Ye Junjiang, Xie Yandong, Ran Biao, Han Ping
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
Front Nutr. 2025 Apr 28;12:1560655. doi: 10.3389/fnut.2025.1560655. eCollection 2025.
There is a lack of prognostic models to predict the outcomes of non-muscle-invasive bladder cancer (NMIBC) patients receiving Bacillus Calmette-Guérin (BCG) immunotherapy. Existing nutritional risk indicators, such as the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI) and Naples prognostic score (NPS), have demonstrated prognostic value in various malignancies. This study aimed to construct novel nutritional risk indexes (NRIs) using peripheral blood markers via Lasso-Cox regression and validate their prognostic value.
The electric medical records in our institution were searched and data of 525 NMIBC patients were collected. The Lasso-Cox regression was employed to screen preoperative blood biomarkers correlated with recurrence-free survival (RFS), time to BCG-treatment failure (TTF), and progression-free survival (PFS). NRIs were developed based on selected markers and validated against GNRI, PNI, NPS, and the EAU2021 risk model using Kaplan-Meier analysis, Cox regression, receiver-operating characteristic (ROC) curves, Concordance index (C-index) and Decision Curve analysis.
Lasso-Cox regression identified distinct blood biomarkers: gamma-glutamyl transpeptidase (GGT), serum total protein (TP), albumin and cholesterol were predictive of tumor recurrence and BCG failure, while GGT, TP, and coefficient variation of red blood cell volume distribution width were linked to tumor progression. Three NRIs-NRITR (RFS), NRIBF (TTF) and NRITP (PFS)-were constructed. The NRIs exhibited prognostic value through Kaplan-Meier analysis. Multivariate Cox analysis confirmed NRITR (HR = 0.38, 95%CI:0.28-0.53), NRIBF (HR = 0.45, 95%CI: 0.30-0.67), and NRITP (HR = 0.38, 95%CI: 0.21-0.69) as independent predictors. Nomograms incorporating NRIs demonstrated superior discriminative performance in predicting RFS (AUC = 0.739, C-index = 0.673), TTF (AUC = 0.795, C-index = 0.767), and PFS (AUC = 0.796, C-index = 0.788), and could bring more net benefit for NMIBC patients.
The Lasso-Cox regression may offer superior value in selecting prognostic biomarkers for NMIBC. The Lasso-Cox regression based NRIs enhance prognostic stratification for BCG-treated NMIBC, outperforming existing blood-based nutritional risk indicators and the EAU2021 model. Incorporation of blood-based nutritional indicators into clinical practice could optimization of personalized NMIBC treatment strategies and clinical decision-making. Further validation is warranted.
缺乏用于预测接受卡介苗（BCG）免疫治疗的非肌肉浸润性膀胱癌（NMIBC）患者预后的模型。现有的营养风险指标，如预后营养指数（PNI）、老年营养风险指数（GNRI）和那不勒斯预后评分（NPS），已在多种恶性肿瘤中显示出预后价值。本研究旨在通过套索-考克斯回归使用外周血标志物构建新的营养风险指数（NRI），并验证其预后价值。
检索了我们机构的电子病历，收集了525例NMIBC患者的数据。采用套索-考克斯回归筛选与无复发生存期（RFS）、卡介苗治疗失败时间（TTF）和无进展生存期（PFS）相关的术前血液生物标志物。基于选定的标志物开发NRI，并使用Kaplan-Meier分析、考克斯回归、受试者工作特征（ROC）曲线、一致性指数（C指数）和决策曲线分析针对GNRI、PNI、NPS和EAU2021风险模型进行验证。
套索-考克斯回归确定了不同的血液生物标志物：γ-谷氨酰转肽酶（GGT）、血清总蛋白（TP）、白蛋白和胆固醇可预测肿瘤复发和卡介苗治疗失败，而GGT、TP和红细胞体积分布宽度的变异系数与肿瘤进展有关。构建了三个NRI——NRITR（RFS）、NRIBF（TTF）和NRITP（PFS）。通过Kaplan-Meier分析，NRI显示出预后价值。多变量考克斯分析证实NRITR（HR = 0.38，95%CI：0.28 - 0.53）、NRIBF（HR = 0.45，95%CI：0.30 - 0.67）和NRITP（HR =
