回肠通道术术前营养控制状态评分对判断膀胱癌患者预后的价值

Prognostic significance of the controlling nutritional status(CONUT)score in patients with bladder cancer treated with radical cystectomy and ileal conduit

目的探讨术前营养控制状态(controlling nutritional status,CONUT)评分与根治性膀胱切除加回肠通道术患者预后的相关性。方法选取2014年3月至2020年6月于首都医科大学附属北京朝阳医院因膀胱癌行膀胱根治性切除加回肠通道术的患者79例,根据纳入患者的中位CONUT评分(2分)将患者分为低CONUT组(≤2分)48例和高CONUT组(>2分)31例。收集临床资料并进行随访,进行回顾性分析。测定患者术前7 d内血清白蛋白浓度、外周血淋巴细胞总数和总胆固醇浓度并计算CONUT评分。收集患者术前合并症、手术时间、术后病理等资料。使用Kaplan-Meier法绘制生存曲线,Cox回归分析CONUT评分与患者术后总生存期(overall survival,OS)和无复发生存期(recurrence-free survival,RFS)的关系。结果不同CONUT评分的两组患者的年龄、性别、体质量指数(body mass index,BMI)、术前合并症、手术时间、出血量等差异均无统计学意义(P>0.05),高CONUT组的术后并发症发生率(P=0.009)、肿瘤T分期(P=0.048)和手术切缘阳性率(P=0.021)显著高于低CONUT组。在中位24个月的随访中,79例患者中分别有27例患者死亡和33例患者出现肿瘤复发或转移。Kaplan-Meier生存曲线显示高CONUT组患者的OS和RFS中位时间均显著短于低CONUT组(OS:24周vs>96周,P=0.0015;RFS:16周vs>96周,P=0.0046)。进一步通过多因素Cox回归分析发现,CONUT>2分是根治性膀胱切除术加回肠通道术后OS(HR=2.283,95%CI:1.038~5.018,P=0.040)和RFS(HR=2.264,95%CI:1.058~1.219,P=0.035)的独立危险因素。结论CONUT评分是根治性膀胱切除加回肠通道术患者临床结局的独立预测因素。高CONUT评分预示着更差的临床结局,应予此类患者更加密切的随访、评估和相应治疗。

Objective To explore the predictive value of controlling nutritional status(CONUT)score on oncological outcomes of bladder cancer(BC)patients receiving radical cystectomy(RC)with ileal conduit(IC).Methods Retrospective analysis was performed on 79 BC patients treated with RC and IC in the Department of Urology,Beijing Chaoyang Hospital,Capital Medical University from March 2014 to June 2020.The CONUT score was calculated based on serum albumin level,total lymphocyte count and total cholesterol level.Kaplan-Meier method and Cox regression analyses were performed to plot cumulative possibility of overall survival(OS)and recurrence-free survival(RFS)and to investigate predictive potential of the CONUT score.Results During a median follow-up of 24-months,27 and 33 patients experienced neoplastic recurrence and metastasis,respectively.All eligible 79 participants were divided into high CONUT group(n=31)and low CONUT group(n=48)according to the median CONUT score of 2.No significant differences were detected between the two groups regarding demographic characteristics,underlying diseases,surgical and oncological data,except T staging(P=0.048)and positive margins(P=0.021).Patient in high CONUT group had significantly worse OS and RFS than those in low CONUT group(OS:24 week vs>96 week,P=0.0015;RFS:16 week vs>96 week,P=0.0046).Multivariate Cox regression analyses indicated that the CONUT score was an independent predictor of OS and RFS(OS:HR=2.283,95%CI:1.038-5.018,P=0.040;RFS:HR=2.264,95%CI:1.058-1.219,P=0.035).Conclusion The CONUT score is independently associated with oncological outcomes among BC patients treated with RC+IC.A close follow-up with continual vigilance and reassessment for patients with high CONUT score.