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术前红细胞平均血红蛋白量水平与上尿路尿路上皮癌预后的相关性分析

Prognostic value of preoperative mean corpuscular hemoglobin on patients with upper tract urothelial carcinoma
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摘要 目的:分析术前红细胞(RBC)相关指标对上尿路尿路上皮癌(UTUC)患者术后的预后影响。方法:回顾性分析2003年1月~2016年12月我院701例UTUC患者的临床资料和随访结果。结果:中位随访时间39(17~67)个月。男401例(57.2%),女300例(42.8%)。515例(73.5%)诊断为高级别肿瘤,pT3和pT4期分别有247例(35.2%)和100例(14.3%)。患者5年总体生存(OS)、肿瘤特异性生存(CSS)及无复发生存(RFS)分别为54.6%、60.6%及49.0%。术前患者的红细胞压积(HCT)<0.39、血红蛋白(HGB)<114g/L、平均血红蛋白量(MCH)<28.6pg、红细胞平均体积(MCV)<91.3fl、RBC<4.09×1012/L或红细胞分布宽度(RDW)>13.9%,其预后明显较差(均P<0.05)。肿瘤T分期和肿瘤分级、淋巴结转移、同时伴多种组织类型(CVH)是CSS、RFS及OS的独立预测因子;肿瘤基底类型与CSS相关(HR=1.67,95%CI:1.06~2.63,P=0.028)。MCH是CSS(HR=1.54,95%CI:1.04~2.27,P=0.032)和RFS(HR=1.46,95%CI:1.04~2.03,P=0.028)的独立预测因子。然而其他RBC相关因子仅在单因素分析时有预测价值,在多因素分析时差异均无统计学意义。结论:本研究全面分析了RBC相关因子在中国西南UTUC患者中的预后作用,研究结果表明MCH是UTUC患者术后CSS和RFS的独立预后因素。 Objective:To explore the impact of blood red cells-related parameters on survival outcomes of upper tract urothelial carcinoma(UTUC).Method:We retrospectively studied the data of 701 patients who diagnosed with UTUC after radical nephroureterectomy in West China Hospital during 2003-2016.Result:The median follow-up period was 39(IQR:17-67)months.In the cohort,401(57.2%)were males and 300(42.8%)females.Five hundred and fifteen cases(73.5%)were pathologically diagnosed with high grade disease,and 247(35.2%)patients and 100(14.3%)patients had pT3 and pT4 tumor,respectively.Kaplan-Meier plots showed the 5-year overall survival(OS),cancer-specific survival(CSS)and recurrence-free survival(RFS)of the cohort were 54.6%,60.6% and 49.0%,respectively.Patients with hematokrit(HCT)less than 0.39,hemoglobin(HGB)<114 g/L,mean corpuscular hemoglobin(MCH)<28.6 pg,mean corpuscular volume(MCV)<91.3 fl,red blood cells(RBC)<4.09×1012/L or red blood cell distribution width(RDW)>13.9% had worse outcomes than their counterparts(all P<0.05).Multivariate analysis showed that tumor T stage and grade,lymph node metastasis,and concomitant variant histology(CVH)were independently prognostic factors for CSS,RFS and OS.And tumor architecture was associated with CSS(HR=1.67,95%CI:1.06-2.63,P=0.028).Importantly,MCH was also proved to be an independent predictor for CSS(HR=1.54,95%CI:1.04-2.27,P=0.032)and RFS(HR=1.46,95%CI:1.04-2.03,P=0.028).While other RBC-based parameters were only proved to be related to survival outcomes in univariate analysis,but not in multivariate analysis.Conclusion:MCH was demonstrated to be a useful predictor for CSS and RFS in our study.
作者 谭平 杨璐 徐航 艾建忠 刘振华 柳良仁 林天海 鲍一歌 金熙 曹德宏 唐钵 李响 魏强 TAN Ping;YANG Lu;XU Hang;AI Jianzhong;LIU Zhenhua;LIU Liangren;LIN Tianhai;BAO Yige;JIN Xi;CAO Dehong;TANG Bo;LI Xiang;WEI Qiang(Department of Urology/Institute of Urology,West China Hospital,Sichuan University,Chengdu,610041,China)
出处 《临床泌尿外科杂志》 2019年第2期98-103,共6页 Journal of Clinical Urology
关键词 上尿路 尿路上皮癌 预后 危险因素 upper tract urothelial carcinoma prognosis risk factors
作者简介 通信作者:魏强,E-mail:weiqiang933@126.com
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