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 Yeh^1,2,3, Wen-Jeng Wu^1,2,3,4, Ching-Chia Li^1,2,3, Chun-Nung Huang^2,3, Hung-Lung Ke^2,3, Wei-Ming Li^2,3,4,5, Hsiang-Ying Lee^1,2,3,4, 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.