Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Int J Clin Oncol. 2019 Dec;24(12):1605-1611. doi: 10.1007/s10147-019-01487-x. Epub 2019 Jun 26.
The objective of this retrospective study was to evaluate the prognostic value of various factors in clear cell sarcoma patients after radical surgery.
Forty-two clear cell sarcoma patients from August 2006 to March 2018 were included in the study. Curves of disease-free survival and overall survival were calculated using the Kaplan-Meier method, and univariate and multivariate analyses of various prognostic factors were performed using a Cox proportional hazard regression model. Laboratory test of peripheral blood was recorded before surgery. The optimal cutoff value of systemic inflammatory markers was defined by receiver-operating curve analysis.
The 5-year DFS and 5-year OS rate were 22% and 46%, respectively. The median DFS and OS times were 12 and 41.5 months, respectively. In univariate analysis, there was a significant association between shorter DFS and tumor size larger than 5 cm (p = 0.0043), positive surgical margin (p = 0.0233), and the neutrophil-to-lymphocyte ratio (NLR) higher than 2.73 (p = 0.0009). Furthermore, we observed a significant association between shorter OS and tumor size larger than 5 cm (p = 0.0075), positive surgical margin (p = 0.0101), NLR higher than 2.73 (p = 0.0126), the platelet-to-lymphocyte ratio (PLR) higher than 103.89 (p = 0.0147) and the lymphocyte-to-monocyte ratio (LMR) lower than 4.2 (p = 0.0445). A multivariate analysis demonstrated that the surgical margin (p = 0.013) and NLR (p = 0.001) were significantly associated with DFS. Tumor size (p = 0.010) and NLR (p = 0.013) were independent prognostic factors for OS.
This study had the second largest sample around the world and preoperative NLR may be a useful prognostic factor in CCS patients after radical surgery.
本回顾性研究旨在评估根治性手术后影响透明细胞肉瘤患者预后的各种因素。
纳入 2006 年 8 月至 2018 年 3 月的 42 例透明细胞肉瘤患者。采用 Kaplan-Meier 法计算无病生存率和总生存率曲线，采用 Cox 比例风险回归模型对各种预后因素进行单因素和多因素分析。记录术前外周血实验室检查。采用受试者工作特征曲线分析确定系统炎症标志物的最佳截断值。
5 年无病生存率和 5 年总生存率分别为 22%和 46%。中位无病生存时间和总生存时间分别为 12 个月和 41.5 个月。单因素分析显示，无病生存时间较短与肿瘤直径大于 5cm（p=0.0043）、切缘阳性（p=0.0233）和中性粒细胞与淋巴细胞比值（NLR）大于 2.73（p=0.0009）显著相关。此外，我们观察到总生存时间较短与肿瘤直径大于 5cm（p=0.0075）、切缘阳性（p=0.0101）、NLR 大于 2.73（p=0.0126）、血小板与淋巴细胞比值（PLR）大于 103.89（p=0.0147）和淋巴细胞与单核细胞比值（LMR）小于 4.2（p=0.0445）显著相关。多因素分析表明，切缘（p=0.013）和 NLR（p=0.001）与无病生存显著相关。肿瘤大小（p=0.010）和 NLR（p=0.013）是总生存的独立预后因素。
本研究是全球范围内第二大样本量的研究，术前 NLR 可能是透明细胞肉瘤患者根治性手术后的一个有用的预后因素。
