术前尿可溶性Fas表达在预测非肌层浸润性膀胱癌复发中的价值

目的：探讨术前尿可溶性Fas(soluble Fas，sFas)表达在预测非肌层浸润性膀胱癌(non-muscle invasive bladder cancer，NMIBC)复发中的作用。方法：采用前瞻性研究方法，选取2008年1月至2011年4月期间经手术病理确诊的128例NMIBC患者，采用ELISA法测定手术前尿sFas值。结合多项临床病理参数进行非参数统计分析，采用Kaplan-Meier生存曲线分析尿sFas水平与NMIBC患者复发之间的关系，采用Cox比例风险模型进行分析，筛选影响NMIBC预后的独立因素，构建计算预后指数(prognosis index，PI)的公式。结果：NMIBC患者尿sFas值随着病理分期、分级、欧洲癌症研究与治疗组织(EORTC)膀胱癌预后风险评分表评分的增加而增高(P<0.05)，与年龄和性别无关(P>0.05)。Kaplan-Meier 生存曲线提示，与低sFas组比较，高sFas组的NMIBC复发率明显增高(P<0.001)。经Cox回归模型分析，尿sFas 值、EORTC评分是影响NMIBC预后的独立因素(P<0.05)，计算得到PI公式为0.004×尿sFas值+1.179×EORTC评分。结论：检测尿液sFas表达是预测NMIBC复发的有用指标，值得深入研究。

Value of detection of preoperative urinary soluble Fas expression in predicting the recurrence of non-muscle invasive bladder cancer

Objective: To investigate the clinical value of detection of preoperative urinary soluble Fas (sFas) expression in predicting the recurrence of non-muscle invasive bladder cancer (NMIBC). Methods: We performed a prospective research, which included 128 cases with NMIBC from January 2008 to April 2011. Expression levels of sFas in urine, which was saved at the first morning from preoperative NMIBC patients, were analyzed by ELISA. Clinical and pathological data, European Organization for Research and Treatment of Cancer (EORTC) risk group category, follow-up data and urinary sFas values were collected from each patient, and each prognostic outcome was evaluated by statistical analysis of non-parametric test. Urinary sFas values and recurrence-free probabilities were estimated by the Kaplan-Meier method and compared by the log rank test. Cox proportional hazards regression models were performed to determine the independent predictors of NMIBC recurrence. The prognosis index (PI) was established. Results: The urinary sFas level was significantly elevated in the NMIBC cases with a higher stage or grade or high-risk EORTC group category than in those with a lower stage or grade or low-risk EORTC group category (each P<0.05), regardless of age or gender (P>0.05). Kaplan-Meier analysis revealed a significant increase in incidence of recurrence in the NMIBC patients with high sFas levels in the urine (P<0.001). According to Cox regression analysis, the urinary sFas level and EORTC risk group category (each P<0.05) were the independent predictors of NMIBC recurrence. Based on the outcome of Cox regression, the formula of PI=(0.004×sFas value+1.179×EORTC score) was established. Conclusion: Our study indicates that urinary sFas test may help to identify NMIBC patients at risk of tumor recurrence and it deserves further research.