非肌层浸润性膀胱尿路上皮癌复发风险预测模型的建立  

Development of a disease recurrence risk predicting model in non-muscle invasive bladder urothelial carcinoma

作　　者：丁飞[1] 郝钢跃[1] 郑克文[1] 田野[1] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,100050

出　　处：《中华泌尿外科杂志》2013年第3期191-196,共6页Chinese Journal of Urology

摘　　要：目的建立准确预测非肌层浸润性膀胱尿路上皮癌患者经尿道膀胱肿瘤切除术后肿瘤复发风险的列线图预测模型。方法以1998—2007年首次诊断为非肌层浸润性膀胱尿路上皮癌的317例患者作为研究对象。通过单变量和多变量Cox比例风险回归分析法对患者的性别、手术时年龄、吸烟史、饮酒史、合并肾衰竭、诊断至手术时间、肿瘤大小、肿瘤数目、病理分级、腔内治疗等预后因素进行分析、筛选，建立预测术后3年、5年内肿瘤复发概率的列线图模型。并对模型的预测准确性进行内部验证和校正。结果317例患者术后3年和5年内膀胱肿瘤复发率分别为36．9％（117／317）和43．5％（138／317）。患者性别（RR=0．617，P=0．011）、手术时年龄（RR=1．369，P=0．088）、肿瘤大小（RR=1．474，P=0．030）、肿瘤数目（RR=1．663，P=0．002）、肿瘤病理分级（RR=1．880，P=0．000）和合并肾衰竭（RR=3．646，P=0．000）为有统计学意义的预测因子。预测术后3年和5年内肿瘤复发的列线图模型预测准确性分别为75．2％和68．3％。结论本研究模型的预测准确性满意，可为患者提供准确的个体化预后风险评估，并为临床制定个体化的治疗、随访方案提供依据。Objective To develop a nomogram which can accurately predict the disease recurrence risk after the transurethra｜ resection of bladder tumor （TURBT） in patients with non-muscle invasive bladder urothelial carcinoma. Methods There were 317 patients in total with newly diagnosed non-muscle inva- sive bladder urothelial carcinoma from 1998 to 2007 enrolled in this study. The patient＇s gender, age, smok- ing history, drinking history, comorbidity of renal failure, time from diagnosis to operation, tumor size, tumor number, tumor grade, and intravesical therapy served as the predictors of the disease recurrence. Ev- ery prognosis factor were analyzed and screened through univariate and multivariate Cox proportional hazard regression statistical analysis, and the nomograms that could be used to predict the 3-year and 5-year recur- rence probability after the surgery were developed. And the prediction accuracy of the nomogram had been internal validated and calibrated as well. Results Of the 317 patients, the three-year and five-year dis- ease recurrence rates were 36.9% （117/317） and 43.5% （138/317） , respectively. The patient＇s gender （RR=0.617, P=0.011）, age （RR=1.369, P=0.088）, tumor size （RR=1.474, P=0.030）, tumor number （ RR = 1. 663, P = 0. 002） , tumor grade （ RR = 1. 880, P = 0. 000） , and comorbidity of renal failure （RR = 3. 646, P = 0. 000） had been proved to be the prognosis factors with significantly statistical difference. The predictive accuracy of the nomograms predicting the 3-year and 5-year disease recurrence after the surgery was 75.2% and 68.3% , respectively. Conclusion The nomograms can provide individualized accurate risk estimations for patients, and therefore it can provide assured proof to formulate the individuali- zing treatment and follow-up protocol in clinic.

关 键 词：膀胱肿瘤 癌 预后 列线图 

分 类 号：R737.14[医药卫生—肿瘤]