根治性肾输尿管切除术后血小板-淋巴细胞比值对膀胱内复发的预测价值：一项回顾性研究
Predictive Value of the Platelet-Lymphocyte Ratio for Intravesical Recurrence After Radical Nephroureterectomy: A Retrospective Study.
作者信息
Zhao Yu, Ma Yina, Zhang Wenhui, Jiao Binbin, Chen Yuanhao, Li Gao, Zhang Xin
机构信息
Department of Urology Surgery, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China.
Department of Hepatobiliary Surgery, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China.
出版信息
J Inflamm Res. 2024 Dec 11;17:10819-10833. doi: 10.2147/JIR.S483242. eCollection 2024.
OBJECTIVE
The aim of this study was to evaluate the impact of preoperative platelet lymphocyte ratio (PLR) on the prognosis of patients after radical nephrectomy (RNU).
METHODS
We retrospectively analyzed clinical data from 226 patients without a history of bladder cancer who underwent RNU at Beijing Chaoyang Hospital, Capital Medical University between January 2009 and December 2020. Patients were stratified into two groups (A low PLR group (n = 174) and a high PLR group (PLR ≥ 169.4) based on an optimal PLR threshold (PLR=169.4). The predictive accuracy of inflammatory biomarkers was assessed using receiver operating characteristic curves. Univariate and multivariate Cox proportional risk analyses were used to estimate the effect of PLR on intravesical recurrence-free survival (IVRFS), recurrence-free survival (RFS), and overall survival (OS). The effect of PLR on IVRFS, RFS and OS was further examined using Kaplan-Meier survival curve analysis.
RESULTS
The study cohort comprised 226 individuals with a mean age of 67.2 ± 9.8, 113 (50%) males and 113 (50%) females, 68 (30.1%) low-grade tumors and 158 (69.9%) high-grade tumors. In this study, 81 patients (36.7%) relapsed and 73 patients (32.3%) died. The area under the curve for PLR prediction of IVRFS was 0.603, superior to other inflammatory biomarkers. Multivariate analysis showed that PLR > 169.4 independently increased the risk of IVR after RNU, resulting in lower IVRFS [2.028 (1.014-4.057), P = 0.046], RFS [1.900 (1.168-3.090), P = 0.010], and OS [1.866 (1.099-3.167), P = 0.021]. In addition, survival analysis showed lower IVRFS [8.815 (62.722-97.278), P = 0.007], RFS [12.084 (44.315-91.685), P = 0.003] and OS RFS [10.165 (62.077-101.923), P = 0.005] in the low PLR group.
CONCLUSION
Elevated preoperative PLR is strongly associated with prognosis in patients with upper urothelial carcinoma (UTUC) after RNU without a history of bladder cancer.
目的
本研究旨在评估术前血小板淋巴细胞比值（PLR）对根治性肾切除术（RNU）后患者预后的影响。
方法
我们回顾性分析了2009年1月至2020年12月期间在首都医科大学附属北京朝阳医院接受RNU且无膀胱癌病史的226例患者的临床资料。根据最佳PLR阈值（PLR = 169.4）将患者分为两组（低PLR组，n = 174；高PLR组，PLR≥169.4）。使用受试者工作特征曲线评估炎症生物标志物的预测准确性。采用单因素和多因素Cox比例风险分析来估计PLR对膀胱内无复发生存期（IVRFS）、无复发生存期（RFS）和总生存期（OS）的影响。使用Kaplan-Meier生存曲线分析进一步检验PLR对IVRFS、RFS和OS的影响。
结果
研究队列包括226例患者，平均年龄67.2±9.8岁，男性113例（50%），女性113例（50%），低级别肿瘤68例（30.1%），高级别肿瘤158例（69.9%）。本研究中，81例患者（36.7%）复发，73例患者（32.3%）死亡。PLR预测IVRFS的曲线下面积为0.603，优于其他炎症生物标志物。多因素分析显示，PLR>169.4独立增加RNU后IVR的风险，导致IVRFS降低[2.028（1.014 - 4.057），P = 0.046]，RFS降低[1.900（1.168 - 3.090），P = 0.010]，OS降低[1.866（1.099 - 3.167），P = 0.021]。此外，生存分析显示低PLR组的IVRFS降低[8.815（62.722 - 97.278），P = 0.007]，RFS降低[12.084（44.315 - 91.685），P = 0.003]，OS RFS降低[10.165（62.077 - 101.923），P = 0.005]。
结论
术前PLR升高与无膀胱癌病史的上尿路上皮癌（UTUC）患者RNU后的预后密切相关。
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