ABSTRACT
Objective To investigate the relationship between preoperative albumin-to-alkaline phosphatase ratio and overall survival (OS) after radical cystectomy of bladder cancer.Methods The clinical date of patients with bladder cancer who underwent radical cystectomy and urinary diversion and confirmed by pathology from Jan 2007 to Dec 2015 were analyzed retrospectively,with 140 cases undergoing laparoscopic surgery and 26 cases undergoing open surgery.There were 148 males and 18 females,aged was 33-85 years,with an ayerage ageof (65.1 ± 9.4) years.There were 55 cases of cutaneous ureterostomy,96 cases of Brick diversior with ileum,and 15 cases of ileal neobladder.The AAPR range 0.03-1.67,with an average 0.62 ± 0.23,and body mass index (BMI) was 16.79-32.65 kg/m2,with an average of (24.00 ± 3.32) kg/m2.There were 33 cases with hydronephrosis and 133 no hydronephrosis,31 cases with hypertension and 135 cases no hypertension,and 14 cases with diabetes and 152 cases no diabetes.Four cases were classified as grade0,65 cases as grade 1,86 cases as grade 2,and 11 cases as grade 3.Based on the preoperative AAPR(0.62 ±0.23),they were divided into three groups,with 55 cases in the low AAPR (0.42 ± 0.09) group,55 cases in the middle AAPR (0.58 ± 0.05) group,and 56 cases in the high AAPR (0.86 ± 0.21)group.Cox proportional hazards regression methodology were used to evaluate the relationship between preoperative AAPR and overall survival.Survival analysis was conducted using the Kaplan-Meier method and compared with the log-rank test.Results 166 patients were followed up for 1-144 months,with a median of 63 months,and 71 cases died and 95 survived.The median serum AAPR level in all cases was 0.59 (range 0.03-1.67).Results of univariate Cox regression model revealed that AAPR(HR =0.09,95％ CI 0.022-0.391,P =0.001),high AAPR (HR=0.40,95％CI0.216-0.742,P=0.003),age (HR =2.42,95％ CI 1.294-4.531,P =0.006),tumor size (HR =2.11,95％ CI 1.112-4.014,P =0.023),pT3 stage (HR=8.93,95％CI3.173-25.114,P＜0.001),pT4 stnge(HR =10.39,95％ CI 3.110-34.707,P ＜0.001),pN1 stage(HR =2.80,95％ CI 1.422-5.531,P =0.003),pN3 stage (HR =17.06,95％ CI2.192-132.863,P =0.007),pathological grade (HR =0.30,95％ CI 0.113-0.817,P =0.019),hydronephrosis (HR =2.36,95 ％ CI 1.406-3.939,P =0.001),adjuvant chemotherapy (HR =2.66,95％ CI 1.674-4.247,P ＜ 0.001)were associated with OS.Compared with patients in the lowest of AAPR,the risk for death in the highest AAPR group decreased about 59％ (HR =0.406,95％ CI 0.200-0.822,P =0.012)after adjustment for age,BMI,tumor size,number of tumor,T category,N category,pathological grade,hydronephrosis,ASA level,adjuvant chemotherapy in multiple Cox regression models.Each unit increase in the AAPR was associated with about 80％ decreased risk of death (HR =0.199,95％ CI 0.051-0.779,P =0.020) after adjusting for the confounding variables.After adjusting for age,BMI,tumor size,number of tumor,T category,N category,pathological grade,hydronephrosis,ASA level,adjuvant chemotherapy,the curve fitting results showed that with the increase of AAPR,the risk of death decreased and the overall survival prolonged.Consistent with the linear trend test results,the relationship between AAPR and OS is linear.Conclusions AAPR was associated with overall survival of patients who underwent radical cystectomy of bladder cancer.
ABSTRACT
Objective To evaluate the efficacy of preoperative aspects and dimensions used for an anatomical (PADUA) scores in determining the surgical approach for T1 stage renal masses.Methods From Jan 2010 to Dec 2012,clinical data of 122 cases (76 males and 46 females),who underwent surgery for T1 stage renal masses,were collected retrospectively.The mean age was 51 years(range 21-81) and mean body mass index was (22.8±3.9) kg/m2.Sixty-three tumors were found in left kidney and 59 in right kidney.Among them,78 patients were diagnosed as T1a stage and 44 patients were T1b stage.In patients with T1a stage,56 received nephron sparing surgery (NSS) and 22 received radical nephrectomy (RN).In patients with T1b stage,21 received NSS and 23 received RN.The PADUA nephrometry score was analyzed to evaluate their relationships to surgical type and the approach of NSS.Results According to the PADUA nephrometry score,the number of low risk,middle risk and high risk patients were 24,62,26,respectively.Inlow risk group,middle risk group and high risk group,the proportion of RN and NSS was 8.3％/ 91.7％,30.6％/69.4％,66.7％/33.3％.In 77 patients received NSS,the unmber of laparoscopic NSS and open NSS was 18 ∶ 4,25 ∶ 18,2 ∶ 10,respectively.The PADUA nephrometry score was significantly associated with the type of surgery (x2 =23.16,P＜0.01),and the NSS approach (x2 =13.57,P＜0.01).Tumor size (HR =2.79 ; 95％ CI,1.29-6.02 ; P＜ 0.01),percentage of tumor deepening into the kidney (HR =3.82; 95％CI,1.77-8.09; P＜0.01),longitudinal (HR=4.00;95％CI,1.83-8.72; P＜0.01),tumor relationships with renal sinus(HR=103.13; 95％CI,21.85-486.81 ; P＜0.01),tumor relationships with urinary collecting system (HR =15.11 ; 95％ CI,5.95-38.35 ; P＜ 0.01),rim tumor location (HR =3.50 ; 95％ CI,1.61-7.59; P＜0.01) were closely related with surgery approach.The correlation coefficients of relationship with renal sinus was highest (r=0.70).Conclusions The PADUA nephrometry score provides a simple,useful and stable system to character the salient renal anatomy and guide the surgery.Low risk group should consider the NSS as the first line therapy.NSS could also be chosen in the middle risk group.However,the renal anatomy in those patients should be referred.RN should be chosen in high risk group.