血液透析并发膀胱尿路上皮癌临床特点及透析龄对其生存期的影响

Clinical characteristics of bladder urothelial carcinoma complicated with maintain hemodialysis and effects of hemodialysis duration on survival

目的了解血液透析患者膀胱尿路上皮癌的临床特点及透析龄对其生存期的影响。方法回顾性分析2003～2009年期间哈尔滨医科大学附属第一医院维持性血液透析(MHD)者中并发膀胱肿瘤的21例患者的临床资料,调查膀胱尿路上皮癌的发生情况、临床诊治特点及预后,分析透析龄与膀胱尿路上皮癌无瘤生存期、总生存期的影响。结果872例MHD患者中21例为膀胱尿路上皮癌,患病率为2.4%。其临床特点为:21例患者均表现为间断、无痛性肉眼血尿及不同程度的贫血,多发肿瘤多见;透析龄超过5年的9例,超过3年7例,3年以下5例。21例均行手术治疗,至今生存时间11～60个月,平均(26.5±15.3)月。已有4例死亡,5例肿瘤复发。透析龄短的患者的无瘤生存率、总生存率较长。结论维持性血液透析患者合并膀胱尿路上皮癌恶性度高。透析龄越长,膀胱尿路上皮癌越易复发,生存期越短。综合评估病情,尽早行合理治疗有利于预后。

Objective To summarize the clinical characteristics of maintain hemodialysis （MHD） on patients with urothelial carcinoma （UC） of the bladder, and to evaluate the effects of hemodialysis duration （HDD） on the survival of such patients. Methods Patients treated for bladder cancer while undergoing MHD were identified by querying the medical registry of the First Hospital of Harbin Medical University during 2003 to 2009. Clinical, pathological and treatment data were retrieved and characterized. Results Among the 872 patients on MHD, 21 （2.4%） developed urothclial carcinoma of the bladder. Hematuria and bloody urethral discharge were the most common clinical manifestations. Most patients exhibited refractory anemia. Tumors were generally large and multifocal. This group included 9 cases of HDD for more than 5 years, 7 cases for more than 3 years, 5 cases for less than 3 years. All patients with UC of bladder were treated with surgery, which had been followed up for 11 to 60 months [-average （26.5±15.3）months]. Four of them died, and 5 had recurrence. Patients who had short HDD had higher tumor-free survival and survival rate. Conclusions Bladder cancer diagnosed in patients on MHD has a high probability of malignancy. Patients with a short HDD tend to have a higher mean tumor-free survival and survival rate. It＇s important to assess patients comprehensively and treat them timely.