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术前血清白蛋白水平与非肌层浸润性膀胱癌长期预后的关系
作者:陶卫琦  孙毅海  丁可 
单位:广西医科大学第三附属医院 泌尿外科, 广西 南宁 530031
关键词:白蛋白 非肌层浸润性膀胱癌 经尿道膀胱肿瘤电切术 Karnofsky评分 病理学T分期 
分类号:R737.33
出版年·卷·期(页码):2019·47·第六期(657-662)
摘要:

目的:探讨术前血清白蛋白(ALB)水平对非肌层浸润性膀胱癌(NMIBC)的预后意义。方法:选取我院2007年1月至2012年12月收治的210例NMIBC患者,入选患者根据术前血清ALB水平分为正常血清ALB组125例(ALB水平≥40 g·L-1)与低血清ALB组85例(ALB水平<40 g·L-1)。所有患者均接受尿道膀胱肿瘤电切术(TURBT)。收集患者的一般资料、病理学指标以及实验室相关指标,通过Cockcroft-Gault公式得到肌酐清除率,并据此进行慢性肾脏病(CKD)分期,患者术后常规行膀胱灌注化疗,比较两组的一般资料,术后随访5年,观察生存情况,进行生存率的单因素及多因素Logistic回归分析。结果:低血清ALB组患者年龄明显高于正常血清ALB组(P<0.05),两组血红蛋白浓度、CKD分期差异有统计学意义(P<0.05),两组间吸烟状况、性别、ASA评分、Karnofsky评分、肿瘤分级、病理学T分期、血小板计数比较差异无统计学意义(P>0.05)。患者均进行5年的随访,共有185例生存,生存率为88.1%,25例患者死亡,死亡率为11.9%,其中正常血清ALB组为5例(4.0%),低血清ALB组为20例(23.5%)。术前年龄、Karnofsky评分、ASA评分和病理学T分期、肿瘤数量、肿瘤分级、血清ALB及血红蛋白浓度、CKD分期与生存率均显著相关(P<0.05);将有差异的因素进行Logistic回归分析,结果显示,术前血清ALB水平、年龄、Karnofsky评分和病理T分期为5年生存率的独立预后因素,差异具有统计学意义(P<0.05)。结论:行TURBT的NMIBC的预后与术前血清ALB水平、病理学T分期、年龄和Karnofsky评分密切相关,术前血清ALB水平可用于患者术后的生存预后评估,具有简单有效且廉价易得的优势。术前血清ALB水平较低者应积极予以治疗,从而改善生存预后。

Objective:To investigate the expression and prognostic significance of serum albumin level in patients with non muscle invasive bladder cancer(NMIBC) after transurethral resection of bladder tumor(TURBT). Methods:210 patients with NMIBC received in our hospital were selected from January 2007 to December 2012.The patients were divided into the normal serum albumin group(≥ 40 g·L-1,125 cases) and low serum albumin group(<40 g·L-1,85 cases) according to the serum albumin level before operation.The general data,pathological indexes and laboratory related indexes were collected,the creatinine clearance rate was obtained by Cockcroft-Gault formula,and the chronic kidney disease(CKD) staging was carried out according to this,the routine bladder perfusion chemotherapy was performed in the patients after the operation.The general data of the two groups were compared.After 5 years of follow-up,the survival rate was observed.Univariate and multivariate Logistic analysis of survival rate was performed. Results:The age of patients in low serum albumin group was significantly higher than that in the normal group(P<0.05).There were significant differences in hemoglobin concentration and CKD staging between the two groups(P<0.05).There was no significant difference in smoking status,sex,ASA score,Karnofsky score,tumor grading,pathological T stage and platelet count between the two groups(P>0.05).The patients were followed up for 5 years.In the follow-up,185 cases survived,the survival rate was 88.1%,25 patients died and the mortality rate was 11.9%,of which 5 cases(4%) were in the normal group and 20 cases in the low serum albumin group(23.5%).The preoperative age,Karnofsky score,ASA score,pathological T staging,tumor number,tumor classification,serum albumin and hemoglobin concentration,CKD staging were significantly correlated with survival rate(P<0.05). Logistic regressionanalysis showed that the preoperative serum albumin level,age,Karnofsky score,and pathological T staging were independent prognostic factors of 5 years survival rate,and the difference was statistically significant(P<0.05). Conclusion:The prognosis of NMIBC undergoing TURBTis closely related to preoperative serum albumin level,pathological T staging,age and Karnofsky score.Preoperative serum albumin can be used to evaluate the survival prognosis of patients after operation,which is simple,effective, cheap and easy to obtain.Patients with lower serum albumin level should be treated actively so as to improve survival prognosis.

参考文献:

[1] 梁怀远,齐锦宏,张丽珍.非肌层浸润性膀胱癌不同术式临床疗效探讨[J].临床医学,2017,37(3):95-96.
[2] 汪金荣,戴英波,谭靖,等.膀胱全切原位W形回肠新膀胱术治疗膀胱癌并发症分析[J].中国现代医学杂志,2014,24(23):110-112.
[3] 王兴盛,田振伟,储洪博,等.非小细胞肺癌患者化疗前后的C反应蛋白和血清白蛋白水平变化[J].中国现代医学杂志,2013,23(24):46-49.
[4] 陈伟.经尿道钬激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术治疗表浅层膀胱癌的疗效和安全性:对比研究[J].中国全科医学,2014,17(2):223-225.
[5] 黄韬,王淼,王勇军,等.第二次经尿道膀胱肿瘤电切术预防高危非肌层浸润性膀胱癌术后肿瘤复发的临床研究[J].临床外科杂志,2013,21(2):98-100.
[6] 王沐廷,郑滢丽,林晓旋,等.非小细胞肺癌胸腔镜手术围术期血清白蛋白和乳酸水平的变化及意义[J].广东医学,2016,37(8):1157-1160.
[7] 孙燕翔,黄建平,杨乐,等.诊断甲状腺肿瘤过程中实施血清细胞白蛋白19片段(CYFRA21-1)、肿瘤特异性生长因子(TSGF)检测的临床意义分析[J/OL].临床检验杂志(电子版),2017,6(4):680.
[8] 裴建强,杜宏纲.经尿道膀胱肿瘤电切术联合吡柔比星膀胱灌注治疗浅表性膀胱癌临床观察[J].山东医药,2013,53(39):41-42.
[9] 孙建涛,杨金辉,魏澎涛,等.二次根治性经尿道膀胱肿瘤电切术加介入栓塞化疗治疗肌层浸润膀胱癌的研究[J].中国现代医学杂志,2015,25(29):106-108.
[10] CANETTA E,MAZILU M,de LUCA A C,et al.Modulated Raman spectroscopy for enhanced identification of bladder tumor cells in urine samples[J].J Biomed Opt,2011,16(3):037002.
[11] 雷普,卜小斌,高飞,等.经尿道钬激光膀胱肿瘤切除术和膀胱肿瘤电切术治疗表浅层膀胱癌的疗效比较[J].现代泌尿外科杂志,2014,19(2):108-110.
[12] DUAN C,YUAN K,LIU F,et al.an adaptive window-setting scheme for segmentation of bladder tumor surface via MR cystography[J].IEEE Trans Inf Technol Biomed,2012,16(4):720-729.
[13] 范晋海,曹建伟.非肌层浸润性膀胱癌合并良性前列腺增生患者可同期行经尿道膀胱肿瘤电切术+经尿道前列腺电切术[J].现代泌尿外科杂志,2014,19(8):547-549.
[14] 李慧,姜行康,马宝杰,等.淋巴血管侵犯在电切术后高级别T1期膀胱癌中的临床病理意义[J].中华泌尿外科杂志,2015,36(2):126-130.
[15] 沈小敏,蒋雄杰,朱尉娇,等.轴向嘧啶衍生物修饰硅酞菁的光谱性质、光动力抗癌活性及与白蛋白相互作用的研究[J].光谱学与光谱分析,2013,33(8):2148-2152.
[16] KU J H,KIM M,CHOI W S,et al.Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma[J].Int Braz J Urol,2014,40(6):753-762.
[17] 赵一品,汤建民,季莹莹,等.急性ST段抬高型心肌梗死患者入院血清白蛋白水平与梗死相关动脉自发再通的关系[J].郑州大学学报(医学版),2019,63(1):68-72.
[18] 陈冠帅,梁红生,钟玉杭,等.妊娠末期红细胞压积及血浆白蛋白对重度子痫前期产后血压的影响[J].实用医院临床杂志,2018,15(6):198-201.
[19] 张长城.血清白蛋白、CEA水平与EGFR-TKI治疗EGFR基因敏感突变的晚期非小细胞肺癌预后的分析[D].太原:山西医科大学,2018.
[20] 李敏杰,孙旭东,申岳峰.鼻咽癌患者放疗前营养和心理因素与放疗敏感性的关系[J].临床肿瘤学杂志,2018,24(12):1118-1122.
[21] 屈家满,刘敏.肠内营养支持对老年肿瘤化疗患者免疫及营养指标的影响[J].现代肿瘤医学,2019,27(1):117-119.
[22] FUJⅡ T,YAJIMA R,TAKADA T,et al.Serum albumin and prealbumin do not predict recurrence in patients with breast cancer[J].Anticancer Res,2014,34(7):3775-3779.

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