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  • 汤仕杰,刘安伟,马重,徐伟东,孙颖浩,许传亮*.术前血清前白蛋白水平在评价膀胱尿路上皮癌患者预后中的价值[J].第二军医大学学报,2018,39(11):1209-1213    [点击复制]
  • TANG Shi-jie,LIU An-wei,MA Chong,XU Wei-dong,SUN Ying-hao,XU Chuan-liang*.Prognostic value of preoperative serum pre-albumin in patients with bladder urothelial carcinoma[J].Acad J Sec Mil Med Univ,2018,39(11):1209-1213   [点击复制]
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术前血清前白蛋白水平在评价膀胱尿路上皮癌患者预后中的价值
汤仕杰,刘安伟,马重,徐伟东,孙颖浩,许传亮*
0
(海军军医大学(第二军医大学)长海医院泌尿外科, 上海 200433
*通信作者)
摘要:
目的 探讨术前血清前白蛋白水平在评价膀胱尿路上皮癌患者预后中的价值。方法 回顾性分析2006年1月至2014年12月在海军军医大学(第二军医大学)长海医院行根治性膀胱切除术的320例膀胱尿路上皮癌患者的临床病理资料。绘制受试者工作特征(ROC)曲线,确定术前血清前白蛋白的最佳截断值。采用χ2检验分析术前血清前白蛋白水平与患者临床病理特征的关系,采用log-rank检验和Kaplan-Meier法分析术前血清前白蛋白水平与患者总生存和无复发生存的关系,再利用Cox回归模型分析影响患者预后的危险因素。结果 根据术前血清前白蛋白最佳截断值249.5 mg/L,将患者分为高前白蛋白(≥249.5 mg/L)组(162例)和低前白蛋白(<249.5 mg/L)组(158例)。与高前白蛋白组患者相比,低前白蛋白组患者年龄更大,术前肾积水、高病理T分期、高病理分级、远处转移和术中输血的患者比例均较高(P均<0.05),总生存情况和无复发生存情况均较差(P均<0.05)。Cox回归模型分析结果显示,高病理T分期、淋巴结侵犯、远处转移、术中输血和术前血清前白蛋白水平降低是患者术后总生存的独立危险因素(P均<0.05),高病理T分期、淋巴结侵犯、远处转移和术前血清前白蛋白水平降低是患者术后无复发生存的独立危险因素(P均<0.05)。结论 术前血清前白蛋白水平降低是膀胱尿路上皮癌患者预后不良的独立危险因素,术前血清前白蛋白可作为监测膀胱尿路上皮癌预后的常用指标。
关键词:  膀胱肿瘤  尿路上皮癌  前白蛋白  预后
DOI:10.16781/j.0258-879x.2018.11.1209
投稿时间:2018-08-02修订日期:2018-11-03
基金项目:国家自然科学基金(81572509,81772720,81502198,81802515).
Prognostic value of preoperative serum pre-albumin in patients with bladder urothelial carcinoma
TANG Shi-jie,LIU An-wei,MA Chong,XU Wei-dong,SUN Ying-hao,XU Chuan-liang*
(Department of Urology, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author)
Abstract:
Objective To explore the prognostic value of preoperative serum pre-albumin in the patients with bladder urothelial carcinoma. Methods A retrospective study was conducted on the clinicopathological data of 320 patients with bladder urothelial carcinoma, who underwent radical cystectomy in Changhai Hospital of Navy Medical University (Second Military Medical University) between Jan. 2006 and Dec. 2014. Receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of preoperative serum pre-albumin level. χ2 test was used to analyze the relationship between preoperative serum pre-albumin level and clinicopathological characteristics. Log-rank test and Kaplan-Meier method were used to analyze the relationship between preoperative serum pre-albumin level and overall survival and relapse-free survival of the patients. Cox proportional hazards model was used to explore the risk factors of prognosis of the patients. Results Based on optimal cut-off value of 249.5 mg/L, the patients were divided into high pre-albumin (≥ 249.5 mg/L) group (162 cases) and low pre-albumin (<249.5 mg/L) group (158 cases). Compared with the patients in the high pre-albumin group, those in the low pre-albumin group were older and more prone to preoperative hydronephrosis, high pathological T staging, high grade classification, distant metastasis and intraoperative transfusion, and the differences were significant (all P<0.05). The patients in the low pre-albumin group had significantly shorter overall survival and relapse-free survival compared with the patients in the high pre-albumin group (both P<0.05). The results of multivariate Cox regression analysis demonstrated that high pathological T staging, lymphatic metastasis, distant metastasis, intraoperative transfusion and low pre-albumin level were independent risk factors for the overall survival (all P<0.05), and high pathological T staging, lymphatic metastasis, distant metastasis and low pre-albumin level were independent risk factors for the relapse-free survival (all P<0.05). Conclusion Low preoperative serum pre-albumin level is an independent prognostic risk factor for the patients with bladder urothelial carcinoma, and preoperative serum pre-albumin can be used as a common indicator for prognosis of bladder urothelial carcinoma patients.
Key words:  urinary bladder neoplasms  urothelial carcinoma  pre-albumin  prognosis