| Background:Bladder cancer is one of the most common urinary system tumors,About 75%of bladder cancerpatients are non-muscle invasive bladder cancer(NMIBC).At present,the standard treatment method of NMIBC is transurethral resection of bladder tumor(TURBT)combined with postoperative intravesical infusion chemotherapy,but the risk of tumor recurrence and progression is high.Therefore,searching for effective prognostic indicators has important clinical value for NMIBC.In recent years,systemic inflammatory response and hypercoagulable state have been proved to be closely related to the occurrence,development and metastasis of many malignant tumors.Fibrinogen not only plays an important role in the coagulation pathway,but also participates in the progression of inflammation and cancer in the body.The Systemic Immune-inflammatory Index(SII)is composed of peripheral blood lymphocytes,neutrophils and platelet counts,and is an indicator reflecting the local immune response and systemic inflammation of the body.Preoperative plasma Fibrinogen and SII have been shown to have a high predictive value in the prognosis of a variety of tumors.However,Few studies on the prognostic value of preoperative plasma Fibrinogen and SII in patients with NMIBC,and whether the combination of the two indicators is more effective in predicting the prognosis of NMIBC patients has not been reportedObjective:The purpose of this study was to explore the correlation between preoperative plasma Fibrinogenand SII and the clinicopathological features of NMIBC and prognosis,and establishing a nomogram prediction model of postoperative relapse free survival(RFS)of NMIBC patients,so as to provide new biomarker for the prognosis evaluation of NMIBC patients.Methods:The clinical data of 152 patients with NMIBC who received TURBT for the first time in ourhospital were retrospectively analyzed.Receiver operating characteristic(ROC)curve was used to obtain the optimal cut-off values of preoperative plasma Fibrinogen level and SII,patients were divided into high and low groups.Pearson X~2 method was used to analyze the correlation between preoperative plasma Fibrinogen,SII and clinicopathologic features of patients with NMIBC.Survival curve was plotted by Kaplan-Meier method,and comparison between groups was performed by Log-rank test.Using Cox regression model to analyze independent risk factors for postoperative tumor recurrence in NMIBC patients,and R software was used to construct a nomogram to predict the 1-year,3-year and 5-year RFS of patients with NMIBC.The C-index and time-dependent receiver operating characteristic curve(ROC)were used to evaluate the discrimination of the model,and the calibration curve evaluates the calibration of the model.Results:1.Compared with the low Fibrinogen group,patients in the high Fibrinogen group had higher tumor histological grade and more patients treated with postoperative perfusion chemotherapy,and the difference was statistically significant(P<0.05);compared with the low SII group,patients in the high SII group had larger tumor diameter,more pathological T1 stages,and higher histological grade,and the difference was statistically significant(P<0.05).There was a positive correlation between preoperative plasma Fibrinogen and SII(r=0.319,P<0.001).2.The results of Kaplan-Meier survival analysis showed that the RFS of low Fibrinogen group was better than that of high Fibrinogen group,and the RFS of low SII group was better than that of high SII group.Univariate Cox regression analysis showed that Fibrinogen,SII,tumor size,number of tumors,histological grade and pathological T stage were the factors affecting postoperative tumor recurrence.The results of multivariate Cox regression analysis showed that Fibrinogen(HR=2.596,95%CI:1.474-4.575,P=0.001),SII(HR=2.237,95%CI:1.292-3.875,P=0.004),tumor number(HR=2.138,95%CI:1.254-3.644,P=0.005),histological grade(HR=2.595,95%CI:1.537-4.379,P<0.001),and pathological T stage(HR=2.422,95%CI:1.439-4.078,P=0.001)were independent risk factors for postoperative tumor recurrence in NMIBC patients.3.Patients were divided into three groups based on the preoperative levels of plasma Fibrinogen and SII:0 score group(Fibrinogen<3.01g/L and SII<425),1 score group(Fibrinogen≥3.01g/L or SII≥425),2 score group(Fibrinogen≥3.01g/L and SII≥25).Kaplan-Meier survival analysis showed that the higher the score,the worse the RFS of NMIBC patients(P<0.001).Multivariate Cox regression analysis found that the score grouping was an independent risk factor for postoperative RFS in NMIBC patients.The risk of postoperative tumor recurrence in group 1 was 2.632 times higher than that in group 0(HR=2.632,95%CI:1.222-5.667,P=0.013),and the risk of postoperative tumor recurrence in group 2 was 5.994 times higher than that in group 0(HR=5.994,95%CI:2.685-13.158,P<0.001).4.Based on the results of multivariate Cox regression analysis,this study included independent prognostic risk factors such as Fibrinogen,SII,tumor number,histological grade,and pathological T stage,and constructed a column chart prediction model for postoperative RFS in NMIBC patients.The C-index of the column chart is 0.776(95%CI:0.713-0.839),and the area under the 1-year,3-year,and 5-year ROC curves of the model is 0.747,0.841,and 0.830 respectively,indicating that the model has good discrimination.The calibration curve shows a high consistency between the predicted values of 1-year,3-year,and 5-year RFS and the actual observed values.Conclusion:1.Preoperative plasma Fibrinogen level was positively correlated with SII.High preoperative plasma Fibrinogen level or high SII were independent risk factors for poor prognosis in patients with NMIBC,are biomarkers that can predict postoperative RFS in NMIBC patients undergoing TURBT.2.The combination of preoperative plasma Fibrinogen level and SII is more accurate than a single index in predicting the prognosis of NMIBC patients undergoing TURBT,suggesting that for patients with hypercoagulable state and severe inflammation before operation,early intervention and individualized treatment should be emphasized after operation.3.The nomogram constructed in this study has good predictive performance and can accurately evaluate the risk of postoperative tumor recurrence in NMIBC patients,which has certain reference value for clinical application. |
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