Yang Yuanfeng, Zhai Changwen, Chang Yuan, Zhou Lin, Shi Tianming, Tan Cheng, Xu Le, Xu Jiejie
Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
Urol Oncol. 2016 May;34(5):238.e19-26. doi: 10.1016/j.urolonc.2015.11.026. Epub 2015 Dec 31.
Chemokine (C-C motif) ligand 2 (CCL2) is known to recruit monocytes and macrophages to sites of inflammation. Recent studies suggest CCL2 is overexpressed in multiple cancer types and may play a role in the tumor progression. The aim of this study was to assess the association between CCL2 expression and the risk of recurrence after surgery in patients with clear-cell renal cell carcinoma (ccRCC).
This study included 268 ccRCC patients who underwent nephrectomy at a single institute between 2001 and 2004. Clinicopathologic variables and recurrence-free survival (RFS) were recorded. CCL2 expression levels were evaluated by immunohistochemical staining in tumor tissues. Kaplan-Meier method was applied to compare survival curves. Cox regression models were fitted to analyze the effect of prognostic factors on recurrence-free survival (RFS). Harrell's concordance index was calculated to assess predictive accuracy.
High CCL2 expression was associated with a greater risk of recurrence in ccRCC patients (P<0.001). Multivariate analysis confirmed that CCL2 expression was an independent prognostic factor for RFS (P = 0.045). The predictive accuracy of the Leibovich prognostic score was improved when CCL2 expression was added (0.76 vs. 0.71, P<0.001). Notably, the improvement in prediction was more pronounced in patients with low-risk disease. A nomogram integrating CCL2 expression and pathologic factors was then constructed, which predicted 5- and 10-year RFS well for ccRCC patients.
High chemokine CCL2 expression is an independent predictor of recurrence in ccRCC patients. Evaluation of CCL2 could help guide postsurgical management for ccRCC patients.
已知趋化因子（C-C基序）配体2（CCL2）可将单核细胞和巨噬细胞募集至炎症部位。近期研究表明，CCL2在多种癌症类型中过度表达，可能在肿瘤进展中发挥作用。本研究旨在评估CCL2表达与透明细胞肾细胞癌（ccRCC）患者术后复发风险之间的关联。
本研究纳入了2001年至2004年间在单一机构接受肾切除术的268例ccRCC患者。记录临床病理变量和无复发生存期（RFS）。通过免疫组织化学染色评估肿瘤组织中的CCL2表达水平。采用Kaplan-Meier法比较生存曲线。拟合Cox回归模型分析预后因素对无复发生存期（RFS）的影响。计算Harrell一致性指数以评估预测准确性。
CCL2高表达与ccRCC患者更高的复发风险相关（P<0.001）。多变量分析证实，CCL2表达是RFS的独立预后因素（P = 0.045）。添加CCL2表达后，Leibovich预后评分的预测准确性得到提高（0.76对0.71，P<0.001）。值得注意的是，在低风险疾病患者中，预测改善更为明显。随后构建了一个整合CCL2表达和病理因素的列线图，该列线图对ccRCC患者的5年和10年RFS预测良好。
趋化因子CCL2高表达是ccRCC患者复发的独立预测因素。评估CCL2有助于指导ccRCC患者的术后管理。
