化疗早期开放性根治性膀胱切除术延迟和围手术期输血对无复发生存率的影响：基于围手术期参数的列线图

IF 2.4 3区医学 Q2 UROLOGY & NEPHROLOGY

Asian Journal of Urology Pub Date : 2024-04-01 DOI:10.1016/j.ajur.2022.09.002

Ahmed M. Harraz, Ahmed Elkarta, Mohamed H. Zahran, Ahmed Mosbah, Atallah A. Shaaban, Hassan Abol-Enein

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引用次数: 0

摘要

方法将 1996 年 1 月至 2016 年 12 月间接受开放性膀胱切除术（RC）和回肠导管手术的患者分为开发组（948 人）和验证组（237 人）。根治性膀胱切除术（TTC）的时间定义为症状出现与 RC 之间的时间间隔。通过 Cox 回归获得的独立预测因子的回归系数用于构建提名图。通过曲线下面积、校准图和决策曲线分析评估了验证队列中的鉴别、验证和临床实用性。多变量分析显示，独立预测因子为 TTC（危险比 [HR] 1.07，95% 置信区间 [CI] 1.05-1.08，p<0.001）、PBT（一个单位：HR 1.40，95% CI 1.03-1.90，p=0.03；两个或两个以上单位：HR 1.72，95% CI 1.29-2.29，p<0.001）、双侧肾积水（HR 1.54，95% CI 1.21-1.97，p<0.001）、鳞状细胞癌（HR 0.60，95% CI 0.45-0.81，p=0.001）、pT3-T4（HR 1.77，95% CI 1.41-2.22，p<0.001）、淋巴结状态（HR 1.53，95% CI 1.21-1.95，p<0.001）和淋巴管侵犯（HR 1.28，95% CI 1.01-1.62，p=0.044）。在验证数据集中，1 年、5 年和 10 年 RFS 的曲线下面积分别为 79.3%、69.6% 和 76.2%。校准图显示，预测生存概率与实际生存概率之间存在相当大的对应关系。结论除了标准病理标准外，还利用 TTC 和 PBT 构建了一个具有良好区分度、验证和临床实用性的提名图。

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The impact of chemotherapy-naïve open radical cystectomy delay and perioperative transfusion on the recurrence-free survival: A perioperative parameters-based nomogram

Objective

To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.

Methods

Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.

Results

In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05–1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03–1.90, p=0.03; two or more units: HR 1.72, 95% CI 1.29–2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21–1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45–0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41–2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21–1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01–1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.

Conclusion

A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.

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来源期刊

Asian Journal of Urology UROLOGY & NEPHROLOGY-

CiteScore

4.00

自引率

3.80%

发文量

100

审稿时长

4 weeks

期刊介绍： Asian Journal of Urology (AJUR), launched in October 2014, is an international peer-reviewed Open Access journal jointly founded by Shanghai Association for Science and Technology (SAST) and Second Military Medical University (SMMU). AJUR aims to build a communication platform for international researchers to effectively share scholarly achievements. It focuses on all specialties of urology both scientifically and clinically, with article types widely covering editorials, opinions, perspectives, reviews and mini-reviews, original articles, cases reports, rapid communications, and letters, etc. Fields of particular interest to the journal including, but not limited to: • Surgical oncology • Endourology • Calculi • Female urology • Erectile dysfunction • Infertility • Pediatric urology • Renal transplantation • Reconstructive surgery • Radiology • Pathology • Neurourology.