Mbeutcha Aurélie, Shariat Shahrokh F, Rieken Malte, Rink Michael, Xylinas Evanguelos, Seitz Christian, Lucca Ilaria, Mathieu Romain, Rouprêt Morgan, Briganti Alberto, Karakiewicz Pierre I, Klatte Tobias
Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, University of Nice Sophia-Antipolis, Hôpital Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France.
Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
Urol Oncol. 2016 Nov;34(11):483.e17-483.e24. doi: 10.1016/j.urolonc.2016.05.013. Epub 2016 Sep 16.
The neutrophil-to-lymphocyte ratio (NLR) and the C-reactive protein (CRP) are markers of systemic inflammatory response, which have been associated with the prognosis of multiple malignancies, but their relationships with oncologic outcomes of non-muscle-invasive bladder cancer (NMIBC) have not been well studied yet.
We retrospectively reviewed the medical records of 1,117 patients with NMIBC who underwent a transurethral resection of the bladder. Univariable and multivariable competing risk regression models were used to assess the association of preoperative NLR and CRP with disease recurrence and progression to muscle-invasive disease. The median follow-up was 64 months.
In total, 360 patients (32.2%) had a high NLR (≥2.5) and 145 (13.0%) had a high CRP (≥5mg/l). On multivariable analyses, a high NLR was associated with both disease recurrence (subhazard ratio [SHR] = 1.27, P = 0.013) and progression (SHR = 1.72, P = 0.007), and high CRP was associated with disease progression (SHR = 1.72, P = 0.031). Adding NLR and CRP to the multivariable model predicting disease progression lead to a relevant change in discrimination (+2.0%). In a subgroup analysis of 300 patients treated with bacillus Calmette-Guerin, both high NLR and high CRP were associated with disease progression (SHR = 2.80, P = 0.026 and SHR = 3.51, P = 0.021, respectively), and NLR was associated with disease recurrence (SHR = 1.46, P = 0.046). There was also an increase in the discrimination of the model predicting progression after bacillus Calmette-Guerin following the inclusion of both markers (+2.4%).
In patients with NMIBC, markers of systemic inflammation response are associated with disease recurrence and progression. The inclusion of such markers in prognostic models does enhance their accuracy.
中性粒细胞与淋巴细胞比值（NLR）和C反应蛋白（CRP）是全身炎症反应的标志物，它们与多种恶性肿瘤的预后相关，但它们与非肌层浸润性膀胱癌（NMIBC）肿瘤学结局的关系尚未得到充分研究。
我们回顾性分析了1117例行膀胱经尿道切除术的NMIBC患者的病历。采用单变量和多变量竞争风险回归模型评估术前NLR和CRP与疾病复发及进展为肌层浸润性疾病的相关性。中位随访时间为64个月。
共有360例患者（32.2%）NLR较高（≥2.5），145例患者（13.0%）CRP较高（≥5mg/l）。多变量分析显示，高NLR与疾病复发（亚风险比[SHR]=1.27，P=0.013）和进展（SHR=1.72，P=0.007）均相关，高CRP与疾病进展相关（SHR=1.72，P=0.031）。将NLR和CRP纳入预测疾病进展的多变量模型后，判别能力有相关提高（+2.0%）。在300例接受卡介苗治疗的患者亚组分析中，高NLR和高CRP均与疾病进展相关（SHR分别为2.80，P=0.026和SHR=3.51，P=0.021），NLR与疾病复发相关（SHR=1.46，P=0.046）。在纳入这两个标志物后，卡介苗治疗后预测进展的模型判别能力也有所提高（+2.4%）。
在NMIBC患者中，全身炎症反应标志物与疾病复发和进展相关。将这些标志物纳入预后模型确实能提高其准确性。
