Department of Urology, NYU Langone Medical Center, New York, NY.
Division of Urology and Urologic Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA.
Clin Genitourin Cancer. 2018 Aug;16(4):e807-e815. doi: 10.1016/j.clgc.2018.02.012. Epub 2018 Feb 23.
Nutritional status has been increasingly recognized as an important predictor of prognosis and surgical outcomes for cancer patients. We evaluated the effect of preoperative malnutrition on the development of surgical complications and mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
Using data from the American College of Surgeons National Surgical Quality Improvement Program, we evaluated the association of poor nutritional status with 30-day postoperative complications and overall mortality after RNU from 2005 to 2015. The preoperative variables suggestive of poor nutritional status included hypoalbuminemia (< 3.5 g/dL), weight loss within 6 months before surgery (> 10%), and a low body mass index.
A total of 1200 patients were identified who had undergone RNU for UTUC. The overall complication rate was 20.5% (n = 246), and mortality rate was 1.75% (n = 21). On univariate analysis, patients who experienced a postoperative complication were more likely to have hypoalbuminemia (25.0% vs. 11.4%; P < .001) and weight loss (3.7% vs. 1.0%; P = .003). After controlling for baseline characteristics and comorbidities, hypoalbuminemia was found to be a significant independent predictor of postoperative complications (odds ratio, 2.09; 95% confidence interval, 1.29-3.38; P = .003). Hypoalbuminemia was also a significant independent predictor of mortality (odds ratio, 4.31; 95% confidence interval, 1.45-12.79; P = .008) on multivariable regression analysis.
Our results have shown that hypoalbuminemia is a significant predictor of surgical complications and mortality after RNU for UTUC. This finding supports the importance of patients' preoperative nutritional status in this population and suggests that effective nutritional interventions in the preoperative setting could improve patient outcomes.
营养状况已被越来越多地认为是癌症患者预后和手术结果的重要预测因素。我们评估了术前营养不良对上尿路上皮癌（UTUC）根治性肾输尿管切除术（RNU）后手术并发症和死亡率的发展的影响。
利用美国外科医师学院国家手术质量改进计划的数据，我们评估了 2005 年至 2015 年间，术前营养状况不良与 RNU 术后 30 天内发生的术后并发症和总体死亡率之间的关系。术前提示营养状况不良的变量包括低白蛋白血症（<3.5 g/dL）、手术前 6 个月内体重减轻（>10%）和低体重指数。
共确定了 1200 例接受 RNU 治疗 UTUC 的患者。总的并发症发生率为 20.5%（n=246），死亡率为 1.75%（n=21）。在单因素分析中，发生术后并发症的患者更有可能出现低白蛋白血症（25.0%比 11.4%；P<0.001）和体重减轻（3.7%比 1.0%；P=0.003）。在控制基线特征和合并症后，低白蛋白血症被发现是术后并发症的显著独立预测因子（优势比，2.09；95%置信区间，1.29-3.38；P=0.003）。在多变量回归分析中，低白蛋白血症也是死亡率的显著独立预测因子（优势比，4.31；95%置信区间，1.45-12.79；P=0.008）。
我们的结果表明，低白蛋白血症是 UTUC 根治性肾输尿管切除术后手术并发症和死亡率的显著预测因子。这一发现支持了患者术前营养状况在这一人群中的重要性，并表明术前有效的营养干预可以改善患者的预后。
