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

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

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。

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.