术前丁酰胆碱酯酶作为接受根治性膀胱切除术的肌层浸润性膀胱癌患者生存独立预测指标的意义
Significance of preoperative butyrylcholinesterase as an independent predictor of survival in patients with muscle-invasive bladder cancer treated with radical cystectomy.
作者信息
Koie Takuya, Ohyama Chikara, Yamamoto Hayato, Hatakeyama Shingo, Imai Atsushi, Yoneyama Takahiro, Hashimoto Yasuhiro, Kitayam Masato, Hirota Kazuyoshi
机构信息
Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
出版信息
Urol Oncol. 2014 Aug;32(6):820-5. doi: 10.1016/j.urolonc.2014.03.010. Epub 2014 Jun 18.
OBJECTIVES
Butyrylcholinesterase (BChE) is an alpha-glycoprotein found in the nervous system and liver. Its serum level is reduced in many clinical conditions, such as liver damage, inflammation, injury, infection, malnutrition, and malignant disease. In this study, we analyzed the potential prognostic significance of preoperative BChE levels in patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC).
METHODS AND MATERIALS
We retrospectively evaluated 327 patients with MIBC who underwent RC from 1996 to 2013 at a single institution. Serum BChE level was routinely measured before operation in all patients. Covariates included age, gender, preoperative laboratory data (anemia, BChE, lactate dehydrogenase, and C-reactive protein), clinical T (cT) and N stage (cN), tumor grade, and RC with/without neoadjuvant chemotherapy. Univariate and multivariate analyses were performed to identify clinical factors associated with overall survival (OS) and disease-free survival (DFS). Univariate analyses were performed using the Kaplan-Meier and log-rank methods, and the multivariate analysis was performed using a Cox proportional hazard model.
RESULTS
The median BChE level was 187 U/l (normal range: 168-470 U/l). The median age of the enrolled patients was 69 years, and the median follow-up period was 51 months. The 5-year OS and DFS rates were 69.6% and 69.3%, respectively. The 5-year OS rates were 90.1% and 51.3% in the BChE ≥ 168 and<168 U/l groups, respectively (P<0.001). The 5-year DFS rates were 83.5% and 55.4% in the BChE ≥ 168 and ≤167 U/l groups, respectively (P<0.001). In the univariate analysis, BChE, cT, cN, and RC with/without neoadjuvant chemotherapy were significantly associated with both OS and DFS. Multivariate analysis revealed that BChE was the factor most significantly associated with OS, and BChE, cT, and cN were significantly associated with DFS.
CONCLUSIONS
This study validated preoperative serum BChE levels as an independent prognostic factor for MIBC after RC.
目的
丁酰胆碱酯酶（BChE）是一种存在于神经系统和肝脏中的α-糖蛋白。在许多临床情况下，如肝损伤、炎症、损伤、感染、营养不良和恶性疾病，其血清水平会降低。在本研究中，我们分析了术前BChE水平对接受根治性膀胱切除术（RC）的肌层浸润性膀胱癌（MIBC）患者的潜在预后意义。
方法和材料
我们回顾性评估了1996年至2013年在单一机构接受RC的327例MIBC患者。所有患者术前均常规检测血清BChE水平。协变量包括年龄、性别、术前实验室数据（贫血、BChE、乳酸脱氢酶和C反应蛋白）、临床T（cT）和N分期（cN）、肿瘤分级以及是否接受新辅助化疗的RC。进行单因素和多因素分析以确定与总生存期（OS）和无病生存期（DFS）相关的临床因素。单因素分析采用Kaplan-Meier法和对数秩检验，多因素分析采用Cox比例风险模型。
结果
BChE水平中位数为187 U/l（正常范围：168 - 470 U/l）。入组患者的年龄中位数为69岁，中位随访期为51个月。5年OS率和DFS率分别为69.6%和69.3%。BChE≥168 U/l组和<168 U/l组的5年OS率分别为90.1%和51.3%（P<0.001）。BChE≥168 U/l组和≤167 U/l组的5年DFS率分别为83.5%和55.4%（P<0.001）。在单因素分析中，BChE、cT、cN以及是否接受新辅助化疗的RC均与OS和DFS显著相关。多因素分析显示，BChE是与OS最显著相关的因素，BChE、cT和cN与DFS显著相关。
结论
本研究验证了术前血清BChE水平是RC术后MIBC的独立预后因素。
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