使用术前脂质代谢指标预测非肌层浸润性膀胱癌患者术后预后的效用

Effects of preoperative lipid metabolism indexes on the prognosis of patients with non-muscular invasive bladder cancer

目的探讨术前脂质代谢水平对非肌层浸润性膀胱癌(NMIBC)患者术后预后的影响。方法回顾性分析2014年3月—2021年5月于西安交通大学第二附属医院行手术治疗的NMIBC患者的临床资料。根据受试者工作特征曲线(ROC)确定所有脂质代谢指标的最佳截断值并据此对患者进行分组。使用Cox回归模型确定NMIBC患者术后复发的独立危险因素。采用Kaplan-Meier法进行生存分析,并用log-rank检验比较组内无复发生存时间(RFS)。联合高密度脂蛋白(HDL)和其他临床病理特征建立患者术后复发风险预测模型,并进行验证。结果多因素Cox回归分析的结果表明,HDL、肿瘤数量、肿瘤大小和组织分级是患者术后肿瘤复发的独立危险因素(P<0.05)。Kaplan-Meier分析显示高HDL组的RFS明显高于低HDL组(P<0.001)。将HDL和肿瘤数量、肿瘤大小、组织分级以及肿瘤分期纳入复发风险模型,计算其AUC为0.706,内部交叉验证显示其AUC为0.711。结论术前HDL是NMIBC患者术后复发的独立危险因素,将其与肿瘤学预后指标结合为更准确地预测肿瘤复发提供参考。

Objective To investigate the effects of preoperative lipid metabolism level on the postoperative prognosis of non-muscular invasive bladder cancer(NMIBC).Methods Clinical data of NMIBC patients who underwent surgical treatment in our hospital during Mar.2014 and May 2021 were retrospectively analyzed.Based on receiver operating characteristic(ROC)curve,the optimal cutoff values of all lipid metabolism indicators were determined and patients were classified accordingly.The independent risk factors for postoperative recurrence were identified with Cox regression model.The survival was analyzed with Kaplan-Meier,and recurrence-free survival(RFS)was compared using log-rank tests.A recurrence risk prediction model was established based on the high-density lipoprotein(HDL)and other clinic pathological factors and the accuracy of prediction was evaluated with the area under the ROC curve(AUC).Results Cox multivariate analysis showed HDL,tumor number,tumor size and histological grade were independent risk factors for recurrence(P<0.05).Kaplan-Meier analysis showed that RFS was significantly longer in the high-HDL group than in the low-HDL group(P<0.001).Incorporating HDL,tumor number,tumor size,histological grade,and tumor stage into the recurrence risk model,the AUC was 0.706,and internal cross validation showed the AUC was 0.711.Conclusion Preoperative HDL is an independent risk factor affecting the RFS of patients with NMIBC,and combining it with clinic pathological factors will improve the prediction of tumor recurrence.