Gao Xiaomin, Pan Yue, Zhou Lina, Li Yeping, Lin Binwei, Zheng Yangqin
Department of Hematology, The Third Clinical Institute Affiliated to Wenzhou Medical University, People's Hospital of Wenzhou, Wenzhou, China.
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Front Oncol. 2021 Jan 5;10:555152. doi: 10.3389/fonc.2020.555152. eCollection 2020.
Cancer-associated inflammation, activation of coagulation cascades, and malnutrition are closely related to the prognosis of patients with malignancy, including renal cell carcinoma (RCC). This study aimed to investigate the prognostic value of a combination of preoperative plasma fibrinogen, prognostic nutritional index, and monocyte-to-lymphocyte ratio (Fib-PNI-MLR) in patients with non-metastatic RCC undergoing nephrectomy. We retrospectively collected medical data from 829 of the 1,019 cases of RCC. The optimal cutoff values of fibrinogen (≥3.54 <3.54, mg/dl), PNI (<47.03 ≥47.03), and MLR (≥0.29 <0.29) were defined using receiver operating characteristic (ROC) analysis and the Fib-PNI-MLR score (range, 0-3) was determined as the sum of points (0 or 1) assigned to each indicator. As a result, Fib-PNI-MLR was an independent risk factor for overall survival (OS), cancer-specific survival (CSS), and metastatic-free survival (MFS) (all < 0.05). The concordance-index and area under the curve (AUC) were larger for the Fib-PNI-MLR score than that for other clinical parameters. Subgroup analysis (Fuhrman grade G1+G2 and Fuhrman grade G3+G4; pathologic T1, T2, and T3-4 stage) revealed the significant association of a higher Fib-PNI-MLR score with poor urological outcomes (all < 0.05). Data indicated that patients with higher Fib-PNI-MLR might benefit from partial nephrectomy. The Fib-PNI-MLR score might serve as a promising prognostic factor in patients with non-metastatic RCC.
癌症相关炎症、凝血级联反应激活和营养不良与包括肾细胞癌（RCC）在内的恶性肿瘤患者的预后密切相关。本研究旨在探讨术前血浆纤维蛋白原、预后营养指数和单核细胞与淋巴细胞比值（Fib-PNI-MLR）联合检测对接受肾切除术的非转移性RCC患者的预后价值。我们回顾性收集了1019例RCC患者中829例的医疗数据。使用受试者工作特征（ROC）分析确定纤维蛋白原（≥3.54 <3.54，mg/dl）、PNI（<47.03 ≥47.03）和MLR（≥0.29 <0.29）的最佳截断值，并将Fib-PNI-MLR评分（范围0-3）确定为分配给每个指标的分数（0或1）之和。结果显示，Fib-PNI-MLR是总生存期（OS）、癌症特异性生存期（CSS）和无转移生存期（MFS）的独立危险因素（均<0.05）。Fib-PNI-MLR评分的一致性指数和曲线下面积（AUC）均大于其他临床参数。亚组分析（Fuhrman分级G1+G2和Fuhrman分级G3+G4；病理分期T1、T2和T3-4期）显示，较高的Fib-PNI-MLR评分与较差的泌尿系统预后显著相关（均<0.05）。数据表明，Fib-PNI-MLR较高的患者可能从部分肾切除术中获益。Fib-PNI-MLR评分可能是预测非转移性RCC患者预后的一个有前景的因素。
