་ ඹ ᵝ ᘧ 㸯
Ꮫ ㄳ ồ ㄽ ᩥ ࡢ ෆ ᐜ ࡢ せ ᪨
ㄽ ᩥ ᥦ ฟ ⪅ Ặ ྡ ⭘ ⒆ ไ ᚚ ⛉ Ꮫ 㡿 ᇦ Ἢ ᒀ ჾ ⭘ ⒆ Ꮫ ศ 㔝 Ặ ྡ ℈ 㔝 㐓 ே
㸦 ㄽ ᩥ 㢟 ┠ 㸧
Preoperative chronic kidney disease predicts poor oncological outcomes after radical cystectomy in patients with muscle -invasive bladder cancer
➽ ᒙ ᾐ ₶ ⭤ ⬔ ⒴ ࠾ ࡅ ࡿ ⭤ ⬔ ⾡ ๓ ࡢ ៏ ᛶ ⭈ ⮚ 㸦
CKD
㸧ࡣ ⒴ ≉ ␗ ⓗ ண ᚋ Ⰻ ᅉ Ꮚ࡛ ࠶ ࡿ
㸦 ෆ ᐜ ࡢ せ ᪨ 㸸 ᩥ ࡛
2,000
Ꮠ ⛬ ᗘ 㸧࠙ ⫼ ᬒ ࠚ
⭤ ⬔ ➽ ᒙ ᾐ ₶ ࡋ ࡓ ➽ ᒙ ᾐ ₶ ⭤ ⬔ ⒴ ࡣ 㸪㠀 ➽ ᒙ ᾐ ₶ ⭤ ⬔ ⒴ ẚ ㍑ ࡋ ⴭ ᫂ ண ᚋ Ⰻ ࡛
࠶ ࡿ 㸬 ➽ ᒙ ᾐ ₶ ⭤ ⬔ ⒴ ᑐ ࡍ ࡿ ᶆ ‽ ⓗ ⒪ ࡣ ⭤ ⬔ 㝖 ⾡ 㸪 ࡞ ࡽ ࡧ ᡤ ᒓ ࣜ ࣥ ࣃ ⠇ 㒌 Ύ
⾡ ࡛ ࠶ ࡿ ࡀ 㸪⭤ ⬔ ⾡ ᚋ ࡢ
5
ᖺ ⏕ Ꮡ ⋡ ࡣ50%⛬ ᗘ ࡉ ࢀ ࡚ ࠾ ࡾ 㸪ண ᚋ ᅉ Ꮚ ࡢ ྠ ᐃ
⒪ ᡂ ⦼ ࡢ ᨵ ၿ ࡣ ࡁ ࡞ ◊ ✲ ࢸ ࣮ ࣐ ࡞ ࡗ ࡚ ࠸ ࡿ 㸬 ㏆ ᖺ ࡢ ᛴ ⃭ ࡞ 㧗 㱋 క ࠸ 㸪 ៏ ᛶ ⭈ ⮚
㸦
Chronic kidney disease; CKD㸧 ࡀ ే Ꮡ ࡍ ࡿ ⭤ ⬔ ⒴ ࡀ ᛴ ቑ ࡋ ࡚ ࠾ ࡾ 㸪 CKD
ࢆ ᭷ ࡍ ࡿ ⭤ ⬔ ⒴ ᝈ ⪅ ࡢ ண ᚋ ᨵ ၿ ࡢ ࡓ ࡵ ࡣ 㸪 ⭤ ⬔ ⒴ ࡢ ⏕ ண ᚋ ࠾ ࡅ ࡿCKD
ࡢ ព ⩏ ࢆ᫂ ☜ ࡍ ࡿ ᚲ せ ࡀ ࠶ ࡿ 㸬 㐣 ཤ ࡢ ሗ ࿌ ࡛ ࡣ 㸪 ⭤ ⬔ ᚋ ࡢ ண ᚋ Ⰻ ᅉ Ꮚ ࡋ ࡚ 㸪 ࣃ ࣇ ࢛ ࣮
࣐ ࣥ ࢫ ࢫ ࢸ ࣮ ࢱ ࢫ 㸦
PS㸧㸪 ᖺ 㱋 㸪 ႚ ↮ 㸪 デ ᩿ ࡽ ᡭ ⾡ ࡲ ࡛ ࡢ ᮇ 㛫 㸪 ⮫ ᗋ ⓗ ᮇ 㸪 ⌮ ⤌
⧊ Ꮫ ⓗ ࣜ ࣥ ࣃ ⟶ ᾐ ₶ 㸦
LVI
㸧㸪 ࣜ ࣥ ࣃ ⠇ ㌿ ⛣ 㸦pN+㸧㸪 ᭷ ≧ ࡛ ࠶ ࡿ ࡇ 㸪 ࡞ ࡀ ᣲ ࡆ ࡽ
ࢀ ࡚ ࠸ ࡿ 㸬 ࡋ ࡋ ࡞ ࡀ ࡽ 㸪
CKD
ࡀ ⭤ ⬔ ⒴ ⾡ ᚋ ࡢ ⒴ ≉ ␗ ⓗ ண ᚋ ᙳ 㡪 ࡍ ࡿ ࡘ ࠸ ࡚ ࡣ 㸪 ࢇ ᳨ ウ ࡀ ࡞ ࡉ ࢀ ࡚ ࠸ ࡞ ࠸ 㸬ᮏ ◊ ✲ ࡛ ࡣ 㸪
CKD
ࡀ ⭤ ⬔ ᚋ ࡢ ⒴ ≉ ␗ ⓗ ⏕ Ꮡ ⋡ ࠼ ࡿ ᙳ 㡪 ࢆ ᳨ ウ ࡋ ࡓ 㸬
࠙ ᪉ ἲ ࠚ
1996
㹼2017
ᖺ ࡢ 㛫 㸪┴ ෆ ࡢ4
タ㸦 ᘯ ๓ Ꮫ ་ Ꮫ 㒊 㝃 ᒓ 㝔 㸪㟷 ᳃ ┴ ❧ ୰ ኸ 㝔 㸪 㟷 ᳃ ປ ⅏ 㝔 㸪ࡴ ࡘ ⥲ ྜ 㝔 㸧 ࡚ ⭤ ⬔ 㝖 ⾡ ࢆ ཷ ࡅ ࡓ581
ྡ ࢆ ᚋ ࢁ ྥ ࡁ ᳨ ウ ࡋ ࡓ 㸬⾡ ๓ ࡢ ⭈ ᶵ ⬟ 㸦
estimated glomerular filtration rate; eGFR
㸧 ࡀ60 mL/min/1.73m
2 ௨ ୗ ࡢ ⩌ 㸦CKD
⩌ 㸧 㸪60
௨ ୖ ࡢ ⩌ 㸦 㠀CKD
⩌ 㸧 ศ ࡅ 㸪 ୧ ⩌ 㛫 ࡛ ⫼ ᬒ ᅉ Ꮚ 㸦 ᖺ 㱋 㸪 ᛶ ู 㸪PS㸪 ⮫ ᗋ ᮇ 㸪 CKD㸪 㧗 ⾑ ᅽ 㸪 ᚰ ⾑ ⟶ ⣔ ᝈ 㸪 ⢾ ᒀ ࡢ ᭷ ↓ 㸪 ⾡ ๓ Ꮫ ⒪ ἲ
ࡢ ᭷ ↓ 㸪ᒀ ㊰ ኚ ྥ ࡢ ✀ 㢮 㸧ࢆ ẚ ㍑ ࡋ ࡓ 㸬ࡲ ࡓ 㸪⾡ ᚋ ࡢ ᅉ Ꮚ ࡋ ࡚ 㸪 ⌮ ⤌ ⧊ Ꮫ ⓗ ᅉ Ꮚ㸦 ⣽⬊ ␗ ᆺ ᗘ 㸪
pT㸪 LVI㸪 pN㸧 ⾡ ᚋ ྜ ే ࡢ ᭷ ↓ ࢆ ẚ ㍑ ࡋ ࡓ 㸬
ࡲ ࡓ 㸪 ୧ ⩌ ࡢ ண ᚋ 㸦 ↓ ቑ ᝏ ⏕ Ꮡ ᮇ 㛫
PFS
㸪 ⒴ ≉ ␗ ⓗ ⏕ Ꮡ ᮇ 㛫CSS㸪 ⏕ Ꮡ ᮇ 㛫 OS㸧
ࢆ ࢝ ࣉ ࣛ ࣥ ࣐ ࣖ ࣮ ἲ ࡼ ࡾ ẚ ㍑ ࡋ ࡓ 㸬 ከ ኚ 㔞 ゎ ᯒ ࢆ ⏝ ࠸ ࡚ 㸪 ண ᚋ Ⰻ ࡢ ࣜ ࢫ ࢡ ᅉ Ꮚ ࢆ
᳨ ⣴ ࡋ ࡓ 㸬 ࡉ ࡽ 㸪 㑅 ᢥ ࣂ ࢫ ࢆ ᢚ ࠼ ࡿ ┠ ⓗ ࡛ 㸪 ഴ ྥ ࢫ ࢥ ㏫ ᩘ 㔜 ࡳ ἲ 㸦
Inverse probability of treatment weighting; IPTW
ἲ 㸧 ࢆ ే ⏝ ࡋ ࡓCox
ẚ ࣁ ࢨ ࣮ ࢻ ࣔ ࢹ ࣝ ࢆ⏝ ࠸ 㸪CKD ࡀ ண ᚋ Ⰻ ᅉ Ꮚ ࡛ ࠶ ࡿ ࢆ ᳨ ウ ࡋ ࡓ 㸬ຍ ࠼ ࡚ 㸪ྛ ࣜ ࢫ ࢡ ᅉ Ꮚ ࢆ ⏝ ࠸ ࡚ 㸪5ᖺ
⏕ Ꮡ ⋡ ࢆ ண ࡍ ࡿ ࣀ ࣔ ࢢ ࣛ ࣒ ࢆ స ᡂ ࡋ ࡓ 㸬
࠙ ⤖ ᯝ ࠚ
581
ྡ ࡢ ࠺ ࡕ 㸪215
ྡ 㸦37%㸧 ࡀ CKD
⩌ ศ 㢮 ࡉ ࢀ ࡓ 㸬CKD
⩌ 㸪 㠀CKD
⩌ ࡢ ࣇ ࢛ࣟ ࣮ ᮇ 㛫 ୰ ኸ ್ ࡣ ࡑ ࢀ ࡒ ࢀ
32
᭶ 㸪54
᭶ ࡛ ࠶ ࡗ ࡓ 㸬 ୧ ⩌ 㛫 ࡛ ࡢ ᭷ ព ᕪ ࢆ ㄆ ࡵ ࡓ ᅉ Ꮚ ࡣ 㸪 ᖺ 㱋 㸪CKD࣭ CVD
ࡢ ᭷ ↓ 㸪 ⾡ ๓ Ꮫ ⒪ ἲ ࡢ ᭷ ↓ 㸪 ᒀ ㊰ ኚ ྥ ࡢ ✀ 㢮 㸪 ⌮ ⤌ ⧊ Ꮫⓗ ⭤ ⬔ ࿘ ᅖ ⬡ ⫫ ⤌ ⧊ ᾐ ₶ 㸦
pT3
௨ ୖ 㸧 ࡛ ࠶ ࡗ ࡓ 㸬࢝ ࣉ ࣛ ࣥ ࣐ ࣖ ࣮ ἲ ࡼ ࡾ ண ᚋ ࢆ ẚ ㍑ ࡋ ࡓ ⤖ ᯝ 㸪
CKD
⩌ ࠾ ࠸ ࡚ 㸪᭷ ព PFS, CSS, OS
ࡀ Ⰻ ࡛ ࠶ ࡗ ࡓ 㸬 ከ ኚ 㔞 ゎ ᯒ ࡛ ࡣ 㸪LVI+㸪 pN+㸪 pT3
௨ ୖ 㸪 ⾡ ๓CKD
㸪CVD
ࡀ ண ᚋ Ⰻ ࡢ ࣜ ࢫ ࢡ ᅉ Ꮚ ࡋ ࡚ 㑅 ᢥ ࡉ ࢀ ࡓ 㸬IPTWἲ ࢆ ⏝ ࠸ ࡓCox
ẚ ࣁ ࢨ ࣮ ࢻ ࣔ ࢹ ࣝ ࡢ ⤖ ᯝ 㸪 ⾡ ๓CKD
ࡣ ᭷ ព ࡞ ண ᚋ Ⰻ ᅉ Ꮚ ࡛ ࠶ ࡗ ࡓ 㸬 ከ ኚ 㔞 ゎ ᯒ ࡛ 㑅 ᢥ ࡉ ࢀ ࡓ ྛ ࣜ ࢫ ࢡ ᅉ Ꮚࢆ ᥇ ⏝ ࡋ ࡓ ࣀ ࣔ ࢢ ࣛ ࣒ ࡣ 㸪
PFS, OS
ࡢ ண ࠾ ࠸ ࡚c
ࣥ ࢹ ࢵ ࢡ ࢫ0.7
௨ ୖ ࢆ ♧ ࡋ 㸪 ⢭ ᗘ ࡢ 㧗 ࠸ ண ࣔ ࢹ ࣝ ⪃ ࠼ ࡽ ࢀ ࡓ 㸬࠙ ⪃ ᐹ ࠚ
ᮏ ◊ ✲ ࡛ ࡣ 㸪 ⭤ ⬔ ⾡ ࢆ ཷ ࡅ ࡓ ➽ ᒙ ᾐ ₶ ⭤ ⬔ ⒴ ᝈ ⪅ ࠾ ࠸ ࡚ 㸪 ⾡ ๓ ࡢ
CKD
ࡀ ⒴ ≉␗ ⓗ ண ᚋ Ⰻ ࡢ ᅉ Ꮚ ࡛ ࠶ ࡿ ྍ ⬟ ᛶ ࡀ ♧ ၀ ࡉ ࢀ ࡓ 㸬⒴ ≉ ␗ ⓗ ண ᚋ ᑐ ࡍ ࡿ
CKD
ࡢ ᙳ 㡪 ࡣ 㸪⒴ ✀ ࡼ ࡗ ࡚ ␗ ࡞ ࡗ ࡓ ሗ ࿌ ࡀ ࠶ ࡿ 㸬 㢌 㢕 㒊 ⒴ 㸪 ⫶ ⒴ 㸪 ⫢ ⒴ 㸪 ⭠ ⒴ 㸪 ᒀ ⟶ ⒴ 㸪 ⭈ ⒴ 㸪 ፬
ே ⛉ ⒴ 㸪 ⾑ ᾮ ⒴ ࠾ ࠸ ࡚
CKD
ࡣ ண ᚋ Ⰻ ᅉ Ꮚ ࡉ ࢀ ࡿ ୍ ᪉ ࡛ 㸪 ⫵ ⒴ 㸪 ங ⒴ ࠾ ࠸ ࡚ ࡣ ண ᚋ ᙳ 㡪 ࡋ ࡞ ࠸ ሗ ࿌ ࡉ ࢀ ࡚ ࠸ ࡿ 㸬CKD
ࡀ ⭤ ⬔ ⾡ ⾡ ᚋ ࡢ ண ᚋ ᙳ 㡪 ࡍ ࡿ ࣓ ࢝ ࢽ ࢬ ࣒ ࡣ ᫂ ࡽ ࡛ ࡣ ࡞ ࡃ 㸪ࡉ ࡽ ࡞ ࡿ ᳨ ウ ࡀ ᚲ せ ࡛ ࠶ ࡿ 㸬CKD
⒴ 㐍 ᒎ ࡢ 㛵 ಀ ࡘ ࠸ ࡚ 㸪 ࠸ ࡃ ࡘ ࡢ ௬ ㄝ ࡀ ⪃ ࠼ ࡽ ࢀ ࡿ 㸬 ➨ ୍ 㸪CKD
㉳ ᅉ ࡋ ࡓ ៏ ᛶ ⓗ ࡞ ⅖ 㸪ᒀ ẘ ࡼ ࡿ ච ᶵ ⬟ ࡢ ప ୗ 㸪ࡉ ࡽ 㓟 ࢫ ࢺ ࣞ ࢫ ࡢ ✚ ࡀ 㸪⒴ ࡢ Ⓨ ࢆ ಁ 㐍 ࡋ ࡚ ࠸ ࡿ ྍ ⬟ ᛶ ࡀ ࠶ ࡿ 㸬ࡲ ࡓ 㸪CKD ࡢ ᝈ ⪅ ࡛ ࡣ ᙅ ᛶ ࡀ 㧗 ࡲ ࡗ ࡓ
࠸ ࢃ ࡺ ࡿ ࠕ ࣇ ࣞ ࣝ ࠖ ࡢ ≧ ែ ࡛ ࠶ ࡿ ࡉ ࢀ 㸪 ࡇ ࢀ ࡀ ⒴ ≉ ␗ ⓗ ண ᚋ ᙳ 㡪 ࡋ ࡚ ࠸ ࡿ ྍ ⬟ ᛶ
ࡶ ⪃ ࠼ ࡽ ࢀ ࡿ 㸬 ⒴ ✀ ࡼ ࡗ ࡚
CKD
ࡢ ᙳ 㡪 ࡀ ␗ ࡞ ࡿ ⌮ ⏤ ࡶ ᫂ ࡽ ࡉ ࢀ ࡚ ࠾ ࡽ ࡎ 㸪 ࢹ ࣮ ࢱ ࡢ ✚ ࡀ ᚲ せ ࡛ ࠶ ࡿ 㸬ᮏ ◊ ✲ ࡛ ࡣ ࠸ ࡃ ࡘ ࡢ ࣜ ࣑ ࢸ ࣮ ࢩ ࣙ ࣥ ࡀ ࠶ ࡿ 㸬 ➨ ୍ 㸪 ᚋ ࢁ ྥ ࡁ ◊ ✲ ࡛ ࠶ ࡾ 㸪 㑅 ᢥ ࣂ
ࢫ ࡸ 㸬 ⤡ ᅉ Ꮚ ࡀ Ꮡ ᅾ ࡍ ࡿ 㸬 ࡲ ࡓ 㸪 ࣇ ࢛ ࣟ ࣮ ᮇ 㛫 ࡀ ༑ ศ ࡛ ࡞ ࠸ Ⅼ 㸪 」 ᩘ タ ࡽ ᚓ
ࡽ ࢀ ࡓ ࢹ ࣮ ࢱ ⤖ ᯝ ࡢ ࡤ ࡽ ࡘ ࡁ ࡀ ࠶ ࡿ Ⅼ 㸪⾡ ๓ ࡢ Ỉ ⭈ 㛵 ࡍ ࡿ ࢹ ࣮ ࢱ ࡀ ᚓ ࡽ ࢀ ࡞ ࡗ ࡓ Ⅼ ࡀ ᣲ ࡆ ࡽ ࢀ ࡿ 㸬 ࡇ ࢀ ࡽ ࡢ ไ ⣙ ࡀ ࠶ ࡿ ୍ ᪉ ࡛ 㸪 ᮏ ◊ ✲ ࡣ ẚ ㍑ ⓗ ࡁ ࡞ ࢧ ࣥ ࣉ ࣝ ࢧ ࢬ
࡛
IPTW
ἲ ࢆ ⏝ ࠸ 㸪 ➽ ᒙ ᾐ ₶ ⭤ ⬔ ⒴ ࠾ ࡅ ࡿ ⾡ ๓ ࡢCKD
ࡀ 㸪 Ṛ ஸ ⋡ ࡔ ࡅ ࡛ ࡣ ࡞ ࡃ ⒴≉ ␗ ⓗ ⏕ Ꮡ ⋡ ࡶ ᙳ 㡪 ࢆ ࠼ ࡿ ᅉ Ꮚ ࡛ ࠶ ࡿ ࡇ ࢆ ᫂ ☜ ࡋ ࡓ ᮏ 㑥 ึ ࡢ ㈗ 㔜 ࡞ ◊ ✲ ࡛ ࠶
ࡿ 㸬
࠙ ⤖ ㄽ ࠚ
➽ ᒙ ᾐ ₶ ⭤ ⬔ ⒴ ᝈ ⪅ ࠾ ࠸ ࡚ 㸪 ⭤ ⬔ 㝖 ⾡ ๓ ࡢ
CKD
ࡣ 㸪 ⏕ Ꮡ ⋡ ࡔ ࡅ ࡛ ࡣ ࡞ ࡃ ⒴≉ ␗ ⓗ ⏕ Ꮡ ⋡ ࡶ ᙳ 㡪 ࡍ ࡿ ண ᚋ Ⰻ ᅉ Ꮚ ࡛ ࠶ ࡿ ྍ ⬟ ᛶ ࡀ ♧ ၀ ࡉ ࢀ ࡓ 㸬
ͤ
1 எ ࡢ ሙ ྜ 㸪ۑ ۑ 㡿 ᇦ ۑ ۑ ᩍ ⫱ ◊ ✲ ศ 㔝 ࠼ ࡚ 㸪ᡤ ᒓ ࡢ ۑ ۑ ㅮ ᗙ ࢆ グ ධ ࡍ ࡿ ࡇ 㸬
ͤ
