| Objective:This study investigate the relationship between preoperative albumin-to-alkaline Phosphatase Ratio and overall survival(OS)after radical cystectomy of bladder cancer.Methods:We retrospectively analyzed the clinical and follow-up date of patients with bladder cancer who underwent radical cystectomy and urinary diversion and confirmed by pathology in Department of urology surgery of Affiliated Hospital of Qingdao University from 2007.1 to 2015.12.Collecting the clinicopathologic data of 166 patients,including gender,age,body mass index(BMI),tumor size and number,tumor stage,pathological grade,lymph node metastasis,preoperative hydronephrosis,postoperative adjuvant chemotherapy,anesthesia ASA grade,hypertension and diabetes.Cox proportional hazards regression was used to evaluate the relationship between preoperative AAPR and overall survival.Trend test was used to detect the variation trend of risk ratio(HR)among different AAPR groups.Stratified analysis and interaction test were used to analyze the relationship between AAPR and OS under different factors stratified in the population sample.Survival analysis was conducted using the Kaplan-Meier method and the log-rank test to compare the survival rate differences among different AAPR groups.Curve fitting of the generalized additive model is used to show the relationship between AAPR and OS.Results:The 166 patients were followed up for 1-144 months,with a median follow-up of 63 months,71 patients died and 95 survived.The 3-year survival rate was 61%and the 5-year survival rate was 50%.The median serum AAPR level in all patients was 0.59(range:0.03-1.67).AAPR range 0.03-1.67,average 0.62±0.23.Results of univariate Cox regression model revealed that AAPR(HR=0.09,95%CI 0.022～0.391,P=0.001),high AAPR group(HR=0.40,95%CI 0.216-0.742,P=0.003),age(HR=2.42,95%CI 1.294-4.531,P=0.006),tumor size(HR=2.11,95%CI 1.112-4.014,P=0.023),pT3 stage(HR=8.93,95%CI 3.173-25.114,P<0.001),pT4 stage(HR=10.39,95%CI 3.110-34.707,P<0.001),pNi stage(HR=2.80,95%CI 1.422-5.531,P=0.003),pN3 Stage(HR=17.06,95%CI 2.192-132.863,P=0.007),pathological grade(HR=0.30,95%CI 0.113-0.817,P=0.019),hydronephrosis(HR=2.36,95%CI 1.406-3.939,P=0.001),adjuvant chemotherapy(HR=2.66,95%CI 1.674-4.247,P<0.001)were associated with OS.Compared with patients in the lowest tertile of AAPR,the risk for death of patient in the highest tertile decreased by about 59%(HR=0.406,95%CI 0.200-0.822,P=0.012)after adjustment for age,BMI,tumor size,number of tumor,T category,N category,pathological grade,hydronephrosis,ASA level,adjuvant chemotherapy in multiple Cox regression models.Each unit increase in the AAPR was associated with about 80%decreased risk of death(HR=0.199,95%CI 0.051-0.779,P=0.020)after adjusting for the confounding variables.After adjusting for age,BMI,tumor size,number of tumor,T category,N category,pathological grade,hydronephrosis,ASA level,adjuvant chemotherapy,the curve fitting results showed that with the increase of AAPR,the risk of death decreased and the overall survival prolonged.Consistent with the linear trend test results,the relationship between AAPR and OS is linear.Conclusions:AAPR was associated with overall survival of patients who underwent radical cystectomy of bladder cancer.With the increase of preoperative AAPR,the risk of death decreased and the OS was prolonged. |
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