Comparison in effect of two nutritional status scores in evaluating prognosis of high-grade T1 stage bladder cancer
-
摘要:目的 比较营养风险筛查表 2002(NRS-2002)评分和术前控制营养状况(CONUT)评分评估高级别T1期膀胱癌患者预后的效果。方法 本研究纳入96例行经尿道膀胱肿瘤切除术(TURBT)的高级别T1期膀胱癌患者，均行NRS-2002评分。检测术前血清白蛋白、外周淋巴细胞计数和总胆固醇，并计算CONUT评分。根据患者NRS-2002、CONUT评分情况将96例患者分为低NRS组(n=60)和高NRS组(n=36)、低CONUT组(n=53)和高CONUT组(n=43)。比较不同组别患者术后恢复情况和生存状况。结果 高CONUT组及高NRS组下床活动时间、住院时间显著长于低CONUT组及低NRS组，差异有统计学意义(P < 0.05)。生存分析显示，高NRS组和低NRS组无进展生存期(PFS)比较，差异无统计学意义(P>0.05), 但低NRS组总生存期(OS)高于高NRS组，差异有统计学意义(P < 0.05)。低CONUT组PFS及OS均高于高CONUT组，差异有统计学意义(P < 0.05)。NRS评分是OS的相关因素但并非独立影响因素, CONUT评分是PFS及OS的独立影响因素。结论 膀胱癌患者术前NRS及CONUT评分均与预后相关，但CONUT评分预后价值优于NRS评分。Abstract:Objective To compare effect of Nutrition Risk Screening Scale 2002(NRS-2002) and Controlling Nutritional Status (CONUT) score in evaluating prognosis of high-grade T1 stage bladder cancer.Methods A total of 96 cases of high-grade T1 stage bladder cancer treated by transurethral rescetion of bladder tumor (TURBT) were collected. All patients were evaluated by NRS-2002 score. Serum albumin, peripheral lymphocyte count and total cholesterol were measured and CONUT score was calculated. These patients were divided into low NRS group (n=60) and high NRS group (n=36), low CONUT group (n=53) and high CONUT group (n=43) according to conditions of NRS-2002 and CONUT scores. The recovery and survival status of patients in different groups were compared.Results Bed-off ambulance time and hospital stay in the high CONUT group and the high NRS group were significantly longer than those in the low CONUT group and low NRS group (P < 0.05). Survival analysis showed that there was no difference in progression-free survival (PFS) between the high NRS group and low NRS group(P>0.05), but the overall survival (OS) of the low NRS group was significantly better than that of the high NRS group (P < 0.05). PFS and OS in the low CONUT group were significantly higher than those in high CONUT group (P < 0.05). NRS was a related factor but not an independent factor of OS, while CONUT score was an independent factor of both PFS and OS.Conclusion The preoperative NRS and CONUT scores of bladder cancer patients were both correlated with prognosis, but the prognostic value of CONUT score is better than that of NRS score.
-
-
![]()
图 1 不同NRS组和CONUT组患者PFS和OS比较
A: 不同NRS组的PFS; B: 不同NRS组的OS; C: 不同CONUT组的PFS; D: 不同CONUT组的OS。
表 1 不同组别患者临床疗效比较(x±s)[n(%)]
组别 n 术后肠道功能恢复时间/d 下床活动时间/d 住院时间/d 术后并发症 高NRS组 60 4.0±1.2 5.2±1.3* 11.4±2.6* 8(13.3) 低NRS组 36 3.6±1.4 4.6±1.4 9.8±2.9 2(5.6) 高CONUT组 53 4.1±1.6 5.3±1.4# 11.6±2.9# 8(15.1) 低CONUT组 43 3.5±1.3 4.5±1.5 9.6±2.7 2(4.6) 与低NRS组比较, * P＜0.05; 与低CONUT组比较, #P＜0.05。 
下载: 导出CSV
表 2 高级别T1期膀胱癌患者预后的单因素分析
指标 PFS OS 风险比率 95% CI P 风险比率 95% CI P 年龄 1.494 0.628~3.553 0.364 1.833 0.664~5.063 0.242 性别 1.508 0.551~4.126 0.424 1.334 0.427~4.169 0.620 BMI 0.503 0.208~1.215 0.127 0.497 0.180~1.370 0.177 吸烟 1.317 0.556~3.115 0.531 1.173 0.434~3.169 0.752 肿瘤数量(多发) 4.444 1.835~10.760 0.001 3.205 1.191~8.621 0.021 肿瘤直径(≥3 cm/ < 3 cm) 2.202 0.886~5.470 0.089 1.493 0.552~4.043 0.430 合并肾积水 3.383 1.413~8.099 0.006 3.305 1.221~8.944 0.019 合并膀胱结石 0.696 0.254~1.907 0.481 0.507 0.144~1.788 0.291 术后灌注化疗 0.252 0.099~0.646 0.004 0.262 0.088~0.782 0.016 NRS 2.122 0.811~5.551 0.125 3.854 1.079~13.763 0.038 CONUT 4.475 1.490~13.444 0.008 4.519 1.268~16.100 0.020 PFS: 无进展生存期; OS: 总体生存期; BMI: 体质量指数; NRS: 营养风险筛查表; CONUT: 控制营养状况。
下载: 导出CSV
表 3 影响高级别T1期膀胱癌患者PFS的多因素分析
变量 B SE Wald Sig. Exp(B) 95.0% CI 肿瘤数量 1.434 0.463 9.595 0.002 4.194 1.693~10.391 合并肾积水 0.998 0.457 4.775 0.029 2.713 1.108~6.639 术后灌注化疗 -1.250 0.516 5.879 0.015 0.286 0.104~0.787 CONUT 1.554 0.582 7.135 0.008 4.728 1.512~14.783
下载: 导出CSV
表 4 影响高级别T1期膀胱癌患者OS的多因素分析
变量 B SE Wald Sig. Exp(B) 95.0% CI 肿瘤数量 1.163 0.506 5.284 0.022 3.199 1.187~8.625 CONUT 1.505 0.648 5.391 0.020 4.503 1.264~16.037
下载: 导出CSV
-
[1] 郑荣魏, 赵益华, 黄伟, 等. 不同分子分型膀胱癌的临床特征及预后[J]. 温州医科大学学报, 2019, 49(10): 760-764. doi: 10.3969/j.issn.2095-9400.2019.10.012 [2] 徐庆祝, 吴宝军. 淋巴血管侵犯在T1期膀胱尿路上皮癌伴鳞状分化中的意义[J]. 国际生物医学工程杂志, 2019, 42(2): 134-138. doi: 10.3760/cma.j.issn.1673-4181.2019.02.008 [3] 邹义华, 李勇, 张威, 等. 1 470 nm激光经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的疗效观察(附55例报告)[J]. 中国内镜杂志, 2019, 25(12): 80-83. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ201912016.htm [4] 叶英俊, 谢淑萍. 老年食管癌患者放疗期营养状况分析[J]. 中华现代护理杂志, 2016(1): 55-58. doi: 10.3760/cma.j.issn.1674-2907.2016.01.014 [5] AHIKO Y, SHIDA D, HORIE T, et al. Controlling nutritional status (CONUT) score as a preoperative risk assessment index for older patients with colorectal cancer[J]. BMC Cancer, 2019, 19(1): 946. doi: 10.1186/s12885-019-6218-8
[6] 谢桂生, 韦皓棠, 陈丰, 等. 术前控制营养状况评分与根治性切除术加辅助化疗胃癌患者预后的关系[J]. 中华普通外科杂志, 2019, 34(10): 850-854. doi: 10.3760/cma.j.issn.1007-631X.2019.10.008 [7] 常艳, 郑文郁, 陈鄢津, 等. 应用营养风险筛查2002方法对天津市三级甲等医院住院患者营养风险、营养不足筛查、营养支持情况调查[J]. 中华临床营养杂志, 2010, 18(5): 272-275. doi: 10.3760/cma.j.issn.1674-635X.2010.05.003 [8] 李昱亮, 庞建, 魏琪波. 经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的疗效分析[J]. 癌症进展, 2019, 17(11): 1296-1298. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ201911015.htm [9] 佘桂娥, 匡雪春, 石艳辉, 等. 老年胃癌根治术病人术前营养状况与预后及生活质量的关系研究[J]. 实用老年医学, 2018, 32(1): 85-88. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLA201801025.htm [10] 石相如, 王绚璇, 张翔, 等. 老年胃癌患者化疗期营养状况及影响因素[J]. 中国老年学杂志, 2018, 38(21): 5179-5181. doi: 10.3969/j.issn.1005-9202.2018.21.024 [11] 李阿芳, 窦艳娜, 王佩佩, 等. 基线老年营养风险指数对维持性腹膜透析患者预后的评估价值[J]. 中华肾脏病杂志, 2019, 35(11): 841-847. doi: 10.3760/cma.j.issn.1001-7097.2019.11.007 [12] SUN J, WANG D, MEI Y, et al. Value of the prognostic nutritional index in advanced gastric cancer treated with preoperative chemotherapy[J]. J Surg Res, 2017, 209: 37-44. doi: 10.1016/j.jss.2016.09.050
[13] 宋国栋, 王力, 沈洪, 等. 预后营养指数在老年胃癌患者治疗与预后中的意义[J]. 中华普通外科杂志, 2017, 32(04): 293-296. doi: 10.3760/cma.j.issn.1007-631X.2017.04.003 [14] 王苗. 肝细胞癌根治性切除术前客观营养指标的预后价值比较[J]. 世界华人消化杂志, 2019, 640(20): 30-37. https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB201920005.htm [15] 赵珅, 黄峰, 林榕波. 控制营养状态评分评估根治性胃癌切除术患者预后的临床价值[J]. 检验医学与临床, 2020, 17(4): 444-446, 451. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL202004006.htm [16] ZHANG W, WU Y, ZHANG Z, et al. Controlling Nutritional Status score: A new prognostic indicator for patients with oligometastatic prostate cancer[J]. Curr Probl Cancer. 2019, 43(5): 461-470. doi: 10.1016/j.currproblcancer.2019.02.001
计量
- 文章访问数: 181
- HTML全文浏览量: 74
- PDF下载量: 17
苏公网安备 32100302010246号