慢性肾脏疾病对上尿路尿路上皮癌患者合并膀胱肿瘤风险的影响

目的 探讨慢性肾脏疾病(CKD)对上尿路尿路上皮癌(UUTUC)患者合并膀胱肿瘤风险的影响. 方法 UUTUC患者161例.男61例,女100例.平均年龄67(37～87)岁.既往有尿路移行细胞肿瘤病史者15例(9.3%).均行肾输尿管全长切除或输尿管下段切除术,病理检查证实为UUTUC.采用MDRD方程计算GFR,GFR＜60 ml/min者认为存在CKD.单因素和多因素分析性别、年龄、既往尿路上皮肿瘤病史、病变数目、肿瘤分期、分级、大小、是否合并CKD等临床病理因素对UUTUC患者合并膀胱肿瘤风险的影响. 结果 161例UUTUC患者中合并膀胱肿瘤20例(12.4%),合并CKD 93例(57.8%).单因素分析显示患者合并CKD(P=0.008)和既往尿路移行细胞肿瘤病史(P=0.001)是UUTUC患者合并膀胱肿瘤的危险因素,患者性别、年龄、病变数目、肿瘤分期、分级、大小与UUTUC患者合并膀胱肿瘤无显著相关性(P＞0.05).多因素分析显示CKD(HR 4.907,95%CI 1.206～19.959,P=0.026)和既往尿路上皮肿瘤病史(HR 6.444,95%CI1.699～24.445,P=0.006)是UUTUC患者合并膀胱肿瘤的独立危险因素.结论 UUTUC患者合并存在膀胱肿瘤并不少见.合并CKD和既往尿路上皮肿瘤病史是UUTUC患者合并膀胱肿瘤的独立危险因素.

Chronic kidney disease as a risk factor for synchronous bladder cancer in patients with upper urinary tract urothelial carcinoma

Objective To evaluate chronic kidney disease (CKD) as a risk factor for synchronous bladder cancer in a cohort of Chinese patients with upper urinary tract urothelial carcinoma (UUTUC). Methods Between 2005 and 2007, 161 patients (61 males and 100 females) underwent surgical management at our institution for pathologically proven UUTUC. The clinical, surgical, and pathological data were reviewed. The glomerular filtration rate(GFR) was calculated using the Modification of Diet in Renal Disease Study equation. And the presence of CKD was determined according to GFR＜60 ml/min. The univariate and multivariate analyses were used to determine prognostic variables for synchronous bladder tumor. Results Of the 161 consecutive cases, the mean age was 67years (range 37 to 87 years). Twenty cases (12.4%) had simultaneous bladder tumor and UUTUC.Ninety-three patients (57.8 % ) had CKD. Fifteen cases (9.3 %) had the history of urothelial carcinoma. Univariate analyses showed that patients with CKD (P=0.008) and the history of urothelial carcinoma (P= 0.001 ) were likely to have synchronous bladder tumor;however, there was no significant impact of other factors on the synchronous intravesical disease, including age, gender, tumor multiplicity, tumor stage, tumor grade, and tumor size. Furthermore, CKD (HR 4. 907, 95% CI 1. 206-19. 959, P=0. 026) and the history of urothelial carcinoma (HR 6. 444, 95% CI 1. 699-24. 445,P=0. 006) were identified as independent predictors for the development of synchronous bladder tumor by multivariate analyses. Conclusions The incidence of synchronous bladder cancer in Chinese patients with UUTUC is not very low. Concurrent CKD and the history of urothelial carcinoma are associated with greater risk of synchronous bladder cancer in UUTUC patients.