中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值及德瑞蒂斯比值与肾细胞癌死亡率的相关性：一项多中心分析
Association of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and De Ritis ratio with mortality in renal cell carcinoma: A multicenter analysis.
作者信息
Keiner Cathrine, Meagher Margaret, Patil Dattatraya, Saito Kazutaka, Walia Arman, Liu Franklin, Dutt Raksha, Miller Nathan, Dhanji Sohail, Saidian Ava, Wan Fang, Yasuda Yosuke, Fujii Yasuhisa, Tanaka Hajime, Master Viraj, Derweesh Ithaar
机构信息
Department of Urology, UC San Diego School of Medicine, La Jolla, CA, United States.
Department of Urology, Emory University School of Medicine, Atlanta, GA, United States.
出版信息
Front Oncol. 2022 Nov 24;12:995991. doi: 10.3389/fonc.2022.995991. eCollection 2022.
BACKGROUND
Several markers of inflammation have been associated with oncologic outcomes. Prognostic markers are not well-defined for renal cell carcinoma (RCC). We sought to investigate the association of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis ratio with mortality in RCC.
METHODS
Multi-center retrospective analysis of patients undergoing surgery for RCC. Primary outcome of interest was all-cause mortality (ACM). Secondary outcomes were non-cancer mortality (NCM) and cancer-specific mortality (CSM). Elevated NLR was defined as ≥2.27, elevated PLR as ≥165, and elevated De Ritis ratio as ≥ 2.72. Multivariable cox regression analysis (MVA) was conducted to elucidate risk factors for primary and secondary outcomes, and Kaplan-Meier analysis (KMA) was used to evaluate survival outcomes comparing elevated and non-elevated NLR, PLR, and De Ritis ratio.
RESULTS
2656 patients were analyzed (874 patients had elevated NLR; 480 patients had elevated PLR and 932 patients had elevated De Ritis). Elevated NLR was a significant predictor of ACM (HR 1.32, 95% CI: 1.07-1.64, p=0.003) and NCM (HR 1.79, 95% CI: 1.30-2.46, p<0.001) in MVA. Elevated De Ritis was a significant predictor of ACM (HR 2.04, 95% CI: 1.65-2.52), NCM (HR 1.84, 95% CI: 1.33-2.55, p<0.001), and CSM (HR 1.97, 95% CI:1.48-2.63, p<0.001). KMA revealed significant difference in 5-year overall survival (OS) (48% vs. 68%, p<0.001), non-cancer survival (NCS) (69% vs. 87%, p<0.001), and cancer-specific survival (CSS) (60% vs. 73%, p<0.001) for elevated versus non-elevated NLR. For PLR, there was a difference in 5-year OS (51% vs. 61%, p<0.001) and CSS (60% vs. 73%, p<0.001) with KMA.
CONCLUSIONS
Elevated NLR was independently associated with worse ACM and NCM, while elevated De Ritis was predictive for CSM in addition to ACM and NCM. These differences may be useful in refining risk stratification with respect to cancer-related and non-cancer mortality in RCC patients and deserve further investigation.
背景
多种炎症标志物已被证明与肿瘤学预后相关。肾细胞癌（RCC）的预后标志物尚未明确界定。我们旨在研究术前中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）以及德瑞蒂斯比值与RCC患者死亡率之间的关联。
方法
对接受RCC手术的患者进行多中心回顾性分析。主要关注的结局是全因死亡率（ACM）。次要结局是非癌症死亡率（NCM）和癌症特异性死亡率（CSM）。NLR升高定义为≥2.27，PLR升高定义为≥165，德瑞蒂斯比值升高定义为≥2.72。进行多变量Cox回归分析（MVA）以阐明主要和次要结局的危险因素，并使用Kaplan-Meier分析（KMA）来评估比较NLR、PLR和德瑞蒂斯比值升高与未升高时的生存结局。
结果
共分析了2656例患者（874例患者NLR升高；480例患者PLR升高；932例患者德瑞蒂斯比值升高）。在MVA中，NLR升高是ACM（HR 1.32，95% CI：1.07 - 1.64，p = 0.003）和NCM（HR 1.79，95% CI：1.30 - 2.46，p < 0.001）的显著预测因素。德瑞蒂斯比值升高是ACM（HR 2.04，95% CI：1.
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