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 / 北京大学学报(医学版)

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.

Effects of laparoscopic versus open hepatectomy on liver function / 中国普通外科杂志

Objective To study the effects of laparoscopic and open hepatectomy(LH and OH) on liver function of patients,and to evaluate patients′ traumatic reaction after LH.Methods Forty patients scheduled to undergo hepatectomy were divided into LH group and OH group randomly in PLA General Hospital from Jun.2004 to Feb.2005.Data of pre-and post-operative liver function of the two groups were compared.Results Postoperative mean value of ALT,AST and LDH in LH group and OH group elevated quickly,and the postoperative mean value of these markers was significantly different compared to that of the preoperative value,and the mean value in OH was higher than that in LH.There was no significant difference between postoperative and preoperative level of ALP and ?-GT in both groups,but postoperative mean value of them in OH was higher than that in LH.There was no significant difference between the 2 groups in TBIL and DBIL level,but their postoperative mean value in OH was higher than that preoperatively.Conclusions The effects of LH on liver function in patients are less than those of OH.This finding suggests that patients′ traumatic reaction after LH is less than that after OH and this is beneficial for the reduction of hepatic failure after LH.