Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Acta Oncol. 2020 Jan;59(1):13-19. doi: 10.1080/0284186X.2019.1654128. Epub 2019 Aug 26.
Elevated neutrophil-lymphocyte ratio (NLR) and hyponatremia each predict poor prognosis in renal cell carcinoma (RCC). Since no previous studies have looked at the combined effect of these two prognostic markers, we examined how NLR and hyponatremia combined associates with mortality and hypothesized that elevated NLR and hyponatremia at RCC diagnosis and at RCC recurrence indicate poorer prognosis. Using Danish medical registries 1999-2015, we included 970 patients from two regions with incident RCC and a measurement of NLR and sodium. NLR was categorized as ≤3.0 and >3.0 and sodium as < lower limit of normal (LLN) and ≥ LLN. Outcomes were survival after RCC diagnosis and first recurrence, respectively. We estimated absolute survival and hazard ratios (HR) using multivariate Cox regression. At RCC diagnosis, 559 (57.6%) had NLR >3.0 and 240 (24.7%) had hyponatremia, the 5 year-survival rate was 35.2% in NLR > 3.0 vs. 69.2% in NLR ≤3.0, adjusted HR 1.8 (95% confidence intervals (CI), 1.4; 2.2). In patients with NLR >3.0 and concomitant hyponatremia vs. NLR ≤3.0 and normal sodium the 5-year survival rate was 21.7% vs. 73.2%, adjusted HR 2.8 (95% CI, 2.1; 3.8). At RCC recurrence, patients with NLR >3.0 and hyponatremia similarly had poorest survival, adjusted HR 3.6 (95% CI, 1.0; 12.8).: Elevated NLR alone and in combination with hyponatremia at time of initial RCC diagnosis and at time of RCC recurrence are associated with poor prognosis. Combining these two prognostic markers yield a stronger association than NLR considered alone. This may impact prognostic prediction and its related therapeutic strategy.
中性粒细胞与淋巴细胞比值（NLR）升高和低钠血症均预示着肾细胞癌（RCC）的预后不良。由于以前没有研究探讨这两种预后标志物的联合作用，我们研究了 NLR 和低钠血症联合与死亡率的关系，并假设 RCC 诊断时和 RCC 复发时 NLR 升高和低钠血症预示着更差的预后。我们使用丹麦医疗登记数据，纳入了 1999 年至 2015 年两个地区的 970 例初诊 RCC 患者，并对其 NLR 和钠进行了测量。NLR 分为≤3.0 和>3.0，钠分为<正常下限（LLN）和≥LLN。结果分别为 RCC 诊断后的生存和首次复发的生存。我们使用多变量 Cox 回归估计绝对生存率和危险比（HR）。在 RCC 诊断时，559 例（57.6%）NLR>3.0，240 例（24.7%）低钠血症，NLR>3.0 的 5 年生存率为 35.2%，NLR≤3.0 的 5 年生存率为 69.2%，调整后的 HR 为 1.8（95%CI，1.4；2.2）。在 NLR>3.0 伴低钠血症与 NLR≤3.0 伴正常钠血症的患者中，5 年生存率分别为 21.7%和 73.2%，调整后的 HR 为 2.8（95%CI，2.1；3.8）。在 RCC 复发时，NLR>3.0 伴低钠血症的患者生存最差，调整后的 HR 为 3.6（95%CI，1.0；12.8）。：RCC 初诊时和 RCC 复发时 NLR 升高和低钠血症单独存在或联合存在与预后不良相关。将这两种预后标志物结合起来比单独考虑 NLR 具有更强的相关性。这可能会影响预后预测及其相关的治疗策略。
