总腰大肌指数与白蛋白-球蛋白评分联合用于预测根治性膀胱切除术后膀胱癌患者的预后：一项基于人群的研究

Combination of Total Psoas Index and Albumin-Globulin Score for the Prognosis Prediction of Bladder Cancer Patients After Radical Cystectomy: A Population-Based Study.

作者信息

Wang Keyi, Gu Yongzhe, Ni Jinliang, Zhang Houliang, Xie Jinbo, Xu Tianyuan, Geng Jiang, Mao Weipu, Peng Bo

机构信息

Department of Urology, Shanghai Shidong Hospital of Yangpu District, Shanghai, China.

Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.

出版信息

Front Oncol. 2021 Sep 20;11:724536. doi: 10.3389/fonc.2021.724536. eCollection 2021.

BACKGROUND

Sarcopenia as the loss of skeletal muscle mass is related with poor postoperative survival. This work purposed to evaluate the prognostic prediction of the total psoas index (TPI), albumin-globulin score (AGS), and the combination of TPI and AGS (CTA) in bladder cancer (BCa) patients after radical cystectomy.

METHODS

BCa patients that received radical cystectomy between 2012 and 2020 were retrieved from our medical center. The calculation of TPI was based on the plain computed tomography images. The predictive effects of TPI, AGS, and CTA grade on survival of BCa patients were analyzed and compared with the albumin-globulin ratio (AGR) through the receiver operating characteristic (ROC) curves. A nomogram was further established based on the Cox regression results from CTA grade and clinicopathological characteristics, which are verified by the decision curve analysis (DCA).

RESULTS

A total of 112 eligible patients diagnosed as BCa were included in this study for retrospective analysis. The patients with lower TPI or higher AGS grade (1/2) contained poorer overall survival (OS) and disease-free survival (DFS). Divided by CTA grade, there were 35 (31.25%) patients in grade 1 associated with the best postoperative prognosis, which was accompanied with increased TPI and decreased AGS. The CTA grade could better predict postoperative outcomes compared with TPI, AGR, and AGS for the highest area under the curve (AUC; 0.674 of OS and 0.681 of DFS). The 3- and 5-year OS and DFS nomograms were conducted based on CTA grade and clinical variables, with a higher predictive performance than the TNM stage.

CONCLUSION

This study revealed that the novel index CTA functioned as an effective prognostic predictor for postoperative OS and DFS of BCa patients after radical cystectomy. Preoperative assessment of CTA would contribute to optimizing clinical therapies.

背景

肌肉减少症作为骨骼肌质量的丧失与术后生存率低相关。本研究旨在评估总腰大肌指数（TPI）、白蛋白 - 球蛋白评分（AGS）以及TPI与AGS的组合（CTA）对膀胱癌（BCa）患者根治性膀胱切除术后的预后预测价值。

方法

从我们的医疗中心检索2012年至2020年间接受根治性膀胱切除术的BCa患者。TPI的计算基于平扫计算机断层扫描图像。通过受试者工作特征（ROC）曲线分析TPI、AGS和CTA分级对BCa患者生存的预测作用，并与白蛋白 - 球蛋白比值（AGR）进行比较。基于CTA分级和临床病理特征的Cox回归结果进一步建立列线图，并通过决策曲线分析（DCA）进行验证。

结果

本研究共纳入112例确诊为BCa的合格患者进行回顾性分析。TPI较低或AGS分级较高（1/2）的患者总体生存率（OS）和无病生存率（DFS）较差。按CTA分级划分，1级有35例（31.25%）患者，其术后预后最佳，同时伴有TPI升高和AGS降低。与TPI、AGR和AGS相比，CTA分级对术后结局的预测能力更好，曲线下面积（AUC）最高（OS为0.674，DFS为0.681）。基于CTA分级和临床变量绘制了3年和5年OS及DFS列线图，其预测性能高于TNM分期。