Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Department of Urology, University of Catania, Catania, Italy.
Eur Urol Oncol. 2018 Oct;1(5):403-410. doi: 10.1016/j.euo.2018.06.006. Epub 2018 Jul 13.
Serum levels of neutrophils, platelets, and lymphocytes have been recognized as factors related to poor prognosis for many solid tumors, including bladder cancer (BC).
To evaluate the prognostic role of the combination of the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) in patients with high-risk non-muscle-invasive urothelial BC (NIMBC).
DESIGN, SETTING, AND PARTICIPANTS: A total of 1151 NMIBC patients who underwent first transurethral resection of the bladder tumor (TURBT) at 13 academic institutions between January 1, 2002 and December 31, 2012 were included in this analysis. The median follow-up was 48 mo.
TURBT with intravesical chemotherapy or immunotherapy.
Multivariable Cox regression analysis was performed to identify factors predictive of recurrence, progression, cancer-specific mortality, and overall mortality. A systemic inflammatory marker (SIM) score was calculated based on cutoffs for NLR, PLR, and LMR.
The 48-mo recurrence-free survival was 80.8%, 47.35%, 20.67%, and 17.06% for patients with an SIM score of 0, 1, 2, and 3, respectively (p<0.01, log-rank test) while the corresponding 48-mo progression free-survival was 92.0%, 75.67%, 72.85%, and 63.1% (p<0.01, log-rank test). SIM scores of 1, 2, and 3 were associated with recurrence (hazard ratio [HR] 3.73, 7.06, and 7.88) and progression (HR 3.15, 4.41, and 5.83). Limitations include the lack of external validation and comparison to other clinical risk models.
Patients with high-grade T1 stage NMIBC with high SIM scores have worse oncologic outcomes in terms of recurrence and progression. Further studies should be conducted to stratify patients according to SIM scores to identify individuals who might benefit from early cystectomy.
In this study, we defined a risk score (the SIM score) based on the measurement of routine systemic inflammatory markers. This score can identify patients with high-grade bladder cancer not invading the muscular layer who are more likely to suffer from tumor recurrence and progression. Therefore, the score could be used to select patients who might benefit from early bladder removal.
中性粒细胞、血小板和淋巴细胞的血清水平已被认为是许多实体瘤（包括膀胱癌）预后不良的相关因素。
评估中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）和淋巴细胞/单核细胞比值（LMR）联合在高危非肌肉浸润性尿路上皮膀胱癌（NIMBC）患者中的预后作用。
设计、地点和参与者：本分析纳入了 2002 年 1 月 1 日至 2012 年 12 月 31 日期间在 13 所学术机构接受首次经尿道膀胱肿瘤切除术（TURBT）的 1151 例 NMIBC 患者。中位随访时间为 48 个月。
TURBT 联合膀胱内化疗或免疫治疗。
采用多变量 Cox 回归分析确定与复发、进展、癌症特异性死亡和总死亡率相关的预测因素。根据 NLR、PLR 和 LMR 的截断值计算了系统炎症标志物（SIM）评分。
SIM 评分为 0、1、2 和 3 的患者在 48 个月时的无复发生存率分别为 80.8%、47.35%、20.67%和 17.06%（p<0.01，对数秩检验），相应的 48 个月时无进展生存率分别为 92.0%、75.67%、72.85%和 63.1%（p<0.01，对数秩检验）。SIM 评分 1、2 和 3 与复发（风险比[HR]3.73、7.06 和 7.88）和进展（HR 3.15、4.41 和 5.83）相关。局限性包括缺乏外部验证和与其他临床风险模型的比较。
SIM 评分高的高级 T1 期 NMIBC 患者在复发和进展方面的肿瘤结局更差。应进行进一步的研究，根据 SIM 评分对患者进行分层，以确定可能受益于早期膀胱切除术的个体。
在这项研究中，我们基于常规系统性炎症标志物的测量定义了一个风险评分（SIM 评分）。该评分可识别出非肌层浸润性膀胱癌且分级较高的患者，这些患者更有可能出现肿瘤复发和进展。因此，该评分可用于选择可能受益于早期膀胱切除的患者。
