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中华腔镜泌尿外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 147 -153. doi: 10.3877/cma.j.issn.1674-3253.2026.02.004

临床研究

凝血酶原时间与膀胱癌患者接受内镜下冷冻消融治疗后复发的相关性分析
宋再桪, 胡锦中, 殷秋萍, 陈艺凌, 党天安, 牟泽中†(), 徐晨阳†(), 姜昊文†()   
  1. 200040　上海，复旦大学附属华山医院泌尿外科
  • 收稿日期:2025-11-23 出版日期:2026-04-01
  • 通信作者: 牟泽中, 徐晨阳, 姜昊文
  • 基金资助:
    国家自然科学基金项目(82373222，82202970); 上海市自然科学基金青年项目(25ZR1402048); 中国博士后科学基金第77批面上资助项目(2025M772172)

Analysis of the correlation between prothrombin time and postoperative recurrence in bladder cancer patients who underwent endoscopic cryoablation therapy

Zaixun Song, Jinzhong Hu, Qiuping Yin, Yiling Chen, Tian'an Dang, Zezhong Mou†(), Chenyang Xu†(), Haowen Jiang†()   

  1. Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2025-11-23 Published:2026-04-01
  • Corresponding author: Zezhong Mou, Chenyang Xu, Haowen Jiang
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引用本文：

宋再桪, 胡锦中, 殷秋萍, 陈艺凌, 党天安, 牟泽中, 徐晨阳, 姜昊文. 凝血酶原时间与膀胱癌患者接受内镜下冷冻消融治疗后复发的相关性分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(02): 147-153.

Zaixun Song, Jinzhong Hu, Qiuping Yin, Yiling Chen, Tian'an Dang, Zezhong Mou, Chenyang Xu, Haowen Jiang. Analysis of the correlation between prothrombin time and postoperative recurrence in bladder cancer patients who underwent endoscopic cryoablation therapy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(02): 147-153.

目的

冷冻消融作为一种微创治疗方式，在膀胱癌中应用广泛，但术后复发率仍较高，缺乏有效预测标志物。本研究旨在探究实验室指标与膀胱癌冷冻消融术后复发风险的相关性。

方法

本研究基于一项多中心、前瞻性、随机对照研究（ChiCTR编号：ChiCTR-INR-17013060）的膀胱癌患者队列进行事后分析。所有患者冷冻消融术后在第7天及4~6周复查实验室指标，并通过超声、膀胱镜进行3年随访，确认复发情况。采用单因素及多因素Logistic回归分析。采用最佳截断值对凝血酶原时间（PT）进行分组，并评估不同分组与临床病理特征之间的关系。

结果

共纳入72例患者，随访期间11例复发。单因素分析显示，年龄（OR=1.082，95%CI：1.008~1.173，P=0.039）、肿瘤数量（OR=2.851，95%CI：1.295~6.773，P=0.011）和术后第7天的PT （OR=0.423，95%CI：0.164~0.889，P=0.043）与复发显著相关。多因素分析证实术后第7天PT缩短为复发的独立危险因素（OR=0.222，95%CI：0.053~0.602，P=0.013）。采用PT截断值12.1 s将患者分组，低PT组患者低级别肿瘤比例更高（P=0.028），血小板水平更高（P=0.014），活化部分凝血活酶时间更短（P<0.001）。

结论

术后第7天PT缩短是膀胱癌冷冻消融术后复发的独立危险因素。

关键词: 冷冻消融, 膀胱肿瘤, 复发, 凝血功能
Objective

Cryoablation, as a minimally invasive treatment, is widely used in bladder cancer. However, postoperative recurrence remains relatively high, and reliable biomarkers for predicting recurrence risk are still lacking. This study aims to explore the correlation between laboratory indicators and recurrence risk after cryoablation of bladder cancer.

Methods

This study is a post-hoc analysis based on a cohort of bladder cancer patients from a multicenter, prospective, randomized controlled trial (ChiCTR registration number: ChiCTR-INR-17013060). All patients underwent laboratory testing on postoperative day 7 and at 4-6 weeks. Recurrence was assessed over a 3-year follow-up period using ultrasound and cystoscopy. Univariate and multivariate Logistic regression analyses were conducted between the recurrence and non-recurrence groups. Patients were grouped according to prothrombin time (PT) using the optimal cutoff value, and the relationship between different groups and clinicopathological characteristics was evaluated.

Results

A total of 72 patients were included, with 11 experiencing recurrence during follow-up. Univariate Logistic regression analysis showed that age (OR=1.082, 95%CI: 1.008-1.173, P=0.039), tumor number (OR=2.851, 95%CI: 1.295-6.773, P=0.011), and PT on postoperative day 7 (OR=0.423, 95%CI: 0.164-0.889, P=0.043) were significantly associated with recurrence. Multivariate analysis identified shortened PT on postoperative day 7 as an independent risk factor of recurrence (OR=0.222, 95%CI: 0.053-0.602, P=0.013). When patients were stratified by a PT cutoff value of 12.1 seconds, patients in the low PT group had a higher proportion of low-grade tumors (P=0.028), higher platelet levels (P=0.014), and shorter activated partial thromboplastin time (P<0.001).

Conclusion

Shortened PT on postoperative day 7 is an independent risk factor of recurrence after bladder cancer cryoablation.

Key words: Cryoablation, Bladder cancer, Recurrence, Coagulation
图1 膀胱癌内镜下球囊冷冻消融关键步骤注：a示TURBt后的创面基底；b示冷冻消融导管球囊末端在膀胱镜直视下稳定定位于肿瘤床；c示球囊充盈并进行冷冻，形成冰球覆盖肿瘤床及周缘；d示完成冷冻循环并复温后创面情况
表1 冷冻消融术后7 d Logistic回归分析评估膀胱癌患者复发的危险因素
变量 单因素Logistic回归分析 多因素Logistic回归分析
OR 95%CI P值 OR 95%CI P值
年龄 1.082 1.008~1.173 0.039 1.045 0.999~1.232 0.051
性别 0.510 0.026~3.144 0.542      
BMI 0.796 0.574~1.052 0.128      
肿瘤数量 2.851 1.295~6.773 0.011 2.820 1.085~8.140 0.039
肿瘤最大径 1.611 0.679~3.967 0.281      
红细胞 0.549 0.144~2.093 0.369      
血红蛋白 0.979 0.929~1.028 0.401      
白细胞 1.067 0.879~1.289 0.497      
血小板 1.002 0.992~1.012 0.624      
凝血酶原时间 0.423 0.164~0.889 0.043 0.222 0.053~0.602 0.013
凝血酶时间 1.023 0.521~1.950 0.944      
活化部分凝血活酶时间 0.891 0.750~1.022 0.140      
纤维蛋白原 1.001 0.996~1.005 0.760      
谷丙转氨酶 0.960 0.885~1.013 0.249      
谷草转氨酶 0.958 0.833~1.059 0.475      
总胆红素 0.986 0.900~1.046 0.710      
肌酐 0.981 0.936~1.017 0.353      
表2 冷冻消融术后4~6周单因素Logistic回归分析评估膀胱癌患者复发的危险因素
变量 单因素Logistic回归分析
OR 95%CI P值
年龄 1.070 1.002~1.142 0.043
性别 2.120 0.271~16.576 0.474
BMI 0.806 0.616~1.054 0.115
肿瘤数量 2.705 1.334~5.485 0.006
肿瘤最大径 1.576 0.713~3.486 0.261
红细胞 0.295 0.070~1.124 0.077
血红蛋白 0.954 0.905~1.002 0.063
白细胞 0.684 0.395~1.069 0.141
血小板 1.000 0.989~1.009 0.944
凝血酶原时间 0.559 0.236~1.055 0.139
凝血酶时间 1.795 0.974~3.530 0.070
活化部分凝血活酶时间 0.892 0.757~1.014 0.119
纤维蛋白原 1.001 0.997~1.005 0.635
谷丙转氨酶 0.908 0.805~0.991 0.071
谷草转氨酶 0.954 0.834~1.057 0.433
总胆红素 0.968 0.830~1.089 0.630
肌酐 0.988 0.953~1.017 0.484
表3 不同凝血酶原时间组患者临床及病理特征比较
组别 例数 年龄[岁，(±s)] 性别(例) BMI[kg/m2，(±s)] 肿瘤数量[个，(±s)] 肿瘤最大径[cm，(±s)] 复发评分[分，(±s)]
男 女
高凝血酶原时间(>12.1 s)组 23 68.73±9.58 22 1 23.41±2.31 1.70±0.82 1.98±0.70 4.17±2.96
低凝血酶原时间(≤12.1 s)组 49 64.77±10.62 39 10 23.54±2.51 1.55±0.77 1.84±0.77 3.10±2.84
统计值   t=1.587 - t=-0.179 t=0.711 t=0.754 t=1.558
P值   0.119 0.093 0.859 0.481 0.455 0.127
组别 病理分期(例) 病理分级(例) 尿pH[(±s)] 尿比重[(±s)]
T1 Ta T2a 高级别 低级别 具低度恶性潜能的乳头状尿路上皮肿瘤
高凝血酶原时间(>12.1 s)组 15 6 2 16 7 0 6.13±0.94 1.02±0.01
低凝血酶原时间(≤12.1 s)组 37 12 0 18 28 3 5.88±0.61 1.02±0.01
统计值 - - t=1.175 t=0.004
P值 0.128 0.028 0.249 0.997
组别 红细胞[×1012/L，(±s)] 血红蛋白[g/L，(±s)] 白细胞[×109/L，(±s)] 血小板[×109/L，(±s)] 凝血酶时间[s，(±s)] 活化部分凝血活酶时间[s，(±s)]
高凝血酶原时间(>12.1 s)组 4.21±0.56 128.57±13.88 11.41±3.85 184.61±45.16 16.73±1.00 31.43±6.23
低凝血酶原时间(≤12.1 s)组 4.33±0.43 132.96±12.97 10.29±3.06 219.08±69.75 16.58±1.00 25.84±3.94
统计值 t=-0.946 t=-1.279 t=1.219 t=-2.515 t=0.580 t=3.956
P值 0.351 0.208 0.231 0.014 0.565 <0.001
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