Sun Jia, Ning Hao, Sun Jintang, Qu Xun
Institute of Basic Medical Sciences, Qilu Hospital, Shandong University, Shandong, PR China.
Department of Urology, Provincial Hospital, Shandong University, Shandong, PR China.
Urol Oncol. 2016 May;34(5):239.e9-15. doi: 10.1016/j.urolonc.2015.12.006. Epub 2016 Jan 21.
As an indicator of inflammatory reaction of immune system, the neutrophil-lymphocyte ratio (NLR) is a significantly independent prognostic factor of renal cell carcinoma (RCC). However, the NLR was not added in any well-established prognostic models. Many physiologic factors were also associated with NLR, such as hypertension. As such, we evaluated the effect of hypertension on NLR evaluation of prognosis of RCC.
Hematological parameters and clinicopathological data during diagnosis were retrospectively recorded for 401 patients with RCC between the years 1999 and 2009. The standardized cutoff-finder algorithm was used to find the suitable NLR cutoff value for recurrence. The Log-rank test and Kaplan-Meier method were used to compare and estimate the recurrence-free survival. Univariate and multivariate Cox regression analyses were used to evaluate the association between NLR and clinicopathologic outcomes.
In the analysis of total subjects, recurrence-free survival was significantly worse among patients with a preoperative NLR (>3.139 [21.9%] vs.≤3.139 [78.1%]; P<0.001). High NLR value was associated with high pathological TNM stage (P = 0.009, 0.018, 0.001, respectively). In the normotensive subgroup, recurrence-free survival was also significantly worse among patients with a preoperative NLR (>3.139 [22.6%] vs.≤3.139 [77.4%]; P<0.001). However, in the subgroup with hypertension, the difference of recurrence-free survival was not significant between patients with preoperative NLR (>3.139 [21.2%] vs.≤3.139 [78.8%]; P = 0.093). Moreover, multivariate analysis identified increased NLR as a poor prognosis index for recurrence-free survival in total group (hazard ratio [HR] = 2.27; 95% CI: 1.50-3.44; P<0.001) and normotensive subgroup (HR = 2.97; 95% CI: 1.74-5.07; P<0.001), but not in hypertensive subgroup (HR = 1.25; 95% CI: 0.59-2.65; P = 0.566).
Hypertension is a disturbance factor in the evaluation of prognosis of RCC by preoperative NLR.
作为免疫系统炎症反应的指标，中性粒细胞与淋巴细胞比值（NLR）是肾细胞癌（RCC）显著独立的预后因素。然而，任何成熟的预后模型中均未纳入NLR。许多生理因素也与NLR相关，如高血压。因此，我们评估了高血压对RCC预后NLR评估的影响。
回顾性记录了1999年至2009年间401例RCC患者诊断时的血液学参数和临床病理数据。采用标准化的临界值查找算法来确定适合复发的NLR临界值。采用对数秩检验和Kaplan-Meier法比较并估计无复发生存率。采用单因素和多因素Cox回归分析评估NLR与临床病理结局之间的关联。
在对所有受试者的分析中，术前NLR>3.139的患者无复发生存率明显更差（分别为21.9% vs.≤3.139的78.1%；P<0.001）。高NLR值与高病理TNM分期相关（分别为P = 0.009、0.018、0.001）。在血压正常亚组中，术前NLR>3.139的患者无复发生存率也明显更差（分别为22.6% vs.≤3.139的77.4%；P<0.001）。然而，在高血压亚组中，术前NLR>3.139的患者与≤3.139的患者之间无复发生存率差异不显著（分别为21.2% vs. 78.8%；P = 0.093）。此外，多因素分析确定NLR升高是全组（风险比[HR]=2.27；95%可信区间：1.50 - 3.44；P<0.001）和血压正常亚组（HR = 2.97；95%可信区间：1.74 - 5.07；P<0.001）无复发生存率的不良预后指标，但在高血压亚组中并非如此（HR = 1.25；95%可信区间：0.59 - 2.65；P = 0.566）。
高血压是术前NLR评估RCC预后的干扰因素。
