摘要
目的探讨术前控制营养状况(CONUT)评分与血红蛋白和红细胞分布宽度比值(HRR)对上尿路尿路上皮癌(UTUC)患者根治术后生存的预测价值。方法回顾性分析2011年5月—2017年6月在徐州医科大学附属医院行手术治疗的145例UTUC患者。收集患者的临床病理资料,应用受试者工作特征曲线(ROC)确定CONUT评分和HRR的最佳截断值并进行分组,建立CONUT-HRR评分系统。比较不同CONUT-HRR评分与UTUC患者临床病理指标的相关性,采用Kaplan-Meier生存曲线和Cox比例风险回归模型评估CONUT-HRR评分在UTUC患者预后预测中的应用价值。结果术前CONUT评分和HRR预测患者肿瘤特异性生存期(CSS)的最佳截断值分别为3和10.41。将患者分为3组:CONUT-HRR 0分组62例(CONUT评分<3分且HRR≥10.41);CONUT-HRR 1分组51例(CONUT评分<3分且HRR<10.41,或者CONUT评分≥3分且HRR≥10.41);CONUT-HRR 2分组32例(CONUT评分≥3分且HRR<10.41)。CONUT-HRR评分与年龄、手术方式、病理T分期、淋巴结转移和脉管浸润情况有关(P均<0.05)。Kaplan-Meier生存曲线结果显示,CONUT-HRR 0分、1分和2分组的5年CSS率分别为96.4%、65.8%和30.9%,组间差异均具有统计学意义(P<0.001)。Cox回归模型分析显示,CONUT-HRR评分、病理T分期、淋巴结转移和脉管浸润是UTUC患者CSS的独立影响因素。结论术前CONUT-HRR评分可作为一项评估UTUC患者预后简便且可靠的指标,评分越高,提示患者预后越差。
Objective To investigate the predictive value of preoperative controlled nutritional status(CONUT)score and ratio of hemoglobin to red cell distribution width(HRR)for survival of patients with upper urinary tract urothelial carcinoma(UTUC)after radical surgery.Methods A retrospective analysis was performed on 145 UTUC patients who underwent surgical treatment in the Affiliated Hospital of Xuzhou Medical University during May 2011 and Jun.2017.Clinic opathologic data were collected,the best cut-off values of CONUT score and HRR were determined with receiver operating characteristic(ROC)curve,and the CONUT-HRR scoring system was established.The correlation between different CONUT-HRR scores and clinic opathological indicators of UTUC patients was compared.The application value of CONUT-HRR score in predicting the prognosis of UTUC patients was evaluated with Kaplan-Meier survival curve and Cox proportional risk regression model.Results The optimal cut-off values of preoperative CONUT score and HRR for predicting cancer specific survival(CSS)were 3 and 10.41,respectively.The patients were divided into three groups:CONUT-HRR 0 group(n=62,CONUT score<3 and HRR≥10.41),CONUT-HRR 1 group(n=51,CONUT score<3 and HRR<10.41,or CONUT score≥3 and HRR≥10.41),and CONUT-HRR 2 group(n=32,CONUT score≥3 and HRR<10.41).CONUT-HRR score was correlated with age,surgical method,pathological T stage,lymph node metastasis and vascular invasion(all P<0.05).Kaplan-Meier survival curve results showed that the 5-year CSS of CONUT-HRR 0,1 and 2 groups were 96.4%,65.8%and 30.9%,respectively,with statistically significant differences(P<0.001).Cox regression model showed that CONUT-HRR score,pathological T stage,lymph node metastasis and vascular infiltration were independent factors of CSS.Conclusion Preoperative CONUT-HRR score can be used as a simple and reliable indicator to evaluate the prognosis of UTUC patients.Higher score indicates worse prognosis.
作者
徐鑫
许阳
陈锐
陈仁富
XU Xin;XU Yang;CHEN Rui;CHEN Renfu(Department of Urology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000;Graduate School of Xuzhou Medical University,Xuzhou 221004;Department of Urology,Huzhou Hospital Affiliated to Zhejiang University School of Medicine,Huzhou 313099,China)
出处
《现代泌尿外科杂志》
CAS
2023年第12期1053-1059,共7页
Journal of Modern Urology
