局部肾细胞癌手术后肿瘤学结局的系统性免疫决定因素。
Systemic Immunological Determinants of Oncological Outcomes After Surgery for Localized Renal Cell Carcinoma.
机构信息
Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
出版信息
Clin Genitourin Cancer. 2022 Oct;20(5):e432-e439. doi: 10.1016/j.clgc.2022.05.010. Epub 2022 May 25.
INTRODUCTION & OBJECTIVES: In systemic therapy trials, a decreasing neutrophil-to-lymphocyte ratio (NLR) after treatment for metastatic renal cell carcinoma (RCC) has been associated with improved oncologic outcomes. Paradoxically, for patients with localized RCC treated with upfront surgery the opposite effect has been reported. We thus aimed to evaluate NLR dynamics on localized RCC recurrence.
MATERIALS AND METHODS
Treatment naïve patients with localized RCC managed surgically between 2005 and 2020 were included. Preoperative NLR was calculated within 6-weeks prior to surgery and postoperative NLR was calculated between 4 and twelve-weeks after surgery. Patients were followed for disease recurrence, noting metastatic sites and postoperative infections. Cox regression were used to determine whether the relative change in postoperative NLR was associated with metastasis-free survival (MFS) and cancer-specific survival (CSS), adjusted for preoperative NLR.
RESULTS
In the cohort of 3310 patients, 996 (30%) had postoperative NLR available. These patients generally had more advanced disease, with 100 developing metastases and 38 dying from kidney cancer. Median MFS follow-up was 4.4 years. Decreasing 2-month postoperative NLR was associated with non-statistically significant worse MFS and CSS (HR 0.79, 95% 0.50, 1.24, P = .3; HR 0.83, 95% C.I. 0.40, 1.73; P = .6). On sensitivity analysis, across all NLR measurements, with NLR as a time-dependent covariate, results were similar, with a declining NLR associated with adverse MFS (HR 0.85, 95% CI 0.69, 1.30, P-value = .10), though not meeting conventional levels of significance.
CONCLUSION
In higher-risk localized RCC patients, postoperative NLR is not suitable as a biomarker for predicting recurrences.
介绍与目的
在转移性肾细胞癌（RCC）的系统治疗试验中，治疗后中性粒细胞与淋巴细胞比值（NLR）的降低与改善肿瘤学结局相关。具有讽刺意味的是，对于接受初始手术治疗的局限性 RCC 患者，却报告了相反的效果。因此，我们旨在评估 NLR 对局限性 RCC 复发的动态变化。
材料与方法
纳入 2005 年至 2020 年间接受手术治疗的局限性 RCC 且未经治疗的患者。在手术前 6 周内计算术前 NLR，在手术后 4 至 12 周内计算术后 NLR。患者接受疾病复发随访，记录转移部位和术后感染。使用 Cox 回归来确定术后 NLR 的相对变化是否与无复发生存（MFS）和癌症特异性生存（CSS）相关，调整术前 NLR。
结果
在 3310 例患者的队列中，有 996 例（30%）有术后 NLR 数据。这些患者的疾病通常更为晚期，有 100 例发生转移，38 例死于肾癌。MFS 中位随访时间为 4.4 年。术后 2 个月 NLR 降低与 MFS 和 CSS 无统计学显著降低相关（HR 0.79，95%CI 0.50，1.24，P=0.3；HR 0.83，95%CI 0.40，1.73；P=0.6）。在敏感性分析中，在所有 NLR 测量中，NLR 作为时间依赖性协变量，结果相似，NLR 下降与不良 MFS 相关（HR 0.85，95%CI 0.69，1.30，P 值=0.10），尽管未达到传统的显著性水平。
结论
在高风险局限性 RCC 患者中，术后 NLR 不适合作为预测复发的生物标志物。
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