Department of Urology, Ludwig Maximilian University Munich, Munich, Germany,
Department of Urology, Ludwig Maximilian University Munich, Munich, Germany.
Urol Int. 2020;104(7-8):551-558. doi: 10.1159/000506263. Epub 2020 Feb 28.
Patients' oncological outcome after radical cystectomy (RC) due to urothelial carcinoma of the urinary bladder (UCB) is always up for debate. There is accumulating evidence on the influence of routine blood parameters. We aimed to identify reasonable and easy-to-detect biomarkers, such as preoperative C-reactive protein (CRP) and hemoglobin (Hb) levels, as predictors of overall survival (OS) and cancer-specific survival (CSS) in patients undergoing RC for UCB.
This is a large single-center study in which both preoperative CRP and Hb levels were available in 1,043 patients undergoing RC for UCB from 2004 to 2018 with a median follow-up time of 22 months (mean 38, max. 170). We used the Kaplan-Meier method, log-rank test, and Cox regression models for assessment of OS and CSS. Using our data, we validated an existing outcome prediction score (TNR-C).
Median CRP level was 0.5 mg/dL (IQR 0.2-1.4), and median Hb level was 13.4 g/dL (IQR 11.9-14.7). We found that patients with CRP values above the median reached a significantly lower median survival than those with CRP values below the median (23 vs. 83 months, p < 0.001). The TNR-C score was successfully validated, and we discriminated between 3 risk groups (5-year CSS: 76, 40, and 16% for low, intermediate, and high risk, respectively). We observed a similar outcome for patients with a Hb level below the median: CSS was significantly poorer than with Hb levels above the median (median CSS 27 vs. 91 months, p < 0.001). Multivariant analysis showed CRP and Hb levels to be independent prognostic parameters for CSS and OS.
We found elevated preoperative CRP levels and decreased Hb levels to be independent prognostic factors indicating an unfavorable outcome in patients undergoing RC for UCB and were able to validate the TNR-C score in a large patient cohort. We propose using these routine biomarkers for individual risk stratification and optimization of therapeutic strategies in patients undergoing RC for UCB.
根治性膀胱切除术（RC）后患者的肿瘤学预后一直存在争议。有越来越多的证据表明常规血液参数有影响。我们旨在确定合理且易于检测的生物标志物，例如术前 C 反应蛋白（CRP）和血红蛋白（Hb）水平，作为接受 RC 治疗的膀胱癌患者总体生存（OS）和癌症特异性生存（CSS）的预测指标。
这是一项大型单中心研究，其中 2004 年至 2018 年间有 1043 例接受 RC 治疗的膀胱癌患者术前 CRP 和 Hb 水平均可用，中位随访时间为 22 个月（均值 38，最大值 170）。我们使用 Kaplan-Meier 方法、对数秩检验和 Cox 回归模型评估 OS 和 CSS。使用我们的数据验证了现有的预后预测评分（TNR-C）。
中位 CRP 水平为 0.5mg/dL（IQR 0.2-1.4），中位 Hb 水平为 13.4g/dL（IQR 11.9-14.7）。我们发现 CRP 值高于中位数的患者中位生存期明显低于 CRP 值低于中位数的患者（23 与 83 个月，p<0.001）。TNR-C 评分得到成功验证，我们区分了 3 个风险组（5 年 CSS：低、中、高危分别为 76%、40%和 16%）。我们观察到 Hb 水平低于中位数的患者也有类似的结果：CSS 明显差于 Hb 水平高于中位数的患者（中位 CSS 27 与 91 个月，p<0.001）。多变量分析表明 CRP 和 Hb 水平是 CSS 和 OS 的独立预后因素。
我们发现术前 CRP 水平升高和 Hb 水平降低是接受 RC 治疗的膀胱癌患者不良预后的独立预后因素，并在大型患者队列中验证了 TNR-C 评分。我们建议在接受 RC 治疗的膀胱癌患者中使用这些常规生物标志物进行个体风险分层和治疗策略优化。
