Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China.
Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of the Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China.
Clin Genitourin Cancer. 2021 Jun;19(3):e156-e165. doi: 10.1016/j.clgc.2020.09.004. Epub 2020 Sep 18.
This study aimed to investigate the preoperative monocyte-to-lymphocyte ratio (MLR) as a biomarker for intravesical recurrence (IVR) in upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU) for the first time.
This study involved the clinical data of 255 patients with UTUC without a history of bladder cancer who had undergone RNU from March 2004 to February 2019 at an academic institution. The associations between MLR and IVR were assessed with Kaplan-Meier method and Cox regression analysis.
The median follow-up was 43.93 months. Of the 255 patients, 37 developed IVR during the follow-up period. Kaplan-Meier analysis revealed that patients with high MLR (> 0.22) had poor IVR-free survival (P = .001); this prognostic value was in accordance with patients with high grade and more advanced stage UTUC. Cox regression preoperative models showed that ureteral tumor site (hazard ratio [HR], 2.784; P = .005), surgical approach (HR, 2.745; P = .008), and high MLR (HR, 4.085; P < .001) were an independent risk factor for IVR. These factors were used as a signature to establish a prognostic risk model, which revealed significant differences among the 3 subgroups of patients with low, intermediate, and high risk (P < .001).
Ureteral tumor site, surgical approach, and preoperative MLR are significant predictors for IVR in patients with UTUC after RNU. MLR may become a useful biomarker to predict IVR in patients with UTUC after RNU.
本研究首次探讨了术前单核细胞与淋巴细胞比值（MLR）作为根治性肾输尿管切除术（RNU）治疗上尿路上皮癌（UTUC）后膀胱内复发（IVR）的生物标志物。
本研究纳入了 2004 年 3 月至 2019 年 2 月在一家学术机构接受 RNU 治疗且无膀胱癌病史的 255 例 UTUC 患者的临床资料。采用 Kaplan-Meier 法和 Cox 回归分析评估 MLR 与 IVR 的相关性。
中位随访时间为 43.93 个月。255 例患者中，37 例在随访期间发生 IVR。Kaplan-Meier 分析显示，MLR 较高（>0.22）的患者 IVR 无复发生存率较差（P=0.001）；这种预后价值与高级别和更晚期的 UTUC 患者一致。术前 Cox 回归模型显示，输尿管肿瘤部位（HR，2.784；P=0.005）、手术方式（HR，2.745；P=0.008）和高 MLR（HR，4.085；P<0.001）是 IVR 的独立危险因素。这些因素被用作建立预后风险模型的标志，该模型显示 3 组患者（低、中、高危）之间存在显著差异（P<0.001）。
输尿管肿瘤部位、手术方式和术前 MLR 是 RNU 治疗 UTUC 后 IVR 的重要预测因素。MLR 可能成为预测 RNU 治疗 UTUC 后 IVR 的有用生物标志物。
