Viers Boyd R, Houston Thompson Robert, Boorjian Stephen A, Lohse Christine M, Leibovich Bradley C, Tollefson Matthew K
Department of Urology, Mayo Clinic, Rochester, MN.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
Urol Oncol. 2014 Nov;32(8):1277-84. doi: 10.1016/j.urolonc.2014.05.014. Epub 2014 Jul 10.
The neutrophil-lymphocyte ratio (NLR) is an indicator of the systemic inflammatory response. An increased pretreatment NLR has been associated with adverse outcomes in other malignancies, but its role in localized (M0) clear cell renal cell carcinoma (ccRCC) remains unclear. As such, we evaluated the ability of preoperative NLR to predict oncologic outcomes in patients with M0 ccRCC undergoing radical nephrectomy (RN).
From 1995 to 2008, 952 patients underwent RN for M0 ccRCC. Of these, 827 (87%) had pretreatment NLR collected within 90 days before RN. Metastasis-free, cancer-specific, and overall survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate models were used to analyze the association of NLR with clinicopathologic outcomes.
At a median follow-up of 9.3 years, 302, 233, and 436 patients had distant metastasis, death from ccRCC, and all-cause mortality, respectively. Higher NLR was associated with larger tumor size, higher nuclear grade, histologic tumor necrosis, and sarcomatoid differentiation (all, P < 0.001). A NLR ≥ 4.0 was significantly associated with worse 5-year cancer-specific (66% vs. 85%) and overall survival (66% vs. 85%). Finally, after controlling for clinicopathologic features, NLR remained independently associated with risks of death from ccRCC and all-cause mortality (hazard ratio for 1-unit increase: 1.02, P < 0.01).
Our results suggest that NLR is independently associated with increased risks of cancer-specific and all-cause mortality among patients with M0 ccRCC undergoing RN. Accordingly, NLR, an easily obtained marker of biologically aggressive ccRCC, may be useful in preoperative patient risk stratification.
中性粒细胞与淋巴细胞比值（NLR）是全身炎症反应的一个指标。术前NLR升高与其他恶性肿瘤的不良预后相关，但其在局限性（M0）透明细胞肾细胞癌（ccRCC）中的作用仍不明确。因此，我们评估了术前NLR对接受根治性肾切除术（RN）的M0 ccRCC患者肿瘤学预后的预测能力。
1995年至2008年，952例患者因M0 ccRCC接受了RN。其中，827例（87%）在RN前90天内收集了术前NLR。采用Kaplan-Meier方法估计无转移生存期、癌症特异性生存期和总生存期，并使用对数秩检验进行比较。多变量模型用于分析NLR与临床病理结局的关联。
中位随访9.3年时，分别有302例、233例和436例患者发生远处转移、死于ccRCC和全因死亡。较高的NLR与肿瘤体积较大、核分级较高、组织学肿瘤坏死和肉瘤样分化相关（均P<0.001）。NLR≥4.0与较差的5年癌症特异性生存率（66%对85%）和总生存率（66%对85%）显著相关。最后，在控制临床病理特征后，NLR仍与死于ccRCC的风险和全因死亡独立相关（每增加1个单位的风险比：1.02，P<0.01）。
我们的结果表明，NLR与接受RN的M0 ccRCC患者癌症特异性死亡和全因死亡风险增加独立相关。因此，NLR作为一种易于获得的具有生物学侵袭性的ccRCC标志物，可能有助于术前患者风险分层。
