术前炎症及营养指标与根治性膀胱切除术后患者预后的相关性分析

达尼亚尔·努尔德别克; 苏比努尔·依孜哈尔; 阿卜杜热合曼·则比布拉; 乔炳璋; 木拉提·热夏提

doi:10.16766/j.cnki.issn.1674-4152.003621

术前炎症及营养指标与根治性膀胱切除术后患者预后的相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.003621

新疆医科大学第一附属医院泌尿外科，新疆乌鲁木齐 830054

基金项目:

国家自然科学基金项目 82260139

新疆维吾尔自治区自然科学基金青年科学基金项目 2022D01C763

详细信息

通讯作者:
木拉提·热夏提，E-mail：muratrixat@126.com

中图分类号: R737.14 R730.56
计量
- 文章访问数: 1
- HTML全文浏览量: 2
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-03-24
- 网络出版日期: 2024-11-19

Correlation analysis of inflammation and nutritional indicators with prognosis in patients after radical cystectomy

Department of Urology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China

摘要

摘要: 目的探究术前全身免疫炎症指数(SII)、预后营养指数(PNI)及血小板淋巴细胞比值(PLR)与根治性膀胱切除术患者预后的关系。方法回顾性分析2012年1月—2022年12月新疆医科大学第一附属医院收治的179例接受根治性膀胱切除术的膀胱癌患者临床及病理资料。根据ROC曲线确定治疗前SII、PNI和PLR最佳临界值，分为高水平组和低水平组，采用Kaplan-Meier法分析患者3、5年生存率，单因素及多因素Cox回归分析研究膀胱癌预后的危险因素。结果以患者总生存期(OS)为判定，治疗前SII、PNI和PLR的ROC曲线下面积分别为0.823、0.739、0.813。单因素分析显示，年龄、基础疾病、吸烟史、T分期、N分期、淋巴脉管是否受侵、肿瘤数目、是否肾积水、PLR、SII、PNI均与患者OS相关(P＜0.05)。年龄、基础疾病、淋巴脉管受侵、肾积水及PLR、SII、PNI均与膀胱癌患者预后相关(P＜0.05)。结论治疗前SII、PNI和PLR是根治性膀胱切除术后患者预后的独立预测因子，低SII、高PNI、低PLR提示其预后更好。
- 膀胱癌 /
- 预后 /
- 全身免疫炎症指数 /
- 预后营养指数 /
- 血小板淋巴细胞比值
Abstract: Objective To investigate the relationship between preoperative systematic immune-inflammation index (SII), prognostic nutritional index (PNI), and platelet to lymphocyte ratio (PLR) and the prognosis of patients undergoing radical cystoprostatectomy. Methods Clinical and pathological data of 179 bladder cancer patients who underwent radical cystectomy from January 2012 to December 2022 in the First Affiliated Hospital of Xinjiang Medical University and met the inclusion criteria were retrospectively analyzed. The optimal critical values of SII, PLR, and PNI before treatment were determined according to the ROC curve, the patients were divided into the high-level group and the low-level group. The Kaplan-Meier method was used to analyze the 3- and 5-year survival rates of the two groups, and univariate and multivariate Cox regressions were performed to analyze the prognostic risk factors of bladder cancer. Results The area under the ROC curve of SII, PNI, and PLR before treatment were 0.823, 0.739, and 0.813, respectively, as determined by the patient ' s overall survival. The results of the univariate analysis suggested that age, underlying disease, smoking history, T-stage, N-stage, whether the lymphatic vasculature was invaded, the number of tumours, whether the patients suffer from hydronephrosis, PLR, SII, and PNI were related to the OS of the patients (P < 0.05). Age, underlying disease, lymphovascular invasion, hydronephrosis, PLR, SII, and PNI were associated with the prognosis of patients with bladder cancer (P < 0.05). Conclusion Pre-treatment SII, PNI, and PLR are independent predictors of prognosis in patients with intermediate and advanced oesophageal cancer, and low SII, high PNI, and low PLR suggest a better prognosis.
- Bladder cancer /
- Prognosis /
- Systematic immune-inflammation index /
- Prognostic nutritional index /
- Platelet to lymphocyte ratio

HTML全文

图 1 治疗前SII、PNI、PLR预测预后的ROC曲线

Figure 1. ROC curves of SII, PNI, and PLR in predicting prognosis before treatment

下载: 全尺寸图片幻灯片

图 2 治疗前高、低水平SII组总体生存期的K-M曲线

Figure 2. K-M curves of overall survival in high and low levels of SII before treatment

下载: 全尺寸图片幻灯片

图 3 治疗前高、低水平PNI组总体生存期的K-M曲线

Figure 3. K-M curves of overall survival in high and low levels of PNI before treatment

下载: 全尺寸图片幻灯片

图 4 治疗前高、低水平PLR组总体生存期的K-M曲线

Figure 4. K-M curves of overall survival in high and low levels of PLR before treatmentt

下载: 全尺寸图片幻灯片

图 5 接受RCP患者列线图预测模型

Figure 5. Nomogram prediction models for RCP patients receicing RCP

下载: 全尺寸图片幻灯片

表 1 治疗前SII、PNI、PLR预测预后的AUC、灵敏度及特异度

Table 1. AUC, sensitivity and specificity of SII, PNI, and PLR in predicting prognosis before treatment

项目	AUC	截断值	灵敏度	特异度	P值	渐近95% CI
PLR	0.813	175.84	0.71	0.88	< 0.001	0.747~0.880
SII	0.823	955.26	0.69	0.92	< 0.001	0.759~0.887
PNI	0.739	49.66	0.90	0.48	< 0.001	0.667~0.812

下载: 导出CSV

表 2 治疗前SII和PNI与RCP术后患者临床病理参数的关系[例(%)]

Table 2. The relationship between SII and PNI before treatment and clinicopathological parameters in patients with RCP after treatment [case(%)]

项目	SII		χ²值	P值	PNI		χ²值	P值
项目	≤955.26(n=117)	>955.26(n=62)	χ²值	P值	≤49.66(n=123)	>49.66(n=56)	χ²值	P值
年龄			2.901	0.089			1.978	0.160
＜62岁	59(50.43)	23(37.10)			52(42.28)	30(53.57)
≥62岁	58(49.57)	39(62.90)			71(57.72)	26(46.43)
民族			0.514	0.474			0.836	0.360
汉族	78(66.67)	38(61.29)			77(62.60)	39(69.64)
其他民族	39(33.33)	24(38.71)			46(37.40)	17(30.36)
基础病			13.520	< 0.001			5.129	0.024
无	87(74.36)	29(46.77)			73(59.35)	43(76.79)
有	30(25.64)	33(53.23)			50(40.65)	13(23.21)
吸烟			2.965	0.085			1.251	0.263
否	63(53.85)	25(40.32)			57(46.34)	31(55.36)
是	54(46.15)	37(59.68)			66(53.66)	25(44.64)
T分期			15.455	< 0.001			5.138	0.023
T2	92(78.63)	31(50.00)			78(63.41)	45(80.36)
T3/T4	25(21.37)	31(50.00)			45(36.59)	11(19.64)
N分期			0.366	0.545			0.058	0.810
N0	100(85.47)	55(88.71)			106(86.18)	49(87.50)
N1/N2	17(14.53)	7(11.29)			17(13.82)	7(12.50)
淋巴脉管受侵			2.980	0.084			1.347	0.246
否	88(75.21)	39(62.90)			84(68.29)	43(76.79)
是	29(24.79)	23(37.10)			39(31.71)	13(23.21)
肿瘤数目			4.989	0.026			6.035	0.014
多	50(42.74)	16(25.81)			38(30.89)	28(50.00)
单	67(57.26)	46(74.19)			85(69.11)	28(50.00)
是否及膀胱三角			1.905	0.167			0.174	0.677
否	56(47.86)	23(37.10)			53(43.09)	26(46.43)
是	61(52.14)	39(62.90)			70(56.91)	30(53.57)
带蒂			0.647	0.419			0.012	0.912
否	114(97.44)	59(95.16)			119(96.75)	54(96.43)
是	3(2.56)	3(4.84)			4(3.25)	2(3.57)
广基			2.342	0.126			0.132	0.716
否	41(35.04)	29(46.77)			47(38.21)	23(41.07)
是	76(64.96)	33(53.23)			76(61.79)	33(58.93)
肾积水			2.840	0.092			0.595	0.441
否	86(73.50)	38(61.29)			83(67.48)	41(73.21)
是	31(26.50)	24(38.71)			40(32.52)	15(26.79)
肾功异常			2.138	0.144			0.021	0.885
否	91(77.78)	42(67.74)			91(73.98)	42(75.00)
是	26(22.22)	20(32.26)			32(26.02)	14(25.00)
PLR			31.885	< 0.001			14.021	< 0.001
低水平	90(76.92)	21(33.87)			65(52.85)	46(82.14)
高水平	27(23.08)	41(66.13)			58(47.15)	10(17.86)
PNI			12.407	< 0.001
低水平	70(59.83)	53(85.48)
高水平	47(40.17)	9(14.52)

下载: 导出CSV

表 3 膀胱癌并接受RCP治疗患者的Cox单因素及多因素分析

Table 3. Cox univariate and multivariate analysis of patients with bladder cancer receiving RCP

项目	单因素		多因素
项目	HR(95% CI)	P值	HR(95% CI)	P值
年龄	2.571(1.583~4.174)	< 0.001	1.731(1.024~2.929)	0.041
民族	0.978(0.617~1.551)	0.925
基础病	2.591(1.642~4.090)	< 0.001	1.673(1.012~2.764)	0.045
吸烟	2.635(1.624~4.274)	< 0.001	1.517(0.858~2.680)	0.151
T分期	3.758(2.386~5.920)	< 0.001	1.216(0.695~2.126)	0.494
N分期	1.235(0.652~2.339)	0.518
淋巴脉管受侵	3.517(2.200~5.623)	< 0.001	2.183(1.246~3.826)	0.006
肿瘤数目	1.803(1.083~3.002)	0.023	0.815(0.458~1.452)	0.488
是否及膀胱三角	1.452(0.910~2.317)	0.118
带蒂	0.631(0.155~2.572)	0.520
广基	0.709(0.453~1.109)	0.131
肾积水	2.290(1.447~3.623)	< 0.001	1.969(1.197~3.238)	0.008
肾功能异常	1.522(0.944~2.453)	0.085
PLR	5.487(3.346~8.999)	< 0.001	1.906(1.050~3.459)	0.034
SII	6.157(3.793~9.995)	< 0.001	2.665(1.519~4.675)	0.001
PNI	0.202(0.097~0.419)	< 0.001	0.369(0.169~0.808)	0.013
注：各变量赋值方法如下，年龄＜62岁=0，≥62岁=1；基础病，有=1，无=0；吸烟史，有=1，无=0；T分期，T2=0，T3~4=1；淋巴脉管受侵，是=1，否=0；肿瘤数目，单=0，多=1；肾积水，有=1，无=0。

下载: 导出CSV

参考文献(22)

[1]	BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. doi: 10.3322/caac.21492
[2]	XIA C F, DONG X S, LI H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants[J]. Chin Med J (Engl), 2022, 135(5): 584-590. doi: 10.1097/CM9.0000000000002108
[3]	SZABADOS B, KOCKX M, ASSAF Z J, et al. Final results of neoadjuvant atezolizumab in cisplatin-ineligible patients with muscle-invasive urothelial cancer of the bladder[J]. Eur Urol, 2022, 82(2): 212-222. doi: 10.1016/j.eururo.2022.04.013
[4]	HE K, SI L X, PAN X H, et al. Preoperative systemic immune-inflammation index (SII) as a superior predictor of long-term survival outcome in patients with stage Ⅰ-Ⅱ gastric cancer after radical surgery[J]. Front Oncol, 2022, 12: 829689. DOI: 10.3389/fonc.2022.829689.
[5]	LI J Z, CAO D H, HUANG Y, et al. The prognostic and clinicopathological significance of systemic immune-inflammation index in bladder cancer[J]. Front Immunol, 2022, 13: 865643. DOI: 10.3389/fimmu.2022.865643.
[6]	周阳阳, 刘静, 朱叶青, 等. 全身免疫炎症指数对HER2阴性晚期胃癌患者一线化疗疗效及生存结局的预测价值[J]. 中华全科医学, 2023, 21(12): 2031-2035. doi: 10.16766/j.cnki.issn.1674-4152.003283 ZHOU Y Y, LIU J, ZHU Y Q, et al. Predictive value of systemic immunoinflammatory index for first-line chemotherapy efficacy and survival outcome in patients with HER2-negative advanced gastric cancer[J]. Chinese Journal of General Practice, 2023, 21(12): 2031-2035. doi: 10.16766/j.cnki.issn.1674-4152.003283
[7]	苏比努尔·依孜哈尔, 达尼亚尔·努尔德别克, 玛依努尔·艾力. 炎症及营养指标与食管癌患者预后相关性分析[J]. 中国临床医生杂志, 2024, 52(1): 39-43. SUBINUER Y, DANIYAER N, MAYINUER A. Analysis of the correlation between inflammation and nutrition indexes and prognosis of patients with esophageal cancer[J]. Chinese Journal of Clinicians, 2019, 52(1): 39-43.
[8]	GRETEN F R, GRIVENNIKOV S I. Inflammation and cancer: triggers, mechanisms, and consequences[J]. Immunity, 2019, 51(1): 27-41. doi: 10.1016/j.immuni.2019.06.025
[9]	CHANG Z L, LI R Q, ZHANG J H, et al. Distinct immune and inflammatory response patterns contribute to the identification of poor prognosis and advanced clinical characters in bladder cancer patients[J]. Front Immunol, 2022, 13: 1008865. DOI: 10.3389/fimmu.2022.1008865.
[10]	DU X Y, DONG J, YAN K, et al. Novel nomograms predicting the survival of patients with nonsurgical thoracic esophageal squamous cell carcinoma treated with IMRT: a retrospective analysis[J]. Medicine, 2022, 101(40): e30305. DOI: 10.1097/MD.0000000000030305.
[11]	GULLER M, HERBERG M, AMIN N, et al. Nutritional status as a predictive biomarker for immunotherapy outcomes in advanced head and neck cancer[J]. Cancers, 2021, 13(22): 5772. DOI: 10.3390/cancers13225772.
[12]	杨丽萍, 吴爱林, 周燕, 等. 放疗前NLR和PLR对局部晚期鼻咽癌患者预后的影响[J]. 中华全科医学, 2022, 20(9): 1458-1461, 1534. doi: 10.16766/j.cnki.issn.1674-4152.002622 YANG L P, WU A L, ZHOU Y, et al. Effect of NLR and PLR before radiotherapy on prognosis of patients with locally advanced nasopharyngeal carcinoma[J]. Chinese Journal of General Practice, 2022, 20(9): 1458-1461, 1534. doi: 10.16766/j.cnki.issn.1674-4152.002622
[13]	陈莉, 汪涌, 祝广峰, 等. 2020年欧洲泌尿协会肌层浸润性膀胱癌诊断和治疗指南概要[J]. 现代泌尿外科杂志, 2020, 25(11): 1025-1029. CHEN L, WANG Y, ZHU G F, et al. 2020 European Urological Association guidelines for the diagnosis and treatment of myoinvasive bladder cancer[J]. Journal of Modern Urology, 20, 25(11): 1025-1029.
[14]	淡一航, 张宇, 杨岭, 等. 全身免疫炎症指数在急性冠状动脉综合征中的应用进展[J]. 中国心血管病研究, 2023, 21(11): 1038-1042. DAN Y H, ZHANG Y, YANG L, et al. Application of systemic immunoinflammatory index in acute coronary syndrome[J]. Chinese Journal of Cardiovascular Diseases, 2023, 21(11): 1038-1042.
[15]	GORGEL S N, AKIN Y, KOC E M, et al. Retrospective study of systemic immune-inflammation index in muscle invasive bladder cancer: initial results of single centre[J]. Int Urol Nephrol, 2020, 52(3): 469-473.
[16]	ZHANG X P, LIU Q. Systemic immune inflammation index and T-staging predict prognosis in patients with muscle-invasive bladder cancer[J]. Arch Esp Urol, 2023, 76(7): 511-518.
[17]	孙祖刚, 刘硕, 王哲, 等. 术前外周血血小板与淋巴细胞比值在评估膀胱癌根治术患者预后中的临床价值[J]. 临床泌尿外科杂志, 2019, 34(4): 284-288. SUN Z G, LIU S, WANG Z, et al. The clinical value of preoperative peripheral blood platelet to lymphocyte ratio in evaluating the prognosis of patients with bladder cancer undergoing radical surgery[J]. Journal of Clinical Urology, 2019, 34(4): 284-288.
[18]	LIU Q, MA Z M, CAO Q, et al. Perineural invasion-associated biomarkers for tumor development[J]. Biomed Pharmacother, 2022, 155: 113691. DOI: 10.1016/j.biopha.2022.113691.
[19]	OKADOME K, BABA Y, YAGI T, et al. Prognostic nutritional index, tumor-infiltrating lymphocytes, and prognosis in patients with esophageal cancer[J]. Ann Surg, 2020, 271(4): 693-700.
[20]	WANG J C, SHI H J, FAN Z N, et al. Prognostic nutritional index combined with NLR to construct a survival prediction model and decision analysis of patients with muscle-invasive bladder cancer after surgery[J]. Cancer Med, 2023, 12(13): 14207-14224.
[21]	唐文超, 李远伟, 陈佳, 等. 预后营养指数评估根治性膀胱切除术患者预后的Meta分析[J]. 肿瘤防治研究, 2021, 48(9): 871-876. TANG W C, LI Y W, CHEN J, et al. Prognostic nutritional index: a meta-analysis of prognosis in patients with radical cystectomy[J]. Cancer Prevention and Treatment Research, 2019, 48(9): 871-876.
[22]	李东辉, 李杰, 王艳伟, 等. 系统免疫炎症指数、预后营养指数对老年食管癌根治性放疗后死亡的预测价值[J]. 浙江医学, 2023, 45(15): 1621-1625. LI D H, LI J, WANG Y W, et al. Value of systemic immunoinflammatory index and prognostic nutrition index in predicting death of elderly esophageal cancer after radical radiotherapy[J]. Zhejiang Medical Journal, 2023, 45(15): 1621-1625.