Yoshida Takashi, Kinoshita Hidefumi, Yoshida Kenji, Yanishi Masaaki, Inui Hidekazu, Komai Yoshihiro, Sugi Motohiko, Inoue Takaaki, Murota Takashi, Matsuda Tadashi
Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka.
Department of Urology and Andrology, Hirakata Hospital, Kansai Medical University, Osaka
Jpn J Clin Oncol. 2015 Dec;45(12):1162-7. doi: 10.1093/jjco/hyv146. Epub 2015 Sep 29.
To evaluate the ability of preoperative lymphocyte-monocyte ratio to predict prognosis and determine post-operative risk stratification in patients with bladder cancer undergoing radical cystectomy.
A retrospective review of the 210 patients who had undergone radical cystectomy for bladder cancer from 2006 to 2013 identified 181 patients with sufficient data to evaluate the prognostic significance of the lymphocyte-monocyte ratio. Overall survival was assessed by the Kaplan-Meier method. The association of clinicopathological findings with overall survival was evaluated by a multivariate Cox proportional model, and a novel risk stratification model to predict prognosis was established.
Median follow-up after radical cystectomy was 6.0 years. The 5-year overall survival rate was significantly lower for patients with low than high lymphocyte-monocyte ratio (27.6 vs 80.7%, P < 0.001). Multivariable analyses showed that pT ≥2, pN ≥1, positive margins and low lymphocyte-monocyte ratio were independent predictors of overall survival. A post-operative risk stratification model using these factors showed significant differences among the three subgroups (low, intermediate and high risk) with a concordance index of 0.84. The 5-year overall survival rates in patients at low, intermediate and high risk were 85.4, 45.5 and 0%, respectively (P < 0.001).
Preoperative lymphocyte-monocyte ratio, pathological tumor and lymph node stage and positive margins are significantly associated with overall survival in patients who have undergone radical cystectomy for bladder cancer.
评估术前淋巴细胞与单核细胞比值预测膀胱癌根治性膀胱切除患者预后及确定术后风险分层的能力。
回顾性分析2006年至2013年接受膀胱癌根治性膀胱切除的210例患者，确定181例有足够数据评估淋巴细胞与单核细胞比值预后意义的患者。采用Kaplan-Meier法评估总生存期。通过多变量Cox比例模型评估临床病理结果与总生存期的关联，并建立预测预后的新型风险分层模型。
根治性膀胱切除术后中位随访时间为6.0年。淋巴细胞与单核细胞比值低的患者5年总生存率显著低于比值高的患者（27.6%对80.7%，P<0.001）。多变量分析显示，pT≥2、pN≥1、切缘阳性和淋巴细胞与单核细胞比值低是总生存期的独立预测因素。使用这些因素的术后风险分层模型在三个亚组（低、中、高风险）之间显示出显著差异，一致性指数为0.84。低、中、高风险患者的5年总生存率分别为85.4%、45.5%和0%（P<0.001）。
术前淋巴细胞与单核细胞比值、病理肿瘤和淋巴结分期以及切缘阳性与膀胱癌根治性膀胱切除患者的总生存期显著相关。
