Changes in Serum Survivin,IFN-γ/IL-4 and NLR After Transurethral Plasma Electrosurgery and Perfusion Chemotherapy for High-risk Cystitis Glandularis and Its Relationship with Recurrence

YUAN Jincheng; LI Fanglong; DU Yabin; ZHAO Xinhong; QIU Jianhong

doi:10.13730/j.issn.2097-2148.2024.05.006

Abstract：Objective To investigate the changes of serum survivin,interferon gamma(IFN-γ)/interleukin-4(IL-4),neutrophil-to-lymphocyte ratio(NLR)and its relationship with recurrence in high-risk cystitis glandularis(CG)after transurethral plasma electrocision and perfusion chemotherapy.Methods A total of 364 patients with high-risk CG ad-mitted to author's hospital from June 2018 to June 2021 were selected as study subjects.All the high-risk CG patients were treated with transurethral plasma electrosurgery and perfusion chemotherapy.The patients were followed up for two years,and they were divided into recurrence group(n=32)and non-recurrence group(n=323)according to the presence of CG in microscopy and biopsy.The clinical efficacy of high-risk CG patients after treatment was analyzed and the chan-ges of serum survivin,IFN-γ/IL-4 and NLR before and after treatment were compared;the clinical data of high-risk CG patients with and without recurrence were compared,the risk factors for recurrence in high-risk CG patients and the pre-dictive value of serum survivin,IFN-γ/IL-4 and NLR for high-risk CG recurrence were analyzed.Results The overall ef-fective rate of transurethral plasma electrosurgery and perfusion chemotherapy was 94.78％.Serum survivin and NLR levels of high-risk CG patients decreased and IFN-γ/IL-4 increased after treatment(all P＜0.05).After two years of follow-up of all the patients,9 patients were lost to fol-low-up and 355 patients remained,of whom 32(9.01％)had recurrence.The proportion of diffuse type of lesion location and serum survivin and NLR levels of high-risk CG patients were higher in the recurrence group than in the non-recurrence group,serum IFN-γ/IL-4 was lower than that in the non-recurrence group(all P＜0.05).Logistic regression analysis showed that serum survivin and NLR were independent risk factors for recurrence after transurethral plasma elec-trocautery and perfusion chemotherapy in high-risk CG patients,and IFN-γ/IL-4 was a protective factor.The area under the curve(AUC)of serum survivin,IFN-γ/IL-4,NLR and the combination of the three for predicting recurrence after transurethral plasma electrosurgery and perfusion chemotherapy for high-risk CG patients were 0.868,0.664,0.712,0.911,and the AUC of combined prediction of the three was higher than that of survivin,IFN-γ/IL-4 and NLR alone.After transurethral plasma electrosurgery and perfusion chemotherapy,the postoperative recurrence rate of high-risk CG patients with serum survivin＞53.2 pg/ml and NLR＞1.99 was higher than that of patients with survivin≤53.2 pg/ml and NLR≤1.99,the postoperative recurrence rate of patients with IFN-γ/IL-4＞3.43 was lower than that of IFN-γ/IL-4≤4.43(Log-rank x2 were 110.369,22.805,52.093 respectively,all P＜0.01).Conclusion Transurethral plasma e-lectrosurgery and perfusion chemotherapy are effective in the treatment of high-risk CG,which can reduce serum survivin and NLR levels,increase IFN-γ/IL-4 and reduce postoperative recurrence rate.