Farag Christian M, Akosman Sinan, Luu Jennica, Haji-Momenian Shawn, Whalen Michael J
George Washington University School of Medicine, Washington, District of Columbia.
Department of Radiology, George Washington University School of Medicine, Washington, District of Columbia.
Urol Pract. 2023 May;10(3):262-269. doi: 10.1097/UPJ.0000000000000386. Epub 2023 Jan 24.
Nutritional status is an independent predictor of overall survival after radical cystectomy. Various biomarkers of nutritional status are proposed to predict postoperative outcome, including albumin, anemia, thrombocytopenia, and sarcopenia. Recently, a score comprising hemoglobin, albumin, lymphocyte, and platelet counts was postulated as an encompassing biomarker to predict overall survival post-radical cystectomy in a single-institution study. However, cutoffs for hemoglobin, albumin, lymphocyte, and platelet count are not well defined. In this study, we analyzed hemoglobin, albumin, lymphocyte, and platelet count thresholds predicting overall survival and examined the platelet-to-lymphocyte as an additional prognostic biomarker.
Fifty radical cystectomy patients were retrospectively evaluated from 2010-2021. American Society of Anesthesiologists classification, pathological data, and survival were extracted from our institutional registry. Univariable and multivariable Cox regression analysis was fit to the data to predict overall survival.
Median follow-up was 22 (12-54) months. Hemoglobin, albumin, lymphocyte, and platelet count (continuous) was a significant predictor of overall survival on multivariable Cox regression analysis (HR 0.95, 95% CI: 0.90-0.99, = .03), adjusting for Charlson Comorbidity Index, lymphadenopathy (pN >N0), muscle-invasive disease, and neoadjuvant chemotherapy. Optimal hemoglobin, albumin, lymphocyte, and platelet count cutoff was 25.0. Patients with hemoglobin, albumin, lymphocyte, and platelet count <25.0 had inferior overall survival (median, 33 months) vs with those with hemoglobin, albumin, lymphocyte, and platelet count ≥25.0 (median, not reached) ( = .03).
Low hemoglobin, albumin, lymphocyte, and platelet count <25.0 was an independent predictor of inferior overall survival.
营养状况是根治性膀胱切除术后总生存期的独立预测指标。人们提出了各种营养状况生物标志物来预测术后结果，包括白蛋白、贫血、血小板减少和肌肉减少症。最近，在一项单机构研究中，有人假定由血红蛋白、白蛋白、淋巴细胞和血小板计数组成的评分可作为一种综合生物标志物，用于预测根治性膀胱切除术后的总生存期。然而，血红蛋白、白蛋白、淋巴细胞和血小板计数的临界值尚未明确界定。在本研究中，我们分析了预测总生存期的血红蛋白、白蛋白、淋巴细胞和血小板计数阈值，并将血小板与淋巴细胞比值作为一种额外的预后生物标志物进行了研究。
对2010年至2021年期间50例行根治性膀胱切除术的患者进行回顾性评估。从我们机构的登记处提取美国麻醉医师协会分类、病理数据和生存期。对数据进行单变量和多变量Cox回归分析，以预测总生存期。
中位随访时间为22（12 - 54）个月。在多变量Cox回归分析中，血红蛋白、白蛋白、淋巴细胞和血小板计数（连续变量）是总生存期的显著预测指标（风险比0.95，95%置信区间：0.90 - 0.99，P = 0.03），校正了Charlson合并症指数、淋巴结病（pN > N0）、肌层浸润性疾病和新辅助化疗。血红蛋白、白蛋白、淋巴细胞和血小板计数的最佳临界值为25.0。血红蛋白、白蛋白、淋巴细胞和血小板计数<25.0的患者总生存期较差（中位生存期33个月），而血红蛋白、白蛋白、淋巴细胞和血小板计数≥25.0的患者（中位生存期未达到）（P = 0.03）。
血红蛋白、白蛋白、淋巴细胞和血小板计数<25.0是总生存期较差的独立预测指标。
