Mano Roy, Flynn Jessica, Blum Kyle A, Silagy Andrew W, DiNatale Renzo G, Marcon Julian, Wang Alan, Sanchez Alejandro, Coleman Jonathan A, Russo Paul, Ostrovnaya Irina, Hakimi A Ari
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Urol Oncol. 2019 Dec;37(12):916-923. doi: 10.1016/j.urolonc.2019.09.006. Epub 2019 Oct 4.
Preoperative inflammatory parameters are associated with outcome in renal cell carcinoma; however, their predictive value in tumors with sarcomatoid dedifferentiation (sRCC) is uncertain. We aimed to evaluate the association between preoperative and postoperative inflammatory parameters and the outcome of patients with locoregional and metastatic sRCC who underwent nephrectomy.
After obtaining IRB approval, we identified 230 patients with sRCC treated between 1994 and 2018 with a complete blood count drawn ≤1 month before nephrectomy. Preoperative neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio, and platelet-lymphocyte ratio were evaluated as continuous variables. Postoperative NLR, 1 to 8 weeks after surgery, and percentage change in NLR were calculated. Cox regression models were used to identify predictors of outcome.
The study cohort included 105 metastatic patients and 112 patients with locoregional disease. Patients with metastatic disease had significantly higher preoperative NLR (4.31 vs. 3.29) and PLR (248 vs. 194), and lower preoperative LMR (2.6 vs. 3.23). Median follow-up for patients with locoregional and metastatic disease was 36 months and 20 months, respectively, and estimated 5-year cancer-specific survival (CSS) rates were 56% and 15%, respectively. Preoperative NLR was a significant predictor of CSS for both metastatic (HR = 1.23, 95% CI 1.1-1.37, P < 0.001) and locoregional (HR = 1.09, 95% CI 1-1.2, P = 0.049) patients. For metastatic patients, postoperative NLR was significantly associated with CSS on univariate analysis; however, change in NLR was not associated with outcome.
Preoperative NLR is associated with CSS in locoregional and metastatic sRCC. NLR should be considered when establishing future predictive models for sRCC.
术前炎症参数与肾细胞癌的预后相关；然而，它们在伴有肉瘤样去分化的肿瘤（sRCC）中的预测价值尚不确定。我们旨在评估术前和术后炎症参数与接受肾切除术的局部区域和转移性sRCC患者预后之间的关联。
获得机构审查委员会（IRB）批准后，我们确定了1994年至2018年间接受治疗的230例sRCC患者，这些患者在肾切除术前行全血细胞计数检查，时间距手术≤1个月。术前中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与单核细胞比值以及血小板与淋巴细胞比值作为连续变量进行评估。计算术后1至8周的NLR以及NLR的百分比变化。采用Cox回归模型确定预后的预测因素。
研究队列包括105例转移性患者和112例局部区域疾病患者。转移性疾病患者术前NLR（4.31对3.29）和PLR（248对194）显著更高，术前LMR（2.6对3.23）更低。局部区域和转移性疾病患者的中位随访时间分别为36个月和20个月，估计5年癌症特异性生存率（CSS）分别为56%和15%。术前NLR是转移性（HR = 1.23，95%CI 1.1 - 1.37，P < 0.001）和局部区域（HR = 1.09，95%CI 1 - 1.2，P = 0.049）患者CSS的显著预测因素。对于转移性患者，术后NLR在单因素分析中与CSS显著相关；然而，NLR的变化与预后无关。
术前NLR与局部区域和转移性sRCC的CSS相关。在建立未来sRCC预测模型时应考虑NLR。
