术前C反应蛋白与清蛋白比值在上尿路尿路上皮癌根治术后预后中的评估价值  

Prognostic value of preoperative C-reactive protein/albumin ratio in patients with upper tract urothelial carcinoma after radical nephroureterectomy

作　　者：王翔宇 冀家源 崔腾 肖荆[1] WANG Xiangyu;JI Jiayuan;CUI Teng;XIAO Jing(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京100050

出　　处：《检验医学与临床》2024年第17期2523-2528,共6页Laboratory Medicine and Clinic

基　　金：首都医科大学附属北京友谊医院院启动资金资助项目(yyqdkt2017-2)。

摘　　要：目的探讨术前C反应蛋白与清蛋白比值(CAR)与接受根治性肾输尿管切除术(RNU)的上尿路尿路上皮癌(UTUC)患者肿瘤特征的关系及其对无进展生存期(PFS)和总生存期(OS)的影响。方法回顾性分析2017年1月至2020年12月该院因UTUC进行RNU的219例患者资料。采用约登指数确定CAR诊断UTUC的Cut-off值,按Cut-off值将219例患者分为高CAR组与低CAR组。比较高CAR组与低CAR组的年龄、性别、合并症、术前肾积水、局部肿瘤分期、淋巴结分期、淋巴血管浸润、病理分级、肿瘤位置,并使用Kaplan-Meier生存曲线分析高CAR组与低CAR组的PFS和OS。采用单因素和多因素COX比例风险回归分析PFS和OS的影响因素。结果高CAR组男性比例高于低CAR组,肾积水比例低于低CAR组,局部肿瘤分期为T3、T4比例高于低CAR组,病理分级为高级别比例高于低CAR组,有淋巴血管浸润比例高于低CAR组,肾盂肿瘤比例高于低CAR组,差异均有统计学意义(P<0.05)。高CAR与低CAR组平均PFS分别为35.4、51.4个月,平均OS分别为40.1、60.6个月,低CAR组PFS及OS明显长于高CAR组,差异均有统计学意义(P<0.05)。术前高CAR是较短PFS(HR=2.450,95%CI:1.579~3.756,P<0.001)和OS(HR=2.121,95%CI:1.417~3.173,P<0.001)的独立危险因素。结论接受RNU的UTUC患者术前高CAR是较短PFS和OS的独立危险因素,CAR有望作为独立的UTUC预后评估指标。Objective To investigate the correlation between preoperative C-reactive protein/albumin ratio(CAR)and tumor characteristics,and the impact of progression-free survival(PFS)and overall survival(OS)in patients with upper tract urothelial carcinoma(UTUC)undergoing radical nephroureterectomy(RNU).Methods The data of 219 cases patients who underwent RNU for UTUC in Beijing Friendship Hospital,Capital Medical University from January 2017 to December 2020 were analyzed retrospectively.The Youden index was used to determine the Cut-off value of CAR,and the 219 cases patients were divided into high CAR group and low CAR group.Age,gender,comorbidities,preoperative hydronephrosis,T stage,lymph node stage,lymphovascular invasion,pathological grade and tumor location were compared between the high CAR group and the low CAR group.Kaplan-Meier survival curve was used to analyze PFS and OS between the high CAR group and the low CAR group.Univariate and multivariate COX proportional hazards regression were used to evaluate the effect factors of PFS and OS.Results Male ratio in the high CAR group was higher than that in the low CAR group,hydronephrosis rate was lower than that in the low CAR group,local tumor staging for T3,T4 ratios were higher than those in the low CAR group,the ratio of high level pathologic stage was higher than that in the CAR group,lymphovascular invasion ratio was higher than that in the low CAR group,renal pelvis tumor ratio was higher than that in the low CAR group,the differences were statistical significant(P<0.05).The average PFS of the high CAR group and the low CAR group were 35.4 and 51.4 months respectively,and the average OS were 40.1 and 60.6 months respectively.The PFS and OS of the low CAR group were significantly higher than those of the high CAR group,the differences were statistically significant(P<0.05).High preoperative CAR was an independent risk factor for poor PFS(HR=2.450,95%CI:1.579-3.756,P<0.001)and poor OS(HR=2.121,95%CI:1.417-3.173,P<0.001).Conclusion High preoperative CAR was an

关 键 词：上尿路上皮癌 生物学标志物 根治性肾输尿管切除术 C反应蛋白 清蛋白 

分 类 号：R446.1[医药卫生—诊断学]