肿瘤特异性生长因子联合血液学炎症指标在肌层浸润性膀胱癌患者预后中的预测价值

Prognostic value of tumor-specific growth factor combined with hematologic inflammatory markers in patients with muscle-invasive bladder cancer

目的分析肿瘤特异性生长因子(TSGF)联合血液学炎症指标在肌层浸润性膀胱癌患者预后中的预测价值.方法回顾性分析2015年1月至2019年1月在西安大兴医院行根治性膀胱切除术的168例肌层浸润性膀胱癌患者的临床资料,所有患者术前均检测血清TSGF及血液学炎症指标[中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)].术后随访36个月,获得随访患者156例,根据是否复发,将患者分为复发组和未复发组,比较两组患者临床病理特征以及术前TSGF、NLR、PLR水平的差异.采用多因素logistic回归分析术后复发的影响因素,使用受试者工作特征曲线(ROC)分析TSGF、NLR、PLR以及三者联合预测术后复发的效能.采用χ^(2)检验比较高TSGF组与低TSGF组、高NLR组与低NLR组、高PLR组与低PLR组患者的3年复发率和3年死亡率的差异.结果156例获得随访的患者中,复发74例,未复发82例.复发组病理T3~T4期患者的比例、淋巴结转移患者的比例以及术前TSGF、NLR、PLR的水平均明显高于未复发组(均P<0.05).多因素logistic回归分析结果显示,病理T3~T4期、淋巴结转移以及术前TSGF、NLR、PLR均是肌层浸润性膀胱癌患者术后复发的独立预测因素(均P<0.05).TSGF、NLR和PLR预测肌层浸润性膀胱癌患者术后复发的曲线下面积(AUC)分别为0.635(95%CI:0.578~0.892)、0.670(95%CI:0.619~0.924)和0.690(95%CI:0.649~0.931),TSGF、NLR和PLR联合预测的AUC为0.930(95%CI:0.505~0.984),明显优于单一指标(均P<0.05).高TSGF组患者术后3年复发率为63.5%,高于低TSGF组(36.6%,P<0.001);高NLR组患者术后3年复发率为64.4%,高于低NLR组(37.1%,P<0.001);高PLR组患者术后3年复发率为68.9%,高于低PLR组(33.7%,P<0.001).高TSGF组与低TSGF组、高NLR组与低NLR组、高PLR组与低PLR组患者术后3年死亡率比较,差异均无统计学意义(均P>0.05).结论术前TSGF、NLR、PLR水平升高的肌层浸润性膀胱癌患者术后更易复发,TSGF、NLR和PLR 3个指标联合预测术后复发的效能更好.

ObjectiveeTo analyze the prognostic value of tumor-specific growth factor(TSGF)combined with hematological inflammatory markers in patients with muscle-invasive bladder cancer.Methods The clinical data of 168 patients with muscle-invasive bladder cancer who underwent radical cystectomy at Xi'an Daxing Hospital from January 2015 to January 2019 were retrospectively analyzed,and all patients were tested for serum TSGF and hematological inflammatory markers,including neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),before surgery.After 36 months of postoperative follow-up,patients were categorized into recurrence and non-recurrence groups according to whether they had relapsed or not,and the differences of clinicopathological characteristics as well as preoperative TSGF,NLR and PLR levels between the two groups were compared.Multivariate logistic regression was used to analyze the influencing factors of postoperative recurrence,and the efficacy of TSGF,NLR,PLR and the combination of the three markers in predicting postoperative recurrence was analyzed using the receiver operating characteristic curve(ROC).The χ^(2) test was used to compare the differences of 3-year recurrence rate and 3-year mortality rate between patients in the high TSGF group and the low TSGF group,the high NLR group and the low NLR group,and the high PLR group and the low PLR group.Results The 156 patients who completed follow-up,74 were recurrent and 82 were nonrecurrent.The proportion of patients with pathologic T3 to T4 stage,the proportion of patients with lymphnode metastasis,and the levels of preoperative TSGF,NLR and PLR in the recurrence group were significantly higher than those in the non-recurrence group(all P<0.05).The results of multivariate logistic regression analysis showed that pathologic T3 to T4 stage,lymphnode metastasis,and the levels of preoperative TSGF,NLR and PLR were independent predictors of postoperative recurrence in patients with muscle-invasive bladder cancer(all P<0.05).The area under the curve(AUC)of TSGF,NLR and PLR in predicting postoperative recurrence for patients with muscle-invasive bladder cancer is 0.635(95%CI:0.578-0.892)、0.670(95%CI:0.619-0.924)和0.690(95%CI:0.649-0.931),respectively,and the AUC of the combination of TSGF,NLR and PLR is 0.930(95%CI:0.505-0.984),which was significantly better than the single index(all P<0.05).The 3-year postoperative recurrence rate of patients in the high TSGF group was 63.5%,which was higher than that of the low TSGF group(36.6%,P<0.001);the 3-year postoperative recurrence rate of patients in the high NLR group was 64.4%,which was higher than that of the low NLR group(37.1%,P<0.001);the 3-year postoperative recurrence rate of patients in the high PLR group was 68.9%,which was higher than that of the low PLR group(33.7%,P<0.001).The difference of 3-year postoperative mortality rate between patients in the high TSGF group and the low TSGF group,the high NLR group and the low NLR group and the high PLR group and the low PLR group was not statistically significant(all P>0.05).Conclusions In muscle-invasive bladder cancer,patients with higher levels of preoperative TSGF,NLR and PLR were more likely to recur after surgery,and the efficacy of the combination of the three markers in predicting postoperative recurrence was better than the single marker.