renal cell cancer

肾细胞癌
  • 文章类型: Journal Article
    胃癌(GC)是全球第四大致命癌症。在几种类型的癌症中,adducin1(ADD1)蛋白参与致癌信号转导途径,和rs4961变体(c.1378G>T,ADD1基因的p.Gly460Trp)与盐敏感性高血压有关,肾细胞癌和乳腺癌易感性;然而,它尚未在GC中进行调查。本研究的目的是评估rs4961变体与墨西哥西部人群中GC和肿瘤前胃病变(PGL)的发展之间的关系。总共对225名接受内窥镜检查的人进行了评估,其中71例患者有组织病理学诊断为GC,53例患者有PGLs,101名患者作为对照。通过使用PCR和DNA测序对rs4961变体进行基因分型。rs4961变体的突变纯合基因型(TT)的频率在三个评估组中<10%,在GC中次要等位基因(T)的频率<21%,PGL和对照组。基因型和等位基因频率在所有研究组中分布相似(P>0.05)。总之,在研究人群中,rs4961变体与GC风险无关;然而,它在其他人群和其他类型癌症中的作用值得未来研究。
    Gastric cancer (GC) is the fourth most deadly cancer globally. The adducin 1 (ADD1) protein is involved in oncogenic signal transduction pathways in several types of cancer, and the rs4961 variant (c.1378 G>T, p.Gly460Trp) of the ADD1 gene is associated with salt-sensitive hypertension, renal cell cancer and breast cancer susceptibility; however, it has not been investigated in GC. The aim of the present study was to evaluate the association between the rs4961 variant and the development of GC and preneoplastic gastric lesions (PGLs) in a population from western Mexico. A total of 225 individuals who underwent an endoscopy were evaluated, of which 71 patients had histopathologically diagnosed GC and 53 patients had PGLs, with 101 patients used as controls. The rs4961 variant was genotyped by using PCR and DNA sequencing. The frequency of the mutated homozygous genotype (TT) of the rs4961 variant was <10% in the three evaluated groups, and the frequency of the minor allele (T) was <21% in the GC, PGL and control groups. Genotypic and allelic frequencies were similarly distributed in all of the studied groups (P>0.05). In summary, in the study population, the rs4961 variant was not associated with GC risk; however, its role in other populations and in other types of cancer is worthy of future research.
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  • 文章类型: Journal Article
    用全身药物治疗肾细胞癌(RCC)后患者的反应,其中包括各种药物类别,通常是贫穷和不可预测的。在这种情况下,理想的药物管理包括预测疾病对治疗的敏感性的工具。本研究旨在系统总结甲基化状态在肾癌全身治疗中的预测价值。本综述仅包括有关启动子甲基化与患者或细胞系对全身性药物的反应相关的原始文章。我们将PRISMA建议应用于本次系统评价的结构和方法。我们的文献检索总结了31篇关于RCC细胞系和患者组织的文章。大多数研究证明了对全身性药物的甲基化依赖性反应。这种相关性表明,甲基化模式可用作各种全身性药物治疗RCC的预测工具。然而,尽管甲基化生物标志物显示出预测反应的前景,这种相关性的证据仍然薄弱。需要更多研究全身治疗患者的基因甲基化模式及其与不同反应程度的相关性。
    Patient response after treatment of renal cell cancer (RCC) with systemic agents, which include various drug categories, is generally poor and unpredictable. In this context, the ideal drug administration includes tools to predict the sensitivity of the disease to therapy. The aim of this study was to systematically summarize the reports on the predictive value of the methylation status in the systemic therapy of RCC. Only original articles reporting on the association of promoter methylation with the response of patients or cell lines to systemic agents were included in this review. We applied PRISMA recommendations to the structure and methodology of this systematic review. Our literature search concluded with 31 articles conducted on RCC cell lines and patient tissues. The majority of the studies demonstrated a methylation-dependent response to systemic agents. This correlation suggests that the methylation pattern can be used as a predictive tool in the management of RCC with various classes of systemic agents. However, although methylation biomarkers show promise for predicting response, the evidence of such correlation is still weak. More studies on the gene methylation pattern in patients under systemic therapy and its correlation with different degrees of response are needed.
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  • 文章类型: Journal Article
    背景:膀胱癌(BC)和肾细胞癌(RCC)是男女最常见的泌尿生殖道癌症,每年全球发病率约为50万。BC和RCC都与糖尿病有关。血糖控制不良(低血糖)是糖尿病的严重后果,也是BC和RCC中使用的全身治疗的可能后果。这项研究的目的是调查BC或RCC患者的糖尿病患病率和基于医院的血糖管理。
    方法:这项瑞典基于人群的回顾性登记研究使用国家健康数据登记来获取15年癌症发病率的纵向数据,使用以医院为基础的医疗保健,并填写了门诊药物的处方。研究终点包括BC/RCC个体中糖尿病的共同患病率,由于血糖不良而导致的医疗保健资源利用,使用全身性皮质类固醇,以及合并2型糖尿病患者的糖尿病管理变化。
    结果:我们确定了36,620和15,581名诊断为BC和RCC的个体,分别,2006年至2019年。在BC中,糖尿病患者的比例为24%,在RCC中为23%。发现BC/RCC与血糖控制不良之间存在关联,尽管医院护理中的血糖不良事件数量很少(糖尿病患者和BC/RCC患者中分别有65/59例,至少有1起事件).与2型糖尿病但没有癌症的匹配个体相比,在BC/RCC中观察到更早地转换为基于胰岛素的糖尿病管理。结果还表明类固醇治疗与血糖控制不良之间存在关联,与糖尿病对照组相比,全身性皮质类固醇在BC/RCC患者中更常见。
    结论:在这项大型国家研究中观察到的糖尿病的高患病率和全身性皮质类固醇治疗的增加,突出了对特定临床管理的需求。风险评估,并监测BC/RCC和糖尿病患者。
    BACKGROUND: Bladder cancer (BC) and Renal cell carcinoma (RCC) are the most common urogenital cancers among both sexes, with a yearly global incidence of around 500 000 each. Both BC and RCC have been linked to diabetes. Poor glycemic control (malglycemia) is a serious consequence of diabetes and a possible consequence of systemic treatments used in BC and RCC. The objective of this study was to investigate the prevalence of diabetes and use of hospital-based care for malglycemia in people with BC or RCC.
    METHODS: This Swedish retrospective population-based register study used national health-data registers for longitudinal data on cancer incidence covering 15 years, use of hospital-based health care, and filled prescriptions of outpatient medications. Study endpoints included co-prevalence of diabetes in individuals with BC/RCC, healthcare resource utilization due to malglycemia, use of systemic corticosteroids, and changes in diabetes management for people with concomitant type 2 diabetes.
    RESULTS: We identified 36,620 and 15,581 individuals diagnosed with BC and RCC, respectively, between 2006 and 2019. The proportion of individuals registered with diabetes was 24% in BC and 23% in RCC. An association between BC/RCC and poor glycemic control was found, although the number of malglycemic events in hospital-based care were few (65/59 per 1000 individuals with diabetes and BC/RCC respectively with at least one event). An earlier switch to insulin-based diabetes management was observed in BC/RCC compared to matched individuals with type 2 diabetes but no cancer. The results also indicated an association between steroid treatment and poor glycemic control, and that systemic corticosteroids were more common among people with BC/RCC compared to diabetes controls.
    CONCLUSIONS: The high prevalence of diabetes and increased use of systemic corticosteroid treatment observed in this large national study highlights the need for specific clinical management, risk-assessment, and monitoring of individuals with BC/RCC and diabetes.
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  • 文章类型: Journal Article
    背景肾癌转移到口腔区域非常罕见。许多研究人员已经发表了分析口腔转移性肿瘤病例的研究。迄今为止,很少进行研究来分析肾癌转移作为口腔软组织的唯一主要来源。这项研究的目的是检查1911年至2022年作为唯一主要来源的肾细胞癌口腔软组织转移的已发表病例。材料和方法在PubMed/Medline中对已发表文献进行了电子搜索,没有出版年份限制,Scopus,谷歌学者,WebofScience,科学直接,Embase,和研究门数据库,使用网格关键字,如(“肾癌,\"或\"肾癌\"或\"肾细胞癌\"或\"肾细胞癌\"),和(“转移”或“转移”),和(“口腔软组织”或“舌头”或“腭”或“扁桃体”或“颊粘膜”或“唾液腺”)。我们还手动搜索了相关期刊和参考文献列表。结果我们的研究共揭示了226篇相关文章,共250例患者。腮腺和舌是最常见的转移部位。23%的患者死亡,生存时间为10天至4年。结论肾细胞癌口腔软组织转移预后不良。需要发布更多病例,以提高对这些病变的认识。
    Background  Renal cancer metastasis to oral region is very rare. Studies have been published analyzing the cases of metastatic tumors to the oral cavity by many researchers. Very few research studies have been conducted till date to analyze the renal cancer metastasis as the sole primary source to the oral soft tissues. The goal of this study was to examine the published cases of oral soft tissue metastasis from renal cell carcinoma as the only primary source from 1911 to 2022. Materials and Methods  An electronic search of the published literature was performed without publication year limitation in PubMed/Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like (\"Renal cancer,\" or \"Renal carcinoma\" or \"Renal cell cancer\" or \"Renal cell carcinoma\"), and (\"Metastasis\" or \"Metastases\"), and (\"Oral soft tissues\" or \"Tongue\" or \"Palate\" or \"Tonsil\" or \"Buccal mucosa\" or \"Salivary glands\"). We also searched related journals manually and the reference lists. Results  Our research revealed a total of 226 relevant articles with 250 patients. Parotid glands and tongue were the most common sites of metastasis. 23% patients died with a survival time of 10 days to 4 years. Conclusions  Oral soft tissue metastasis from renal cell carcinoma has a bad prognosis. More cases need to be published in order to raise awareness of these lesions.
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  • 文章类型: Case Reports
    对于免疫组织化学等“旧”诊断工具,遗传性皮肤肿瘤的诊断很困难。全外显子组测序分析作为一种“新的”诊断工具,使我们能够在过去未知的遗传性疾病的情况下做出最终诊断。遗传性平滑肌瘤和肾细胞癌是以子宫肌瘤为特征的常染色体显性遗传性癌症综合征。皮肤平滑肌瘤,和侵袭性肾细胞癌。该综合征与富马酸水合酶基因的致病性种系变异有关。在这里,我们在一名患有多发性皮肤平滑肌瘤的60岁女性中证明了富马酸水合酶基因的致病性种系变异,导致遗传性平滑肌瘤病和肾细胞癌的诊断。使用从外周血白细胞中提取的基因组DNA进行的全外显子组测序分析显示,1号染色体上的FH基因中有一个种系变异(c.290G>A,p.Gly97Asp)。她因子宫肌瘤接受了全子宫切除术,这强烈支持了诊断。计算机断层扫描和超声检查未在她的肾脏中检测到肿瘤。富马酸水合酶基因突变的遗传检查对于达到正确诊断并在早期检测肾癌很重要。
    The diagnosis of hereditary skin tumors is difficult for \"old\" diagnostic tools such as immunohistochemistry. Whole-exome sequencing analysis as a \"new\" diagnostic tool enables us to make a final diagnosis in spite of unknown hereditary diseases in the past. Hereditary leiomyomatosis and renal cell cancer are autosomal dominant hereditary cancer syndromes characterized by uterine myomas, cutaneous leiomyomas, and aggressive renal cell cancer. The syndrome is associated with pathogenic germline variants in the fumarate hydratase gene. Herein, we demonstrate a pathogenic germline variant of the fumarate hydratase gene in a 60-year-old woman with multiple cutaneous leiomyomas, leading to the diagnosis of hereditary leiomyomatosis and renal cell cancer. Whole-exome sequencing analysis using genomic DNA extracted from peripheral blood leukocytes revealed one germline variant in the FH gene on chromosome 1 (c.290G>A, p.Gly97Asp). She received total hysterectomy due to uterine myoma, which strongly supported the diagnosis. No tumor was detected in her kidney by computed tomography and ultrasound examination. Genetic examination for the mutation of the fumarate hydratase gene is important in order to reach the correct diagnosis and to detect renal cancer at its early stage.
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  • 文章类型: Journal Article
    在我们最近的研究中,我们探讨了三维(3D)测量肿瘤体积在预测肾细胞癌(RCC)患者生活质量(QoL)改善中的功效,接受阿西替尼和抗PD-L1抗体治疗的患者。这项研究包括18例RCC患者,包括10名男性和8名女性,平均年龄56.83±9.94岁。通过利用3D切片器软件,我们分析了治疗前后的CT扫描,以评估肿瘤体积的变化.通过FKSI-DRS问卷评估患者的QoL。我们的研究结果表明,所有患者的3D模型都被成功创建,基于RECIST1.1标准的治疗应答分类与体积分析之间存在中度一致性(kappa=0.556,p=0.001).值得注意的是,9例患者报告治疗后QoL有临床意义的改善.有趣的是,与CT测量的直径变化相比,3D模型显示的肿瘤体积变化在预测QoL改善方面显示出更高的曲线下面积,尽管这种差异没有统计学意义(z=0.593,p=0.553).此外,一项多变量分析将基于3D模型的肿瘤体积变化确定为QoL改善的独立预测因子(比值比=1.073,95%CI1.002-1.149,p=0.045).总之,我们的研究表明,与传统的基于CT的直径测量相比,通过3D模型测量的肿瘤体积变化可能更有效地预测RCC患者的症状改善.这提供了一种评估治疗反应和患者健康状况的新方法,在RCC治疗领域取得了重大进展。
    In our recent study, we explored the efficacy of three-dimensional (3D) measurement of tumor volume in predicting the improvement of quality of life (QoL) in patients suffering from renal cell cancer (RCC), who were treated with axitinib and anti-PD-L1 antibodies. This study encompassed 18 RCC patients, including 10 men and 8 women, with an average age of 56.83 ± 9.94 years. By utilizing 3D Slicer software, we analyzed pre- and post-treatment CT scans to assess changes in tumor volume. Patients\' QoL was evaluated through the FKSI-DRS questionnaire. Our findings revealed that 3D models for all patients were successfully created, and there was a moderate agreement between treatment response classifications based on RECIST 1.1 criteria and volumetric analysis (kappa = 0.556, p = 0.001). Notably, nine patients reported a clinically meaningful improvement in QoL following the treatment. Interestingly, the change in tumor volume as indicated by the 3D model showed a higher area under the curve in predicting QoL improvement compared to the change in diameter measured by CT, although this difference was not statistically significant (z = 0.593, p = 0.553). Furthermore, a multivariable analysis identified the change in tumor volume based on the 3D model as an independent predictor of QoL improvement (odds ratio = 1.073, 95% CI 1.002-1.149, p = 0.045).In conclusion, our study suggests that the change in tumor volume measured by a 3D model may be a more effective predictor of symptom improvement in RCC patients than traditional CT-based diameter measurements. This offers a novel approach for assessing treatment response and patient well-being, presenting a significant advancement in the field of RCC treatment.
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  • 文章类型: Case Reports
    背景:多原发癌(MPC)由于其发病率的增加而在医学研究中引起了关注。浸润性乳腺癌与肾透明细胞癌并存,还有家族癌症史,突出了MPC的多因素起源,特别是它们与遗传因素的潜在关联。
    方法:一名70岁的女性最初寻求医疗护理,因为她的主要问题集中在长期的肿块上。临床评估和影像学研究显示浸润性乳腺癌诊断,同时,她的左肾偶发肿块被确定为透明细胞癌。
    结论:重点和进一步的研究应该是遗传因素在MPC发育中的潜在作用。需要全面的遗传评估。
    结论:这项研究强调了定制治疗方法对每种恶性肿瘤的重要性,促进早期检测,改善患者预后,增强对MPC的理解。
    BACKGROUND: Multiple primary cancers (MPCs) have attracted attention in medical research due to their increasing incidence. The coexistence of invasive breast carcinoma and clear cell carcinoma of the kidney, alongside a family history of cancer, highlights the multifactorial origins of MPCs, particularly their potential association with genetic factors.
    METHODS: A 70-year-old female initially sought medical attention for a two-year history of a right breast lump as her primary concerns centered on the long-standing lump. Clinical evaluations and imaging studies revealed an invasive breast carcinoma diagnosis, and simultaneously, an incidental mass in her left kidney was identified as clear cell carcinoma.
    CONCLUSIONS: Emphasis and further researh should be on the potential role of genetic factors in MPC development, necessitating comprehensive genetic evaluations.
    CONCLUSIONS: This study highlights the significance of customized treatment approaches for each malignancy, facilitating early detection, improved patient outcomes, and an enhanced understanding of MPCs.
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  • 文章类型: Journal Article
    背景:遗传性平滑肌瘤病和肾细胞癌综合征是一种罕见的常染色体显性遗传综合征。以前,我们发表了西班牙最大的FH突变携带者队列,并观察到一个高度复发的错义杂合变体,FH(NM_000143.4):c.1118A>Gp.(Asn373Ser),来自31个明显无关家庭的104个人。这里,我们旨在建立其创始人效应并表征相关的临床表型。
    结果:单倍型分析证实,家族共有一个共同的单倍型(32/38标记),跨越0.61-0.82Mb,表明这种反复变异是继承自创始人的祖先。在64.6%(64/99)和98%(50/51)的患者中诊断出皮肤和子宫平滑肌瘤病,分别,肾细胞癌的发生率为10.4%(10/96)。致病性FH_c.1118A>G变体是西班牙的创始人突变,起源于12-26代以前。我们估计该变体可能出现在1370和1720之间。与该综合征的其他队列相比,携带该创始人突变的个体的肾细胞癌发生率相似,肾囊肿和平滑肌瘤发生率更高。
    结论:在西班牙的阿利坎特省,由于创始人突变FHc.1118A>G;p。(Asn373Ser),HLRCC的患病率很高。创始人突变的表征提供了有关其外显率和表现力的准确而具体的信息。在阿利坎特省怀疑有HLRCC的个人中,通过直接分析创始人FHc.1118A>G;p.(Asn373Ser)突变进行基因检测,与完整的基因测序相比,可能是一种更快,更有效的诊断工具。
    BACKGROUND: Hereditary leiomyomatosis and renal cell cancer syndrome is a rare autosomal dominant hereditary syndrome. Previously, we published the largest cohort of FH mutation carriers in Spain and observed a highly recurrent missense heterozygous variant, FH(NM_000143.4):c.1118A > G p.(Asn373Ser), in 104 individuals from 31 apparently unrelated families. Here, we aimed to establish its founder effect and characterize the associated clinical phenotype.
    RESULTS: Haplotype analysis confirmed that families shared a common haplotype (32/38 markers) spanning 0.61-0.82 Mb, indicating this recurrent variant was inherited from a founder ancestor. Cutaneous and uterine leiomyomatosis were diagnosed in 64.6% (64/99) and 98% (50/51) of patients, respectively, and renal cell cancer was present in 10.4% (10/96). The pathogenic FH_c.1118A > G variant is a Spanish founder mutation that originated 12-26 generations ago. We estimate that the variant may have appeared between 1370 and 1720. Individuals carrying this founder mutation had similar frequency of renal cell cancer and a higher frequency of renal cysts and leiomyomas than those in other cohorts of this syndrome.
    CONCLUSIONS: In the Spanish province of Alicante there is a high prevalence of HLRCC because of the founder mutation FH c.1118A > G; p.(Asn373Ser). The characterization of founder mutations provides accurate and specific information regarding their penetrance and expressivity. In individuals with suspected HLRCC from the province of Alicante, genetic testing by direct analysis of the founder FH c.1118A > G; p.(Asn373Ser) mutation may be a faster and more efficient diagnostic tool compared with complete gene sequencing.
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  • 文章类型: Journal Article
    标准化,高质量的PRO数据报告对于肿瘤学领域以患者为中心的护理至关重要,尤其是在建立护理标准的临床试验中。本研究评估了PRO终点设计,FDA批准的GU恶性肿瘤药物的实施和报告方法。
    对FDA档案的系统审查确定了2007年2月至2022年7月的GU癌症药物批准。使用ClinicalTrials.gov和PubMed检索相关数据。PRO数据进行了筛选,和分析工具,对发表的论文和研究方案中的解释方法进行了综述。使用PRO终点分析评分(PROEAS)评估PRO报告标准的合规性,来自制定国际标准分析患者报告结果和生活质量终点数据联盟(SISAQOL)的24分评分表。
    我们评估了27,011名参与者的40项试验方案,导致14例肾细胞癌(RCC),16前列腺癌(PC),和10个尿路上皮癌(UC)批准。PRO数据公布了27项试验,有23份PRO出版物(85%)只关注PRO数据,而4(15%)在原始论文中包含PRO数据。具有PRO数据的主要临床论文和次要论文之间的中位时间为10.5个月(范围:9-25个月)。没有计划将PROs作为任何研究的主要终点,但14(52%)将其报告为次要终点,10(37%)作为探索性结果,3(11%)缺乏作为终点的PRO数据的清晰度。所有GU癌症的平均PROEAS评分为11.10(范围:6-15),RCC(11.86,范围:6-15),UC(11.50,范围:9-14),和PC(10.56,范围:6-15)。没有人符合SISAQOL的所有建议。
    在过去十年中进行的GU癌症药物试验中,PROEAS总体得分低和PRO数据发布延迟,强调了在未来试验中需要改进PRO终点的设计和实施质量,并加快PRO终点的发布。使用标准化分析,和预先指定的假设驱动终点。这些改进对于促进PRO研究结果的解释和应用以定义患者护理至关重要。
    无。
    UNASSIGNED: Standardized, high-quality PRO data reporting is crucial for patient centered care in the field of oncology, especially in clinical trials that establish standard of care. This study evaluated PRO endpoint design, conduct and reporting methods in FDA approved drugs for GU malignancies.
    UNASSIGNED: A systematic review of the FDA archives identified GU cancer drug approvals from Feb 2007 to July 2022. ClinicalTrials.gov and PubMed were used to retrieve relevant data. PRO data was screened, and analytic tools, interpretation methods in the published papers and study protocols were reviewed. Compliance with PRO reporting standards were assessed using PRO Endpoint Analysis Score (PROEAS), a 24-point scoring scale from Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data Consortium (SISAQOL).
    UNASSIGNED: We assessed 40 trial protocols with 27,011 participants, resulting in 14 renal cell cancer (RCC), 16 prostate cancer (PC), and 10 urothelial cancer (UC) approvals. PRO data was published for 27 trials, with 23 PRO publications (85%) focusing solely on PRO data, while 4 (15%) included PRO data in the original paper. Median time between primary clinical and secondary paper with PRO data was 10.5 months (range: 9-25 months). PROs were not planned as primary endpoints for any study but 14 (52%) reported them as secondary, 10 (37%) as exploratory outcomes, and 3 (11%) lacked any clarity on PRO data as endpoint. Mean PROEAS score of all GU cancers was 11.10 (range: 6-15), RCC (11.86, range: 6-15), UC (11.50, range: 9-14), and PC (10.56, range: 6-15). None met all the SISAQOL recommendations.
    UNASSIGNED: Low overall PROEAS score and delays in PRO data publication in GU cancer drug trials conducted in the past decade emphasize the need for improvement in quality of design and conduct of PRO endpoint in future trials and accelerated publication of PRO endpoints, using standardized analysis, and prespecified hypothesis driven endpoint. These improvements are essential for facilitating interpretation and application of PRO study findings to define patient care.
    UNASSIGNED: None.
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  • 文章类型: Journal Article
    背景:了解诊断前的处方活动可以揭示更及时的癌症调查和检测窗口。
    目的:在肾癌和膀胱癌诊断前检查常见泌尿系统临床特征的处方模式。
    方法:使用电子初级保健和癌症登记数据对膀胱癌和肾癌患者进行了一项回顾性队列研究,他们在2012年4月至2015年12月期间在英国接受了诊断。
    方法:对5组临床特征(刺激性泌尿系统症状,阻塞性症状,尿路感染[UTIs],生殖器感染,和萎缩性阴道炎)。估计处方率从基线增加的拐点的泊松回归用于识别诊断窗口的开始,在所述诊断窗口期间可以检测到癌症。
    结果:共分析了5322例患者的48094张处方。在诊断前9个月为肾癌(95%置信区间[CI]=5.3至12.7)和膀胱癌(95%CI=7.4至10.6)确定了UTI处方增加的拐点。对于膀胱癌,UTI抗生素处方率的变化发生在女性4个月前(诊断前11个月,95%CI=9.7至12.3)比男性(诊断前7个月,95%CI=5.4至8.6)。对于其他临床特征,没有确定拐点,因此,无法定义诊断窗口。
    结论:尿路感染的处方率在膀胱和肾癌诊断前9个月增加,这表明,在具有UTI特征的患者中,有可能加快这些癌症的诊断。更及时诊断的最大机会可能是女性膀胱癌,谁经历了最早的UTI处方率增加。
    BACKGROUND: Understanding pre-diagnostic prescribing activity could reveal windows during which more timely cancer investigation and detection may occur.
    OBJECTIVE: To examine prescription patterns for common urological clinical features prior to renal and bladder cancer diagnoses.
    METHODS: A retrospective cohort study was performed using electronic primary care and cancer registry data on patients with bladder and renal cancer, who received their diagnosis between April 2012 and December 2015 in England.
    METHODS: Primary care prescriptions up to 2 years pre- diagnosis were analysed for five groups of clinical features (irritative urological symptoms, obstructive symptoms, urinary tract infections [UTIs], genital infections, and atrophic vaginitis). Poisson regressions estimating the inflection point from which the rate of prescriptions increased from baseline were used to identify the start of diagnostic windows during which cancer could be detected.
    RESULTS: A total of 48 094 prescriptions for 5322 patients were analysed. Inflection points for an increase in UTI prescriptions were identified 9 months pre- diagnosis for renal (95% confidence interval [CI] = 5.3 to 12.7) and bladder (95% CI = 7.4 to 10.6) cancers. For bladder cancer, the change in UTI antibiotic prescription rates occurred 4 months earlier in females (11 months pre- diagnosis, 95% CI = 9.7 to 12.3) than in males (7 months pre-diagnosis, 95% CI = 5.4 to 8.6). For other clinical features, no inflection points were identified and, as such, no diagnostic windows could be defined.
    CONCLUSIONS: Prescription rates for UTIs increased 9 months before bladder and renal cancer diagnoses, indicating that there is potential to expedite diagnosis of these cancers in patients presenting with features of UTI. The greatest opportunity for more timely diagnosis may be in females with bladder cancer, who experienced the earliest increase in UTI prescription rate.
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