回肠通道术术前营养控制状态评分对判断膀胱癌患者预后的价值

doi:10.3969/j.issn.1006-7795.2023.03.014

摘要/Abstract

摘要： 目的探讨术前营养控制状态（controlling nutritional status，CONUT）评分与根治性膀胱切除加回肠通道术患者预后的相关性。方法选取 2014年3月至2020年6月于首都医科大学附属北京朝阳医院因膀胱癌行膀胱根治性切除加回肠通道术的患者79例，根据纳入患者的中位CONUT评分（2分）将患者分为低CONUT组（≤2分）48例和高CONUT组（＞2分）31例。收集临床资料并进行随访，进行回顾性分析。测定患者术前7 d内血清白蛋白浓度、外周血淋巴细胞总数和总胆固醇浓度并计算CONUT评分。收集患者术前合并症、手术时间、术后病理等资料。使用Kaplan-Meier法绘制生存曲线，Cox回归分析CONUT评分与患者术后总生存期（overall survival，OS）和无复发生存期（recurrence-free survival，RFS）的关系。结果不同CONUT评分的两组患者的年龄、性别、体质量指数（body mass index，BMI）、术前合并症、手术时间、出血量等差异均无统计学意义（P＞0.05），高CONUT组的术后并发症发生率（P=0.009）、肿瘤T分期（P=0.048）和手术切缘阳性率（P=0.021）显著高于低CONUT组。在中位24个月的随访中，79例患者中分别有27例患者死亡和33例患者出现肿瘤复发或转移。Kaplan-Meier生存曲线显示高CONUT组患者的OS和RFS中位时间均显著短于低CONUT组（OS：24周vs ＞96周，P=0.001 5；RFS：16周vs ＞96周，P=0.004 6）。进一步通过多因素Cox回归分析发现，CONUT ＞ 2分是根治性膀胱切除术加回肠通道术后OS（HR =2.283，95%CI：1.038~5.018，P=0.040）和RFS（HR=2.264，95%CI：1.058~1.219，P=0.035）的独立危险因素。结论 CONUT评分是根治性膀胱切除加回肠通道术患者临床结局的独立预测因素。高CONUT评分预示着更差的临床结局，应予此类患者更加密切的随访、评估和相应治疗。

关键词: 营养控制状态评分, 膀胱癌, 根治性膀胱切除术, 回肠通道术, 营养状态, 预测指数, 肿瘤学结果

Abstract: Objective To explore the predictive value of controlling nutritional status (CONUT) score on oncological outcomes of bladder cancer (BC) patients receiving radical cystectomy (RC) with ileal conduit (IC). Methods Retrospective analysis was performed on 79 BC patients treated with RC and IC in the Department of Urology, Beijing Chaoyang Hospital, Capital Medical University from March 2014 to June 2020. The CONUT score was calculated based on serum albumin level, total lymphocyte count and total cholesterol level. Kaplan-Meier method and Cox regression analyses were performed to plot cumulative possibility of overall survival (OS) and recurrence-free survival (RFS) and to investigate predictive potential of the CONUT score. Results During a median follow-up of 24-months, 27 and 33 patients experienced neoplastic recurrence and metastasis， respectively. All eligible 79 participants were divided into high CONUT group (n=31) and low CONUT group (n=48) according to the median CONUT score of 2. No significant differences were detected between the two groups regarding demographic characteristics, underlying diseases, surgical and oncological data, except T staging （P=0.048）and positive margins (P=0.021). Patient in high CONUT group had significantly worse OS and RFS than those in low CONUT group（OS：24 week vs ＞96 week，P=0.0015；RFS：16 week vs ＞96 week，P=0.0046）. Multivariate Cox regression analyses indicated that the CONUT score was an independent predictor of OS and RFS(OS:HR=2.283，95%CI: 1.038-5.018，P=0.040； RFS:HR=2.264，95%CI: 1.058-1.219，P=0.035). Conclusion The CONUT score is independently associated with oncological outcomes among BC patients treated with RC+IC. A close follow-up with continual vigilance and reassessment for patients with high CONUT score.

Key words: controlling nutritional status score, bladder cancer, radical cystectomy, ileal conduit, nutritional status, prediction index, oncological outcome

中图分类号:

R737.14

张玉冬, 魏后忆, 王润锦, 蒋铭心, 杨坤, 王明帅, 瓦斯里江·瓦哈甫, 宋黎明, 金木兰, 邢念增, 牛亦农. 回肠通道术术前营养控制状态评分对判断膀胱癌患者预后的价值[J]. 首都医科大学学报, 2023, 44(3): 449-456.

Zhang Yudong, Wei Houyi, Wang Runjin, Jiang Mingxin, Yang Kun, Wang Mingshuai, Wasilijiang Wahafu, Song Liming, Jin Mulan, Xing Nianzeng, Niu Yinong. Prognostic significance of the controlling nutritional status (CONUT) score in patients with bladder cancer treated with radical cystectomy and ileal conduit[J]. Journal of Capital Medical University, 2023, 44(3): 449-456.

参考文献

［1］Richters A, Aben K K H, Kiemeney L A L M. The global burden of urinary bladder cancer: an update［J］. World J Urol, 2020, 38(8): 1895－1904.
［2］Jemal A, Bray F, Center M M, et al. Global cancer statistics［J］. CA Cancer J Clin, 2011, 61(2): 69－90.
［3］Babjuk M, Bhle A, Burger M, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016［J］. Eur Urol, 2017, 71(3): 447－461.
［4］Ogihara K, Kikuchi E, Yuge K, et al. The preoperative neutrophil-to-lymphocyte ratio is a novel biomarker for predicting worse clinical outcomes in non-muscle invasive bladder cancer patients with a previous history of smoking［J］. Ann Surg Oncol, 2016, 23(Suppl 5): 1039－1047.
［5］Sylvester R J, Van Der Meijden A P M, Oosterlinck W, et al. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials［J］. Eur Urol, 2006, 49(3): 466－467.
［6］杨诚, 梁朝朝. 机器人辅助根治性全膀胱切除加体内尿流改道术的研究进展［J］. 中华泌尿外科杂志, 2016, 37(5): 395－397.
［7］Zheng R R, Huang M, Jin C, et al. Cervical cancer systemic inflammation score: a novel predictor of prognosis［J］. Oncotarget, 2016, 7(12): 15230－15242.
［8］McMillan D C. Systemic inflammation, nutritional status and survival in patients with cancer［J］. Curr Opin Clin Nutr Metab Care, 2009, 12(3): 223－226.
［9］Ryan A M, Power D G, Daly L, et al. Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later［J］. Proc Nutr Soc, 2016, 75(2): 199－211.
［10］Ignacio de Ulíbarri J, González-Madroo A, De Villar N G P, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population［J］. Nutr Hosp, 2005, 20(1): 38－45.
［11］Kuroda D, Sawayama H, Kurashige J, et al. Controlling nutritional status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection［J］. Gastric Cancer, 2018, 21(2): 204－212.
［12］Zhang G Y, Zhang Y Z, He F F, et al. Preoperative controlling nutritional status (CONUT) score is a prognostic factor for early-stage cervical cancer patients with high-risk factors［J］. Gynecol Oncol, 2021, 162(3): 763－769.
［13］Tsunematsu M, Haruki K, Fujiwara Y, et al. Preoperative controlling nutritional status (CONUT) score predicts long-term outcomes in patients with non-B non-C hepatocellular carcinoma after curative hepatic resection［J］. Langenbecks Arch Surg, 2021, 406(1): 99－107.
［14］Sun F, Zhang C, Liu Z J, et al. Controlling nutritional status (CONUT) score as a predictive marker for short-term complications following gastrectomy of gastric cancer: a retrospective study［J］. BMC Gastroenterol, 2021, 21(1): 107.
［15］姚佳佳, 周世秋, 高华, 等. 控制营养状况评分预测弥漫大B细胞淋巴瘤化疗患者预后的价值［J］. 中国临床医生杂志, 2021, 49(12): 1442－1444.
［16］Huang Z Z, Song C G, Huang J J, et al. Prognostic significance of the controlling nutritional status (CONUT) score in surgically treated breast cancer patients［J］. Gland Surg, 2020, 9(5): 1370－1379.
［17］Wang A K, He Z X, Cong P, et al. Controlling nutritional status (CONUT) score as a new indicator of prognosis in patients with hilar cholangiocarcinoma is superior to NLR and PNI: a single-center retrospective study［J］. Front Oncol, 2021, 10: 593452.
［18］Nemoto Y, Kondo T, Ishihara H, et al. The controlling nutritional status CONUT score in patients with advanced bladder cancer after radical cystectomy［J］. In Vivo, 2021, 35(2): 999－1006.
［19］郭克存, 王腾春, 袁守娴, 等. CONUT评分评估行根治性膀胱切除术的膀胱癌患者预后的临床价值［J］. 现代泌尿外科杂志, 2017, 22(12): 925－929.
［20］Lee R K, Abol-Enein H, Artibani W, et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes［J］. BJU Int, 2014, 113(1): 11－23.
［21］Stein R, Hohenfellner M, Pahernik S, et al. Urinary diversion—approaches and consequences［J］. Dtsch Arztebl Int, 2012, 109(38): 617－622.
［22］Kang H W, Seo S P, Kim W T, et al. Prognostic impact of nutritional status assessed by the controlling nutritional status (CONUT) score in patients with surgically treated renal cell carcinoma［J］. Nutr Cancer, 2018, 70(6): 886－894.
［23］Lallas C D, Fashola Y, Den R B, et al. Predictors of positive surgical margins after radical prostatectomy at a single institution: preoperative and pathologic factors, and the impact of surgeon variability and technique on incidence and location［J］. Can J Urol, 2014, 21(5): 7479－7486.
［24］Tokunaga R, Sakamoto Y, Nakagawa S, et al. CONUT: a novel independent predictive score for colorectal cancer patients undergoing potentially curative resection［J］. Int J Colorectal Dis, 2017, 32(1): 99－106.
［25］Corcoran A T, Kaffenberger S D, Clark P E, et al. Hypoalbuminaemia is associated with mortality in patients undergoing cytoreductive nephrectomy［J］. BJU Int, 2015, 116(3): 351－357.
［26］Hu W H, Eisenstein S, Parry L, et al. Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study［J］. Nutr J, 2019, 18(1): 33.
［27］Wiedermann C J, Wiedermann W, Joannidis M. Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies［J］. Intensive Care Med, 2010, 36(10): 1657－1665.
［28］Hirasawa Y, Nakashima J, Yunaiyama D, et al. Sarcopenia as a novel preoperative prognostic predictor for survival in patients with bladder cancer undergoing radical cystectomy［J］. Ann Surg Oncol, 2016, 23(Suppl 5): 1048－1054.
［29］Ornaghi P I, Afferi L, Antonelli A, et al. The impact of preoperative nutritional status on post-surgical complication and mortality rates in patients undergoing radical cystectomy for bladder cancer: a systematic review of the literature［J］. World J Urol, 2021, 39(4): 1045－1081.
［30］Templeton A J, McNamara M G, eruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis［J］. J Natl Cancer Inst, 2014, 106(6): dju124.
［31］Wu E S, Oduyebo T, Cobb L P, et al. Lymphopenia and its association with survival in patients with locally advanced cervical cancer［J］. Gynecol Oncol, 2016, 140(1): 76－82.
［32］Suzuki R, Wei X, Allen P K, et al. Prognostic significance of total lymphocyte count, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in limited-stage small-cell lung cancer［J］. Clin Lung Cancer, 2019, 20(2): 117－123.
［33］Ray-Coquard I, Cropet C, Van Glabbeke M, et al. Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas［J］. Cancer Res, 2009, 69(13): 5383－5391.
［34］罗娜, 时荣臣, 代荣阳, 等. 胆固醇代谢与肿瘤免疫［J］. 四川大学学报: 医学版, 2022, 53(2): 335－341.
［35］Luo C, Wang K, Liu D Q, et al. The functional roles of lipid rafts in T cell activation, immune diseases and HIV infection and prevention［J］. Cell Mol Immunol, 2008, 5(1): 1－7.

[1]	巫剑红, 田玉翠, 蒋子雯, 唐世倩, 刘朝晖, 代荫梅. LncRNA FAM95B1调控胰岛素样生长因子2的表达对宫腔粘连发生的影响[J]. 首都医科大学学报, 2023, 44(5): 821-827.
[2]	王泽铖, 阮祥燕, 李婧, 蒋玲玲, Alfred O.Mueck. 医源性早发性卵巢功能不全对脂代谢的影响[J]. 首都医科大学学报, 2023, 44(4): 535-539.
[3]	陶鲁铭, 李冬月, 张希诺, 苏庆军, 海涌. 单侧双通道内镜辅助下双侧减压治疗腰椎管狭窄症[J]. 首都医科大学学报, 2023, 44(4): 684-689.
[4]	张明珍, 阮祥燕, 闵敏, Alfred O.Mueck. 奥利司他综合干预对超重或肥胖多囊卵巢综合征患者脂蛋白（a）、糖脂代谢及肝、肾功能的影响[J]. 首都医科大学学报, 2023, 44(4): 544-549.
[5]	李雪, 冯正田, 郑思思, 段宇航, 吴子遥, 朱虹, 贾竑晓. 广泛性焦虑障碍中医精神症状与躯体症状网络分析研究[J]. 首都医科大学学报, 2023, 44(4): 568-577.
[6]	杨瑜, 阮祥燕, 程姣姣, 许新, Alfred O.Mueck. 单侧及双侧卵巢切除对大鼠脂肪组织及子宫质量的影响[J]. 首都医科大学学报, 2023, 44(4): 524-529.
[7]	王润锦, 叶小波, 张玉冬, 朱光艺, 杨坤, 牛亦农. 不同侵袭模式对T3a肾细胞癌患者预后的影响[J]. 首都医科大学学报, 2023, 44(3): 439-448.
[8]	熊天宇, 牛亦农. 前列腺周围脂肪组织影响前列腺癌发展的机制[J]. 首都医科大学学报, 2023, 44(3): 457-462.