膀胱全切手术预后与术前合并症的关系—基于中国人口的单中心研究  

Relationship between comorbidity and outcome of radical cystectomy in Chinese a single-center study with the ACE-27 comorbidity index

作　　者：朱煊[1] 钟朝晖[1] 张磊[1] 张选志[1] 徐冉[1] 赵晓昆[1] 

机构地区：[1]中南大学湘雅二医院泌尿外科,长沙410011

出　　处：《现代泌尿生殖肿瘤杂志》2013年第5期269-273,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的调查研究在中国人口中,合并症与膀胱全切术后生存率之间的关系。方法选取2000年至2010年间在中南大学湘雅二医院泌尿外科行膀胱全切的246例患者进行回顾性研究。收集包括年龄、性别、手术延搁时间、尿流改道类型、盆腔淋巴结清扫范围、TNM分期、肿瘤细胞病理分级在内的临床资料。使用ACE-27合并症评分表对患者的术前合并症情况进行评估。使用单因素和多因素Cox比例风险回归模型分析合并症与术后总生存率之间的关系。结果入选患者平均年龄(62±11)岁,中位随访时间为(47±31)个月。151例(61.38%)患者在随访期间死亡,118例(47.97%)患者至少存在一个器官的合并症。其中无合并症患者128例(52.03%),轻度合并症患者79例(32.11%),中度合并症患者33例(13.41%),重度合并症患者6例(2.45%)。多因素分析结果显示,中度合并症(P=0.002)和重度合并症(P<0.001)患者的术后总生存率较无合并症和轻度合并症患者低。除此之外,年龄≥70岁(P=0.002)、手术延搁时间≥12周(P=0.044)、盆腔淋巴结清扫的范围(P=0.014)及TNM分期>T3(P<0.001)也与患者术后总体生存率的降低有关。结论随着合并症严重程度的增加,膀胱全切术后患者的生存率逐渐下降。Objective To determine the relationship between comorbidity and outcome after radical cystectomy. Methods 246 patients received radical cystectomy at the Second Xiangya Hos- pital of Central South University between 2000 and 2010, and the date were retrospectively analyzed. Medical records were reviewed for age, gender, delayed time of radical cystectomy, urinary diversion type, pelvic lymphadenectomy status, TNM stage, and pathological grade. Comorbidity information was assessed by the ACE-27 index. Univariate and multivariate Cox proportional hazards regression analyses were used to determine the association between comorbidity and outcome. Results The study population consist of 215 （87.40%） males and 31 （12. 60%） females with a mean age of 62% 11 years. Median duration of follow-up was 47-31 months. A total of 151 （61.38%） patents died during follow-up. Of those, 118 （47.97%） had at least one comorbidity. According to the ACE-27 scores, 128 （52. 03%） patients had no comorbidity, 79 （32. 11%） had mild, 33 （13. 41%） had moderate, and 6 （2.45%） had severe comorbidities. Multivariate analysis indicated that moderate （P=0. 002） and severe （P〈0. 001） comorbidity was significantly associated with decreased overall survival. In addition, age ≥70 years （P=0. 002）, delayed time of radical cyste：ctomy ≥12 weeks （P=0. 044）, pelvic lymphadenectomy status （P=0. 014）, and TNM stage 〉T3 （P〈0. 001） were determined to be independent risk factors of overall survival. Conclusions Increasing severity of comorbidity statistically correlated with decreased overall survival after radical cystectomy.

关 键 词：膀胱全切术 合并症 生存率 

分 类 号：R737.14[医药卫生—肿瘤]