膀胱根治性切除术后生存获益影响因素及与术前AAPR相关性研究

Influencing factors of survival benefit of patients after radical cystectomy and its correlation with preoperative AAPR

目的探讨膀胱根治性切除术后患者生存获益影响因素及与术前白蛋白与碱性磷酸酶比值(AAPR)的相关性。方法回顾性分析2011年1月—2020年1月邯郸市第一医院收治的166例膀胱根治性切除术后患者的病例资料,分析膀胱根治性切除术后患者生存获益的影响因素;评价术前AAPR与患者总生存时间的相关性。生存分析采用Kaplan-Meier法,组间比较采用的Log-rank检验;采用Cox风险比例回归模型分析生存预后影响因素及与术前AAPR的相关性;采用趋势性χ^(2)检验评价术前AAPR水平。结果单因素Cox回归分析结果显示,年龄、肿瘤最大径、pT分期、pN分期、病理组织学分级、肾积水、术后是否接受辅助化疗及术前AAPR水平与膀胱根治性切除术后患者总生存时间有关(P<0.05);多因素Cox回归分析结果显示,校准模型Ⅰ和Ⅱ中术前高AAPR水平组死亡风险分别为低AAPR水平组的0.351倍和0.433倍(P<0.05);术前AAPR每升高1个单位,死亡风险分别下降到85.9%、84.6%(P<0.05);术前高AARP水平患者总生存时间显著长于低、中AARP水平患者(P<0.05)。结论膀胱根治性切除术后患者生存获益与术前AAPR水平独立相关,患者术前AAPR水平越高则总生存时间越长。

Objective To investigate the influencing factors of survival benefit of patients after radical cystectomy and its correlation with preoperative albumin-to-alkaline phosphatase ratio(AAPR).Methods The clinical data of 116 patients after radical cystectomy were retrospectively analyzed from January 2011 to January 2020 in Handan First Hospital.The influencing factors of survival benefit of patients after radical cystectomy were analyzed and the correlation between preoperative AAPR and overall survival time were evaluated.Kaplan-Meier method was used for survival analysis,and Log-rank test was used for comparison between groups.Cox proportional regression model was used to analyze the influencing factors of survival and prognosis and the correlation with preoperative AAPR.Trend Chi-square test was used to evaluate the level of preoperative AAPR.Results Univariate Cox regression analysis showed that age,tumor diameter,pT stage,pN stage,histopathological grade,hydronephrosis,postoperative adjuvant chemotherapy and preoperative AAPR level were related to the overall survival time of patients after radical cystectomy(P<0.05).Multivariate Cox regression analysis showed that in calibration modelⅠandⅡ,the risk of death in high AAPR group was 0.351 and 0.433 times higher than low AAPR group(P<0.05).The risk of death decreased to 85.9% and 84.6% for every one unit increase of preoperative AAPR.The overall survival time of patients with high AARP level were significantly longer than patients with low and medium AARP level(P<0.05).Conclusion The survival benefit of patients after radical cystectomy was independently related to the preoperative AAPR level;the higher the preoperative AAPR level,the longer the overall survival time.