术前血清尿酸对非肌层浸润性膀胱癌的预后分析

Prognostic analysis of serum uric acid in patients with non-muscular invasive bladder cancer

目的术前血清尿酸(SUA)对非肌层浸润性膀胱癌(NMIBC)的预后分析。方法经回顾性研究分析河南省人民医院接受经尿道膀胱肿瘤切除术(TURBT)的NMIBC患者202例,收集临床资料,包括性别、年龄、吸烟史、肿瘤大小、多发情况、病理分级、临床分期等,应用受体工作特征曲线(ROC)确定SUA最佳临界值(328.5μmol/L),根据该临界值将患者分为高水平SUA组(>328.5μmol/L)和低水平SUA组(≤328.5μmol/L)。采用χ^(2)检验或t检验分析患者组间临床病理因素与SUA的关系。采用Kaplan-Meier法绘制生存曲线,并采用Log-Rank检验分析生存结局。使用Cox风险模型对NMIBC患者潜在的生存预测因素进行单、多因素分析。结果高水平SUA组与低水平SUA组在肿瘤多发情况、肿瘤分级、临床分期等比较差异有统计学意义(均P<0.05),性别、年龄、吸烟、肿瘤大小等比较差异无统计学意义(均P>0.05)。KaPlan-Meier生存曲线并Log-Rank检验结果显示:低水平SUA组较高水平SUA组有着更低的无复发生存(RFS)率与更低的无进展生存(PFS)率(均P<0.05)。Cox比例风险回归模型发现:术前SUA水平可为NMIBC患者RFS率(P<0.001)与PFS率(P=0.008)的独立影响因素。结论术前低血清尿酸(SUA)可能是非肌层浸润性膀胱癌(NMIBC)患者不良预后因素,可作为NMIBC患者预后的生物分子。

Objective To determine preoperative serum uric acid(SUA)for the prognosis of non-muscular invasive bladder cancer(NMIBC).Methods Totally 202 NMIBC patients who had received transurethral resection of bladder tumor(TURBT)in Henan University People’s Hospital,Collect clinical data,including gender,age,smoking history,tumor size,multiple conditions,pathological grade,clinical stage etc.The optimal critical value of SUA(328.5 umol/L)was determined by receiver operating characteristic curve(ROC).According to this critical value,patients were divided into the high-level SUA group(>328.5 umol/L)and the low-level SUA group(≤328.5 umol/L).The correlation between clinicopathological factors and SUA was analyzed byχ^(2)test or t test.The survival curve was plotted by Kaplan-Meier method and the difference of survival outcome was analyzed by log-rank test.Univariate and multivariate analyses were performed on potential predictors of survival in NMIBC patients using Cox risk models.Results There were statistically significant differences between the high level SUA group and the low level SUA group(all P<0.05)in tumor frequency,tumor grade,and clinical stage,while there were no statistically significant differences between the high level SUA group and the low level SUA group in terms of gender,age,smoking,tumor size,etc(all P>0.05).Kaplan-meier survival curve and log-rank test results showed that the lower level SUA group and the higher level SUA group had a lower recurrence-free survival(RFS)rate and a lower progression-free survival(PFS)rate(all P<0.05).Cox proportional hazard regression model found that preoperative SUA level was an independent influence factor for RFS rate(P<0.001)and PFS rate(P=0.008)in NMIBC patients.Conclusion Preoperative patients with low serum uric acid(SUA)may be a poor prognostic factor in Non-muscle-invasive bladder cancer(NMIBC)patients and can be used as a prognostic biomolecule in NMIBC patients.