Sung Hyun Hwan, Jeon Hwang Gyun, Jeong Byong Chang, Seo Seong Il, Jeon Seong Soo, Choi Han-Yong, Lee Hyun Moo
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
BJU Int. 2015 Apr;115(4):587-94. doi: 10.1111/bju.12846. Epub 2014 Dec 7.
To evaluate the clinical significance of preoperative erythrocyte sedimentation rate (ESR) and neutrophil-lymphocyte ratio (NLR) as prognostic factors in patients undergoing radical nephroureterectomy for upper tract urothelial carcinoma (UTUC).
A total of 410 patients were retrospectively reviewed. An elevated NLR was defined as ≥2.5 and a normal ESR was considered to be in the range of 0-22 mm/h in men and 0-27 mm/h in women. Patients were divided into three groups: those with ESR and NLR in the normal range (group 0, n = 168), those with either elevated ESR or elevated NLR (group I, n = 169), and those with both elevated ESR and elevated NLR (group II, n = 73).
The median patient age was 64 years and the median follow-up duration was 40.2 months. In all, 35.6 and 41.2% of patients had elevated NLRs and ESRs, respectively. Group II was associated with advanced tumour status in terms of size, grade, stage, lymph node and margin status (P < 0.05). Preoperative ESR (hazard ratio [HR] 1.784, 95% confidence interval [CI] 1.173-2.712), NLR (HR 1.704, 95% CI 1.136-2.556), and prognostic grouping (HR 2.285, 95% CI 1.397-3.737 for group I; HR 2.962, 95% CI 1.719-5.102 for group II) were independent predictors of progression-free survival (PFS) in the multivariate model (P < 0.05). Prognostic grouping was also an independent prognostic factor for cancer-specific survival (CSS) and overall survival (OS). Time-dependent area under the receiver-operating characteristic curves showed that NLR plus ESR had a greater diagnostic value than NLR alone regarding oncological outcomes (P < 0.05).
Prognostic grouping using ESR and NLR was identified as an independent prognostic marker in patients with UTUC. The addition of ESR improved the prognostic value of NLR alone in predicting oncological outcomes. The combination of preoperative ESR and NLR might be a new prediction tool in patients with UTUC after radical nephroureterectomy.
评估术前红细胞沉降率（ESR）和中性粒细胞与淋巴细胞比值（NLR）作为上尿路尿路上皮癌（UTUC）患者行根治性肾输尿管切除术预后因素的临床意义。
回顾性分析410例患者。NLR升高定义为≥2.5，男性ESR正常范围为0 - 22mm/h，女性为0 - 27mm/h。患者分为三组：ESR和NLR均在正常范围的患者（0组，n = 168）；ESR或NLR升高的患者（I组，n = 169）；ESR和NLR均升高的患者（II组，n = 73）。
患者中位年龄为64岁，中位随访时间为40.2个月。总体而言，分别有35.6%和41.2%的患者NLR和ESR升高。II组在肿瘤大小、分级、分期、淋巴结及切缘状态方面与晚期肿瘤状态相关（P < 0.05）。术前ESR（风险比[HR] 1.784，95%置信区间[CI] 1.173 - 2.712）、NLR（HR 1.704，95% CI 1.136 - 2.556）及预后分组（I组HR 2.285，95% CI 1.397 - 3.737；II组HR 2.962，95% CI 1.719 - 5.102）是多变量模型中无进展生存期（PFS）的独立预测因素（P < 0.05）。预后分组也是癌症特异性生存期（CSS）和总生存期（OS）的独立预后因素。受试者工作特征曲线的时间依赖性曲线下面积显示，就肿瘤学结局而言，NLR加ESR比单独的NLR具有更大的诊断价值（P < 0.05）。
使用ESR和NLR进行预后分组被确定为UTUC患者的独立预后标志物。ESR的加入提高了单独NLR预测肿瘤学结局的预后价值。术前ESR和NLR的联合可能是UTUC患者行根治性肾输尿管切除术后的一种新的预测工具。
