Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Tottori-ken, Japan.
Urol Oncol. 2013 Oct;31(7):1343-9. doi: 10.1016/j.urolonc.2011.09.008. Epub 2011 Dec 7.
In order to characterize the significance of immune system function in patients with advanced renal cell carcinoma (RCC), we investigated the interactive relationships among the following parameters: metastatic characteristics, expression of Fas ligand (FasL) in nephrectomized specimens, immunological parameters, and patient's prognosis.
Thirty-five patients with advanced RCC were stratified into 3 groups according to the characteristics of metastasis timing, at first presentation (mFP), within 5 years of nephrectomy (early-recurrence), after 5 years (late-recurrence). Immunological parameters [hemoglobin, lymphocyte count, neutrophil/lymphocyte ratio (NLR), serum albumin, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and Charlson Comorbidity Index], FasL expression in RCC, and patient prognosis from occurrence of metastasis were compared among the groups. Thirty-five patients were also stratified into 2 groups according to FasL positivity and individual parameters. Patient's prognosis and the remaining immunological parameters were compared between groups.
The NLRs of the late-recurrence group were significantly lower than those of the mFP (P = 0.0004) and early-recurrence (P = 0.013) groups. The FasL mRNA positivity of the late-recurrence group was significantly lower than those of the mFP (P = 0.001) and early-recurrence (P = 0.0277) groups. The prognosis of the late-recurrence group was significantly better than that of the early-recurrence group (P = 0.0255). NLRs were significantly lower in the FasL-negative group than in the -positive group (P = 0.0182). The cause-specific survival rates of the ECOG PS 0 group were significantly higher than that of the ECOG PS > 0 group (P < 0.0001).
Our results suggest the associations of the prognosis in advanced RCC with peripheral blood NLR and FasL expression in nephrectomized tumor. The characteristics of lower values of NLR and FasL expression positivity in late-recurrence compared with other metastatic timings suggest strong host immune activity, and may imply relatively long survival. On the other hand, elucidation of the patient's general condition obtained not only by chemical data but also by ECOG PS is crucial in the management of patients with advanced RCC.
为了阐明免疫系统功能在晚期肾细胞癌（RCC）患者中的意义，我们研究了以下参数之间的相互关系：转移特征、肾切除标本中 Fas 配体（FasL）的表达、免疫参数以及患者的预后。
根据转移时间的特征，我们将 35 例晚期 RCC 患者分为 3 组，首次表现（mFP）、肾切除后 5 年内（早期复发）和 5 年后（晚期复发）。比较了各组间免疫参数[血红蛋白、淋巴细胞计数、中性粒细胞/淋巴细胞比值（NLR）、血清白蛋白、东部合作肿瘤组（ECOG）表现状态（PS）和 Charlson 合并症指数]、RCC 中的 FasL 表达以及从转移发生开始患者的预后。根据 FasL 阳性和个体参数，将 35 例患者进一步分为 2 组。比较组间患者的预后和其余免疫参数。
晚期复发组的 NLR 明显低于 mFP（P = 0.0004）和早期复发组（P = 0.013）。晚期复发组的 FasL mRNA 阳性率明显低于 mFP（P = 0.001）和早期复发组（P = 0.0277）。晚期复发组的预后明显好于早期复发组（P = 0.0255）。NLR 在 FasL 阴性组明显低于 FasL 阳性组（P = 0.0182）。ECOG PS 0 组的特定原因生存率明显高于 ECOG PS > 0 组（P < 0.0001）。
我们的结果表明，晚期 RCC 的预后与外周血 NLR 和肾切除肿瘤中 FasL 的表达有关。与其他转移时间相比，晚期复发时 NLR 值和 FasL 表达阳性率较低，提示宿主免疫活性较强，可能意味着生存时间较长。另一方面，不仅通过化学数据，而且通过 ECOG PS 获得患者的一般情况至关重要。
