Department of Urology, Singapore General Hospital, Singapore.
Department of Urology, Sengkang General Hospital, Singapore.
Clin Genitourin Cancer. 2020 Aug;18(4):304-313. doi: 10.1016/j.clgc.2019.11.013. Epub 2019 Dec 4.
Our objective was to evaluate the effect of the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and red blood cell distribution width (RDW) on the survival outcomes of nonmetastatic clear cell renal cell carcinoma (ccRCC).
We accessed our single-center, urologic-oncologic registry to extract the data for patients who had undergone nephrectomy for nonmetastatic ccRCC. The optimal cutoff for these markers was determined using X-tile software, and survival analyses using Cox regression were performed.
A total of 687 patients had undergone nephrectomy. The optimal cutoffs for NLR, PLR, LMR, and RDW were 3.3, 210, 2.4, and 14.3%, respectively. The NLR, PLR, LMR, and RDW were significantly associated with a larger pathologic tumor size, and stage, more aggressive Fuhrman grade, and the presence of tumor necrosis. After adjusting for age, baseline Eastern Cooperative Oncology Group, pathologic tumor and nodal stage, and Fuhrman grade, only PLR remained an independent prognostic marker for both cancer-specific survival (hazard ratio, 2.69; 95% confidence interval, 1.36-5.33; P = .004) and overall survival (hazard ratio, 2.19; 95% confidence interval, 1.36-3.50; P = .001). When the PLR was included with the Leibovich score and University of California, Los Angeles, integrated staging system, the Harrell's c-index increased from 0.854 to 0.876 and 0.751 to 0.810, respectively, for cancer-specific survival at 5 years after nephrectomy. When risk stratified by the Leibovich risk group and UCLA integrated staging system, PLR was a significant prognostic factor only within the intermediate- to high-risk groups.
PLR is a robust prognostic marker in nonmetastatic ccRCC that clearly outperforms other inflammatory indexes in those who had undergone nephrectomy. However, its prognostic effect was limited in the low-risk category of ccRCC.
本研究旨在评估中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、淋巴细胞/单核细胞比值（LMR）和红细胞分布宽度（RDW）对非转移性透明细胞肾细胞癌（ccRCC）患者生存结局的影响。
我们查阅了单中心泌尿科肿瘤登记处的数据，提取了接受肾切除术治疗非转移性 ccRCC 患者的数据。使用 X-tile 软件确定这些标志物的最佳截断值，并使用 Cox 回归进行生存分析。
共 687 例患者接受了肾切除术。NLR、PLR、LMR 和 RDW 的最佳截断值分别为 3.3、210、2.4 和 14.3%。NLR、PLR、LMR 和 RDW 与较大的病理肿瘤大小、更高级别的 Fuhrman 分级以及肿瘤坏死的存在显著相关。在校正年龄、基线东部合作肿瘤组、病理肿瘤和淋巴结分期以及 Fuhrman 分级后，只有 PLR 仍然是癌症特异性生存（危险比，2.69；95%置信区间，1.36-5.33；P=0.004）和总生存（危险比，2.19；95%置信区间，1.36-3.50；P=0.001）的独立预后标志物。当将 PLR 与 Leibovich 评分和加利福尼亚大学洛杉矶分校综合分期系统结合使用时，Harrell's c 指数分别从肾切除术后 5 年时的 0.854 增加到 0.876 和 0.751 增加到 0.810，用于癌症特异性生存。当根据 Leibovich 风险组和 UCLA 综合分期系统进行风险分层时，PLR 仅在中高危组中是显著的预后因素。
PLR 是一种强大的非转移性 ccRCC 预后标志物，在接受肾切除术的患者中明显优于其他炎症指标。然而，其预后效果在 ccRCC 的低风险类别中受到限制。
