膀胱癌患者术后影响因素研究

Study on Postoperative Influencing Factors in Patients with Bladder Cancer

摘要: 目的：探讨膀胱癌患者术后预后的关键影响因素，为临床诊疗提供参考。方法：基于大连医科大学第二医院和南方医科大学南方医院714例膀胱癌术后患者的临床数据，采用机器学习算法XGBoost结合SHAP可解释性分析进行特征重要性排序，结合生存分析(Kaplan-Meier曲线及Cox回归)验证核心影响因素。结果：年龄增长、高T分期(肿瘤侵袭程度深)及淋巴结转移(N分期升高)显著增加术后死亡风险，而白蛋白水平升高可改善预后。生存分析进一步表明，高龄、晚期肿瘤分期及低白蛋白患者生存率显著降低。结论：年龄、肿瘤分期、淋巴结转移及白蛋白水平是膀胱癌术后预后的核心影响因素，临床需针对高危患者优化干预策略。

Abstract: Objective: To investigate the key influencing factors of postoperative prognosis of patients with bladder cancer, and to provide reference for clinical diagnosis and treatment. Methods: Based on the clinical data of 714 postoperative bladder cancer patients in the Second Hospital of Dalian Medical University and Nanfang Hospital of Southern Medical University, the machine learning algorithm XGBoost combined with SHAP interpretability analysis was used to rank the importance of features, and the core influencing factors were verified by survival analysis (Kaplan-Meier curve and Cox regression). Results: Increasing age, high T stage (deep tumor invasion) and lymph node metastasis (increased N stage) significantly increased the risk of postoperative mortality, while increased albumin level improved the prognosis. Survival analysis further showed that the survival rate of patients with advanced age, advanced tumor stage and low albumin was significantly reduced. Conclusion: Age, tumor stage, lymph node metastasis and albumin level are the core influencing factors for the prognosis of bladder cancer after surgery, and it is necessary to optimize the intervention strategy for high-risk patients.