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
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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.
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.
引文
1 周利群,李学松,熊耕砚.中国人群上尿路尿路上皮癌新进展[J].北京大学学报(医学版),2014,46(4):504-506.
2 Rouprêt M,Babjuk M,Compérat E,et al.European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma:2017Update[J].Eur Urol,2018,73(1):111-122.
3 中国医师协会泌尿外科医师分会肿瘤专业委员会,中国医师协会泌尿外科医师分会上尿路尿路上皮癌(CU-DA-UTUC)协作组.上尿路尿路上皮癌诊断与治疗中国专家共识[J].中华泌尿外科杂志,2018,39(7):485-488.
4 梁成才,张林,叶敏,等.上尿路尿路上皮癌术前预后因子研究进展[J].临床泌尿外科杂志,2017,32(1):77-82.
5 Rouprêt M,Babjuk M,Compérat E,et al.European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma:2015 Update[J].Eur Urol,2015,68(5):868-879.
6 Ge W,Xie J,Chang L.Elevated red blood cell distribution width predicts poor prognosis in patients with oral squamous cell carcinoma[J].Cancer Manag Res,2018,10:3611-3618.
7 Xu W Y,Yang X B,Wang W Q,et al.Prognostic impact of the red cell distribution width in esophageal cancer patients:A systematic review and meta-analysis[J].World J Gastroenterol,2018,24(19):2120-2129.
8 Yang D,Quan W,Wu J,et al.The value of red blood cell distribution width in diagnosis of patients with colorectal cancer[J].Clin Chim Acta,2018,479:98-102.
9 Sung H H,Jeon H G,Jeong B C,et al.Clinical significance of prognosis using the neutrophil-lymphocyte ratio and erythrocyte sedimentation rate in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma[J].BJU Int,2015,115(4):587-594.
10 Alquaiz J M,Abdulghani H M,Khawaja R A,et al.Accuracy of Various Iron Parameters in the Prediction of Iron Deficiency Anemia among Healthy Women of Child Bearing Age,Saudi Arabia[J].Iran Red Crescent Med J,2012,14(7):397-401.
11 Vartolomei M D,Kimura S,Ferro M,et al.Is neutrophil-to-lymphocytes ratio a clinical relevant preoperative biomarker in upper tract urothelial carcinoma?A metaanalysis of 4385patients[J].World J Urol,2018,36(7):1019-1029.
12 Qu X,Zhang T,Ma H,et al.Lower mean corpuscular hemoglobin concentration is associated with unfavorable prognosis of resected lung cancer[J].Future Oncol,2014,10(14):2149-2159.
13 Beutler E,Waalen J.The definition of anemia:what is the lower limit of normal of the blood hemoglobin concentration?[J].Blood,2006,107(5):1747-1750.
14 Tan P,Xie N,Liao H,et al.Prognostic impact of preoperative anemia on upper tract urothelial carcinoma[J].Medicine(Baltimore),2018,97(37):e12300.
15 邢云超,熊耕砚,方东,等.上尿路尿路上皮癌术前预后相关因素分析及初步风险分层模型构建[J].北京大学学报(医学版),2016,48(6):1032-1037.
16 Warwick R,Mediratta N,Shackcloth M,et al.Preoperative red cell distribution width in patients undergoing pulmonary resections for non-small-cell lung cancer[J].Eur J Cardiothoracic Surg,2014,45(1):108-113.
17 Yoon H J,Kim K,Nam Y S,et al.Mean corpuscular volume levels and all-cause and liver cancer mortality.Clinical chemistry and laboratory medicine[J].Clin Chem Lab Med,2016,54(7):1247-1257.
18 周杨,于洋,张庆云,等.红细胞分布宽度对膀胱尿路上皮癌的诊断价值[J].广西医科大学学报,2016,33(1):77-79.
19 Shibing Y,Liangren L,Qiang W,et al.Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy:a multi-institutional analysis of 795cases[J].BJU Int,2016,118(6):902-910.
2 Rouprêt M,Babjuk M,Compérat E,et al.European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma:2017Update[J].Eur Urol,2018,73(1):111-122.
3 中国医师协会泌尿外科医师分会肿瘤专业委员会,中国医师协会泌尿外科医师分会上尿路尿路上皮癌(CU-DA-UTUC)协作组.上尿路尿路上皮癌诊断与治疗中国专家共识[J].中华泌尿外科杂志,2018,39(7):485-488.
4 梁成才,张林,叶敏,等.上尿路尿路上皮癌术前预后因子研究进展[J].临床泌尿外科杂志,2017,32(1):77-82.
5 Rouprêt M,Babjuk M,Compérat E,et al.European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma:2015 Update[J].Eur Urol,2015,68(5):868-879.
6 Ge W,Xie J,Chang L.Elevated red blood cell distribution width predicts poor prognosis in patients with oral squamous cell carcinoma[J].Cancer Manag Res,2018,10:3611-3618.
7 Xu W Y,Yang X B,Wang W Q,et al.Prognostic impact of the red cell distribution width in esophageal cancer patients:A systematic review and meta-analysis[J].World J Gastroenterol,2018,24(19):2120-2129.
8 Yang D,Quan W,Wu J,et al.The value of red blood cell distribution width in diagnosis of patients with colorectal cancer[J].Clin Chim Acta,2018,479:98-102.
9 Sung H H,Jeon H G,Jeong B C,et al.Clinical significance of prognosis using the neutrophil-lymphocyte ratio and erythrocyte sedimentation rate in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma[J].BJU Int,2015,115(4):587-594.
10 Alquaiz J M,Abdulghani H M,Khawaja R A,et al.Accuracy of Various Iron Parameters in the Prediction of Iron Deficiency Anemia among Healthy Women of Child Bearing Age,Saudi Arabia[J].Iran Red Crescent Med J,2012,14(7):397-401.
11 Vartolomei M D,Kimura S,Ferro M,et al.Is neutrophil-to-lymphocytes ratio a clinical relevant preoperative biomarker in upper tract urothelial carcinoma?A metaanalysis of 4385patients[J].World J Urol,2018,36(7):1019-1029.
12 Qu X,Zhang T,Ma H,et al.Lower mean corpuscular hemoglobin concentration is associated with unfavorable prognosis of resected lung cancer[J].Future Oncol,2014,10(14):2149-2159.
13 Beutler E,Waalen J.The definition of anemia:what is the lower limit of normal of the blood hemoglobin concentration?[J].Blood,2006,107(5):1747-1750.
14 Tan P,Xie N,Liao H,et al.Prognostic impact of preoperative anemia on upper tract urothelial carcinoma[J].Medicine(Baltimore),2018,97(37):e12300.
15 邢云超,熊耕砚,方东,等.上尿路尿路上皮癌术前预后相关因素分析及初步风险分层模型构建[J].北京大学学报(医学版),2016,48(6):1032-1037.
16 Warwick R,Mediratta N,Shackcloth M,et al.Preoperative red cell distribution width in patients undergoing pulmonary resections for non-small-cell lung cancer[J].Eur J Cardiothoracic Surg,2014,45(1):108-113.
17 Yoon H J,Kim K,Nam Y S,et al.Mean corpuscular volume levels and all-cause and liver cancer mortality.Clinical chemistry and laboratory medicine[J].Clin Chem Lab Med,2016,54(7):1247-1257.
18 周杨,于洋,张庆云,等.红细胞分布宽度对膀胱尿路上皮癌的诊断价值[J].广西医科大学学报,2016,33(1):77-79.
19 Shibing Y,Liangren L,Qiang W,et al.Impact of tumour size on prognosis of upper urinary tract urothelial carcinoma after radical nephroureterectomy:a multi-institutional analysis of 795cases[J].BJU Int,2016,118(6):902-910.