饮水习惯与上尿路尿路上皮癌病理特征的相关性分析

doi:10.19723/j.issn.1671-167X.2022.04.007

摘要/Abstract

摘要：

目的: 探究饮水习惯与上尿路尿路上皮癌(upper tract urothelial carcinoma, UTUC)患者的临床病理特征之间的相关性。方法: 选取北京大学第一医院泌尿外科2020年8月至2021年7月收治的拟行根治性切除术的UTUC患者，在术前进行问卷调查，了解其饮水习惯，结合其术后病理特点进行统计分析。统计过程采用SPSS 22.0软件，首先采用列联表χ²检验，对UTUC肿瘤病理特点作为因变量与患者一般信息、既往史及饮水习惯相关因素等作为自变量逐一进行初步分析，筛选出针对各因变量病例组和对照组之间满足P＜0.2的自变量，将筛选后的变量纳入二元Logistic回归分析，以P＜0.05为差异有统计学意义。结果: 共纳入239例患者，男性134例，女性105例，平均年龄(68.1±9.98)岁，中位病程4.8个月。统计结果提示，经调整了混杂因素的影响后，有白天每小时至少饮水1次习惯的UTUC患者患高级别(G3)肿瘤的概率增加(OR=1.941, 95%CI: 0.352~1.029，P＜0.01)；有白天每小时至少饮水1次习惯的患者相对于没有这一习惯的患者患多灶性UTUC肿瘤的发病风险显著下降(OR=0.344, 95%CI: 1.18~5.582，P=0.004)，同时有每次饮水≥100 mL习惯的患者相对于无这一习惯者多灶性UTUC肿瘤的发病风险也显著下降(OR=0.477, 95%CI: 0.225~1.012，P=0.046)；有自我关注每日饮水这一习惯的患者相对于无这一习惯的患者患肾盂癌的风险显著升高(OR=2.530, 95%CI: 1.434~4.463，P=0.001)，而患输尿管癌的风险显著降低(OR=0.314, 95%CI: 0.172~0.573，P＜0.01)；其他纳入回归模型的变量对肿瘤病理特点发生的影响差异无统计学意义。结论: 有白天每小时至少饮水1次、每次饮水≥100 mL、自我关注每日饮水等饮水习惯分别与上尿路尿路上皮癌病理特点(如肿瘤G3、肿瘤多灶性及肿瘤位于肾盂或输尿管)存在显著相关性，这一结论仍需后续更高证据等级的试验加以验证。

关键词: 上尿路尿路上皮癌, 饮水习惯, 病理特征, 相关性分析

Abstract:

Objective: To investigate the correlation between drinking habits and pathological characteristics of patients with upper tract urothelial carcinoma (UTUC). Methods: A preoperative questionnaire survey was conducted to understand the drinking habits of UTUC patients who were admitted to the Department of Urology, Peking University First Hospital for radical nephroureterectomy within one year from August 2020 to July 2021, and statistical analysis was performed in combination with their postoperative pathological characteristics. The statistical procedure was performed using SPSS 22.0 software, and firstly, the preliminary analysis was performed one by one using the columnar χ² test on the pathological characteristics of UTUC tumors as the dependent variable and the factors related to patients' general information, past history and drinking habits as the independent variables, and the independent variables that met P < 0.2 between the case and control groups for each dependent variable were specified for screening. The screened variables were included in the binary Logistic regression analysis. A difference of P < 0.05 was used to indicate a statistically significant difference. Results: A total of 239 patients, 134 males and 105 females, with a mean age of (68.1±9.98)years and a median disease duration of 4.8 months, were included in this study. Multifactorial Logistic regression results suggested that after adjusting for the effects of other variables, UTUC patients who had the habit of drinking at least once every hour during the daytime had a significantly increased risk of high grade (G3) tumors(OR=1.941, 95%CI: 0.352-1.029, P < 0.01); these patients also had a significantly decreased risk of multifocal UTUC tumors (OR=0.344, 95% CI: 1.18-5.582, P=0.004). The patients who had the habit of drinking over 100 mL water each time had a significantly decreased risk of mutifocal UTUC incidence (OR=0.477, 95%CI: 0.225-1.012, P=0.046). Patients who pay attention to daily water intakes had a significantly increased risk of renipelvic carcinoma (OR=2.530, 95%CI: 1.434-4.463, P=0.001) and a significantly decreased risk of ureteral carcinoma (OR=0.314, 95%CI: 0.172-0.573, P < 0.01). Other variables included in the regression model did not differ significantly in their effects on the occurrence of tumor pathological characteristics. Conclusion: Having the awareness of drinking water every 1 h during the day, drinking over 100 mL water each time, having the awareness of daily drinking habits correlated significantly with pathological characteristics of UTUC such as the presence of G3 tumor, multifocal tumors and location of the tumor. This conclusion still needs to be verified by subsequent trials with higher levels of evidence.

Key words: Upper tract urothelial carcinoma, Drinking habit, Pathological characteristic, Correlation analysis

中图分类号:

R737.1

李志华,徐纯如,刘颖,贯华,张萌,车新艳,唐琦,黄燕波,李学松,周利群. 饮水习惯与上尿路尿路上皮癌病理特征的相关性分析[J]. 北京大学学报（医学版）, 2022, 54(4): 621-627.

Zhi-hua LI,Chun-ru XU,Yin LIU,Hua GUAN,Meng ZHANG,Xin-yan CHE,Qi TANG,Yan-bo HUANG,Xue-song LI,Li-qun HOU. Correlation between daily fluid intake behavioral habits and pathological characteristics of upper tract urothelial carcinoma[J]. Journal of Peking University (Health Sciences), 2022, 54(4): 621-627.

图/表 3

表1

表2

经列联表χ2分析筛选后可纳入多因素回归分析的变量"

	Case group	Control group	χ²	P
G3 tumor，n	138	101
Drink at least once every hour, n(%)	44 (31.88)	45 (44.55)	4.006	0.045^*
Drink over 200 mL water when get up, n(%)	102 (73.91)	82 (81.19)	1.742	0.187
Smoking history, n(%)	36 (26.07)	38 (37.62)	3.631	0.057
Family history of cancer, n(%)	48 (34.78)	25 (24.75)	2.766	0.096
Multifocal tumor，n	39	200
Time of drinking
When thirsty, n(%)	13 (33.33)	93 (46.50)	2.292	0.130
Drinking water intentionally, n(%)	26 (66.67)	107 (53.50)
Drink at least once every hour during the daytime, n(%)	19 (48.72)	60 (35.00)	2.628	0.105
Drink over 100 mL water every time, n(%)	28 (71.80)	162 (81.19)	1.697	0.193
Drink water at night, n(%)	13 (33.33)	93 (46.50)	2.292	0.130
Drink over 200 mL tea every day, n(%)	21 (53.85)	75 (37.50)	3.628	0.057
Tumor located in renal pelvic，n	127	112
Time of drinking
When thirsty, n(%)	63 (49.61)	43 (38.40)	3.032	0.082
Drinking water intentionally, n(%)	64 (50.39)	69 (61.60)
Drink over 200 mL tea every day, n(%)	35 (35.43)	51 (45.54)	2.527	0.112
Paying attention to daily water intakes, n(%)	85 (66.93)	55 (49.11)	7.791	0.005^#
Family history of cancer, n(%)	48 (37.80)	25 (22.32)	6.717	0.010^*
Tumor located in ureter，n	132	107
Time of drinking
When thirsty, n(%)	49 (31.12)	57 (53.27)	6.245	0.012^*
Drinking water intentionally, n(%)	83 (62.88)	50 (46.73)
Drink at least once every hour during the daytime, n(%)	55 (41.67)	34 (31.78)	2.474	0.116
Drink water at night, n(%)	51 (38.64)	55 (51.40)	3.902	0.048^*
Drink over 200 mL tea every day, n(%)	64 (48.48)	32 (29.91)	8.487	0.004^*
Paying attention to daily water intakes, n(%)	66 (50.00)	74 (69.16)	8.940	0.003^#
Family history of cancer, n(%)	34 (25.76)	39 (36.45)	3.184	0.074

表2

表3

参考文献 28

1	Siegel RL , Miller KD , Jemal A , et al. Cancer statistics, 2019[J]. CA Cancer J Clin, 2019, 69 (1): 7- 34. doi: 10.3322/caac.21551
2	Audenet F , Isharwal S , Cha EK , et al. Clonal relatedness and mutational differences between upper tract and bladder urothelial carcinoma[J]. Clin Cancer Res, 2019, 25 (3): 967- 976. doi: 10.1158/1078-0432.CCR-18-2039
3	Zamboni S , Foerster B , Abufaraj M , et al. Incidence and survival outcomes in patients with upper urinary tract urothelial carcinoma diagnosed with variant histology and treated with nephroureterectomy[J]. BJU Int, 2019, 124 (5): 738- 745. doi: 10.1111/bju.14751
4	Belhadj Y , Grande P , Seisen T , et al. Bladder mapping of tumour recurrence after radical nephroureterectomy for upper tract urothe-lial carcinoma and its influence on oncological outcomes[J]. BJU Int, 2019, 123 (4): 618- 623. doi: 10.1111/bju.14647
5	Scott AM , Clark J , Mar CD , et al. Increased fluid intake to prevent urinary tract infections: systematic review and meta-analysis[J]. Br J Gen Pract, 2020, 70 (692): e200- e207. doi: 10.3399/bjgp20X708125
6	卢海梅. 饮食饮水习惯女性泌尿系结石复发的前瞻性研究[J]. 实用临床护理学电子杂志, 2020, 5 (15): 94.
7	Bai Y , Yuan H , Li J , et al. Relationship between bladder cancer and total fluid intake: a meta-analysis of epidemiological evidence[J]. World J Surg Oncol, 2014, 12, 223. doi: 10.1186/1477-7819-12-223
8	Hong X , Xu Q , Lan K , et al. The effect of daily fluid management and beverages consumption on the risk of bladder cancer: a meta-analysis of observational atudy[J]. Nutr Cancer, 2018, 70 (8): 1217- 1227. doi: 10.1080/01635581.2018.1512636
9	李金蓉, 蒙有轩, 廖君娟, 等. 泌尿系结石复发病人饮水习惯调查[J]. 护理研究, 2017, 31 (36): 4691- 4693. doi: 10.3969/j.issn.1009-6493.2017.36.030
10	Collà Ruvolo C , Nocera L , Stolzenbach LF , et al. Incidence and survival rates of contemporary patients with invasive upper tract urothelial carcinoma[J]. Eur Urol Oncol, 2021, 4 (5): 792- 801. doi: 10.1016/j.euo.2020.11.005
11	周利群, 熊耕砚, 李学松. 中国人群上尿路尿路上皮癌诊疗策略选择和东西方差异[J]. 临床泌尿外科杂志, 2019, 34 (2): 83- 87.
12	方冬, 黄吉炜, 鲍一歌, 等. 中国上尿路尿路上皮癌人群特征和地区差异: 基于CUDA-UTUC协作组的多中心研究[J]. 中华泌尿外科杂志, 2017, 38 (12): 885- 890. doi: 10.3760/cma.j.issn.1000-6702.2017.12.002
13	张宁, 崔剑锋, 李岩, 等. 上尿路尿路上皮癌预后生物标志物的研究进展[J]. 临床泌尿外科杂志, 2019, 34 (2): 119- 123.
14	Rolim I , Henriques V , Rolim N , et al. Clinicopathologic analysis of upper urinary tract carcinoma with variant histology[J]. Virchows Arch, 2020, 477 (1): 111- 120. doi: 10.1007/s00428-020-02745-4
15	陈晗, 王明, 任轲, 刘苑, 等. 不同分期上尿路尿路上皮癌患者预后分析[J]. 临床泌尿外科杂志, 2021, 36 (5): 357- 361.
16	陈金虎, 方卫华, 梁朝朝. 上尿路尿路上皮癌临床治疗进展[J]. 临床泌尿外科杂志, 2021, 36 (5): 415- 420.
17	Martin C , Leiser CL , O'Neil B , et al. Familial cancer clustering in urothelial cancer: a population-based case-control study[J]. J Natl Cancer Inst, 2018, 110 (5): 527- 533. doi: 10.1093/jnci/djx237
18	曹振朋, 关豹, 方冬, 等. 年轻上尿路尿路上皮癌患者的临床病理和预后特征[J]. 现代泌尿外科杂志, 2017, 22 (9): 661- 665. doi: 10.3969/j.issn.1009-8291.2017.09.004
19	Han J , Xian Z , Zhang Y , et al. Systematic overview of aristo-lochic acids: nephrotoxicity, carcinogenicity, and underlying mechanisms[J]. Front Pharmacol, 2019, 10, 648. doi: 10.3389/fphar.2019.00648
20	Simon D , Yen S , Cole P . Coffee-drinking and cancer of the lower urinary tract[J]. J Natl Cancer Inst, 1975, 54 (3): 587- 591.
21	Morgan RW , Jain MG . Bladder cancer: smoking, beverages and artificial sweeteners[J]. Can Med Assoc J, 1974, 111 (10): 1067- 1070.
22	Jensen OM , Wahrendorf J , Knudsen JB , et al. The Copenhagen case-control study of bladder cancer. Ⅱ. Effect of coffee and other beverages[J]. Int J Can-cer, 1986, 37 (5): 651- 657. doi: 10.1002/ijc.2910370503
23	Silverman DT , Alguacil J , Rothman N , et al. Does increased urination frequency protect against bladder cancer?[J]. Int J Can-cer, 2008, 123 (7): 1644- 1648. doi: 10.1002/ijc.23572
24	Zhou J , Smith S , Giovannucci E , et al. Reexamination of total fluid intake and bladder cancer in the Health Professionals Follow-up Study Cohort[J]. Am J Epidemiol, 2012, 175 (7): 696- 705.
25	van Hensbergen M , van Osch FHM , Jochems S , et al. Fluid intake and clinicopathological characteristics of bladder cancer: the west midlands bladder cancer prognosis programme[J]. Eur J Cancer Prev, 2020, 29 (2): 110- 118.
26	Wang J , Wu X , Kamat A , et al. Fluid intake, genetic variants of UDP-glucuronosyltransferases, and bladder cancer risk[J]. Br J Cancer, 2013, 108 (11): 2372- 2380.
27	Jochems SHJ , van Osch FHM , Reulen RC , et al. Total fluid intake and the risk of recurrence in patients with muscle invasive bladder cancer: a prospective cohort study[J]. Bladder Cancer, 2018, 4 (3): 303- 310.
28	Sfakianos JP , Gul Z , Shariat SF , et al. Genetic differences between bladder and upper urinary tract carcinoma: implications for therapy[J]. Eur Urol Oncol, 2021, 4 (2): 170- 179.

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Items	n	%
Type of water
Boiled water	140	58.58
Mineral water	18	7.53
Purified water	37	15.48
Tea or other beverage	44	18.41
Timing of drinking water
When feel thirsty	106	44.35
Drinking water intentionally	133	55.65
Daily water intakes
500-1 000 mL	32	13.39
＞1 000-1 500 mL	58	24.27
＞1 500-2 000 mL	56	23.43
＞2 000 mL	93	38.91
Drink at least once every hour during the daytime	89	37.24
Drink over 100 mL water every time	190	79.50
Drink over 200 mL water before bed	104	43.51
Drink over 200 mL water at night	39	16.32
Drink over 200 mL water when get up	184	76.99
Drink over 200 mL tea every day	96	40.17
Drink over 200 mL carbonated drinks every day	3	1.26
Drink over 200 mL coffee every day	8	3.25
Drink over 200 mL juice every day	3	1.26
Drink over 200 mL milk every day	112	46.86
Paying attention to daily water intakes	140	58.58
Having the will to drink more water every day intentionally	135	56.49
Lower urinary track obstruction disease history/ BPH history	55	23.01
Having the habit to hold back urine	35	14.64

	B	OR(95%CI)	P
Tumor G3
Drink at least once every hour during the daytime
No		1.00
Yes	0.663	1.941 (0.352-1.029)	< 0.001^#
Multifocal tumor
Drink at least once every hour during the daytime
No		1.00
Yes	-1.067	0.344 (1.181-5.582)	0.004^#
Drink over 100 mL water every time
No		1.00
Yes	-0.876	0.477 (0.225-1.012)	0.046^*
Tumor located in renal pelvic
Paying attention to daily water intakes
No		1.00
Yes	0.928	2.530 (1.434-4.463)	0.001^#
Tumor located in ureter
Paying attention to daily water intakes
No		1.00
Yes	-1.159	0.314 (0.172-0.573)	< 0.001^#
Drink over 200mL tea every day
No		1.00
Yes	-0.572	0.565 (1.200-3.878)	0.208

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