【摘要】 目的 研究术前炎性指标对高危非肌层浸润性膀胱癌（NMIBC）患者行经尿道膀胱肿瘤电切术（TURBT）后肿瘤复发的预测能力，并构建肿瘤复发预测模型。方法 回顾性分析2023年1月至2023年12月期间于苏州大学附属第一医院手术治疗的高危NMIBC患者数据，共111例患者纳入研究，其中男94例，女17例，年龄72(68,78)岁。随访至2024年4月，根据有无膀胱肿瘤复发将入组患者分为复发组及未复发组，比较两组间临床病理特征的差异，进而通过COX多因素分析寻找肿瘤复发的独立危险因素，绘制诺莫图构建肿瘤复发的预测模型，并利用calibration校准曲线评估模型拟合度。结果 所有患者共随访10(7, 13)个月，其中20例复发患者为复发组，总复发率18.02%,91例未复发患者为未复发组。复发组与未复发组间在肿瘤分期、肿瘤多发性、中性粒淋巴细胞比值（NLR）、血小板淋巴细胞比值（PLR）、淋巴单核细胞比值（LMR）、系统免疫炎症指数（SII）、白蛋白碱性磷酸酶比值（AAPR）、白蛋白纤维蛋白原比值（AFR）方面，差异有统计学意义（P<0.05）。将两组间有差异的影响因素进行COX单因素及多因素分析，发现肿瘤分期（OR=5.577, 95%CI1.214～25.618,P=0.027）、NLR(OR=3.219,95%CI 1.100～9.421,P=0.033)、PLR(OR=1.017,95%CI 1.004～1.030,P=0.011)是高危NMIBC患者TURBT术后肿瘤复发的独立危险因素。基于COX多因素分析结果绘制预测肿瘤复发诺莫图及calibration校准曲线，模型拟合度较好（~χ2=1.314, P=0.726）。结论 肿瘤分期、 NLR、 PLR与高危NMIBC患者行TURBT术后肿瘤复发相关，且由此构建的预测模型有较强的预测能力。更多还原

【Abstract】 Objective To investigate the predictive value of preoperative inflammatory markers for tumor recurrence of highrisk non-muscle-invasive bladder cancer(NMIBC) following transurethral resection of bladder tumor(TURBT), and to develop a prediction model for tumor recurrence. Methods A retrospective analysis was conducted on data from high-risk NMIBC patients, who underwent surgical treatment at the First Affiliated Hospital of Soochow University between January 2023 and December 2023. A total of 111 patients were included in the study, comprising 94 males and 17 females, with a median age of 72(interquartile range: 68-78) years. Patients were followed-up until April 2024. According to whether there was bladder tumor recurrence, the patients were divided into recurrence and non-recurrence groups. Clinical and pathological characteristics between the two groups were compared, and independent risk factors for tumor recurrence were determined through COX multifactorial analysis. A nomogram for predicting tumor recurrence was constructed and the model fit was evaluated using calibration curve. Results The median follow-up period for all patients was 10 months(interquartile range: 7-13 months).Among them, 20 patients experienced recurrence(recurrence group) with an overall recurrence rate of 18.02%, while the remaining 91 patients did not experience recurrence(non-recurrence group). There were statistically significant differences between the recurrence group and the non-recurrence group in tumor stage, tumor multiplicity, neutrophil-lymphocyte ratio(NLR), platelet-lymphocyte ratio(PLR), lymphocyte-monocyte ratio(LMR), systemic immune inflammation index(SII),albumin-alkaline phosphatase ratio(AAPR), and albumin-fibrinogen ratio(AFR)(P<0.05). COX univariate and multivariate analyses revealed that tumor stage(OR=5.577, 95%CI 1.214-25.618, P=0.027), NLR(OR=3.219, 95%CI 1.100-9.421, P=0.033),and PLR(OR=1.017, 95%CI 1.004-1.030, P=0.011) were independent risk factors for tumor recurrence after TURBT in high-risk NMIBC patients. A nomogram was created based on the results of COX multifactorial analysis to predict tumor recurrence, and the calibration curve demonstrate good model fit(χ~2=1.314, P=0.726). Conclusion Tumor stage, NLR and PLR are associated with tumor recurrence after TURBT in high-risk NMIBC patients, and the constructed prediction model has strong predictive capability.更多还原