切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 243 -248. doi: 10.3877/cma.j.issn.1674-3253.2024.03.008

临床研究

纤维蛋白原与白蛋白比值及其列线图模型对非肌层浸润性膀胱癌患者电切术后复发的预测价值
魏微阳1, 杨浩1, 周川鹏1, 王奇1, 黄红星2, 黄亚强2,()   
  1. 1. 524000 湛江,广东医科大学
    2. 528400 广东医科大学附属中山市人民医院泌尿外科
  • 收稿日期:2024-02-18 出版日期:2024-06-01
  • 通信作者: 黄亚强
  • 基金资助:
    广东省中山市科技计划项目(2019B1062)

The value of fibrinogen to albumin ratio and its nomogram model in predicting the recurrence of non-muscle invasive bladder tumor after transurethral resection

Weiyang Wei1, Hao Yang1, Chuanpeng Zhou1, Qi Wang1, Hongxing Huang2, Yaqiang Huang2,()   

  1. 1. Guangdong Medical University, Zhanjiang 524000, China
    2. Department of Urology, Zhongshan City People's Hospital Affiliated to Guangdong Medical University, Guangdong 528400, China
  • Received:2024-02-18 Published:2024-06-01
  • Corresponding author: Yaqiang Huang
引用本文:

魏微阳, 杨浩, 周川鹏, 王奇, 黄红星, 黄亚强. 纤维蛋白原与白蛋白比值及其列线图模型对非肌层浸润性膀胱癌患者电切术后复发的预测价值[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 243-248.

Weiyang Wei, Hao Yang, Chuanpeng Zhou, Qi Wang, Hongxing Huang, Yaqiang Huang. The value of fibrinogen to albumin ratio and its nomogram model in predicting the recurrence of non-muscle invasive bladder tumor after transurethral resection[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 243-248.

目的

探究术前纤维蛋白原与白蛋白比值(FAR)在预测非肌层浸润性膀胱癌(NMIBC)患者TURBT术后复发中的价值,基于FAR构建预测NMIBC患者TURBT术后复发的列线图(nomogram)模型并验证。

方法

回顾性收集2016年9月至2021年12月在广东医科大学附属中山市人民医院诊治的162例NMIBC患者临床资料,使用Cox回归模型筛选NMIBC患者术后复发的独立危险因素并构建nomogram模型。

结果

术前低FAR组患者的无复生存率优于术前高FAR组(P<0.05),且两组在肿瘤数目、病理分级方面差异具有统计学意义(P<0.05)。术前高FAR、肿瘤数量≥8个、临床T1分期、病理高分级是患者NMIBC复发的独立危险因素(P<0.05),由以上4个因素构建的nomogram模型预测NMIBC患者TURBT术后1年、3年、5年无复发生存率的ROC曲线下面积分别为0.87(95%CI:0.81~0.94)、0.80(95%CI:0.70~0.89)、0.73(95%CI:0.56~0.89)。在术后1年、3年、5年,nomogram模型(临床T分期+病理分级+肿瘤数目+FAR)整体临床获益均高于无FAR因素模型(临床T分期+病理分级+肿瘤数目)。

结论

术前高FAR是NMIBC患者TURBT术后复发的独立危险因素,基于FAR构建的nomogram模型可为NMIBC患者TURBT术后的后续治疗及拟定个体化随访方案提供理论依据,在一定程度上指导临床实践。

Objective

To explore the value of preoperative fibrinogen to albumin ratio (FAR) in predicting postoperative recurrence in NMIBC patients after transurethral resection of bladder tumor (TURBT), and to construct a nomogram model for predicting postoperative recurrence in NMIBC patients based on FAR.

Methods

Clinical data from 162 NMIBC patients treated at Zhongshan City People's Hospital Affiliated to Guangdong Medical University from September 2016 to December 2021 was retrospectively analyzed. Cox regression model was used to screen for independent risk factors for postoperative recurrence in NMIBC patients and a nomogram model was constructed.

Results

The no recurrence survival rate of patients in the preoperative low FAR group was better than that in the preoperative high FAR group (P<0.05), and there was a statistically significant difference in tumor number and pathological grading between the two groups (P<0.05). Preoperative high FAR, number of tumors ≥8, clinical T1 stage, and high pathological grade are independent risk factors for recurrence in patients (P<0.05). The nomogram model constructed from the above four factors predicts the ROC area under the curve for 1 year, 3 year, and 5 year recurrence free survival in NMIBC patients after TURBT, with ROC values of 0.87 (95%CI:0.81-0.94), 0.80 (95%CI:0.70-0.89), and 0.73 (95%CI:0.56-0.89), respectively. At 1 year, 3 years, and 5 years after surgery, the overall clinical benefits of the nomogram model (clinical T stage+pathological grade+number of tumors+FAR) were higher than those of the non FAR factor model (clinical T stage+pathological grade+number of tumors).

Conclusions

Preoperative high FAR is an independent risk factor for postoperative recurrence in NMIBC patients undergoing TURBT. The nomogram model constructed based on FAR can provide theoretical basis for the subsequent treatment of NMIBC patients undergoing TURBT and the formulation of personalized follow-up plans, guiding clinical practice to a certain extent.

图1 FAR预测术后复发的ROC曲线图(a)、术前FAR与患者无复发生存期的关系(b)注:FAR为纤维蛋白原与白蛋白比值
表1 162例非肌层浸润性膀胱癌患者临床资料及病理特征分析[例(%)]
表2 非肌层浸润性膀胱癌患者复发的Cox回归单因素及多因素分析
图2 由肿瘤数目、临床T分期、病理分级、术前FAR构建的非肌层浸润性膀胱癌患者术后无复发生存率列线图模型
图3 由肿瘤数目、临床T分期、病理分级、术前FAR构建的非肌层浸润性膀胱癌患者术后无复发生存率列线图模型预测效能的ROC曲线及内部验证注:a为列线图模型预测患者术后1、3、5年无复发生存率的ROC曲线;b为列线图模型的校准图;FAR为纤维蛋白原与白蛋白比值
图4 由肿瘤数目、临床T分期、病理分级、术前FAR构建的非肌层浸润性膀胱癌患者术后无复发生存率列线图模型和由临床T分期、病理分级、肿瘤数目构建的model 2模型预测术后1年(a)、3年(b)、5年(c)年无复发生存率临床获益分析
[1]
李海涛,田军,王东文, 等. 2014年中国肿瘤登记点大陆地区膀胱癌发病率差异分析 [J]. 现代泌尿生殖肿瘤杂志, 2023, 15 (3): 139-143.
[2]
Garg T, Connors JN, Ladd IG, et al. Defining priorities to improve patient experience in non-muscle invasive bladder cancer[J]. Bladder Cancer, 2018, 4(1): 121-128.
[3]
Wang Z, Gao W, Li J, et al. Development and validation of a novel recurrence risk stratification for initial non-muscle invasive bladder cancer in the Han Chinese population[J]. J Cancer, 2020, 11(7): 1668-1678.
[4]
Babjuk M, Böhle A, Burger M, et al. EAU guidelines on non-muscle-invasive urothelial car-cinoma of the bladder: update 2016[J]. Eur Urol, 2017, 71(3): 447-461.
[5]
Kim HS, Jeong CW, Kwak C, et al. Novel nomograms to predict recurrence and progression in primary non-muscle-invasive bladder cancer: validation of predictive efficacy in comparison with European Organization of Research and Treatment of Cancer scoring system[J]. World J Urol, 2019, 37(9): 1867-1877.
[6]
赵静, 石志浩, 苏芳, 等. 外周血纤维蛋白原与白蛋白比值预测晚期非小细胞肺癌一线化疗疗效的价值 [J]. 热带医学杂志, 2023, 23 (9): 1188-1192.
[7]
Matsuda S, Takeuchi H, Kawakubo H, et al. Validation study of fibrinogen and albumin score in esophageal cancer patients who underwent esophagectomy: multicenter prospective cohort study[J]. Ann Surg Oncol, 2021, 28(2): 774-784.
[8]
Wang Y, Chen W, Hu C, et al. Albumin and fibrinogen combined prognostic grade predicts prognosis of patients with prostate cancer[J]. J Cancer, 2017, 8(19): 3992-4001.
[9]
马平, 褚锋. 血浆血栓弹力图与纤维蛋白原及D-二聚体检测对恶性肿瘤患者凝血功能评估的临床价值[J]. 现代检验医学杂志, 2020, 35(2): 72-75.
[10]
Zhang D, Zhou X, Bao W, et al. Plasma fibrinogen levels are correlated with postoperative distant metastasis and prognosis in esophageal squamous cell carcinoma[J]. Oncotarget, 2015, 6(35): 38410-38420.
[11]
Dolan RD, McSorley ST, Horgan PG, et al. The role of the systemic inflammatory response in predicting outcomes in patients with advanced inoperable cancer: systematic review and meta-analysis[J]. Crit Rev Oncol Hematol, 2017, 116: 134-146.
[12]
张鹏, 韩从辉, 刘大闯. 血浆FIB与前列腺癌关系的研究进展[J]. 新医学, 2023, 54(10): 708-711.
[13]
Sharma BK, Mureb D, Murab S, et al. Fibrinogen activates focal adhesion kinase (FAK) promoting colorectal adenocarcinoma growth[J]. J Thromb Haemost, 2021, 19(10): 2480-2494.
[14]
Loftus TJ, Brown MP, Slish JH, et al. Serum levels of prealbumin and albumin for preoper-ative risk stratification[J]. Nutr Clin Pract, 2019, 34(3): 340-348.
[15]
李小峰, 王玺, 卢文杰, 等. 冠状动脉慢性完全闭塞患者纤维蛋白原/白蛋白比值与冠状动脉侧支循环形成的关系[J]. 河南医学研究, 2020, 29(4): 589-592.
[16]
Miao Y, Li S, Yan Q, et al. Prognostic significance of preoperative prognostic nutritional index in epithelial ovarian cancer patients treated with platinum-based chemotherapy[J]. Oncol Res Treat, 2016, 39(11): 712-719.
[17]
Deme D, Telekes A. Prognostic importance of albumin in oncology[J]. Orv Hetil, 2018, 159(3): 96-106.
[18]
Cook WH, Baker JF. Retrospective evaluation of prognostic factors in metastatic spine disease: serum albumin and primary tumour type are key[J]. ANZ J Surg, 2020, 90(6): 1070-1074.
[19]
Cao X, Cui J, Yu T, et al. Fibrinogen/albumin ratio index is an independent prognosis pre-dictor of recurrence-free survival in patients after surgical resection of gastrointestinal stromal tumors[J]. Front Oncol, 2020, 10: 1459.
[20]
Yang Z, Zheng Y, Wu Z, et al. Association between pre-diagnostic serum albumin and cancer risk: results from a prospective population-based study[J]. Cancer Med, 2021, 10(12): 4054-4065.
[21]
McGettrick AF, O’Neill LAJ. The role of HIF in immunity and inflammation[J]. Cell Metab, 2020, 32(4): 524-536.
[22]
Lu S, Liu Z, Zhou X, et al. Preoperative fibrinogen-albumin ratio index (FARI) is a reliable prognosis and chemoradiotherapy sensitivity predictor in locally advanced rectal cancer pa-tients undergoing radical surgery following neoadjuvant chemoradiotherapy[J]. Cancer Manag Res, 2020, 12: 8555-8568.
[23]
Diakos CI, Charles KA, McMillan DC, et al. Cancer-related inflammation and treatment effectiveness[J]. Lancet Oncol, 2014, 15(11): e493-e503.
[24]
Xu Q, Yan Y, Gu S, et al. A novel inflammation-based prognostic score: the fibrino-gen/albumin ratio predicts prognoses of patients after curative resection for hepatocellular carcinoma[J]. J Immunol Res, 2018, 2018: 4925498.
[25]
Wang YY, Liu ZZ, Xu D, et al. Fibrinogen-albumin ratio index (FARI): a more promising inflammation-based prognostic marker for patients undergoing hepatectomy for colorectal liver metastases[J]. Ann Surg Oncol, 2019, 26(11): 3682-3692.
[26]
Liang Y, Wang W, Que Y, et al. Prognostic value of the fibrinogen/albumin ratio (FAR) in patients with operable soft tissue sarcoma[J]. BMC Cancer, 2018, 18(1): 942.
[1] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[2] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[3] 谢田伟, 庞于樊, 吴丽. 超声引导下不同消融术对甲状腺良性结节体积缩减率、复发率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 80-83.
[4] 张钊, 骆成玉, 张树琦, 何平, 李旭斌. 不同术式治疗早期乳腺癌的效果及并发症发生率、复发率比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 494-497.
[5] 屈勤芳, 束方莲. 盆腔器官脱垂患者盆底重建手术后压力性尿失禁发生的影响因素及列线图预测模型构建[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 606-612.
[6] 李伟, 宋子健, 赖衍成, 周睿, 吴涵, 邓龙昕, 陈锐. 人工智能应用于前列腺癌患者预后预测的研究现状及展望[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 541-546.
[7] 皮尔地瓦斯·麦麦提玉素甫, 李慧灵, 艾克拜尔·艾力, 李赞林, 王志, 克力木·阿不都热依木. 生物补片修补巨大复发性腹壁切口疝临床疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 624-628.
[8] 周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[9] 闫亚飞, 范学圣, 张舰, 吴勇. 经腹腹膜前疝修补术治疗复发腹股沟疝的临床效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 552-556.
[10] 公宇, 廖媛, 尚梅. 肝细胞癌TACE术后复发影响因素及预测模型建立[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 818-824.
[11] 焦振东, 惠鹏, 金上博. 三维可视化结合ICG显像技术在腹腔镜肝切除术治疗复发性肝癌中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 859-864.
[12] 杭丽, 张耀辉, 孙文恺. 参菝抗瘤液对结直肠腺瘤性息肉术后肠道功能、炎症指标及复发情况的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 413-416.
[13] 韦巧玲, 黄妍, 赵昌, 宋庆峰, 陈祖毅, 黄莹, 蒙嫦, 黄靖. 肝癌微波消融术后中重度疼痛风险预测列线图模型构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 715-721.
[14] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[15] 郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.
阅读次数
全文


摘要