术前营养风险对膀胱癌根治术患者预后的影响

The effect of preoperative nutritional risk on the prognosis of patients with bladder cancer after radical cystectomy

目的:探讨术前营养风险对膀胱癌根治术患者预后的影响。方法:回顾性分析2010年02月至2018年05月我院泌尿外科收治的186例行根治性全膀胱切除术患者的临床资料。术前采用营养风险评估表(NRS-2002)筛查患者营养风险,根据NRS-2002评分结果将患者分为有营养风险组(总评分≥3分)96例和无营养风险组(总评分<3分)90例。比较两组患者临床资料;采用Kaplan-Meier模型对两组患者的肿瘤无复发生存期(recurrence free survival,RFS)和总生存期(overall survival,OS)进行分析;患者RFS和OS的独立危险因素采用多因素Cox比例风险回归模型分析。结果:有营养风险组和无营养风险组在病理T分期、肿瘤大小、是否淋巴结转移、肾积水方面比较差异有统计学意义(P<0.05);有营养风险组和无营养风组险5年RFS率分别为29.17%(28/96)、45.56%(41/90),5年OS率分别为43.75%(42/96)、58.89%(53/90);Kaplan-Meier分析结果显示,有营养风险组患者的RFS和OS均短于无营养风险组(P<0.05);Cox比例风险回归模型显示,术前营养风险是影响膀胱癌根治术患者RFS和OS的独立危险因素(P<0.05)。结论:术前有营养风险是膀胱癌根治术患者RFS和OS的独立危险因素,有营养风险的患者术后预后更差。

Objective:To explore the effect of preoperative nutritional risk on the prognosis of patients with bladder cancer after radical cystectomy.Methods:The clinical data of 186 patients with radical cystectomy admitted to department of urology surgery in our hospital from February 2010 to May 2018 were analyzed retrospectively.Nutritional Risk Screening-2002(NRS-2002)was used to screen the patients with bladder cancer for nutritional risk.According to the NRS-2002 score,the patients were divided into the group with nutritional risk(total score≥3 points,n=96)and the group without nutritional risk(total score<3 points,n=90).The clinical data between the two groups were compared.Kaplan-Meier method was used to analyze the recurrence free survival(RFS)and overall survival(OS)between the two groups.The independent risk factors of RFS and OS were analyzed by the multivariate Cox proportional risk regression model.Results:There were significant differences in pathological T stage,tumor size,lymph node metastasis and hydronephrosis between the group with nutritional risk and the group without nutritional risk(P<0.05).The 5-year RFS rates of the group with and without nutritional risk were 29.17%(28/96)and 45.56%(41/90),respectively.The 5-year OS rates of the group with and without nutritional risk were 43.75%(42/96)and 58.89%(53/90),respectively.Kaplan-Meier analysis showed that RFS and OS of patients with nutritional risk were shorter than those without nutritional risk(P<0.05).The Cox proportional risk regression model showed that preoperative nutritional risk was an independent risk factor for RFS and OS in bladder cancer patients undergoing radical cystectomy(P<0.05).Conclusion:Preoperative nutritional risk is an independent risk factor for RFS and OS in bladder cancer patients undergoing radical cystectomy.Patients with nutritional risk had worse prognosis.