Cheng Yuling, Kou Wei, Zhu Yu
Department of Urology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
Int J Gen Med. 2023 Jul 19;16:3067-3080. doi: 10.2147/IJGM.S417948. eCollection 2023.
This study aimed to investigate the association between preoperative inflammation-associated blood cell markers and the prognosis of patients with non-metastatic clear cell renal cell carcinoma (ccRCC) who underwent nephrectomy.
We retrospectively analyzed data from our single-center cohort of patients who underwent radical or partial nephrectomy for non-metastatic ccRCC. The optimal cutoff values for red blood cell distribution width (RDW), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR) were determined using X-tile software. We evaluated recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) using the Kaplann-Meier method. Cox proportional-hazards regression models were utilized to assess predictors of RFS, CSS, and OS. The predictive accuracy was evaluated using Harrell's Concordance Index (C-index).
A total of 444 patients who underwent nephrectomy were included in the study. The optimal cutoff values for RDW, PLR, NLR, and LMR were determined as 13.1, 157.3, 3.4, and 2.7, respectively. On univariate Cox regression analysis, NLR, PLR, and LMR were significant predictors for RFS, CSS, and OS. After adjusting for important prognostic factors, only NLR remained a significant prognostic marker for both CSS and OS. When NLR was added to the stage, size, grade, and necrosis (SSIGN) model, the C-index increased from 0.777 to 0.826 for CSS and from 0.703 to 0.734 for OS. Similarly, when NLR was added to the University of California, Los Angeles, Integrated Staging System (UISS), the C-index increased from 0.796 to 0.811 for CSS and from 0.735 to 0.745 for OS.
NLR is a reliable prognostic biomarker for patients with non-metastatic ccRCC. The prognostic capabilities of UISS and SSIGN models could be improved by adding NLR to UISS and SSIGN models.
本研究旨在探讨术前炎症相关血细胞标志物与接受肾切除术的非转移性透明细胞肾细胞癌（ccRCC）患者预后之间的关联。
我们回顾性分析了单中心队列中接受根治性或部分肾切除术治疗非转移性ccRCC患者的数据。使用X-tile软件确定红细胞分布宽度（RDW）、血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）以及淋巴细胞与单核细胞比值（LMR）的最佳临界值。我们采用Kaplan-Meier法评估无复发生存期（RFS）、癌症特异性生存期（CSS）和总生存期（OS）。利用Cox比例风险回归模型评估RFS、CSS和OS的预测因素。使用Harrell一致性指数（C指数）评估预测准确性。
本研究共纳入444例接受肾切除术的患者。RDW、PLR、NLR和LMR的最佳临界值分别确定为13.1、157.3、3.4和2.7。单因素Cox回归分析显示NLR、PLR和LMR是RFS、CSS和OS的显著预测因素。在对重要预后因素进行校正后，仅NLR仍然是CSS和OS的显著预后标志物。当将NLR添加到分期、大小、分级和坏死（SSIGN）模型中时，CSS的C指数从0.777增加到0.826，OS的C指数从0.703增加到0.734。同样，当将NLR添加到加利福尼亚大学洛杉矶分校综合分期系统（UISS）中时，CSS的C指数从0.796增加到0.811，OS的C指数从0.735增加到0.745。
NLR是无转移性ccRCC患者可靠的预后生物标志物。将NLR添加到UISS和SSIGN模型中可提高UISS和SSIGN模型的预后能力。
