关系及其对预后的预测价值。方法 回顾性收集北京大学第一医院泌尿外科2000年1月至2013年12月686例手术治疗的UTUC患者的临床病理资料及临床随访数据,患者血红蛋白水平测定均在入院第1天,并按照世界卫生组织国际贫血分类标准(男性血红蛋白＜130 g/L,女性血红蛋白＜120 g/L), 将患者分为贫血和正常血红蛋白水平两组,并使用SPSS 20.0进行统计学分析。结果 686例患者中,女性383(55.8%, 383/686)例,男性303(44.2%,303/686)例,中位年龄为68岁(四分位距:60~74岁), 术前贫血患者320例(46.6%,320/686)。术前贫血和患者性别(P = 0.002)、年龄(P ＜ 0.001)、淋巴结转移(P = 0.026)、肿瘤分级(P = 0.018)、伴随原位癌(P = 0.038)、肿瘤组织坏死(P = 0.007)和肾功能状态(P ＜ 0.001)显著相关。患者中位随访时间47个月(四分位距:31~75个月), 随访期间共有160例(23.3%,160/686)患者死亡,其中141例(20.6%,141/686)死于肿瘤,19(2.7%,19/686)例死于其他疾病或意外。单因素和多因素回归分析发现术前贫血是患者总生存(P＜0.001,HR = 1.861)和肿瘤特异性生存(P = 0.003,HR = 1.688)的独立危险因素。结论 术前贫血是UTUC患者总生存和肿瘤特异性生存的独立预后因素。

关键词: 上尿路尿路上皮癌, 肾输尿管全长切除术, 血红蛋白, 贫血

Abstract:

Objective: To identify the effect of preoperative anemia on the prognosis of patients with upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy. Methods: Clinicopathological and prognosis data on 686 patients with UTUC who underwent RNU at Peking University First Hospital between January 2000 and December 2013 were retrospectively analyzed. Preoperative anemia was defined as hemoglobin ＜130 g/L in men and ＜120 g/L in women based on the World Health Organization classification. The Kaplan-Meier method with log-rank test was applied to estimate the effect of anemia on survival. The associations of clinicopathologic features with overall survival and cancer-specific survival were evaluated using univariate and multivariate Cox regression models. Results: There were 303(44.2%, 303/686) male and 383(55.8%, 383/686) female patients, and the median age was 68 years (interquartile range: 60-74 years). In all, 320(46.6%, 320/686)patients were anemic before surgery. The median follow-up duration was 47 months. In all, 160 (23.3%) patients died, 141 (20.6%) died of cancer and 19 (2.7%) died of other disease or accidents. Preoperative anemia was associated with gender (P=0.002), age (P＜0.001), lymph node positive (P=0.026), increased tumor grade (P=0.018), concomitant carcinoma in situ (P=0.038), tumor necrosis (P=0.007) and poor renal function (P＜0.001). In univariate analysis, overall mortality was correlated with pre-operative anemia (P＜0.001), gender (P=0.009), hydronephrosis (P=0.024), tumor stage (P＜0.001), lymph node positive (P＜0.001), tumor grade (P＜0.001), tumor architecture(P＜0.001), sarcomatoid differentiation (P=0.013), history of ureteroscope (P=0.033) and tumor hemorrhage (P＜0.001); cancer-specific mortality was correlated with preoperative anemia (P=0.001), gender (P=0.001), hydronephrosis (P=0.043), tumor stage (P＜0.001), lymph node positive (P＜0.001), tumor grade (P＜0.001), tumor architecture (P＜0.001), sarcomatoid differentiation (P=0.016), history of ureteroscope (P=0.028) and tumor hemorrhage (P=0.003). A multivariate Cox proportional hazards model indicated that preoperative anemia was an independent prognositic predictor for overall mortality (P＜0.001, HR=1.861) and cancer-specific mortality (P=0.003, HR=1.688). Conclusion: The preoperative anemia is an independent risk factor for cancer-specific survival and overall survival. Hemoglobin levels should be considered during patient counseling and in decision-making for further therapy.

Key words: Upper tract urothelial carcinoma, Radical nephroureterectomy, Hemoglobin, Anemia

中图分类号: 

  • R730.261

表1

上尿路尿路上皮癌患者临床病理特点及与术前贫血的关系"

Items Overall, n Normal hemoglobin, n Anemia, n P value
Total 686 366 320
Gender 0.002*
Male 303 182 121
Female 383 184 199
Age group/years old ＜0.001*
＜50 48 35 13
50 - 115 76 39
60 - 217 119 98
70 - 248 115 133
>80 58 21 37
Hydronephrosis 0.868
Absent 296 159 137
Present 390 207 183
Pathological stage 0.586
Ta, Tis, T1 245 134 111
T2 238 124 114
T3 183 102 81
T4 20 6 14
Lymph node status 0.026*
Negative 632 345 287
Positive 54 21 33
Tumor grade status 0.018*
G1 20 16 4
G2 366 203 163
G3 300 147 153
Concomitant CIS 0.038*
Absent 664 359 305
Present 22 7 15
Tumor architecture 0.086
Papillary 518 286 232
Sessile 168 80 88
Items Overall, n Normal hemoglobin, n Anemia, n P value
Tumor necrosis 0.007*
Absent 609 336 273
Present 77 30 47
Tumor multifocality 0.519
Absent 487 256 231
Present 199 110 89
Tumor differentiation 0.025*
Urothelium 573 317 256
Squamous 60 25 35
Sarcomatoid 28 10 18
Adenoid 25 14 11
eGFR/(mL/min) ＜0.001*
>90 58 44 14
60- 250 172 78
30- 290 143 147
15- 34 4 30
≤15 54 3 51
History of ureteroscope 0.655
Present 88 45 43
Absent 598 321 277
Tumor hemorrhage 0.347
Present 29 13 16
Absent 657 353 304

图1

术前血红蛋白分组与肿瘤特异性生存的Kaplan-Meier生存曲线"

图2

术前血红蛋白分组与总生存的Kaplan-Meier生存曲线"

表2

单因素及多因素Cox回归分析预测UTUC患者总生存及肿瘤特异性生存"

Parameters Overall survival Cancer-specific survival
Univariate analysis Multivariate analysis Univariate analysis Multivariate analysis
HR 95%CI P HR 95%CI P HR 95%CI P HR 95%CI P
Anemia (yes vs. no) 1.915 1.390-2.638 ＜0.001* 1.861 1.337-2.590 ＜0.001* 1.733 1.236-2.428 0.001* 1.688 0.191-2.391 0.003*
Gender (male vs. female) 1.508 1.106-2.056 0.009* 1.498 1.086-2.065 0.014* 1.776 1.273-2.477 0.001* 1.702 1.207-2.401 0.002*
Age (continuous) 1.002 0.988-1.017 0.773 1.012 0.998-1.026 0.091
Hydronephrosis (yes vs. no) 1.451 1.051-2.002 0.024* 1.747 1.256-2.429 0.001* 1.424 1.011-2.007 0.043* 1.744 1.228-2.477 0.002*
Tumor stage (≤T2 vs. T3&T4) 1.830 1.524-2.196 ＜0.001* 1.706 1.399-2.079 ＜0.001* 1.921 1.582-2.33 ＜0.001* 1.745 1.413-2.154 ＜0.001*
Lymph node status (positive vs. negative) 2.871 1.841-4.476 ＜0.001* 1.696 1.047-2.747 0.032* 3.210 2.049-5.029 ＜0.001* 1.830 1.121-2.988 0.016*
Tumor grade (G3 vs.G1&G2) 1.735 1.298-2.318 ＜0.001* 1.764 1.293-2.408 ＜0.001*
Concomitant CIS (yes vs. no) 1.014 0.448-2.294 0.973 0.970 0.397-2.369 0.947
Tumor architecture (papillary vs. sessile) 1.872 1.343-2.610 ＜0.001* 1.955 1.378-2.773 ＜0.001*
Tumor multifocality (yes vs. no) 0.903 0.643-1.266 0.553 0.845 0.586-1.219 0.367
Sarcomatoid differentiation (yes vs. no) 2.166 1.173-4.000 0.013* 2.209 1.161-4.204 0.016*
Renal function (CKD vs. normal) 1.103 0.949-1.280 0.201 1.034 0.879-1.216 0.688
Treated with ureteroscope (yes vs. no) 0.561 0.33-0.955 0.033* 0.516 0.285-0.933 0.028*
Tumor hemorrhage (yes vs. no) 2.451 1.481-4.056 ＜0.001* 2.204 1.317-3.687 0.003* 2.294 1.320-3.987 0.003* 2.125 1.210-3.732 0.009*
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ISSN 1671-167X
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