Morozumi Kento, Mitsuzuka Koji, Takai Yuki, Katsumata Yuki, Kuromoto Akito, Hoshi Senji, Numahata Kenji, Arai Yoichi
Department of Urology, Yamagata Prefectural Central Hospital, Yamagata.
Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Medicine (Baltimore). 2019 Jan;98(2):e13962. doi: 10.1097/MD.0000000000013962.
The objective of this study was to evaluate intraoperative hypothermia as a predictor of complication and prognosis in patients with muscle-invasive bladder cancer treated with radical cystectomy.The data of 124 patients treated with radical cystectomy for muscle-invasive bladder cancer in our department, from 2003 to 2016, were retrospectively collected. The patients were divided into 2 groups according to the lowest intraoperative deep body temperature, that is, the hypothermia group (<96.8°F) and the normothermia group (≥96.8°F). Preoperative and intraoperative variables were compared among the 2 groups, and factors associated with complications, recurrences, and survivals were analyzed.Sixty-eight (54.8%) of the 124 patients presented intraoperative hypothermia. There was no significant difference in the patient's characteristics between the 2 groups. Postoperative complications (Clavien-Dindo ≤III) of any types occurred in 15 patients (22.1%) in the hypothermia group, as compared with 8 patients (14.3%) in the normothermia group (P = .27). The hypothermia group had a higher pathologic stage (P = .029) and a higher recurrence rate within 12 months (P = .013), as compared with the normothermia group. Intraoperative hypothermia was an independent prognostic factor for overall survival in all patients (hazard ratio [HR] 2.47; 95% confidence interval [CI], 1.01-2.85; P = .047). When stratified by disease stage, stage II intraoperative hypothermia was an independent prognostic factor for disease-free survival (HR 3.35; 95% CI, 1.27-8.83; P = .015) and overall survival (HR 4.24; 95% CI, 1.38-12.9; P = .011).This study suggests that intraoperative hypothermia could be a significant predictor for recurrence and survival in muscle-invasive bladder cancer treated with radical cystectomy.
本研究的目的是评估术中低体温作为根治性膀胱切除术治疗肌层浸润性膀胱癌患者并发症和预后的预测指标。回顾性收集了2003年至2016年在我科接受根治性膀胱切除术治疗肌层浸润性膀胱癌的124例患者的数据。根据术中最低深部体温将患者分为2组，即低体温组（<96.8°F）和正常体温组（≥96.8°F）。比较两组患者的术前和术中变量，并分析与并发症、复发和生存相关的因素。124例患者中有68例（54.8%）出现术中低体温。两组患者的特征无显著差异。低体温组有15例患者（22.1%）发生任何类型的术后并发症（Clavien-Dindo≤III级），而正常体温组有8例患者（14.3%）发生术后并发症（P = 0.27）。与正常体温组相比，低体温组的病理分期更高（P = 0.029），12个月内的复发率更高（P = 0.013）。术中低体温是所有患者总生存的独立预后因素（风险比[HR] 2.47；95%置信区间[CI]，1.01 - 2.85；P = 0.047）。按疾病分期分层时，II期术中低体温是无病生存（HR 3.35；95% CI，1.27 - 8.83；P = 0.015）和总生存（HR 4.24；95% CI，1.38 - 12.9；P = 0.011）的独立预后因素。本研究表明，术中低体温可能是根治性膀胱切除术治疗肌层浸润性膀胱癌复发和生存的重要预测指标。
