术前营养缺乏对膀胱癌根治性切除术患者死亡率的影响。
Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer.
机构信息
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
出版信息
J Urol. 2011 Jan;185(1):90-6. doi: 10.1016/j.juro.2010.09.021. Epub 2010 Nov 12.
PURPOSE
Poor preoperative nutritional status is a risk factor for adverse outcomes after major surgery. We evaluated the effect of preoperative nutritional deficiency on perioperative mortality and overall survival in patients undergoing radical cystectomy for bladder cancer.
MATERIALS AND METHODS
A total of 538 patients underwent radical cystectomy for urothelial carcinoma between January 2000 and June 2008, and had nutritional parameters documented. Patients with preoperative albumin less than 3.5 gm/dl, body mass index less than 18.5 kg/m(2) or preoperative weight loss greater than 5% of body weight were considered to have nutritional deficiency. Primary outcomes were 90-day mortality and overall survival. Survival was estimated using Kaplan-Meier analysis and compared using the log rank test. Cox proportional hazards models were used for multivariate survival analysis.
RESULTS
Of 538 patients 103 (19%) met the criteria for nutritional deficiency. The 90-day mortality rate was 7.3% overall (39 deaths), with 16.5% in patients with nutritional deficiency and 5.1% in the others (p < 0.01). Nutritional deficiency was a strong predictor of death within 90 days on multivariate analysis (HR 2.91; 95% CI 1.36, 6.23; p < 0.01). Overall survival at 3 years was 44.5% (33.5, 54.9) for nutritionally deficient patients and 67.6% (62.4, 72.2) for those who were nutritionally normal (p < 0.01). On multivariate analysis nutritional deficiency cases had a significantly higher risk of all cause mortality (HR 1.82; 95% CI 1.25, 2.65; p < 0.01).
CONCLUSIONS
Nutritional deficiency, as measured by preoperative weight loss, body mass index and serum albumin, is a strong predictor of 90-day mortality and poor overall survival. Prospective studies are needed to demonstrate the best indices of preoperative nutritional status and whether nutritional intervention can alter the poor prognosis for patients treated with radical cystectomy who have nutritional deficiencies.
目的
术前营养状况不良是大手术后不良结局的危险因素。我们评估了术前营养缺乏对接受根治性膀胱切除术治疗膀胱癌的患者围手术期死亡率和总生存率的影响。
材料与方法
共纳入 538 例 2000 年 1 月至 2008 年 6 月期间因尿路上皮癌接受根治性膀胱切除术的患者，记录了营养参数。术前白蛋白<3.5g/dl、体质指数<18.5kg/m(2)或术前体重减轻>5%的患者被认为存在营养缺乏。主要结局为 90 天死亡率和总生存率。采用 Kaplan-Meier 分析估计生存率，并采用对数秩检验进行比较。采用 Cox 比例风险模型进行多变量生存分析。
结果
538 例患者中，103 例（19%）符合营养缺乏标准。总体 90 天死亡率为 7.3%（39 例死亡），营养缺乏组为 16.5%，无营养缺乏组为 5.1%（p<0.01）。多变量分析显示，营养缺乏是 90 天内死亡的强烈预测因素（HR 2.91；95%CI 1.36，6.23；p<0.01）。营养缺乏组 3 年总生存率为 44.5%（33.5，54.9），无营养缺乏组为 67.6%（62.4，72.2）（p<0.01）。多变量分析显示，营养缺乏组全因死亡率明显更高（HR 1.82；95%CI 1.25，2.65；p<0.01）。
结论
术前体重减轻、体质指数和血清白蛋白等指标衡量的营养缺乏是 90 天死亡率和总体生存率不良的强烈预测因素。需要前瞻性研究来确定术前营养状况的最佳指标，以及营养干预是否可以改变接受根治性膀胱切除术且存在营养缺乏的患者的不良预后。
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