术前白蛋白与纤维蛋白原比值对非肌层浸润性膀胱癌患者预后的价值

目的:探讨术前白蛋白与纤维蛋白原比值（AFR）与非肌层浸润性膀胱癌患者预后的关系。方法:回顾性分析于我院行经尿道膀胱肿瘤切除术的205名非肌层浸润性膀胱癌患者的临床资料，根据受试者工作曲线确定AFR最佳临界值为12.127，并将患者分为高AFR组（n=136）和低AFR组（n=69）。并分析AFR水平与膀胱癌患者临床资料及预后的关系。构建患者术后无复发列线图，并利用Bootstrap法计算一致性指数（C指数）以及校准曲线对其预测精准度及一致性进行验证。结果:低AFR组患者具有更高的糖尿病患病率、更大的肿瘤体积、更多肿瘤数量以及更差的组织学分级（P<0.05）。低AFR组患者的无复发生存时间较高AFR组明显缩短。COX多因素分析提示肿瘤分化程度（HR=0.530，95%CI:0.314~0.895，P=0.017）及AFR<12.127（HR=0.275，95%CI:0.161~0.471，P<0.001）是影响患者术后复发的独立危险因素。结论:AFR是非肌层浸润性膀胱癌患者的预后不良因素，对预后有一定预测价值。

Prognostic value of preoperative albumin-fibrinogen ratio in patients with non-muscular invasive bladder cancer

Objective:To investigate the significance of the preoperative albumin-fibrinogen ratio (AFR) in evaluating the prognosis of patients with non-muscular invasive bladder cancer (NMIBC).Methods:The clinical data of 205 patients with NMIBC who underwent transurethral resection of bladder tumor in our hospital were retrospectively analyzed.According to the receiver operating curve,the optimal AFR cut-off value was determined to be 12.127,and they were divided into high AFR group (n=136) and low AFR group(n=69).The Kaplan-Meier method was used to draw the survival curve.Log-rank was used to analyze the recurrence-free survival (RFS) of patients between groups.The receiver-operating characteristic (ROC) curve was used to determine the best critical values of AFR.The nomogram was produced to predict the RFS of patients.The concordance index (C-index) was calculated by Bootstrap and the calibration curve determined the prediction accuracy and consistency of nomogram.Results:Compared with the high AFR group,patients in the low AFR group had a higher prevalence of diabetes,a larger tumor size,a greater number of tumors,and a worse tumor differentiation (P<0.05).RFS in the high AFR group was significantly longer than those in the low AFR group.Multivariate COX regression analysis showed that tumor differentiation (HR=0.530,95%CI:0.314~0.895,P=0.017) and AFR<12.127 (HR=0.275,95%CI:0.161~0.471,P<0.001) were independent risk factors affecting postoperative recurrence.Conclusion:Preoperative AFR has a certain predictive value for the prognosis of patients with non-muscular invasive bladder cancer.