Clinical Value Of Serum Cholinesterase In Urothelial Carcinoma Of The Bladder

Background and Purpose Serum cholinesterase（Serum CHE）has been reported to affect the prognosis of a variety of cancers,including bladder cancer.Previous studies only evaluated the correlation between pretreated serum CHE and prognosis,but did not evaluate the time curve of serum CHE after surgery and its association with prognosis,and the evaluation indexes were relatively few.In this research,we further investigated the relationship between Serum CHE and urothelial carcinoma of the bladder.Data and Methods 279 cases of bladder urothelial carcinoma were retrospectively analyzed.Clinical data were collected and the expression of serum cholinesterase(Within 1 month before surgery,day 7^th after surgery,day 14^th after surgery,day 30^th after surgery,the 3st months after surgery,the 6st months after surgery,and the a year after surgery)were determined.Follow-up was performed until December 31,2019.The windows SPSS22.0 was used for statistical analysis,and P<0.05 indicated significant statistical significance.Graph Pad Prism 8 is used for drawing.Results Tumor size,squamous cell differentiation were correlated with the differentiation pathological grade and invasion of bladder urothelial carcinoma,respectively.And pathological grade was also related to invasion of bladder urothelial carcinoma.Previous（surgery）history of urothelial carcinoma,tumor size,pathological grade,squamous differentiation,T stage,N stage,and M stage affect the prognosis of those patients.Postoperative adjuvant bladder intracavitary perfusion chemotherapy can prolong the progression-free survival（PFS）of patients with non-muscle invasive bladder urothelial carcinoma（NMIBUC）,and the overall survival（OS）of patients with postoperative recurrence were significantly shortened.The expression of preoperative serum CHE was associated with tumor size,pathological grade,squamous differentiation,invasion,muscle-invasion,lymphnode metastasis,distant metastasis and recurrence of bladder urothelial carcinoma.Logistic multivariate regression analysis identified preoperative serum CHE in the high expression group as an independent protective factor for pathological grade and invasion of bladder urothelial carcinoma.After ROC curve correction,the preoperative serum CHE was of lower value to the pathological grade and invasion of bladder urothelial carcinoma.After surgical treatment,the expression of serum CHE decreased steeply.Then the recovery was compensated slowly and approached the original basic level on average 6 months after surgery.The pretreatment serum cholinesterase was significantly different from that on the 7^th,14^th and 30^th day after surgery,respectively but no significant difference from serum CHE at 3 months,6 months and a year after operation.Subgroup analysis of patients with bladder urothelial carcinoma treated with non-radical cystectomy（Non-RC）and radical cystectomy（RC）were conducted.And serum CHE in the non-RC group decreased to the bottom on the 14^th day after surgery and approached the preoperative baseline level about 3 months later.While serum CHE in the RC group reached the bottom instantly and approached the preoperative baseline level about 6 months after surgery.Compared with the non-RC group,the decrease of serum CHE in the RC group was greater,and the rate of feedback regulation compensation was slower.In the non-RC group,the expression of pretreated serum CHE was significant statistical differences in comparison with it of the 7^th day and the 14^th day after surgery,respectively.While no statistical significance in the expression of preoperative serum CHE compared with it of the 1^st month,the 3rd month,6th month and 1^st year after surgery.In the RC group,significant statistical differences were found in the expression of pretreated serum CHE compared with the serum CHE on the 7^th,the 14th day and the 1st month after surgery,respectively.while no statistical significance in the expression of pretreated serum CHE compared with it at the 3^rd month,the 6^th month and the 1^st year.The low level group of preoperative serum CHE predicted poor prognosis,including poor progression-free survival（PFS）and overall survival（OS）.The prognosis of muscle-invasive bladder urothelial carcinoma（MIBUC）was worse in the group of large decline in serum CHE than in the group of a decreas small decline in serum CHE at 7 days after surgery.COX multivariate regression analysis confirmed that preoperative low level of serum CHE was an independent factor for poor prognosis in patients with MIBUC without distant metastases.And it can be used as a moderately reliable predictor of postoperative recurrence and death for patients with muscle-invasive bladder urothelial carcinoma after ROC curve correction.Conclusion Preoperative serum CHE level was negatively correlated with the pathological grade and invasion of bladder urothelial carcinoma.Serum CHE level decreased precipitously after surgery and then compensated slowly and compensatively to the original basal level about 6 months after surgery.And serum CHE level decreased more rapidly in patients with bladder urothelial carcinoma after radical cystectomy,while the rate of feedback regulation increased more slowly than that in patients without radical cystectomy.The low level group of preoperative serum CHE predicted a poor prognosis in patients with muscle-invasive bladder urothelial carcinoma（MIBUC）without distant metastases.The poor prognosis of patients with MIBUC was related to the large decline group of serum CHE after surgical treatment.