摘要
目的探讨局部晚期膀胱癌患者根治性膀胱切除术后吉西他滨联合顺铂(GC)方案辅助化疗过程中出现耐药的独立危险因素,并构建相关预测模型。方法回顾性分析2013年1月至2024年6月首都医科大学附属北京友谊医院228例局部晚期膀胱癌行根治性膀胱切除术后GC方案辅助化疗患者的临床资料。其中男184例,女44例;年龄(68.8±10.6)岁,体质量指数(24.2±3.6)kg/m^(2)。所有患者根据化疗期间是否出现肿瘤进展分为化疗耐药组(CR)和化疗非耐药组(NCR)。采用独立样本t检验、χ^(2)检验以及非参数检验分析两组患者一般资料情况、化疗过程中相关检查结果的差异。采用多因素线性回归分析对GC方案化疗耐药的独立危险因素。采用倾向性评分匹配两组TNM资料,采用Kaplan-Meier法和log-rank检验比较匹配后两组患者的总生存情况。结果本研究228例中,CR组59例,NCR组169例,其中CR组中位化疗周期为3个周期,NCR组为4个周期。CR组较NCR组患者平均年龄更小[(66.3±9.4)岁与(69.7±10.9)岁],肾移植病史[6.8%(4/59)与0.6%(1/169)]、高血压病[50.8%(30/59)与36.1%(61/169)]、冠心病[23.7%(14/59)与9.5%(16/169)]及肾积水比例[13.6%(8/59)与4.1%(7/169)]更高(均P<0.05)。CR组较NCR组患者T 4期[20.3%(12/59)与5.9%(10/169)]、N_(2)期比例更高[42.4%(25/59)与8.3%(14/169)],初诊时多发病灶比例更高[59.3%(35/59)与26.6%(45/169)],肿瘤最大径更大[2.5(1.5,3.4)cm与1.6(1.2,2.5)cm](均P<0.05)。CR组与NCR组患者长期处于泌尿系感染状态的比例[90.1%(53/59)与7.7%(15/169)]、系统性免疫炎症指数(SII)[991.6(451.0,1577.9)与462.8(309.0,766.7)]、中性粒细胞绝对值[6.5(4.1,7.8)×10^(9)/L与3.9(2.9,5.1)×10^(9)/L]和血小板计数[(220.0±96.2)×10^(9)/L与(191.0±64.8)×10^(9)/L]均较高,白蛋白[(34.3±4.2)g/L与(39.9±3.8)g/L]和白蛋白与球蛋白比值(1.2±0.3与1.3±0.2)均较低,差异均有统计学意义(P<0.05)。多因素线性回归分析结果表明,仅T分期和泌尿系感染为化疗耐药的独立危险因素(P<0.05);膀胱癌患者GC方案化疗的耐药发生概率=[0.155×T分期数值+0.624×(化疗过程中是否有长期泌尿系感染)]×100%(化疗过程中如存在长期泌尿系感染,为1;否则为0)。倾向性评分匹配后,两组生存分析结果显示,NCR组患者中位生存时间(55个月)高于CR组(30个月),差异有统计学意义(P=0.020)。结论本研究结果表明,T分期较高和长期泌尿系感染是局部晚期膀胱癌患者GC方案化疗耐药的独立危险因素,据此构建的多因素线性回归模型可预测化疗耐药概率。
Objective To explore the independent risk factors for chemoresistance during gemcitabine plus cisplatin(GC)adjuvant chemotherapy in patients with locally advanced bladder cancer after radical cystectomy and to construct a related predictive model.Methods The clinical data of 228 patients with locally advanced bladder cancer who received GC chemotherapy after radical cystectomy at Beijing Friendship Hospital,Capital Medical University,from January 2013 to June 2024 were retrospectively analyzed.Among them,184 were males,and 44 were females,with an average age of(68.8±10.6)years and an average body mass index(BMI)of(24.2±3.6)kg/m^(2).According to tumor progression during chemotherapy,patients were divided into a chemotherapy-resistant(CR)group(n=59)and a non-chemotherapy-resistant(NCR)group(n=169).Independent sample t-test,chi-square test,and non-parametric test were used to compare general clinical characteristics and relevant examination results during chemotherapy between the two groups.Multivariate linear regression analysis was used to identify independent risk factors for GC chemoresistance.Propensity score matching(PSM)was used to match the TNM stage data between the two groups,and Kaplan-Meier and log-rank tests were used to compare overall survival(OS)after matching.ResultsThe median number of chemotherapy cycles was 3 in the CR group and 4 in the NCR group.Compared with the NCR group,CR patients were younger[(66.3±9.4)years vs.(69.7±10.9)years],had a higher proportion of kidney transplantation history[6.8%(4/59)vs.0.6%(1/169)],hypertension[50.8%(30/59)vs.36.1%(61/169)],coronary heart disease[23.7%(14/59)vs.9.5%(16/169)],and hydronephrosis[13.6%(8/59)vs.4.1%(7/169)](all P<0.05).CR patients had a higher proportion of T 4 stage[20.3%(12/59)vs.5.9%(10/169)],N_(2) stage[42.4%(25/59)vs.8.3%(14/169)],multifocal tumors at initial diagnosis[59.3%(35/59)vs.26.6%(45/169)],and larger maximum tumor diameter[2.5(1.5,3.4)cm vs.1.6(1.2,2.5)cm](all P<0.05).The CR group showed higher proportions of long-term urinary tract infection(UTI)[90.1%(53/59)vs.7.7%(15/169)],higher systemic immune-inflammation index(SII)[991.6(451.0,1577.9)vs.462.8(309.0,766.7)],absolute neutrophil count[6.5(4.1,7.8)×10^(9)/L vs.3.9(2.9,5.1)×10^(9)/L],and platelet count[(220.0±96.2)×10^(9)/L vs.(191.0±64.8)×10^(9)/L],but lower albumin levels[(34.3±4.2)g/L vs.(39.9±3.8)g/L]and albumin-to-globulin ratio(A/G)[(1.2±0.3)vs.(1.3±0.2)](all P<0.05).Multivariate linear regression analysis identified only T stage and long-term UTI as independent risk factors for GC chemoresistance(P<0.05).The probability of GC chemoresistance in bladder cancer patients was calculated as:P(Chemoresistance)=[0.155×T stage+0.624×(long-term UTI)]×100%(long-term UTI=1 if present during chemotherapy,otherwise=0).After PSM,survival analysis showed that the median OS was significantly higher in the NCR group(55 months)than that in the CR group(30 months)(P=0.020).Conclusions This study demonstrates that advanced T stage and persistent UTI are independent risk factors for GC chemotherapy resistance in locally advanced bladder cancer patients.Based on these findings,a predictive model for chemotherapy resistance probability was constructed using multivariate linear regression analysis.
作者
岳瑞雨
崔美娟
常铭谕
杨博宇
吕竟成
朱一辰
胡新一
Yue Ruiyu;Cui Meijuan;Chang Mingyu;Yang Boyu;Lyu Jingcheng;Zhu Yichen;Hu Xinyi(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中华泌尿外科杂志》
北大核心
2025年第3期173-179,共7页
Chinese Journal of Urology
关键词
膀胱肿瘤
癌
化疗耐药
预测因素
泌尿系感染
Urinary bladder neoplasms
Carcinoma
Chemoresistance
Predictive factors
Urinary tract infection
