营养状况控制评分对机器人辅助根治性前列腺切除术后患者尿控情况的预测

Predictive value of CONUT score for urinary continence in patients with prostate cancerafter robot-assisted radical prostatectomy

目的探讨术前营养状况控制(CONUT)评分对行机器人辅助根治性前列腺切除术(RARP)的前列腺癌患者术后尿控恢复情况的预测价值。方法选取2019年1月至2020年1月期间在南京市鼓楼医院泌尿外科接受RARP的前列腺癌患者的临床资料进行回顾性分析。所有患者均自术后拔除导尿管第1日起每月对患者的尿控功能恢复情况进行持续3年的随访,以全天不需要或仅预防性使用1块尿垫作为尿控功能恢复的标准。通过卡方检验、单因素和多因素Cox回归分析,明确影响术后12个月尿控功能恢复的独立危险因素,并用Log-rank检验比较各组间术后尿控功能恢复曲线的统计学意义。结果单因素Cox回归分析结果显示,年龄(P=0.003)、CONUT评分(P<0.001)、手术方式(P=0.031)是患者尿控预后的相关因素;多因素Cox回归分析结果显示,CONUT评分是患者预后的独立危险因素(P<0.001);Kaplan-Meier法生存分析结果显示,CONUT评分≥4的患者拔除导尿管后12个月的尿控恢复率低于CONUT评分<4的患者(P<0.001)。结论CONUT评分对根治性切除前列腺癌患者的术后尿控恢复具有重要的预测价值,可作为患者发生术后尿失禁的潜在预测指标。

Objective To investigate the predictive value of the preoperative controlling nutritional status(CONUT)score for the recovery of postoperative urinary continence(UC)in patients with prostate cancer undergoinrobot-assisteded radical prostatectomy(RARP).Methods Clinical data of prostate cancer patients who underwent RARP at the Department of Urology,Nanjing Drum Tower Hospital between January 2019 and January 2020 were selected for this retrospective analysis.All patients were followed up monthly for 3 years for functional recovery of urinary continence since the 1st day of postoperative urinary catheter removal.No need or only prophylactic use of 1 pad per day was the definition for functional recovery of urinary continence.Chi-square test,univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting the recovery of urinary continence 12 months after surgery,and Log-rank test was used to compare the curves of postoperative recovery of urinary continence between groups for statistical significance.Results Univariate Cox regression analysis showed that age(P=0.003),CONUT score(P<0.001),and surgical approach(P=0.031)were significant predictors of urinary continence,and the results of multivariate Cox regression analysis showed that the CONUT score was an independent risk factor for postoperative urinary continence(P<0.001).Kaplan-Meier method survival analysis showed that patients with CONUT score≥4 had a lower recovery rate of urinary continence at 12 months than those with CONUT score<4(P<0.001).Conclusions The CONUT score has a significant predictive value for postoperative recovery of UC in patients undergoing RARP and can be applied as a potential predictor for the occurrence of postoperative urinary incontinence(UI).