摘要
目的探讨膀胱灌注卡介苗(Bacillus Calmette-Guérin,BCG)对于中高危非肌层浸润性膀胱癌(nonmuscle invasive bladder cancer,NMIBC)的疗效,结合术前血液学指标建立疗效预测模型筛选获益人群。方法 回顾性分析2014年1月至2019年1月收治于复旦大学附属中山医院泌尿外科258例中高危NMIBC患者。所有患者均采用尿道膀胱肿瘤切除术后膀胱灌注卡介苗治疗,记录患者术前血液学指标及临床病理信息。在训练集(n=180)中采用LASSO回归和Cox多因素回归模型筛选预后因子,同时建立疗效预测模型,利用C-index验证模型预测效能,并在验证集(n=78)中进行确认。结果 258例患者均获得有效随访,中位随访时间为53.0个月(12.0~98.2个月),总体复发率为31.0%(80/258),1年复发率为15.1%(39/258),3年复发率为25.6%(66/258),通过LASSO回归方法筛选出中性粒细胞和C-反应蛋白(C-reactive protein,CRP)作为预后因子,纳入多因素Cox分析,显示灌注前行二次经尿道膀胱肿瘤切除术(P=0.001),高龄(>70岁)(P=0.008)、CRP(P=0.002)和中性粒细胞(P=0.044)是中高危NMIBC患者行膀胱灌注卡介苗疗效的独立预测因子。疗效预测模型在训练集中的C-index为0.744,在验证集中的C-index为0.847。结论 膀胱灌注卡介苗治疗对中高危NMIBC安全有效,本研究所建立疗效预测模型(包含中性粒细胞、CRP、高龄和二次经尿道膀胱肿瘤切除术)预测中高危NMIBC患者膀胱灌注卡介苗疗效的准确性较高。
Objective To investigate the efficacy of intravesical Bacillus Calmette-Guérin(BCG)irrigation in the treatment of medium-risk and high-risk non-muscle-invasive bladder cancer(NMIBC),and to establish a predictive model with preoperative blood routine indexes in order to screen the patients who can gain benefit.Methods A retrospective analysis was performed on 258 medium-and high-risk NMIBC patients admitted to the department of urology,Zhongshan Hospital,Fudan University from Jan 2014 to Jan 2019.All patients were treated with intravesical BCG injection after transurethral resection of bladder tumor(TURBT).The preoperative blood indexes and clinicopathological information of the patients were recorded.In the training set(n=180),LASSO regression and Cox multivariate regression models were used to screen prognostic factors in order to establish an efficacy predictive model.C-index was used to verify the predictive efficacy of the model,and the validation was carried out in the validation set(n=78).Results All the 258 patients were followed up effectively,the median follow-up time was 53.0 months(12.0-98.2 months).The overall recurrence rate was 31.0%(80/258),the 1-year recurrence rate was 15.1%(39/258)and the 3-year recurrence rate was 25.6%(66/258).The screening of neutrophils,white blood cell and C-reactive protein(CRP)by LASSO regression could be used as prognostic factors.Multivariate Cox analysis showed that re-TURBT(P=0.001),age(>70,P=0.008),CRP(P=0.002),and neutrophils(P=0.044)were independent predictors of the efficacy of BCG treatment.The C-index of the predictive model in the training set and the verification set were 0.744 and 0.847,respectively.Conclusion Intravesical BCG irrigation is effective for the treatment of medium-risk and high-risk NMIBC.The established prognostic model(including neutrophils,CRP,age and re-TURBT)was more accurate in predicting the efficacy of intravesical BCG irrigation in non-muscular invasive bladder cancer.
作者
戚宇
王杭
郭剑明
姜帅
QI Yu;WANG Hang;GUO Jian-ming;JIANG Shuai(Department of Urology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Urology,Wusong Hospital,Zhongshan Hospital,Fudan University,Shanghai 200940,China)
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2023年第6期810-819,共10页
Fudan University Journal of Medical Sciences
基金
国家自然科学基金面上项目(82073413)
国家自然科学基金青年项目(82102967)。
