前白蛋白、血红蛋白、纤维蛋白原在评估RARC预后中的临床价值

doi:10.19558/j.cnki.10-1020/r.2022.04.011

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摘要 目的：分析前白蛋白、血红蛋白、纤维蛋白原等临床观察指标与RARC患者的病理特征及预后的相关性。方法：回顾性分析了四川省人民医院2017年01月至2019年12月接受机器人辅助膀胱癌根治术（Robotic-assisted radical cystectomy for bladder cancer, RARC）的148例患者的病理特征、临床观察指标与预后的关系。首先通过受试者工作特征曲线（Receiver Operating Characteristic, ROC）对前白蛋白、血红蛋白、纤维蛋白原等进行分组;然后对于计数资料的组间比较采用χ²检验或Fisher确切概率法;接着采用Kaplan-Meier法计算术后总生存率（overall survival rate, OS）和无进展生存率（Progression-free survival, PFS）,并绘制生存曲线,再使用log-rank检验比较不同组间OS和PFS的差异;最后采用Cox回归模型分析影响OS和PFS的危险因素,并获得风险比（Hazard Ratio, HR）,本研究中均以P<0.05表示差异具有统计学意义。结果：前白蛋白、血红蛋白、纤维蛋白原的最佳截断值分别为188.5mg/L、127.5g/L、3.13g/L,由此分为高前白蛋白组115例和低前白蛋白组33例,高血红蛋白组81例和低血红蛋白组67例,高纤维蛋白原组72例和低纤维蛋白原组76例。χ²检验或Fisher确切概率法结果显示：低前白蛋白组与高前白蛋白组相比,前组患者中出现合并有其他病理类型、高病理T分期的比例较高（P<0.05）;低血红蛋白组与高血红蛋白组相比,前组患者中出现女性、高病理T分期的比例较高（P<0.05）;高纤维蛋白原组与低纤维蛋白原组相比,前组患者中出现合并有其他病理类型的比例较高（P<0.05）。Kaplan-Meier法和log-rank检验结果显示：低前白蛋白组、低血红蛋白组、高纤维蛋白原组的OS和PFS较差（P<0.05）。Cox单因素分析显示：病理分类、病理分级、病理T分期、淋巴结转移、前白蛋白、血红蛋白、纤维蛋白原是预后的危险因素（P<0.05）;Cox多因素分析显示：病理分类、病理T分期、前白蛋白、血红蛋白、纤维蛋白原是预后的独立危险因素（P<0.05）。结论：前白蛋白、血红蛋白、纤维蛋白原是RARC患者预后的独立危险因素,可作为术前评估指标。

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	冯华林
	任尚青
	吕倩
	王强
	范世达
	周放
	罗铖
	卫义
	欧勇
	王尧谦
	聂钰
	陈正军
	王东

关键词 ：膀胱肿瘤, 机器人手术, 前白蛋白, 血红蛋白, 纤维蛋白原

Abstract：Objective： To analyze the correlation between clinical indexes （serum prealbumin, hemoglobin, fibrinogen） and the pathological characteristics and prognosis of patients with bladder cancer receiving robot-assisted radical cystectomy （RARC）. Methods： A retrospective analysis was performed on the pathological characteristics, clinical indicators, and prognosis of 148 bladder cancer patients who received RARC in Sichuan Provincial People's Hospital from January 2017 to December 2019. According to prealbumin, hemoglobin, fibrinogen, groups were set up by receiver operating characteristic curve （ROC）.The χ² test or Fisher's exact probability method were used for the comparison of count data between groups. The Kaplan-Meier method was used to calculate the postoperative overall survival rate （OS） and progression-free survival rate （PFS）, and the survival curve was drawn. The log-rank test was used to compare the differences in OS and PFS between different groups.The Cox regression model was used to analyze the risk factors influencing OS and PFS, and the hazard ratio （HR） was obtained. P<0.05 indicated that the difference was statistically significant. Results： The best cut-off values of prealbumin, hemoglobin, and fibrinogen were 188.5mg/L, 127.5g/L and 3.13g/L respectively, which could be divided into high prealbumin group （115 cases） and low prealbumin group （33 cases）, high hemoglobin group （81 cases） and low hemoglobin group （67 cases）, high fibrinogen group （72 cases） and low fibrinogen group （76 cases）. The results of χ² test or Fisher exact probability method showed the percentage of patients with other pathological types and high pathological T stagingin the low prealbumin group was higher than in the high prealbumin group （P<0.05）. The percentage of females and high pathological T staging in the low hemoglobin group was higher than in the high hemoglobin group （P<0.05）. The percentage of patients with other pathological types in the high-fibrinogen group was higher than in the low-fibrinogen group （P<0.05）. Kaplan-Meier method and log-rank test results showedthe OS and PFS in the low prealbumin group, low hemoglobin group, and high fibrinogen group were poor （P<0.05）.Cox single factor analysis shows that pathological classification, pathological grade, pathological T staging, lymph node metastasis, prealbumin, hemoglobin, and fibrinogen were risk factors for prognosis （P<0.05）. Cox multivariate analysis showed that pathological classification, pathological T staging, prealbumin, hemoglobin, and fibrinogen were independent risk factors for prognosis （P<0.05）. Conclusion： Prealbumin, hemoglobin, and fibrinogen are independent risk factors for the prognosis of RARC patients, and can be used as preoperative evaluation indicators.

Key words： bladder tumor robotic surgery prealbumin hemoglobin fibrinogen

收稿日期: 2022-04-19

通讯作者: 王东, wangdong_robot@163.com

引用本文:

冯华林, 任尚青, 吕倩, 王强, 范世达, 周放, 罗铖, 卫义, 欧勇, 王尧谦, 聂钰, 陈正军, 王东. 前白蛋白、血红蛋白、纤维蛋白原在评估RARC预后中的临床价值[J]. 微创泌尿外科杂志, 2022, 11(4): 268-275.
Feng Hualin, Ren Shangqing, Lv Qian, Wang Qiang, Fan Shida, Zhou Fang, Luo Cheng, Wei Yi, Ou Yong, Wang Yaoqian, Nie Yu, Chen Zhengjun, Wang Dong. Clinical value of prealbumin, hemoglobin and fibrinogen in evaluating the prognosis of RARC. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(4): 268-275.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1789.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2022/V11/I4/268

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