Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
Clin Nutr. 2021 Dec;40(12):5792-5801. doi: 10.1016/j.clnu.2021.10.019. Epub 2021 Nov 1.
To investigate the predictors of response to intravesical Bacillus Calmette-Guerin (BCG) immunotherapy for intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) patients.
We retrospectively analyzed the clinicopathological data of 184 intermediate and high risk NMIBC cases receiving transurethral resection of bladder tumor (TURBT) and intravesical BCG immunotherapy from December 2014 to April 2021 at our center. All patients were divided into BCG responders and non-responders. Multivariate Logistic regression analysis was performed to identify the independent predictors of response to intravesical BCG immunotherapy. Univariate and multivariate Cox regression analyses were applied to explore the independent prognostic factors of recurrence-free survival (RFS). Receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis were also utilized.
The RFS of BCG responders was significantly increased compared with BCG non-responders. Multivariate Cox regression analysis demonstrated that low grade, pTa stage, non-CIS, lower relative visceral fat area (rVFA) and lower systemic immune inflammation index (SII) were independent prognostic factors of increased RFS after intravesical BCG immunotherapy. Multivariate Logistic regression analysis demonstrated that pTa stage, low grade, non-CIS, low rVFA, and low SII were independent predictors of response to intravesical BCG immunotherapy. Kaplan-Meier survival analysis indicated that the RFS of patients in low rVFA group or low SII group was significantly increased in comparison with those in high rVFA group or high SII group. ROC curve analysis showed that the area under ROC (AUC) of including SII and rVFA was significantly increased, indicating that the inclusion of preoperative SII and rVFA could significantly improve the predictive efficiency.
Low grade, pTa stage, non-CIS, preoperative lower rVFA and lower SII were vital independent predictors of response to intravesical BCG immunotherapy and were associated with preferable prognosis in NMIBC patients. The inclusion of preoperative SII and rVFA could significantly improve the predictive efficiency.
探讨预测卡介苗（BCG）膀胱内免疫治疗中高危非肌层浸润性膀胱癌（NMIBC）患者反应的因素。
我们回顾性分析了 2014 年 12 月至 2021 年 4 月期间在我中心接受经尿道膀胱肿瘤切除术（TURBT）和膀胱内 BCG 免疫治疗的 184 例中高危 NMIBC 病例的临床病理资料。所有患者均分为 BCG 应答者和非应答者。采用多因素 Logistic 回归分析识别膀胱内 BCG 免疫治疗反应的独立预测因素。采用单因素和多因素 Cox 回归分析探讨无复发生存（RFS）的独立预后因素。还应用了受试者工作特征（ROC）曲线和 Kaplan-Meier 生存分析。
BCG 应答者的 RFS 明显高于 BCG 无应答者。多因素 Cox 回归分析表明，低级别、pTa 期、非 CIS、较低的相对内脏脂肪面积（rVFA）和较低的全身性免疫炎症指数（SII）是膀胱内 BCG 免疫治疗后 RFS 增加的独立预后因素。多因素 Logistic 回归分析表明，pTa 期、低级别、非 CIS、低 rVFA 和低 SII 是膀胱内 BCG 免疫治疗反应的独立预测因素。Kaplan-Meier 生存分析表明，rVFA 低或 SII 低组患者的 RFS 明显高于 rVFA 高或 SII 高组患者。ROC 曲线分析表明，包括 SII 和 rVFA 的 ROC 曲线下面积（AUC）显著增加，表明术前 SII 和 rVFA 的纳入可显著提高预测效率。
低级别、pTa 期、非 CIS、术前较低的 rVFA 和较低的 SII 是膀胱内 BCG 免疫治疗反应的重要独立预测因素，与 NMIBC 患者的较好预后相关。术前 SII 和 rVFA 的纳入可显著提高预测效率。
