Department of Urology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 1600023, Japan.
World J Urol. 2013 Aug;31(4):953-8. doi: 10.1007/s00345-012-0942-x. Epub 2012 Sep 13.
Preoperative elevation of markers of systemic inflammation is associated with a poor outcome in several cancers. The purpose of this study was to evaluate the prognostic significance of preoperative systemic inflammatory markers in patients with non-metastatic upper urinary tract cancer (UUTC).
The records of 84 patients with non-metastatic UUTC who had undergone nephroureterectomy were reviewed, and the associations between preoperative clinical variables and recurrence-free survival (RFS) were analyzed by univariate and multivariate analyses.
Clinical tumor stage, neutrophil count, and neutrophil-to-lymphocyte ratio were significantly associated with RFS in univariate analysis. Multivariate analysis showed that clinical T stage (hazard ratio [HR], 3.009; 95 % confidence interval [CI], 1.149-9.321; p = 0.024) and neutrophil count (HR, 3.521; 95 % CI, 1.423-9.108; p = 0.007) were independent predictors of RFS. The 3-year RFS in patients with a neutrophil count <4,000/μL was significantly higher than that in patients with a neutrophil count ≥ 4,000/μL (82.9 vs. 51.0 %, p = 0.004). Based on clinical T stage (T2 or less vs. T3 or greater) and neutrophil count (<4,000 vs. ≥ 4,000/μL), patients were stratified into 3 groups: low, intermediate, and high risk groups. RFS rates were significantly different between the 3 groups (p = 0.0005).
Preoperative neutrophil count was an independent predictor of RFS in patients with non-metastatic UUTC. Stratification of patients based on neutrophil count and clinical T stage may be valuable for preoperative patient counseling and identifying patients with poor prognosis who may be candidates for neoadjuvant chemotherapy.
多项研究表明，术前全身性炎症标志物升高与多种癌症的不良预后相关。本研究旨在评估术前全身炎症标志物在非转移性上尿路上皮癌（UUTC）患者中的预后意义。
回顾性分析 84 例行肾输尿管切除术的非转移性 UUTC 患者的病历资料，采用单因素和多因素分析方法分析术前临床变量与无复发生存率（RFS）之间的关系。
单因素分析显示，临床肿瘤分期、中性粒细胞计数和中性粒细胞与淋巴细胞比值与 RFS 显著相关。多因素分析显示，临床 T 分期（危险比 [HR]，3.009；95 %置信区间 [CI]，1.149-9.321；p = 0.024）和中性粒细胞计数（HR，3.521；95 % CI，1.423-9.108；p = 0.007）是 RFS 的独立预测因素。中性粒细胞计数 <4,000/μL 的患者 3 年 RFS 显著高于中性粒细胞计数≥4,000/μL 的患者（82.9% vs. 51.0%，p = 0.004）。根据临床 T 分期（T2 或更低 vs. T3 或更高）和中性粒细胞计数（<4,000 vs. ≥4,000/μL），将患者分为低危、中危和高危组。3 组间 RFS 率差异有统计学意义（p = 0.0005）。
术前中性粒细胞计数是非转移性 UUTC 患者 RFS 的独立预测因素。基于中性粒细胞计数和临床 T 分期对患者进行分层可能有助于术前患者咨询，并识别预后不良的患者，这些患者可能是新辅助化疗的候选者。
