Email Alert | RSS

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)

RICH HTML

 5   

PDF (PC)

177

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*
[1] Feng C, Wang L, Ding G , et al. Predictive value of clinicopathological markers for the metachronous bladder cancer and prognosis of upper tract urothelial carcinoma[J]. Sci Rep, 2014,4(6):4015.
[2] Mehta R, Gillan AS, Ming ZY , et al. Socio-economic deprivation and outcomes following radical nephroureterectomy for clinically localized upper tract transitional cell carcinoma[J]. World J Urol, 2015,33(1):41-49.
[3] Ishioka J, Saito K, Kijima T , et al. Risk stratification for bladder recurrence of upper urinary tract urothelial carcinoma after radical nephroureterectomy[J]. BJU Int, 2015,115(5):705-712.
[4] Hamada S, Horiguchi A, Asano T , et al. Prognostic impact of fatty acid synthase expression in upper urinary tract urothelial carcinoma[J]. Jpn J Clin Oncol, 2014,44(5):486-492.
[5] Rink M, Sharifi N, Fritsche HM , et al. Impact of preoperative anemia on oncologic outcomes of upper tract urothelial carcinoma treated with radical nephroureterectomy[J]. J Urol, 2014,191(2):316-322.
[6] Krabbe LM, Westerman ME, Bagrodia A , et al. Surgical management of the distal ureter during radical nephroureterectomy is an independent predictor of oncological outcomes: results of a current series and a review of the literature[J]. Urol Oncol, 2014,32(1):54e19-54e26.
[7] Chromecki TF, Cha EK, Fajkovic H , et al. The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy[J]. Eur Urol, 2012,61(2):245-253.
[8] Nutritional anaemias . Report of a WHO scientific group[J]. World Health Organ Tech Rep Ser, 1968,405:5-37.
[9] Epstein JI, Amin MB, Reuter VR , et al. The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee[J]. Am J Surg Pathol, 1998,22(12):1435-1448.
[10] Greene FL, Sobin LH . A worldwide approach to the TNM staging system: collaborative efforts of the AJCC and UICC[J]. J Surg Oncol, 2009,99(5):269-272.
[11] Yeh HC, Chien TM, Wu WJ , et al. Is preoperative anemia a risk factor for upper tract urothelial carcinoma following radical nephroureterectomy?[J]. Urol oncol, 2016,34(8):337e331-337e339.
[12] Lu YM, Li CC, Wu WJ , et al. Patients’ renal function is important when evaluating preoperative anemia in upper tract urothelial carcinoma[J]. Clin Genitourin Cancer, 2016,14(2):e241-e243.
[13] Gilreath JA, Stenehjem DD, Rodgers GM . Diagnosis and treatment of cancer-related anemia[J]. Am J Hematol, 2014,89(2):203-212.
[14] Gaspar BL, Sharma P, Das R . Anemia in malignancies: pathogenetic and diagnostic considerations[J]. Hematology, 2015,20(1):18-25.
[1] 樊理诗,高敏,Edwin B.FISHER,孙昕霙. 北京市通州区和顺义区747例2型糖尿病患者生存质量影响因素[J]. 北京大学学报（医学版）, 2021, 53(3): 523-529.
[2] 王兆年,高文静,王碧琦,曹卫华,吕筠,余灿清,逄增昌,丛黎明,汪华,吴先萍,刘彧,李立明. 成年双生子空腹血糖、糖化血红蛋白与全基因组DNA甲基化的相关性研究[J]. 北京大学学报（医学版）, 2020, 52(3): 425-431.
[3] 马闰卓,夏海缀,陆敏,张智荧,张启鸣,卢剑,王国良,马潞林. 输尿管镜活体组织检查对上尿路尿路上皮癌根治性手术的影响[J]. 北京大学学报（医学版）, 2019, 51(4): 665-672.
[4] 吴进锋,林榕城,林友成,蔡旺海,朱庆国,方冬,熊耕砚,张雷,周利群,叶烈夫,李学松. 肾输尿管全长切除术两种不同术式的双中心疗效对比[J]. 北京大学学报（医学版）, 2019, 51(4): 646-652.
[5] 杨超，王晋伟，杨尧政，白坤昊，高碧霞，赵明辉，张路霞，吴寿岭，王芳. 贫血及慢性肾脏病对糖尿病人群心脑血管事件发生与死亡的影响[J]. 北京大学学报(医学版), 2018, 50(3): 495-500.
[6] 刘晓宇, 杨晓庆, 肖慧捷, 丁洁. 外周血无创总血红蛋白测定与静脉血血红蛋白检测在肾病患儿中的对比[J]. 北京大学学报(医学版), 2017, 49(5): 778-782.
[7] 关豹，曹振朋，彭鼎，李一帆，詹永豪，刘漓波，何世明，熊耕砚，李学松，周利群. T2N0M0期上尿路尿路上皮癌患者预后相关因素分析：单中心235例患者回顾性研究[J]. 北京大学学报(医学版), 2017, 49(4): 603-607.
[8] 曹亚英，唐迅，孙可欣，刘志科，项骁，隽娟，宋菁，殷琼洲，扎西德吉，胡亚楠，. 2型糖尿病患者血糖控制与内脏脂肪指数的关系[J]. 北京大学学报(医学版), 2017, 49(3): 446-450.
[9] 宋逸，张冰，胡佩瑾，马军. 中国少数民族学生贫血现况及其与营养状况的关联研究[J]. 北京大学学报(医学版), 2016, 48(3): 429-435.
[10] 刘丹, 李茹, 刘佳钰, 姚海红, 陈庆平, 贾园, 苏茵 . 显微镜下多血管炎合并自身免疫性溶血性贫血的临床特点及治疗转归[J]. 北京大学学报(医学版), 2015, 47(4): 657-660.
[11] 孙可欣, 刘志, 曹亚英, 隽娟, 项骁, 杨成, 黄少平, 刘晓芬, 李娜, 唐迅, 李劲, 吴涛, 陈大方, 胡永华 . 北京某社区2型糖尿病患者血糖控制情况与肱踝脉搏波传导速度的相关性研究[J]. 北京大学学报（医学版）, 2015, 47(3): 431-436.
[12] 周利群, 李学松, 熊耕砚. 中国人群上尿路尿路上皮癌新进展[J]. 北京大学学报（医学版）, 2014, 46(4): 504-506.
[13] 徐菁玲, 孟焕新, 李峥, 李凤云, 张琳. 牙周基础治疗对2型糖尿病伴慢性牙周炎患者血糖代谢指标及血清生化指标的影响[J]. 北京大学学报（医学版）, 2013, 45(1): 27-32.
[14] 房玥晖, 冯鑫, 徐昊, 吴峥昊, 许雅君, . 铁饱和重组人乳铁蛋白对大鼠缺铁性贫血的恢复作用[J]. 北京大学学报（医学版）, 2013, 45(03): 417-421.
[15] 张燕京, 李晓玫. 药物相关肾实质性急性肾衰竭患者的贫血特征、红细胞生成素水平及其与肾损害的关系[J]. 北京大学学报（医学版）, 2005, 37(5): 471-475.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究（英文稿）[J]. 北京大学学报（医学版）, 2009, 41(4): 456 -458 .
[2] 卢恬, 朱晓辉, 柳世庆, 郑杰, 邱晓彦. 白细胞介素2促进宫颈癌细胞系HeLaS3免疫球蛋白G的表达[J]. 北京大学学报（医学版）, 2009, 41(2): 158 -161 .
[3] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报（医学版）, 2009, 41(2): 217 -220 .
[4] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报（医学版）, 2009, 41(1): 52 -55 .
[5] 董稳, 刘瑞昌, 刘克英, 关明, 杨旭东. 氯诺昔康和舒芬太尼用于颌面外科术后自控静脉镇痛的比较[J]. 北京大学学报（医学版）, 2009, 41(1): 109 -111 .
[6] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报（医学版）, 2009, 41(3): 297 -301 .
[7] 李伟军, 邢晓芳, 曲立科, 孟麟, 寿成超. PRL-3基因C104S位点突变体和CAAX缺失体的构建及表达[J]. 北京大学学报（医学版）, 2009, 41(5): 516 -520 .
[8] 丰雷, 王玉凤, 曹庆久. 哌甲酯对注意缺陷多动障碍儿童平衡功能影响的开放性研究[J]. 北京大学学报（医学版）, 2007, 39(3): 304 -309 .
[9] 刘津, 王玉凤. 父母培训对共患对立违抗性障碍的注意缺陷多动障碍的作用[J]. 北京大学学报（医学版）, 2007, 39(3): 310 -314 .
[10] 汪毅, 刘粹, 王玉凤. 社会技能训练对有行为问题儿童影响的随机对照研究[J]. 北京大学学报（医学版）, 2007, 39(3): 315 -318 .
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部