| Background:Bladder cancer（BC）is one of the most common urologic malignancies,incidence rate is about 3%of all new cancers,accounting for 2.1%[1]of the total number of cancer deaths.The epidemiological characteristics of BC showed significant gender and age differences[2],and smoking history was also considered as one of the major influencing factors[3].In recent years,the incidence rate of BC is high.The most common clinical symptom is intermittent painless gross hematuria.The most common pathological type is low-grade urothelial carcinoma[4].Some BC patients are concealed,resulting in delay in diagnosis and treatment,resulting in higher pathological grading and staging at the first diagnosis.However,the pathogenesis of BC is complex.Whether hematuria is related to the pathological grade and stage of BC is still uncertain.The prognosis of BC is closely related to the pathological results of tumor.The 5-year survival rate of muscle invasive bladder cancer is only 60%[5].The high incidence rate,recurrence rate and mortality rate of BC indicate that it is still an unresolved clinical and social problem.It is an urgent problem to improve the early diagnosis rate of BC and identify BC patients earlier.Objective:Objective to analyze the relationship between the severity of hematuria and the grade and stage of BC,and to reveal its guiding significance for prognosis and follow-up.Methods:This study was a retrospective study of patients who were initially diagnosed with BC between June 2010 and June 2020.All patients were diagnosed by pathology.The clinical data including gender,age,smoking history,operation history,hematuria degree and pathological results were collected retrospectively.There are three types of hematuria:gross hematuria（GH）,microscopic hematuria（MH）and non hematuria（none）.The pathological grade of bladder urothelial carcinoma was performed by WHO2004 grading system,and the tumor stage was evaluated by uicc2009 TNM classification.The tumor stage was further divided into two categories（T1+Ta/CIS and≥T2）according to the presence or absence of myometrial invasion.T test was used to compare numerical variables,chi square test was used to compare categorical variables.The relationship between variables and tumor grade or stage was tested by univariate and multivariate logistic regression analysis.All statistical analyses were performed using SPSS version 24.0.All P values were bilateral,with P<0.05 as the difference was statistically significant.Result:1.The average age of 398 BC patients was 68.33±11.96 years.The average age of GH group was 69.18±11.85 years old,MH group was 68.45±12.01 years old,and no hematuria group was 63.74±11.44 years old.T test was used to analyze the relationship between age and the degree of hematuria in BC patients.The results showed that the average age of onset was different among the groups（P<0.05）.The results of ANOVA multiple comparison showed that the average age of GH group was significantly higher than that of non hematuria group,and there was no significant difference between GH and MH groups（P>0.05）.2.Among the 398 BC patients,326 were male and 72 were female.Male patients with BC were more than female patients.There was no significant difference in hematuria between different gender groups（P>0.05）.3.Among the 398 BC patients,81 had a history of smoking and 317 had no history of smoking.Most BC patients had no history of smoking,and there was no significant relationship between the severity of hematuria and smoking history（P>0.05）.4.Among the 398 BC patients,258（64.82%）were in GH group,85（21.36%）in MH group and 55（13.82%）in non hematuria group.In GH and MH patients,175 and 44cases were classified as high-grade diseases（72.92%and 18.33%respectively）.Chi square test was used to compare the relationship between the severity of hematuria and the pathological grade of the disease.The degree of hematuria was significantly correlated with the pathological grade of the disease（P<0.05）.5.Among the 398 BC patients,258（64.82%）were in GH group,85（21.36%）in MH group and 55（13.82%）in non hematuria group.Most patients with BC were diagnosed as NMIBC.The diagnosis stage of GH was Ta/CIS in 12 cases（4.65%）,T1 in 89 cases（34.50%）,and≥T2 in 157 cases（60.85%）.Among the patients with MH as the first symptom,18 cases（21.18%）were Ta/carcinoma in situ（CIS）,33 cases（38.82%）were T1,34 cases（40.0%）were≥T2.Chi square test was used to compare the relationship between the severity of hematuria and pathological stage.The type of hematuria was correlated with pathological stage（P<0.05）.GH group predicted higher pathological stage.6.In the 398 BC patients included in the study,the non hematuria group was excluded,and the relationship between the pathological grade and the degree of hematuria was further analyzed by multivariate logistic regression.It was found that the pathological grade was correlated with the degree of hematuria（or=1.930,95%confidence interval1.164-3.199,P=0.011）.GH group was associated with higher pathological grade.After excluding the non hematuria group,the relationship between the pathological stage and the degree of hematuria was further analyzed by multivariate logistic regression.The pathological stage results were divided into two categories（T1+Ta/CIS and≥T2）.MH was independently correlated with the pathological stage of<T2 at the time of diagnosis（or=0.454,95%confidence interval 0.273-0.754,P=0.002）,that is,GH predicted higher pathological stage of BC patients.Conclusion:1.The degree of hematuria in patients with newly diagnosed bladder cancer is independently correlated with their pathological grade,and MH indicates a lower pathological grade.2.The degree of hematuria in patients with newly diagnosed bladder cancer is independently related to their pathological stage.MH indicates a lower pathological stage,that is,GH indicates a higher pathological stage.3.To improve the vigilance of patients with MH and detect the disease before GH may affect the treatment and improve the prognosis,and may even play a role in the short-term or long-term follow-up. |
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