术前血清白蛋白水平对非肌层浸润性膀胱癌患者行经尿道膀胱肿瘤电切术的预后价值

摘要

目的 明确术前血清白蛋白水平能否作为非肌层浸润性膀胱癌(NMIBC)患者经尿道膀胱肿瘤电切术(TURBT)的生存预后指标.方法 纳入2007年1月～2012年4月间在本院初治诊为NMIBC,并行TURBT术治疗,有完整临床资料及随访数据的216名膀胱癌患者.将纳入患者根据术前血清白蛋白水平分为低血清白蛋白组(<40 g/L)和正常血清白蛋白组(≥40 g/L).应用Kaplan-Meier模型评估两组患者生存情况,并用Cox比例风险模型对总体生存率(OS)进行单、多因素分析.结果 216例NMIBC患者中,低血清白蛋白组共82(39％)例,正常血清白蛋白组共127(61％)例.Kaplan-Meier分析结果显示低血清白蛋白组的5年OS低于正常血清白蛋白组(P=0.017).进一步进行Cox多因素分析以排除干扰因素的影响后发现,术前血清白蛋白水平仍可成为NMIBC电切患者5年OS(HR:3.102,95％CI:1.200～8.020,P=0.020)的独立危险因素.结论 术前低血清白蛋白水平的NMIBC电切患者拥有更差的5年OS.对于NMIBC电切患者,术前血清白蛋白水平可作为一项廉价易得且简单有效的生存预后指标.%Objective To assess the value of preoperative serum albumin level in predicting the survival of patients with non-muscle-invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumor (TURBT). Methods Two hundred and sixteen newly diagnosed patients with NMIBC who underwent TURBT between January, 2007 and April, 2012 were retrospectively analyzed. The patients were categorized into low albumin (<40 g/L) and normal albumin (≥40 g/L) groups. The patient survival was estimated using the Kaplan-Meier method, and univariate and multivariate Cox proportional analyses were used to determine the hazard ratios (HRs) for the overall survival (OS). Results Of the patients with available data, 82 (39％) and 127 (61％) patients were classified into low albumin (<40 g/L) and normal albumin (≥40 g/L) groups, respectively. Kaplan-Meier analysis showed a significantly worse 5-year OS in low albumin group than in normal albumin group (P=0.017). In the multivariate Cox regression analysis, after adjusting for confounding variables, the preoperative albumin level remained as an independent predictor for 5-year OS (HR:3.102, 95％CI:1.200-8.020, P=0.020). Conclusion A low preoperative albumin level predicts a poor 5-year OS in patients with NMIBC who underwent TURBT. Preoperative serum albumin can be a good prognostic factor for predicting survival of the patients with NMIBC treated with TURBT.