术前血清白蛋白水平与非肌层浸润性膀胱癌长期预后的关系

Detection and prognostic significance of preoperative serum albumin level in patients with non muscle invasive bladder cancer undergoing transurethral resection of bladder tumor

目的:探讨术前血清白蛋白(ALB)水平对非肌层浸润性膀胱癌(NMIBC)的预后意义。方法:选取我院2007年1月至2012年12月收治的210例NMIBC患者,入选患者根据术前血清ALB水平分为正常血清ALB组125例(ALB水平≥40 g·L^-1)与低血清ALB组85例(ALB水平<40 g·L^-1)。所有患者均接受尿道膀胱肿瘤电切术(TURBT)。收集患者的一般资料、病理学指标以及实验室相关指标,通过Cockcroft-Gault公式得到肌酐清除率,并据此进行慢性肾脏病(CKD)分期,患者术后常规行膀胱灌注化疗,比较两组的一般资料,术后随访5年,观察生存情况,进行生存率的单因素及多因素Logistic回归分析。结果:低血清ALB组患者年龄明显高于正常血清ALB组(P<0.05),两组血红蛋白浓度、CKD分期差异有统计学意义(P<0.05),两组间吸烟状况、性别、ASA评分、Karnofsky评分、肿瘤分级、病理学T分期、血小板计数比较差异无统计学意义(P>0.05)。患者均进行5年的随访,共有185例生存,生存率为88.1%,25例患者死亡,死亡率为11.9%,其中正常血清ALB组为5例(4.0%),低血清ALB组为20例(23.5%)。术前年龄、Karnofsky评分、ASA评分和病理学T分期、肿瘤数量、肿瘤分级、血清ALB及血红蛋白浓度、CKD分期与生存率均显著相关(P<0.05);将有差异的因素进行Logistic回归分析,结果显示,术前血清ALB水平、年龄、Karnofsky评分和病理T分期为5年生存率的独立预后因素,差异具有统计学意义(P<0.05)。结论:行TURBT的NMIBC的预后与术前血清ALB水平、病理学T分期、年龄和Karnofsky评分密切相关,术前血清ALB水平可用于患者术后的生存预后评估,具有简单有效且廉价易得的优势。术前血清ALB水平较低者应积极予以治疗,从而改善生存预后。

Objective: To investigate the expression and prognostic significance of serum albumin level in patients with non muscle invasive bladder cancer( NMIBC) after transurethral resection of bladder tumor( TURBT).Methods: 210 patients with NMIBC received in our hospital were selected from January 2007 to December 2012.The patients were divided into the normal serum albumin group(≥40 g·L^-1,125 cases) and low serum albumin group(< 40 g · L^-1,85 cases) according to the serum albumin level before operation. The general data,pathological indexes and laboratory related indexes were collected,the creatinine clearance rate was obtained by Cockcroft-Gault formula,and the chronic kidney disease( CKD) staging was carried out according to this,the routine bladder perfusion chemotherapy was performed in the patients after the operation. The general data of the two groups were compared. After 5 years of follow-up,the survival rate was observed. Univariate and multivariate Logistic analysis of survival rate was performed. Results: The age of patients in low serum albumin group was significantly higher than that in the normal group( P < 0. 05). There were significant differences in hemoglobin concentration and CKD staging between the two groups( P < 0. 05). There was no significant difference in smoking status,sex,ASA score,Karnofsky score,tumor grading,pathological T stage and platelet count between the two groups( P > 0. 05).The patients were followed up for 5 years. In the follow-up,185 cases survived,the survival rate was 88. 1%,25 patients died and the mortality rate was 11. 9%,of which 5 cases( 4%) were in the normal group and 20 cases in the low serum albumin group( 23. 5%). The preoperative age,Karnofsky score,ASA score,pathological T staging,tumor number,tumor classification,serum albumin and hemoglobin concentration,CKD staging were significantly correlated with survival rate( P < 0. 05). Logistic regression analysis showed that the preoperative serum albumin level,age,Karnofsky score,and pathological T staging were independent prognostic factors of 5 years survival rate,and the difference was statistically significant( P < 0. 05). Conclusion: The prognosis of NMIBC undergoing TURBT is closely related to preoperative serum albumin level,pathological T staging,age and Karnofsky score. Preoperative serum albumin can be used to evaluate the survival prognosis of patients after operation,which is simple,effective,cheap and easy to obtain. Patients with lower serum albumin level should be treated actively so as to improve survival prognosis.