We examined the impact of preoperative plasma potassium levels (PPLs) on outcomes in patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB), hypothesizing that potassium imbalances might influence outcomes. In this retrospective study, 501 UCB patients undergoing RC from 2009 to 2017 at a tertiary center were analyzed. Blood samples collected a week prior to surgery defined normal and abnormal PPL based on institutional standards. We assessed overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), postoperative complications, 30-day mortality, and non-organ confined disease. Kaplan-Meier estimates, Cox proportional hazards, logistic regression, and decision curve analyses (DCA) were employed. 63 (13%) patients had abnormal preoperative PPLs, with 50 (10%) elevated and 13 (2.5%) decreased. In a 59 months median follow-up, 152 (31%) had disease recurrence, 197 (39%) died from any cause, and 119 (24%) from UCB. Multivariable cox regression analyses adjusting for perioperative parameters demonstrated abnormal PPL was associated with worse OS (HR=1.9, =0.009), CSS (HR=2.8, <0.001) and RFS (HR=2.1; =0.007). Elevated preoperative PPLs also demonstrated significant associations with adverse outcomes in OS, CSS, and RFS (all <0.05). In multivariable logistic regression analyses, abnormal and elevated PPLs were not associated with 30-day mortality, major 30-day postoperative complications, positive nodal disease, pT3/4 stage, and non-organ confined disease (all >0.05). Abnormal and elevated preoperative PPLs correlate with adverse oncologic outcomes in UCB patients treated with RC. Pending external validation, preoperative PPLs might be a cost-effective, easily obtainable supplemental biomarker for enriching accuracy of outcome prediction in this highly variable maladie.

中文翻译：

---

术前血浆钾水平对接受根治性膀胱切除术的膀胱癌患者的肿瘤结果、主要并发症和 30 天死亡率的影响

我们研究了术前血浆钾水平 (PPL) 对接受膀胱尿路上皮癌 (UCB) 根治性膀胱切除术 (RC) 的患者结局的影响，假设钾失衡可能会影响结局。在这项回顾性研究中，对 2009 年至 2017 年在三级中心接受 RC 的 501 名 UCB 患者进行了分析。手术前一周采集的血样根据机构标准定义正常和异常 PPL。我们评估了总生存期 (OS)、癌症特异性生存期 (CSS)、无复发生存期 (RFS)、术后并发症、30 天死亡率和非器官局限性疾病。采用了 Kaplan-Meier 估计、Cox 比例风险、逻辑回归和决策曲线分析 (DCA)。 63 例（13%）患者术前 PPL 异常，其中 50 例（10%）升高，13 例（2.5%）降低。在中位随访 59 个月中，152 例 (31%) 出现疾病复发，197 例 (39%) 因任何原因死亡，119 例 (24%) 死于 UCB。调整围手术期参数的多变量 cox 回归分析表明，异常 PPL 与较差的 OS（HR=1.9，=0.009）、CSS（HR=2.8，<0.001）和 RFS（HR=2.1；=0.007）相关。术前 PPL 升高还与 OS、CSS 和 RFS 不良结局显着相关（均 <0.05）。在多变量逻辑回归分析中，异常和升高的 PPL 与 30 天死亡率、主要 30 天术后并发症、阳性淋巴结疾病、pT3/4 分期和非器官局限性疾病无关（均 >0.05）。术前 PPL 异常和升高与接受 RC 治疗的 UCB 患者的不良肿瘤结局相关。在等待外部验证之前，术前 PPL 可能是一种具有成本效益、易于获得的补充生物标志物，可提高这种高度变异性疾病的结果预测的准确性。