术前血浆纤维蛋白原与非肌层浸润性膀胱癌患者临床病理特征和预后的关系

The significance of plasma fibrinogen level in predicting pathological outcomes and prognosis in non -muscle -invasive bladder cancer patients

目的针对采用经尿道电切术治疗的非肌层浸润性膀胱癌患者，评估其术前血浆纤维蛋白原与病理特征、预后的关系。方法回顾性分析我科治疗的283例非肌层浸润性膀胱癌患者，统计其血浆纤维蛋白原及其他临床病理和随访信息，评估血浆纤维蛋白原与临床病理因素及肿瘤复发、进展的关系。结果所有患者中位年龄57岁（20～82岁），纤维蛋白原值中位数为3．37g／L（3．15～3．56μg/L）。采用受试者工作特征曲线（ROC）评估纤维蛋白原值与出现肿瘤复发、肿瘤进展的曲线下面积分别为O．614、0．590，最佳临界值为3．34μg/L。较高的纤维蛋白原值与较高的肿瘤分期、较高的组织学分级之间呈显著相关（P=0．030和P=0．000）。所有患者中位随访时间45个月（33-59个月）。5年的无复发生存率和无进展生存率分别为63．5％和83．8％。经单因素和多因素生存分析，较高的纤维蛋白原值是影响肿瘤复发和进展的独立危险因素。结论在非肌层浸润性膀胱癌患者中，术前血浆纤维蛋白原浓度与术后不良病理结局以及术后肿瘤复发、进展有关。

Objective To investigate the correlation of pre - operative plasma fibrinogen level with the pathological outcomes and oncologic prognosis in non - muscle - invasive bladder cancer （NMIBC） pa- tients. Methods The data of 283 NMIBC patients treated in our department were retrospectively reviewed. The pre - operative plasma fibrinogen level and other clinical ＆ pathological characteristics and follow - up data were collected. Results The median age of all patients was 57 years old （ range from 20 to 82 years）, and the median fibrinogen level was 3.37 g/L （range from 3. 15 to 3.56 g/L）. The areas under receiver operating characteristic （ROC） curve for evaluating the predictive role of fibrinogen level for tumor recur- rence and progression was 0. 614 and 0. 590, respectively, and the best cut - off was 3.34 g/L. Higher fibrinogen level was related to higher tumor stage （ P = 0. 030） and higher tumor grade （ P = 0. 000）. The median follow -up duration was 45 months （range from 33 to 59 months） and the 5 year recurrence -free and progression - free survival rate was 63.5% and 83.8% respectively. The univariate and multivariate survival analysis revealed that higher fibrinogen level was proved to be an independent predictive factor for tumor recurrence and tumor progression. Conclusion In NMIBC patients, pre - operative plasma fibrino- gen level was related to adverse pathological outcomes and worse prognosis.