上尿路上皮癌接受根除手術前的貧血是否為疾病的危險因子?

葉信志1,2,3、吳文正1,2,3,4、李經家1,2,3、黃俊農2,3、柯宏龍2,3、李威明2,3,4,5、李香瑩1,2,3,4、錢祖明2

1高雄市立大同醫院 泌尿科;2高雄醫學大學附設中和紀念醫院 泌尿部;3高雄醫學大學 醫學系泌尿學科;4高雄醫學大學 醫學研究所;5衛生福利部屏東醫院 泌尿科

Is preoperative anemia a risk factor for upper tract urothelial carcinoma following radical nephroureterectomy?

Hsin-Chih Yeh1,2,3, Wen-Jeng Wu1,2,3,4, Ching-Chia Li1,2,3, Chun-Nung Huang2,3, Hung-Lung Ke2,3, Wei-Ming Li2,3,4,5, Hsiang-Ying Lee1,2,3,4, Tsu-Ming Chien2

1Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; 2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 3Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 4Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Department of Urology, Ministry of Health and Welfare Pingtung Hospital, Pingtung, Taiwan

 

Purpose: We aimed to identify the effect of preoperative anemia on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) who had different levels of renal function.

Materials and Methods: Between 2000 and 2013, we enrolled 370 patients who underwent radical nephroureterectomy for nonmetastatic UTUC. Preoperative anemia was defined as hemoglobin < 130 g/l in men and < 120 g/l in women based on the World Health Organization classification. Kaplan-Meier method was applied to estimate the effect of anemia on survival, and hazard ratios (HR) of anemia and other clinicopathological parameters were evaluated by Cox regression model. The analyses were also performed in patients with different chronic kidney disease (CKD) stages.

Results: In all, 242 (65.4%) patients were anemic before surgery. Those with preoperative anemia had worse CKD stage (P < 0.001) and higher pathological tumor stage (P = 0.023). In univariate analysis, metastasis-free and cancer-specific survival rates were not significantly associated with preoperative anemia (HR = 1.51, 95% CI: 0.93–2.44, P = 0.093 and HR = 1.59, 95% CI: 0.93–2.72, P = 0.094, respectively). However, in patients without stage 5 CKD, those with preoperative anemia had apparently inferior metastasis-free and cancer-specific survival than those without (HR = 1.88, 95% CI: 1.14–3.01, P = 0.014 and HR = 2.03, 95% CI: 1.16–3.56, P = 0.010, respectively). A multivariate Cox proportional hazards model indicated that preoperative anemia was an independent predictor for both metastasis-free (HR = 2.17, 95% CI: 1.21–3.90, P = 0.010) and cancer-specific survival (HR = 2.21, 95% CI: 1.15–4.21, P = 0.017).

Conclusion: Among patients without stage 5 CKD, preoperative anemia was a significant prognostic factor to predict metastatic progression and cancer-specific death in UTUC following radical nephroureterectomy. It was important to be aware of patients' renal function while evaluating the effect of anemia on outcome of UTUC.

 

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    2017-06-01 11:24:16
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