目的 探讨围手术期控制营养状态(COUNT)评分与预后营养指数(PNI)在膀胱癌(BC)患者预后中的价值。 方法 回顾性分析 2012 年 1 月至 2018 年 12 月首都医科大学附属北京朝阳医院进行手术治疗的膀胱尿路上皮恶性肿瘤 360 例患者 的资料,计算 COUNT 评分及 PNI,利用 Spearman 秩相关检验判断 2 个指标的相关性。 通过绘制 Kaplan-Meier 生存曲线,利用 log-rank 检验单因素分析以及 Cox 比例风险回归模型分析评估 2 个指标对患者总生存(OS)期及肿瘤特异生存(CSS)期的影 响。 结果 COUNT 评分与 PNI 呈现负相关性( r = -0. 505,P<0. 001),高 COUNT 评分与低 PNI 预示患者更低的生存率。 logrank 检验提示,高 COUNT 评分及低 PNI 患者的 OS 和 CSS 显著降低。 多因素 Cox 比例风险回归模型提示,高 COUNT 评分 (HR= 2. 472,95%CI = 1. 213 ~ 5. 040,P = 0. 013)与低 PNI(HR = 2. 760,95%CI = 1. 303 ~ 5. 848,P = 0. 008)是 OS 的独立危险因 素;高 COUNT 评分(HR= 3. 136,95%CI = 1. 417 ~ 6. 940,P = 0. 012)与低 PNI(HR = 2. 619,95%CI = 1. 178 ~ 5. 825,P = 0. 018)同 样是 CSS 的独立危险因素。 结论 COUNT 评分与 PNI 是具有相关性的一组指标,围手术期更高的 COUNT 评分与更低的 PNI 是 BC 患者预后不佳的独立危险因素。

Objective To investigate the prognostic value of the controlling nutritional status COUNT score and the Prognostic nutritional index PNI in predicting the prognosis of patients with bladder cancer BC . Method A retrospective analysis was conducted on 360 patients with urothelial carcinoma of the bladder who underwent surgical treatment in the Department of Urology Beijing Chaoyang Hospital Capital Medical University from January 2012 to December 2018. The COUNT score and PNI were calculated for each patient. The Spearman rank correlation test was used to determine the correlation between the two indicators. The Kaplan-Meier survival curve was plotted and the effects of log-rank test univariate analysis and Cox regression multivariate analysis on overall survival OS and tumor-specific survival CSS were evaluated. Result There was a negative correlation between COUNT score and PNI r = -0. 505 P<0. 001 and high COUNT score and low PNI predicted lower survival rate. Meanwhile the Log-Rank test showed that the OS and CSS of patients in the high COUNT score and low PNI group were significantly reduced. Multivariate Cox regression analysis showed that high COUNT score HR = 2. 472 95% CI = 1. 213- 5. 040 P = 0. 013 and low PNI HR = 2. 760 95%CI = 1. 303-5. 848 P= 0. 008 were independent risk factors for OS. High COUNT score HR= 3. 136 95%CI = 1. 417-6. 940 P= 0. 012 and low PNI HR = 2. 619 95% CI = 1. 178 - 5. 825 P = 0. 018 were also independent risk factors affecting CSS. Conclusion There is a significant correlation between the COUNT score and PNI. A higher COUNT score and a lower PNI during the perioperative period are independent risk factors for poor prognosis in BC patients.