术前系统免疫炎症指数对非肌层浸润性膀胱癌预后的评估价值

Value preoperative systemic immune inflammation index in the prognosis evaluation of non-muscle invasive bladder cancer

目的探讨术前系统免疫炎症指数(SII)对接受经尿道膀胱肿瘤电切(TURBT)术的非肌层浸润性膀胱癌(NMIBC)患者预后的评估价值。方法回顾性分析2014年3月至2017年1月期间在郑州大学第一附属医院泌尿外科初诊为NMIBC且符合纳入和排除标准的257例患者的临床资料。绘制受试者工作曲线(ROC)并确定SII的最佳截断值,将患者分为低SII组(SII<340.57)和高SII组(SII≥340.57),分析2组患者与临床病理特征的关系,利用Kaplan-Meier法进行生存分析,比较无复发生存时间,并采用COX比例风险回归模型评估影响NMIBC患者预后的独立危险因素。结果在257例患者中,低SII组107例(41.6%),高SII组150例(58.4%),SII与病理T分期、肿瘤数量、冠心病有关(χ^(2)=5.546,P=0.019;χ^(2)=4.345,P=0.037;χ^(2)=3.867,P=0.039),与性别、年龄、吸烟史、病理分级、肿瘤大小、高血压、糖尿病无关(χ^(2)=0.978,P=0.323;χ^(2)=1.770,P=0.183;χ^(2)=0.033,P=0.856;χ^(2)=3.620,P=0.057;χ^(2)=1.015,P=0.314;χ^(2)=0.616,P=0.432;χ^(2)=0.030,P=0.862)。Kaplan-Meier分析显示低SII组的无复发生存率明显高于高SII组(P<0.001)。COX单因素分析结果表明SII、年龄、吸烟史、病理T分期、病理分级、肿瘤数量及肿瘤大小与患者术后复发有关(P=0.001,P=0.018,P=0.033,P<0.001,P<0.001,P<0.001,P=0.001),多因素分析结果表明SII、吸烟史、病理分级及肿瘤数量是影响NMIBC患者术后复发的独立危险因素(P=0.001,P=0.048,P=0.004,P<0.001)。结论术前SII是影响NMIBC患者预后的独立危险因素,可作为一项评估预后的临床指标。低SII的NMIBC患者RFS比高SII的NMIBC患者更高。

Objective To investigate the value of preoperative systemic immune inflammation index(SII)in evaluating the prognosis of patients with non-muscular invasive bladder cancer(NMIBC)undergoing transurethral resection of bladder tumor(TURBT).Methods The clinical data of 257patients who were diagnosed as NMIBC and met the inclusion and exclusion criteria in the Department of Urology,the First Affiliated Hospital of Zhengzhou University from March 2014 to January 2017 were retrospectively analyzed.The receiver operating curve(ROC)was draw and the best cut-off value of SII were determined,all the patients were divide into the low-level SII group(SII<340.57)and the high-level SII group(SII≥340.57),The patients and clinicopathological characteristics of two groups were analyzed,the Kaplan-Meier method was used for survival analysis,the recurrence-free survival time was compared,and the Cox proportional hazard regression model was used to evaluate the independent risk factors that affect the prognosis of NMIBC patients.Results Among the 257 patients,107(41.6%)in the low SII group and 150(58.4%)in the high SII group,SII was associated with pathological T stage,tumor number,and coronary heart disease(χ^(2)=5.546,P=0.019;χ^(2)=4.345,P=0.037;χ^(2)=3.867,P=0.039),and was not related to gender,age,smoking history,pathological grade,tumor size,hypertension,and diabetes(χ^(2)=0.978,P=0.323;χ^(2)=1.770,P=0.183;χ^(2)=0.033,P=0.856;χ^(2)=3.620,P=0.057;χ^(2)=1.015,P=0.314;χ^(2)=0.616,P=0.432;χ^(2)=0.030,P=0.862).Kaplan-Meier analysis showed that the recurrence-free survival rate of the low SII group was significantly higher than that of the high SII group(P<0.001).COX univariate analysis showed that SII,age,smoking history,pathological T stage,pathological grade,tumor number and tumor size were associated with postoperative recurrence(P=0.001,P=0.018,P=0.033,P<0.001,P<0.001,P<0.001,P=0.001),multivariate analysis showed that SII,smoking history,pathological grade and number of tumors were independent risk factors for postoperative recurrence in patients with NMIBC(P=0.001,P=0.048,P=0.004,P<0.001).Conclusion Preoperative SII is an independent risk factor for postoperative recurrence in NMIBC patients,and it can be used as a clinical indicator to evaluate the prognosis.NMIBC patients with low SII have higher RFS than NMIBC patients with high SII.