Zhao Zihan, Xie Shangxun, Feng Baofu, Zhang Shiwei, Sun Yifan, Guo Hongqian, Yang Rong
Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China.
Cancer Manag Res. 2020 Sep 25;12:9023-9032. doi: 10.2147/CMAR.S274332. eCollection 2020.
To improve the preoperative prediction of the outcomes of patients diagnosed with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), we explored various preoperative laboratory factors and established a prognostic risk stratification method.
We retrospectively reviewed 232 UTUC patients who underwent RNU from September 2010 to October 2019 and analyzed their comprehensive clinicopathologic data and preoperative blood-based biomarkers. Kaplan-Meier analysis, receiver-operating characteristic (ROC) curves analysis and Cox regression analysis were performed to assess the relationship between these factors and the prognosis.
The median follow-up and age were 24 months and 68.5 years, respectively. Preoperative elevated neutrophil-to-lymphocyte ratio (NLR > 3.44) and decreased albumin (ALB < 39.8 g/L) were negatively correlated with progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) in both univariate and multivariate analyses. Patients were sorted into three groups based on their NLR and ALB: the low-risk group (neither elevated NLR nor decreased ALB), intermediate-risk group (either elevated NLR or decreased ALB) and high-risk group (elevated NLR and decreased ALB). Their 5-year PFS rates were 77.8%, 52.6% and 32.3%; their 5-year CSS rates were 97.7%, 71.4% and 32.9%; and their 5-year OS rates were 92.7%, 70.4% and 29.2%, respectively (all P < 0.0001). ROC curves analysis showed that NLR plus ALB had a more accurate prognostic value (P < 0.05).
Preoperative risk classification using NLR and ALB was identified as an independent prognostic factor for patients with UTUC. The combination of NLR and ALB may help to determine the most appropriate treatment options before RNU.
为了改善对接受根治性肾输尿管切除术（RNU）治疗的上尿路尿路上皮癌（UTUC）患者预后的术前预测，我们探究了各种术前实验室因素，并建立了一种预后风险分层方法。
我们回顾性分析了2010年9月至2019年10月期间接受RNU的232例UTUC患者，并分析了他们的综合临床病理数据和术前血液生物标志物。进行了Kaplan-Meier分析、受试者操作特征（ROC）曲线分析和Cox回归分析，以评估这些因素与预后之间的关系。
中位随访时间和年龄分别为24个月和68.5岁。术前中性粒细胞与淋巴细胞比值升高（NLR>3.44）和白蛋白降低（ALB<39.8 g/L）在单因素和多因素分析中均与无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）呈负相关。根据患者的NLR和ALB将其分为三组：低风险组（NLR未升高且ALB未降低）、中风险组（NLR升高或ALB降低）和高风险组（NLR升高且ALB降低）。他们的5年PFS率分别为77.8%、52.6%和32.3%；他们的5年CSS率分别为97.7%、71.4%和32.9%；他们的5年OS率分别为92.7%、70.4%和29.2%（所有P<0.0001）。ROC曲线分析表明，NLR加ALB具有更准确的预后价值（P<0.05）。
使用NLR和ALB进行术前风险分类被确定为UTUC患者的独立预后因素。NLR和ALB的联合使用可能有助于在RNU之前确定最合适的治疗方案。
