Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
Eur Urol Focus. 2019 Nov;5(6):1085-1090. doi: 10.1016/j.euf.2018.06.008. Epub 2018 Jun 22.
Further biomarkers are warranted to improve prognostic stratification of penile squamous cell carcinoma (PSCC) patients undergoing inguinal lymph node dissection (ILND).
To assess the prognostic value of pretreatment neutrophil-to-lymphocyte ratio (NLR) in PSCC patients undergoing ILND and to investigate its role in predicting pathologic node-positive (pN+) disease.
DESIGN, SETTING, AND PARTICIPANTS: In total, 84 consecutive patients undergoing ILND for PSCC at our institution between 1994 and 2014 were identified. Sixty-eight patients with a complete blood count and differential prior to surgery were included. Median follow-up was 35.5 mo.
Cut-off point analysis of NLR was performed using the Contal and O'Quigley method. Estimates of overall survival (OS), cancer-specific survival, and recurrence-free survival stratified by NLR were provided by the Kaplan-Meier method. Cox regression models were performed to determine predictors of survival and recurrence. Logistic regression models were used to identify factors associated with pathologic node-positivity.
The cut-off point value was determined to be 3. Median OS was significantly shorter for patients with NLR ≥3 than those with NLR <3 (30 vs 158 mo, p<0.001). NLR ≥3 was an independent predictor of worse OS (hazard ratio=2.48; 95% confidence interval [CI]: 1.02-6.06, p=0.046). On univariable analysis, NLR ≥3 was associated with an increased risk of pN+ disease (odds ratio [OR]=3.75; 95% CI: 1.30-10.81, p=0.014). However, on multivariable analysis adjusted for primary tumor grade, lymphovascular invasion, clinical N stage, and neoadjuvant treatment receipt, the association between NLR and pN+ disease was no longer significant (OR=3.66; 95% CI: 0.82-16.42, p=0.091). The retrospective design and limited size of the study are acknowledged limitations.
Pretreatment NLR is an independent predictor of OS in PSCC patients undergoing ILND and highlights the association between systemic inflammation and survival. Our data suggests that a simple biomarker of inflammation can serve as a prognosticator in PSCC.
Penile cancer is a rare malignancy in North America and Europe. Therefore, there is a lack of prognostic parameters to help predict oncologic and survival outcomes. In this report, patients with an elevated neutrophil-to-lymphocyte ratio had an increased risk of mortality.
需要进一步的生物标志物来改善接受腹股沟淋巴结清扫术（ILND）的阴茎鳞癌（PSCC）患者的预后分层。
评估 PSCC 患者行 ILND 前中性粒细胞与淋巴细胞比值（NLR）的预后价值，并探讨其预测病理性淋巴结阳性（pN+）疾病的作用。
设计、地点和参与者：共确定了 1994 年至 2014 年间我院 84 例连续接受 ILND 治疗的 PSCC 患者。纳入了 68 例手术前有完整的血细胞计数和分类的患者。中位随访时间为 35.5 个月。
采用 Contal 和 O'Quigley 方法进行 NLR 截断点分析。NLR 分层的总生存（OS）、癌症特异性生存和无复发生存估计采用 Kaplan-Meier 法提供。Cox 回归模型用于确定生存和复发的预测因素。Logistic 回归模型用于确定与病理性淋巴结阳性相关的因素。
确定截断值为 3。NLR≥3 的患者 OS 明显短于 NLR<3 的患者（30 与 158 个月，p<0.001）。NLR≥3 是 OS 较差的独立预测因素（危险比=2.48；95%置信区间[CI]：1.02-6.06，p=0.046）。单变量分析中，NLR≥3 与 pN+疾病的风险增加相关（优势比[OR]=3.75；95%CI：1.30-10.81，p=0.014）。然而，在多变量分析中，调整了原发肿瘤分级、脉管侵犯、临床 N 分期和新辅助治疗后，NLR 与 pN+疾病之间的关联不再显著（OR=3.66；95%CI：0.82-16.42，p=0.091）。研究设计为回顾性且样本量有限是公认的局限性。
PSCC 患者行 ILND 前 NLR 是 OS 的独立预测因子，突出了全身炎症与生存之间的关联。我们的数据表明，炎症的简单生物标志物可作为 PSCC 的预后指标。
阴茎癌在北美和欧洲是一种罕见的恶性肿瘤。因此，缺乏预测肿瘤学和生存结果的预后参数。在本报告中，升高的中性粒细胞与淋巴细胞比值的患者死亡风险增加。
