目的 探讨血清白细胞介素-10(IL-10)水平判断卡介苗(BCG)膀胱灌注治疗T1非肌层浸润性膀胱癌(NMIBC)预后的价值。方法 回顾性分析2017-01至2021-12在联勤保障部队928医院泌尿外科接受BCG膀胱灌注治疗和经尿道膀胱肿瘤电切术(TURBT)的T1期高风险NMIBC的149例患者临床资料。收集患者的一般资料,记录TURBT术前1周患者血常规检查结果。记录并分析术后3个月,膀胱镜检查结果。在BCG诱导治疗前和治疗期间收集血清样本,采用人IL-10酶联免疫吸附测定试剂盒检测血清IL-10水平,并进行对比分析。结果 149例中,有45例在诱导治疗后6个月内复发,视为BCG无应答者。其他104例视为BCG应答者。在膀胱灌注BCG之前(基线)、诱导治疗早期、中期和治疗后,无应答者血清IL-10水平均显著高于应答者(P＜0.05)。基线血清IL-10≥242.55 pg/ml时,预测BCG治疗反应的受试者工作特征曲线下面积(AUC)为0.729,灵敏度为66.70%,特异性为74.0%。从基线到最后一个时间点血清IL-10水平变化也可以良好地区分BCG应答者和无应答者(AUC=0.676)。中位随访42个月,肿瘤复发69例。以GSIL-10中位值将患者分为高危组和低危组。与低危组相比,高危组无复发生存(RFS)时间更短(P＜0.001),RFS率更低(P=0.011)。COX比例风险回归分析证实,基线血清IL-10高水平(HR=2.042,P=0.007)是膀胱内灌注BCG治疗NMIBC患者肿瘤复发的重要变量。结论 血清IL-10可成为一种预测NMIBC对BCG反应和预后的可靠标志物。
Abstract
Objective To investigate the value of serum IL-10 level in evaluating the prognosis of bacillus calmette-guerin (BCG) bladder perfusion therapy in the treatment of T1 non-muscular invasive bladder cancer (NMIBC). Methods A retrospective cohort study was conducted on 149 patients with high-risk T1 NMIBC who received BCG bladder perfusion therapy and transurethral electrotomy for bladder tumor (TURBT) from January 2017 to December 2021. General data of patients were collected and blood routine results of patients with TURBT 1 week before surgery were recorded. The results of cystoscopy were recorded and analyzed 3 months after operation. Serum samples were collected before and during BCG induction therapy, and serum IL-10 levels were detected by human IL-10 enzyme-linked immunosorbent assay kit, and comparative analysis was performed. Results Among 149 cases, 45 cases recurred within 6 months after induction therapy and were considered as non-responders to BCG, and the other 104 patients were considered responders. Serum IL-10 levels in non-responders were significantly higher than those in non-responders before BCG infusion into the bladder (baseline), in the early and middle stages of induction therapy and after treatment (P＜0.05). When baseline serum IL-10≥242.55 pg/ml, the area under the receiver operating characteristic curve (AUC) for predicting BCG treatment response was 0.729, the sensitivity was 66.70%, and the specificity was 74.0%. Changes in serum IL-10 levels from baseline to the last time point also distinguished well between BCG responders and non-responders (AUC=0.676). During a median follow-up of 42 months, 69 cases of tumor recurrence occurred. Patients were divided into high-risk group and low-risk group with median GSIL-10 value. The high risk group had a shorter recurrence-free survival (RFS) (P＜0.001) and a lower RFS rate (P=0.011) than the low risk group. COX proportional hazard regression analysis confirmed that high serum IL-10 level at baseline (HR=2.042, P=0.007) was an important variable for tumor recurrence in patients treated with BCG bladder perfusion. Conclusions Serum IL-10 may be a reliable marker for predicting the response and prognosis of NMIBC to BCG.
关键词
卡介苗膀胱灌注治疗 /
白细胞介素IL-10 /
非肌层浸润性膀胱癌 /
无复发生存 /
治疗反应
Key words
bacillus calmette-guerin bladder perfusion therapy /
interleukin Il-10 /
non-muscular invasive bladder cancer /
recurrence-free survival /
treatment response
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基金
海南省科技项目资助(编号ZDYF2017125)
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