Zheng Yangqin, Bao Lian Min, Ye Junjie, Pan Yue, Wang Qinquan, Gao Xiaomin
Department of Hematology, The Third Clinical Institute Affiliated to Wenzhou Medical University, People's Hospital of Wenzhou, Wenzhou, Zhejiang 325006, P.R. China.
Department of Respiratory Medicine, Ruian People's Hospital, The Third Affiliated Hospital of The Wenzhou Medical University, Wenzhou, Zhejiang 325200, P.R. China.
Exp Ther Med. 2019 Feb;17(2):1268-1275. doi: 10.3892/etm.2018.7093. Epub 2018 Dec 13.
The aim of the present study was to evaluate the effect of diabetes mellitus (DM) on the neutrophil-lymphocyte ratio (NLR)-based prediction of the prognosis of patients with renal cell carcinoma (RCC). The data of 662 patients who had undergone nephrectomy for RCC between January 2004 and July 2014 were retrospectively reviewed. X-tile analysis was used to determine the optimal cutoff value for the NLR. Kaplan-Meier curves were drawn and the log-rank test was applied to determine the impact of the NLR (high vs. low) on the overall survival (OS) and metastasis-free survival (MFS). Univariate and multivariate Cox regression analyses were used to identify prognostic factors for OS and MFS. The median follow-up period after surgery was 50.35 months (range, 30.30-85.08 months). The optimal cutoff value of the NLR was determined to be 3.2 using X-tile software. In the analysis of total subjects, patients with a high NLR (≥3.2) had significantly worse OS and MFS rates than those with a low NLR (<3.2) (21.60% vs. 78.40%, P=0.001 for OS and 21.60% vs. 78.40%, P<0.0001 for MFS). In the non-DM subgroup, the OS and MFS rates of patients with a high NLR were significantly worse compared with those of patients with a low NLR (21.69% vs. 78.31%, P=0.003 for OS and 21.69% vs. 78.31%, P<0.001 for MFS). In the DM subgroup, although a high NLR was still associated with the MFS (NLR≥3.2, 21.43% vs. NLR<3.2, 78.57%; P=0.015), it was no longer associated with the OS (NLR≥3.2, 21.43% vs. NLR<3.2, 78.57%; P=0.192). Furthermore, multivariate analysis identified the NLR as a risk factor for OS and MFS in all patients [hazard ratio (HR)=1.77, 95% confidence interval (CI): 1.04-3.01, P=0.037; and HR=2.31, 95% CI: 1.45-3.70, P<0.001, respectively) and in the non-DM subgroup (HR=2.03, 95% CI: 1.05-3.93, P=0.036; and HR=2.57, 95% CI: 1.47-4.49, P=0.001, respectively), but not in the DM subgroup (P>0.05). In conclusion, DM is a factor that impairs the evaluation of the prognosis of RCC using NLR.
本研究的目的是评估糖尿病（DM）对基于中性粒细胞与淋巴细胞比值（NLR）预测肾细胞癌（RCC）患者预后的影响。回顾性分析了2004年1月至2014年7月间因RCC接受肾切除术的662例患者的数据。采用X-tile分析确定NLR的最佳临界值。绘制Kaplan-Meier曲线，并应用对数秩检验确定NLR（高 vs. 低）对总生存期（OS）和无转移生存期（MFS）的影响。采用单因素和多因素Cox回归分析确定OS和MFS的预后因素。术后中位随访期为50.35个月（范围：30.30 - 85.08个月）。使用X-tile软件确定NLR的最佳临界值为3.2。在对所有受试者的分析中，NLR高（≥3.2）的患者的OS和MFS率显著低于NLR低（<3.2）的患者（OS：21.60% vs. 78.40%，P = 0.001；MFS：21.60% vs. 78.40%，P < 0.0001）。在非DM亚组中，NLR高的患者的OS和MFS率显著低于NLR低的患者（OS：21.69% vs. 78.31%，P = 0.003；MFS：21.69% vs. 78.31%，P < 0.001）。在DM亚组中，虽然高NLR仍与MFS相关（NLR≥3.2，21.43% vs. NLR<3.2，78.57%；P = 0.015），但不再与OS相关（NLR≥3.2，21.43% vs. NLR<3.2，78.57%；P = 0.192）。此外，多因素分析确定NLR是所有患者（分别为风险比（HR）= 1.77，95%置信区间（CI）：1.04 - 3.01，P = 0.037；HR = 2.31，95% CI：1.45 - 3.70，P < 0.001）和非DM亚组（HR = 2.03，95% CI：1.05 - 3.93，P = 0.036；HR = 2.57，95% CI：1.47 - 4.49，P = 0.001）OS和MFS的危险因素，但在DM亚组中不是（P > 0.05）。总之，DM是影响使用NLR评估RCC预后的一个因素。
