全身炎症反应指数评估高级别非肌层浸润性膀胱癌患者预后的价值

凌能勇; 汪盛

doi:10.16766/j.cnki.issn.1674-4152.003584

全身炎症反应指数评估高级别非肌层浸润性膀胱癌患者预后的价值

doi: 10.16766/j.cnki.issn.1674-4152.003584

凌能勇,
汪盛^,

蚌埠医科大学第一附属医院泌尿外科，安徽蚌埠 233004

基金项目:

安徽省自然科学基金项目 1808085MH293

详细信息

通讯作者:
汪盛，E-mail：bydoctorw@163.com

中图分类号: R737.14 R730.7
计量
- 文章访问数: 130
- HTML全文浏览量: 93
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-26
- 网络出版日期: 2024-09-05

Evaluation of prognosis in patients with high-grade non-muscle invasive bladder cancer using systemic inflammatory response index

LING Nengyong,
WANG Sheng^,

Department of Urology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探究全身炎症反应指数(SIRI)在高级别非肌层浸润性膀胱癌(NMIBC)患者预后中的评估价值，为高级别NMIBC患者的诊治提供新的思路。方法回顾性分析2019年1月1日—2020年1月1日在蚌埠医科大学第一附属医院泌尿外科行经尿道膀胱肿瘤电切术(TURBT)的40例高级别NMIBC患者的临床资料，根据患者术后是否出现肿瘤复发，绘制ROC曲线以确定SIRI最佳截断值，并作为截点将患者分为高值组和低值组，分析SIRI对高级别NMIBC患者预后的影响。结果绘制SIRI预测预后(有无复发)的ROC曲线，得出SIRI最佳截断值为1.46，根据最佳截断值将患者分为高SIRI组(SIRI≥1.46，18例)与低SIRI组(SIRI＜1.46，22例)。高、低SIRI组间肿瘤大小比较差异有统计学意义，高SIRI患者术前肿瘤最大径≥3 cm的可能性较大。生存分析显示，不同SIRI、肿瘤数量、肿瘤大小组间无复发生存期(RFS)差异有统计学意义，即低SIRI组患者的生存情况优于高SIRI组、肿瘤单发患者的生存情况优于多发患者、肿瘤最大径＜3 cm患者的生存情况优于肿瘤最大径≥3 cm患者。Cox单因素分析结果显示，SIRI、肿瘤数量和肿瘤大小是高级别NMIBC患者术后RFS的独立影响因素；Cox多因素分析结果显示，SIRI≥1.46是NMIBC患者术后RFS的独立危险因素。结论 SIRI可以作为高级别NMIBC患者的风险评估指标，可能为高级别NMIBC治疗带来新的方案和方向。
- 非肌层浸润性膀胱癌 /
- 全身炎症反应指数 /
- 高级别 /
- 预后
Abstract: Objective The systemic inflammatory response index (SIRI) was used to evaluate the prognosis of high-grade non-muscle invasive bladder cancer (NMIBC) patients, which provided new ideas and theoretical value for the diagnosis and treatment of patients with high-grade NMIBC. Methods A total of 40 cases with high-grade NMIBC who underwent transurethral resection of bladder tumor (TURBT) in the First Affiliated Hospital of Bengbu Medical University from January 1, 2019 to January 1, 2020 were analyzed retrospectively. According to whether the patient has a tumor recurrence after surgery, the working subjects operated the characteristic curve (ROC) to determine the best cutoff value of SIRI and divided it into high-value group and low-value group, so as to determine the influence on the prognosis of high-grade NMIBC patients. Results The ROC curve of SIRI to predict prognosis (with or without recurrence) is drawn, and the best cut-off value of SIRI was 1.46. According to the optimal cut-off value, patients were divided into high SIRI group (SIRI≥1.46, 18 cases) and low SIRI group (SIRI < 1.46, 22 cases). Tumor size varied in the distribution between the high and low SIRI groups. Patients with high SIRI were more likely to have a 3 cm maximum tumor diameter before surgery. Survival analysis showed that there were significant differences in SIRI, tumor number, and recurrence-free survival (RFS) during different size of tumors. The survival of patients with low SIRI was better than that of patients with high SIRI. Patients with single tumor were better than patients with multiple tumors, and patients with maximum tumor diameter less than 3 cm were better than patients with tumor diameter more than 3 cm. Cox univariate analysis confirmed that SIRI, tumor number, and tumor size were independent influencing factors for postoperative RFS in the advanced group. Cox multivariate analysis confirmed that SIRI more than 1.46 was an independent risk factor for postoperative RFS in NMIBC patients. Conclusion SIRI can be used as a risk assessment index for patients with high-grade NMIBC, which can provide new options and directions for the treatment of high-grade NMIBC.
- Non-muscular invasive bladder cancer /
- Systemic inflammatory response index /
- High grade /
- Prognosis

HTML全文

图 1 SIRI预测NMIBC患者预后的ROC曲线

Figure 1. ROC curve of SIRI for predicting prognosis in NMIBC patients

下载: 全尺寸图片幻灯片

图 2 高低SIRI组NMIBC患者无复发生存曲线比较

注：组间比较，χ²=11.106，P=0.001。

Figure 2. Comparison of recurrence-free survival curves in NMIBC patients between high and low SIRI groups

下载: 全尺寸图片幻灯片

图 3 不同肿瘤数量组NMIBC患者无复发生存曲线比较

注: 组间比较, χ²=5.564, P=0.018。

Figure 3. Comparison of recurrence-free survival curves in NMIBC patients based on tumor number

下载: 全尺寸图片幻灯片

图 4 不同肿瘤大小组NMIBC患者无复发生存曲线比较

注: 组间比较, χ²=6.975, P=0.008。

Figure 4. Comparison of recurrence-free survival curves in NMIBC patients based on tumor groups

下载: 全尺寸图片幻灯片

表 1 SIRI分组NMIBC患者一般资料比较(例)

Table 1. Comparison of general data of NMIBC patients in SIRI group (case)

项目	高SIRI组 (n=18)	低SIRI组 (n=22)	χ²值	P值
性别
男性	8	13	0.852	0.356
女性	10	9
年龄(岁)
≥65	8	12	0.404	0.525
＜65	10	10
吸烟史
有	7	10	0.175	0.676
无	11	12
高血压
有	12	12	0.606	0.436
无	6	10
高脂血症
有	12	8	3.636	0.057
无	6	14
肿瘤数量
单发	6	12	1.800	0.180
多发	12	10
肿瘤大小(cm)
最大径≥3	12	4	9.697	0.002
最大径＜3	6	18

下载: 导出CSV

表 2 RFS影响因素的Cox单因素分析

Table 2. Univariate analysis of Cox influencing RFS

变量	B	SE	Waldχ²	P值	HR值	95% CI
SIRI	2.669	1.056	6.390	0.011	14.420	1.821~114.182
性别	0.688	0.649	1.125	0.289	1.989	0.558~7.093
年龄	0.483	0.646	0.559	0.455	1.621	0.457~5.752
吸烟	0.079	0.649	0.015	0.904	1.082	0.303~3.860
高血压	0.251	0.692	0.132	0.717	1.285	0.331~4.986
高脂血症	0.697	0.651	1.147	0.284	2.008	0.561~7.189
肿瘤数量	1.413	0.649	4.744	0.029	4.108	1.152~14.652
肿瘤大小	1.654	0.696	5.648	0.017	5.227	1.336~20.446

下载: 导出CSV

表 3 RFS影响因素的Cox多因素分析

Table 3. Multivariate analysis of Cox influencing RFS

变量	B	SE	Waldχ²	P值	HR值	95% CI
SIRI	2.534	1.153	4.825	0.028	12.600	1.314~120.832
肿瘤数量	0.411	0.773	0.282	0.595	1.508	0.331~6.868
肿瘤大小	1.117	0.789	2.002	0.157	3.055	0.650~14.345

下载: 导出CSV

参考文献(21)

[1]	张永琪, 邹震海, 吴梦琦, 等. 敲低EPHA2通过mTOR磷酸化调控膀胱癌细胞自噬和生物学行为[J]. 中华全科医学, 2023, 21(7): 1117-1120, 1129. doi: 10.16766/j.cnki.issn.1674-4152.003063 ZHONG Y Q, ZOU Z H, WU M Q, et al. Knockdown of EPHA2 regulates autophagy and biological behavior of bladder cancer cell through mTOR phosphorylation[J]. Chinese Journal of General Practice, 2023, 21(7): 1117-1120, 1129. doi: 10.16766/j.cnki.issn.1674-4152.003063
[2]	SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[3]	BABJUK M, BURGER M, CAPOUN O, et al. European association of urology guidelines on non-muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ)[J]. Eur Urol, 2021, 81(1): 75-94.
[4]	PYRGIDIS N, VOLZ Y, EBNER B, et al. The effect of hospital caseload on perioperative mortality, morbidity and costs in bladder cancer patients undergoing radical cystectomy: results of the German nationwide inpatient data[J]. World J Urol, 2024, 42(1): 19. DOI: 10.1007/s00345-023-04742-z.
[5]	VAISHNAV M, GARG S, ADHADUK B. Association of smoking, p53 and Ki-67 immunomarkers with bladder neoplasms in tribal region of India[J]. Int J Health Sci(Qassim), 2022, 16(6): 11-17.
[6]	HU H P, LAI S C, WANG M R, et al. Effect of subsequent bladder cancer on survival in upper tract urothelial carcinoma patients post-radical nephroureterectomy: a systematic review and meta-analysis[J]. BMC Urol, 2023, 23(1): 212. DOI: 10.1186/s12894-023-01387-3.
[7]	WANG P. Evaluation of the effect of transurethral resection of bladder tumors in the treatment of bladder cancer and its impact on CA19-9 and CA125 levels[J]. Urol Res, 2023, 1(3): 17-22. doi: 10.26689/ur.v1i3.5986
[8]	HOOGEVEEN F, BLANKER M H, CAUBERG E, et al. Recurrence of non-muscle invasive bladder carcinoma after transurethral resection with hexaminolevulinate photodynamic diagnosis or regular cystoscopy[J]. Scand J Urol, 2023, 58: 120-125. doi: 10.2340/sju.v58.10160
[9]	WARAICH T A, KHALID S Y, ALI A, et al. Comparative outcomes of radical cystectomy in muscle-invasive bladder cancer: a systematic review and meta-analysis[J]. Cureus, 2023, 15(12): e50646. DOI: 10.7759/cureus.50646.
[10]	ABBATE V, BARONE S, BORRIELLO G, et al. Diagnostic performance of inflammatory biomarkers and cytological analysis in salivary gland tumors[J]. Head neck, 2023, 45(12): 3015-3023. doi: 10.1002/hed.27528
[11]	ZHANG Y Y, LI W Q, LI Z F, et al. Higher levels of pre-operative peripheral lymphocyte count is a favorable prognostic factor for patients with stage Ⅰ and Ⅱ rectal cancer[J]. Front Oncol, 2019, 9: 960. DOI: 10.3389/fonc.2019.00960.
[12]	ALAME M, PIREL M, COSTES-MARTINEAU V, et al. Characterisation of tumour microenvironment and immune checkpoints in primary central nervous system diffuse large B cell lymphomas[J]. Virchows Arch, 2020, 476(6): 891-902. doi: 10.1007/s00428-019-02695-6
[13]	SHADPOUR P, ZAMANI M, AGHAALIKHANI N, et al. Inflammatory cytokines in bladder cancer[J]. J Cell Physiol, 2019, 234(9): 14489-14499. doi: 10.1002/jcp.28252
[14]	NIEDERBERGER E, MÖLLER M, MUNGO E, et al. Distinct molecular mechanisms contribute to the reduction of melanoma growth and tumor pain after systemic and local depletion of alpha-synuclein in mice[J]. FASEB J, 2023, 37(12): e23287. DOI: 10.1096/fj.202301489R.
[15]	WIGNER P, GREBOWSKI R, BIJAK M, et al. The interplay between oxidative stress, inflammation and angiogenesis in bladder cancer development[J]. Int J Mol Sci, 2021, 22(9): 4483. DOI: 10.3390/ijms22094483.
[16]	SHAH M A, ROGOFF H A. Implications of reactive oxygen species on cancer formation and its treatment[J]. Semin Oncol, 2021, 48(3): 238-245. doi: 10.1053/j.seminoncol.2021.05.002
[17]	ZHU H H, LIU Y T, FENG Y, et al. Circulating tumor cells (CTCs)/circulating tumor endothelial cells (CTECs) and their subtypes in small cell lung cancer: predictors for response and prognosis[J]. Thorac Cancer, 2021, 12(20): 2749-2757. doi: 10.1111/1759-7714.14120
[18]	DO M H, SHI W, JI L L, et al. Reprogramming tumor-associated macrophages to outcompete endovascular endothelial progenitor cells and suppress tumor neoangiogenesis[J]. Immunity, 2023, 56(11): 2555-2569. e5. doi: 10.1016/j.immuni.2023.10.010
[19]	WANG X, JIA Y, WEN L, et al. Porphyromonas gingivalis promotes colorectal carcinoma by activating the hematopoietic NLRP3 inflammasome[J]. Cancer Res, 2021, 81(10): 2745-2759. doi: 10.1158/0008-5472.CAN-20-3827
[20]	CHEN Z, WANG K, LU H, et al. Systemic inflammation response index predicts prognosis in patients with clear cell renal cell carcinoma: a propensity score-matched analysis[J]. Cancer Manag Res, 2019, 11: 909-919. doi: 10.2147/CMAR.S186976
[21]	HUA X, LONG Z Q, HUANG X, et al. The preoperative systemic inflammation response index (SIRI) independently predicts survival in postmenopausal women with breast cancer[J]. Curr Probl Cancer, 2020, 44(4): 100560. DOI: 10.1016/j.currproblcancer.2020.100560.