Albisinni S, Pretot D, Al Hajj Obeid W, Aoun F, Quackels T, Peltier A, Roumeguère T
Urology Department, université libre de Bruxelles, University Clinics of Brussels, hôpital Erasme, route de Lennik 808, Brussels, Belgium.
Urology Department, université libre de Bruxelles, University Clinics of Brussels, hôpital Erasme, route de Lennik 808, Brussels, Belgium.
Prog Urol. 2019 Jul-Aug;29(8-9):423-431. doi: 10.1016/j.purol.2019.05.008. Epub 2019 Jun 10.
The neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) are established markers of systemic inflammation. Moreover, anemia is a known adverse prognostic factor and reduced haemoglobin to platelet ratio (HPR) seems associate to poor outcomes in urothelial cancer. Aim of the current study was to explore the prognostic value of NLR, HPR and PLR in patients harboring localized RCC. Materials and Methods 184 patients undergoing partial and radical nephrectomy for renal mass in a single hospital were retrospectively analyzed. Uni- and multivariate logistic regressions were performed to assess associations between various risk factors, including NLR, PLR and HPR and locally advanced disease (≤pT2 vs.≥pT3) and tumor grade. Kaplan Meier curves and Cox regressions were constructed to assess the association of NLR, PLR and HPR to recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS). To determine thresholds for variables, we considered the 75 percentile of our distribution of values, which was computed at 3.45 for NLR, 189 for PLR and 0.48 for HPR. A two-sided P<0.05 defined statistical significance.
Patients with an elevated NLR (>3.45) were more likely to present with≥pT3 stage (p=0.046). RFS was significantly different according to NLR value, with patients having an NLR>3.45 experiencing significantly worst RFS (P=0.019); similarly, an increased PLR was significantly associated to a reduced RFS (P=0.012). Restricting the Cox regression to patients with locally advanced disease (≥pT3), NLR was even more associated to recurrence (HR 3.22; 95%CI: 1.06-9.81, P=0.039). Patients exhibiting an NLR>3.45 (p=0.03) or a PLR>189 (P=0.005) did have a significantly worse CSS, while a HPR<0.48 did not predict CSS (P=0.12) on Kaplan Meier curves. Finally, an increased NLR (P=0.047), increased PLR (P=0.0006) and decreased HPR (P=0.05) were all associated to a poor overall survival on univariate analysis. On multivariate analysis, only HPR remained significantly predictive of OS (HR 0.077; 95%CI: 0.02-0.37, P=0.001).
In this single-center study analyzing non-metastatic RCC, an increased NLR was significantly associated to a reduced RFS, CSS and OS on univariate analyses and to RFS on multivariate analysis. Larger prospective studies are needed to validate our findings.
中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）是公认的全身炎症标志物。此外，贫血是已知的不良预后因素，血红蛋白与血小板比值（HPR）降低似乎与尿路上皮癌的不良预后相关。本研究的目的是探讨NLR、HPR和PLR在局限性肾细胞癌（RCC）患者中的预后价值。材料与方法：回顾性分析了一家医院184例因肾肿物接受部分或根治性肾切除术的患者。进行单因素和多因素逻辑回归分析，以评估包括NLR、PLR和HPR在内的各种危险因素与局部晚期疾病（≤pT2 vs.≥pT3）和肿瘤分级之间的关联。构建Kaplan-Meier曲线和Cox回归模型，以评估NLR、PLR和HPR与无复发生存期（RFS）、癌症特异性生存期（CSS）和总生存期（OS）之间的关联。为确定变量的阈值，我们考虑了值分布的第75百分位数，NLR为3.45，PLR为189，HPR为0.48。双侧P<0.05定义为具有统计学意义。
NLR升高（>3.45）的患者更有可能出现≥pT3期（p=0.046）。根据NLR值，RFS有显著差异，NLR>3.45的患者RFS明显更差（P=0.019）；同样，PLR升高与RFS降低显著相关（P=0.012）。将Cox回归分析限制在局部晚期疾病（≥pT3）患者中，NLR与复发的相关性更强（HR 3.22；95%CI：1.06-9.81，P=0.039）。在Kaplan-Meier曲线上，NLR>3.45（p=0.03）或PLR>189（P=0.005）的患者CSS明显更差，而HPR<0.48不能预测CSS（P=0.12）。最后，单因素分析显示，NLR升高（P=0.047）、PLR升高（P=0.0006）和HPR降低（P=0.05）均与总生存期差相关。多因素分析显示，只有HPR仍然是OS的显著预测因素（HR 0.077；95%CI：0.02-0.37，P=0.001）。
在这项分析非转移性RCC的单中心研究中，单因素分析显示NLR升高与RFS、CSS和OS降低显著相关，多因素分析显示与RFS相关。需要更大规模的前瞻性研究来验证我们的发现。
4级。
