术前炎性指标对高危非肌层浸润性膀胱癌电切除术后复发的预测价值

Prognostic value of preoperative inflammatory markers for recurrence after transurethral resection of high-risk non-muscle-invasive bladder cancer

目的研究术前炎性指标对高危非肌层浸润性膀胱癌(NMIBC)患者行经尿道膀胱肿瘤电切术(TURBT)后肿瘤复发的预测能力,并构建肿瘤复发预测模型。方法回顾性分析2023年1月至2023年12月期间于苏州大学附属第一医院手术治疗的高危NMIBC患者数据,共111例患者纳入研究,其中男94例,女17例,年龄72(68,78)岁。随访至2024年4月,根据有无膀胱肿瘤复发将入组患者分为复发组及未复发组,比较两组间临床病理特征的差异,进而通过COX多因素分析寻找肿瘤复发的独立危险因素,绘制诺莫图构建肿瘤复发的预测模型,并利用calibration校准曲线评估模型拟合度。结果所有患者共随访10(7,13)个月,其中20例复发患者为复发组,总复发率18.02%,91例未复发患者为未复发组。复发组与未复发组间在肿瘤分期、肿瘤多发性、中性粒淋巴细胞比值(NLR)、血小板淋巴细胞比值(PLR)、淋巴单核细胞比值(LMR)、系统免疫炎症指数(SII)、白蛋白碱性磷酸酶比值(AAPR)、白蛋白纤维蛋白原比值(AFR)方面,差异有统计学意义(P<0.05)。将两组间有差异的影响因素进行COX单因素及多因素分析,发现肿瘤分期(OR=5.577,95%CI1.214~25.618,P=0.027)、NLR(OR=3.219,95%CI 1.100~9.421,P=0.033)、PLR(OR=1.017,95%CI 1.004~1.030,P=0.011)是高危NMIBC患者TURBT术后肿瘤复发的独立危险因素。基于COX多因素分析结果绘制预测肿瘤复发诺莫图及calibration校准曲线,模型拟合度较好(χ2=1.314,P=0.726)。结论肿瘤分期、NLR、PLR与高危NMIBC患者行TURBT术后肿瘤复发相关,且由此构建的预测模型有较强的预测能力。

Objective To investigate the predictive value of preoperative inflammatory markers for tumor recurrence of highrisk non-muscle-invasive bladder cancer(NMIBC)following transurethral resection of bladder tumor(TURBT),and to develop a prediction model for tumor recurrence.Methods A retrospective analysis was conducted on data from high-risk NMIBC patients,who underwent surgical treatment at the First Affiliated Hospital of Soochow University between January 2023 and December 2023.A total of 111 patients were included in the study,comprising 94 males and 17 females,with a median age of 72(interquartile range:68-78)years.Patients were followed-up until April 2024.According to whether there was bladder tumor recurrence,the patients were divided into recurrence and non-recurrence groups.Clinical and pathological characteristics between the two groups were compared,and independent risk factors for tumor recurrence were determined through COX multifactorial analysis.A nomogram for predicting tumor recurrence was constructed and the model fit was evaluated using calibration curve.Results The median follow-up period for all patients was 10 months(interquartile range:7-13 months).Among them,20 patients experienced recurrence(recurrence group)with an overall recurrence rate of 18.02%,while the remaining 91 patients did not experience recurrence(non-recurrence group).There were statistically significant differences between the recurrence group and the non-recurrence group in tumor stage,tumor multiplicity,neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),lymphocyte-monocyte ratio(LMR),systemic immune inflammation index(SII),albumin-alkaline phosphatase ratio(AAPR),and albumin-fibrinogen ratio(AFR)(P<0.05).COX univariate and multivariate analyses revealed that tumor stage(OR=5.577,95%CI 1.214-25.618,P=0.027),NLR(OR=3.219,95%CI 1.100-9.421,P=0.033),and PLR(OR=1.017,95%CI 1.004-1.030,P=0.011)were independent risk factors for tumor recurrence after TURBT in high-risk NMIBC patients.A nomogram was created based on the results of COX multifactorial analysis to predict tumor recurrence,and the calibration curve demonstrate good model fit(χ~2=1.314,P=0.726).Conclusion Tumor stage,NLR and PLR are associated with tumor recurrence after TURBT in high-risk NMIBC patients,and the constructed prediction model has strong predictive capability.