围手术期糖皮质激素与膀胱癌根治性切除术患者的癌症转移和生存的关系：一项单中心回顾性研究。
Association between perioperative glucocorticoids and cancer metastasis and survival in patients undergoing radical cystectomy for urothelial carcinoma of the bladder: A single-center retrospective study.
机构信息
Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Urology, Shanghai Tenth People's Hospital, Anhui Medical University, Hefei, China.
出版信息
Investig Clin Urol. 2020 Jul;61(4):382-389. doi: 10.4111/icu.2020.61.4.382. Epub 2020 May 18.
PURPOSE
Perioperative glucocorticoids have the potential to increase the risk of tumor metastasis. However, the relationship between perioperative glucocorticoids and oncologic outcomes remains controversial. The present study was undertaken to evaluate the association of perioperative glucocorticoids with clinicopathologic outcomes following radical cystectomy (RC).
MATERIALS AND METHODS
We screened and included 185 patients who underwent radical surgery for bladder cancer in our center between 2009 and 2018. The Kaplan-Meier method was applied, and a log-rank test was used to estimate differences in metastasis-free survival (MFS) and overall survival (OS) between the groups. Multivariate Cox proportional hazards regression models were used to analyze any association of glucocorticoids with clinical outcomes.
RESULTS
A total of 76 (41.1%) patients received perioperative glucocorticoids. Median postoperative follow-up was 2.0 years. Kaplan-Meier survival curve indicated that the glucocorticoids group was significantly associated with increased distant MFS (p=0.008) but not with OS. In the multivariate analysis, no significant differences were observed for MFS between the groups. Interestingly, when the variable of blood transfusion was excluded from the multivariate analysis model, we found that patients receiving glucocorticoids were independently associated with worse MFS (hazard ratio, 1.790; p=0.030). Furthermore, the partial correlation analysis showed a significant positive correlation between perioperative glucocorticoids and blood transfusion (r=0.604, p<0.001). In the nontransfusion subgroup, propensity score matching showed that patients receiving glucocorticoids had a higher risk of distant metastasis.
CONCLUSIONS
Perioperative glucocorticoids were associated with a higher rate of distant metastasis in patients undergoing RC for bladder cancer.
目的
围手术期糖皮质激素有可能增加肿瘤转移的风险。然而，围手术期糖皮质激素与肿瘤学结果之间的关系仍存在争议。本研究旨在评估围手术期糖皮质激素与根治性膀胱切除术（RC）后临床病理结果的关系。
材料和方法
我们筛选并纳入了 2009 年至 2018 年在我们中心接受根治性膀胱癌手术的 185 名患者。应用 Kaplan-Meier 法，对数秩检验估计两组之间无转移生存（MFS）和总生存（OS）的差异。多变量 Cox 比例风险回归模型用于分析糖皮质激素与临床结果的任何关联。
结果
共有 76 名（41.1%）患者接受了围手术期糖皮质激素治疗。术后中位随访时间为 2.0 年。Kaplan-Meier 生存曲线表明，糖皮质激素组与远处 MFS 的增加显著相关（p=0.008），但与 OS 无关。多变量分析中，两组之间 MFS 无显著差异。有趣的是，当将输血变量从多变量分析模型中排除时，我们发现接受糖皮质激素治疗的患者与较差的 MFS 独立相关（危险比，1.790；p=0.030）。此外，偏相关分析显示围手术期糖皮质激素与输血之间存在显著正相关（r=0.604，p<0.001）。在非输血亚组中，倾向评分匹配显示接受糖皮质激素治疗的患者远处转移的风险更高。
结论
围手术期糖皮质激素与接受 RC 治疗的膀胱癌患者远处转移发生率增加相关。
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