Effect of intraoperative hypothermia on postoperative immune function and long-term recurrence in patients with non-muscle invasion bladder cancer in plateau area

doi:10.3877/cma.j.issn.1674-3253.2021.05.008

Abstract

Abstract:

Objective

To explore the effect of intraoperative hypothermia on postoperative immune function and long-term recurrence in patients with non-muscle invasion bladder cancer (NMIBC).

Methods

This study was a prospective study which included 337 NMIBC patients meeting the conditions between January 2015, and December 2019. Patients were divided into hypothermia group and control group according to the lowest body temperature (36℃) during operation. Peripheral venous blood was taken to detect Thl/Th2 intracellular cytokines at 1 h before induction of anesthesia (T0), the end of surgery (T1) and 24 h after operation (T2). The main form of follow-up was telephone follow-up. Endpoint was bladder cancer recurrence.

Results

Of the 337 participants, 158 cases (46.9%) showed intraoperative hypothermia. Compared with the control group, the hypothermia group had a significantly lower level of IFN-γ and IFN-γ/IL-4 at T1, and a significantly lower level of IFN-γand IFN-γ/IL-4 and a significantly higher level of IL-4 at T2. In the control group, 102 patients had recurrence of bladder cancer, and the recurrence-free survival time was 15 (3-48) months. In the hypothermia group, 97 patients had bladder cancer recurrence, and the recurrence-free survival time was 12 (3-60) months. There was no significant difference in the recurrence-free survival curve between the 2 groups (χ²=0.533, P=0.465). For patients with T1, 28 patients had recurrence of bladder cancer, and the recurrence-free survival time was 10.5(3-48) months in the control group, 36 patients had recurrence of bladder cancer, and the recurrence-free survival time was 10.5(3-45)months in the hypothermia group. There was a significant difference in the recurrence-free survival curves between the 2 groups (χ²=5.261, P=0.022). For non-T1 patients, 74 patients had bladder cancer recurrence in the control group, and the recurrence-free survival time was 15(3-48) months. 61 patients had bladder cancer recurrence in the hypothermia group, and the recurrence-free survival time was 12(3-60) months. There was no significant difference in the recurrence-free survival curve between the 2 groups (χ²=0.199, P=0.656). Multivariate Cox regression analysis showed that intraoperative hypothermia was one of the independent risk factors for recurrence [HR:1.153(1.055-3.984), P=0.039].

Conclusions

Intraoperative hypothermia inhibits postoperative cellular immune function in patients with NMIBC is one of risk factors for postoperative recurrence in NMIBC patients with T1. Intraoperative warming has a certain significance for further improving the prognosis of patients with NMIBC.

Key words: Bladder cancer, Hypothermia, Immune function, Recurrence, Prospective study

Hongxia Yang, Xihua Long, Zhaoxia Luo. Effect of intraoperative hypothermia on postoperative immune function and long-term recurrence in patients with non-muscle invasion bladder cancer in plateau area[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(05): 396-400.

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URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2021.05.008

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References 27

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组别	例数	T0时间			T1时间			T2时间
组别	例数	Thl型	Th2型	Thl/Th2	Thl型	Th2型	Thl/Th2	Thl型	Th2型	Thl/Th2
对照组	179	9.8±3.1	3.4±1.1	2.9±1.4	7.2±3.9	4.8±2.0	1.7±0.7	8.5±4.2	5.7±2.8	1.6±0.7
低体温组	158	9.6±3.2	3.5±1.2	3.0±1.3	6.2±3.5	5.2±2.8	1.2±0.5	7.6±2.9	6.5±3.3	1.3±0.6
t值		0.582	0.798	0.677	2.464	1.522	7.455	2.260	2.407	4.196
P值		0.561	0.425	0.499	0.014	0.129	<0.001	0.024	0.017	<0.001

组别	例数	T0时间			T1时间			T2时间
组别	例数	Thl型	Th2型	Thl/Th2	Thl型	Th2型	Thl/Th2	Thl型	Th2型	Thl/Th2
对照组	179	9.8±3.1	3.4±1.1	2.9±1.4	7.2±3.9	4.8±2.0	1.7±0.7	8.5±4.2	5.7±2.8	1.6±0.7
低体温组	158	9.6±3.2	3.5±1.2	3.0±1.3	6.2±3.5	5.2±2.8	1.2±0.5	7.6±2.9	6.5±3.3	1.3±0.6
t值		0.582	0.798	0.677	2.464	1.522	7.455	2.260	2.407	4.196
P值		0.561	0.425	0.499	0.014	0.129	<0.001	0.024	0.017	<0.001

组别	例数	性别(例)		年龄[岁，(±s)]	吸烟史(例)		病理分级(例)		肿瘤直径(例)		肿瘤数目(例)		术中低体温(例)
组别	例数	男	女	年龄[岁，(±s)]	有	无	G1	G2+G3	< 3 cm	≥3 cm	单发	多发	有	无
对照组	64	48	16	69±13	40	24	10	54	31	33	40	24	28	36
低体温组	58	45	13	63±13	30	28	21	37	41	17	46	12	37	21
统计值		χ²=0.112		t=2.276	χ²=1.445		χ²=6.800		χ²=6.229		χ²=4.134		χ²= 4.910
P值		0.738		0.025	0.229		0.009		0.013		0.042		0.027

组别	例数	性别(例)		年龄[岁，(±s)]	吸烟史(例)		病理分级(例)		肿瘤直径(例)		肿瘤数目(例)		术中低体温(例)
组别	例数	男	女	年龄[岁，(±s)]	有	无	G1	G2+G3	< 3 cm	≥3 cm	单发	多发	有	无
对照组	64	48	16	69±13	40	24	10	54	31	33	40	24	28	36
低体温组	58	45	13	63±13	30	28	21	37	41	17	46	12	37	21
统计值		χ²=0.112		t=2.276	χ²=1.445		χ²=6.800		χ²=6.229		χ²=4.134		χ²= 4.910
P值		0.738		0.025	0.229		0.009		0.013		0.042		0.027

指标	年龄（每增加一个标准差）	病理分级（G2+G3 vs G1）	肿瘤直径（≥3 cm vs <3 cm）	肿瘤数目（多发vs单发）	术中低体温（有vs无）
B值	0.182	0.7560	0.6110	0.495	0.477
标准差	0.056	0.1590	0.2100	0.183	0.155
Wald χ²值	2.738	16.563	12.721	9.952	5.743
HR(95%CI)	1.033(0.821~2.759)	1.853(1.326~2.995)	1.411(1.214~3.024)	1.225(1.086~4.313)	1.153(1.055~3.984)
P值	0.389	0.002	0.011	0.026	0.039

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