CAJ | 학술논문

目的建立准确预测非肌层浸润性膀胱尿路上皮癌患者经尿道膀胱肿瘤切除术后肿瘤复发风险的列线图预测模型. 方法以1998-2007年首次诊断为非肌层浸润性膀胱尿路上皮癌的317例患者作为研究对象.通过单变量和多变量Cox比例风险回归分析法对患者的性别、手术时年龄、吸烟史、饮酒史、合并肾衰竭、诊断至手术时间、肿瘤大小、肿瘤数目、病理分级、腔内治疗等预后因素进行分析、筛选,建立预测术后3年、5年内肿瘤复发概率的列线图模型.并对模型的预测准确性进行内部验证和校正. 结果 317例患者术后3年和5年内膀胱肿瘤复发率分别为36.9％(117/317)和43.5％ (138/317).患者性别(RR=0.617,P=0.011)、手术时年龄(RR=1.369,P=0.088)、肿瘤大小(RR=1.474,P =0.030)、肿瘤数目(RR=1.663,P=0.002)、肿瘤病理分级(RR=1.880,P=0.000)和合并肾衰竭(RR=3.646,P=0.000)为有统计学意义的预测因子.预测术后3年和5年内肿瘤复发的列线图模型预测准确性分别为75.2％和68.3％. 结论本研究模型的预测准确性满意,可为患者提供准确的个体化预后风险评估,并为临床制定个体化的治疗、随访方案提供依据.
목적 건립준학예측비기층침윤성방광뇨로상피암환자경뇨도방광종류절제술후종류복발풍험적렬선도예측모형. 방법 이1998-2007년수차진단위비기층침윤성방광뇨로상피암적317례환자작위연구대상.통과단변량화다변량Cox비례풍험회귀분석법대환자적성별、수술시년령、흡연사、음주사、합병신쇠갈、진단지수술시간、종류대소、종류수목、병리분급、강내치료등예후인소진행분석、사선,건립예측술후3년、5년내종류복발개솔적렬선도모형.병대모형적예측준학성진행내부험증화교정. 결과 317례환자술후3년화5년내방광종류복발솔분별위36.9％(117/317)화43.5％ (138/317).환자성별(RR=0.617,P=0.011)、수술시년령(RR=1.369,P=0.088)、종류대소(RR=1.474,P =0.030)、종류수목(RR=1.663,P=0.002)、종류병리분급(RR=1.880,P=0.000)화합병신쇠갈(RR=3.646,P=0.000)위유통계학의의적예측인자.예측술후3년화5년내종류복발적렬선도모형예측준학성분별위75.2％화68.3％. 결론 본연구모형적예측준학성만의,가위환자제공준학적개체화예후풍험평고,병위림상제정개체화적치료、수방방안제공의거.
Objective To develop a nomogram which can accurately predict the disease recurrence risk after the transurethral resection of bladder tumor (TURBT) in patients with non-muscle invasive bladder urothelial carcinoma.Methods There were 317 patients in total with newly diagnosed non-muscle invasive bladder urothelial carcinoma from 1998 to 2007 enrolled in this study.The patient's gender,age,smoking history,drinking history,comorbidity of renal failure,time from diagnosis to operation,tumor size,tumor number,tumor grade,and intravesical therapy served as the predictors of the disease recurrence.Every prognosis factor were analyzed and screened through univariate and multivariate Cox proportional hazard regression statistical analysis,and the nomograms that could be used to predict the 3-year and 5-year recurrence probability after the surgery were developed.And the prediction accuracy of the nomogram had been internal validated and calibrated as well.Results Of the 317 patients,the three-year and five-year disease recurrence rates were 36.9％ (117/317) and 43.5％ (138/317),respectively.The patient's gender (RR=0.617,P=0.011),age (RR=1.369,P=0.088),tumor size (RR=1.474,P=0.030),tumor number (RR =1.663,P =0.002),tumor grade (RR =1.880,P =0.000),and comorbidity of renal failure (RR =3.646,P =0.000) had been proved to be the prognosis factors with significantly statistical difference.The predictive accuracy of the nomograms predicting the 3-year and 5-year disease recurrence after the surgery was 75.2％ and 68.3％,respectively.Conclusion The nomograms can provide individualized accurate risk estimations for patients,and therefore it can provide assured proof to formulate the individualizing treatment and follow-up protocol in clinic.