机器人膀胱癌根治术患者早期死亡的危险因素研究

Predictive factors of early death in patients with bladder cancer undergoing robot-assisted radical cystectomy

目的选取接受机器人膀胱癌根治术(RARC)的膀胱癌患者,探讨影响RARC患者早期死亡的危险因素.方法分析在郑州大学第一附属医院接受RARC治疗的186例膀胱癌患者的临床资料.早期死亡定义为RARC术后总生存时间小于1年.采用x^2检验分析RARC患者术前临床特征与早期死亡的关系.采用Cox单因素和多因素回归来分析可能影响膀胱癌患者早期死亡的危险因素.结果患者中位随访时间为20.6个月(四分位数13.5~30.2个月),共有31例(16.7%)患者早期死亡.Cox单因素分析显示,年龄(P<0.01)、纤维蛋白原(P<0.05)、血小板与淋巴细胞比值(PLR,P<0.05)、预后营养指数(PNI,P<0.05)、肿瘤分期(P<0.05)及淋巴转移(P<0.05)是影响RARC患者早期死亡的危险因素.Cox多因素分析显示,年龄>60岁(P<0.05)和纤维蛋白原≥3.295 g/L(P <0.05)可作为独立危险因素来预测RARC患者的早期死亡.结论年龄和术前血浆纤维蛋白原水平是影响RARC患者早期死亡的独立危险因素.

Objective To investigate the predictive factors of early death in patients with bladder cancer undergoing robot-assisted radical cystectomy ( RARC). Methods We retrospectively reviewed 186 bladder cancer patients undergoing RARC at our institution. Early death was defined as death within one year of RARC. The association between clinicopathological variables and early death was analyzed. Cox proportional hazards models were used to determine the predictive factors of early death in bladder cancer patients receiving RARC. Results Median follow-up period was 20. 6 months ( interquartile range : 13. 5 to 30. 2 ), and 31 patients (16. 7%) died within one year of RARC. The Cox univariate analysis revealed that age (P <0. 01), fibrinogen ( P <0. 05), the ratio of platelet to lymphocyte ( PLR, P <0. 05), prognostic nutrition index ( PNI, P < 0. 05 ), tumor stage ( P < 0. 05 ) and lymph node metastasis ( P < 0. 05 ) were associated with early death after RARC. The Cox multivariate analysis demonstrated that age ( P < 0. 05) and fibrinogen ( P < 0. 05) independently predicted early death after RARC. Conclusion Age and preoperative plasma fibrinogen were independent predictors of early death for patients with bladder cancer undergoing RARC.