Çavdar Ümit, Kalender Derya Sema Yaman, Yüksel Berna Demir, Pamuk Barış Önder, Çömlekçi Abdurrahman, Ertürk Mehmet Sercan, Gür Emine Özlem, Kahraman Aslı, Yörükoglu Kutsal, Yener Serkan
Division of Endocrinology and Metabolism, Atatürk Training and Research Hospital, Katip Celebi University, Izmir, Turkey.
Division of Endocrinology and Metabolism, Dokuz Eylul University Hospital, Izmir, Turkey.
Clin Endocrinol (Oxf). 2025 Mar;102(3):362-368. doi: 10.1111/cen.15192. Epub 2024 Dec 30.
Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have recently emerged in assessing pheochromocytomas and paragangliomas (PPGLs). However, their combined use with PASS scale has not yet been explored.
Our goal was to investigate the prognostic values of NLR and PLR and incorporate the PASS score into our analysis.
Data from 74 histologically confirmed pheochromocytomas/paragangliomas across two centres were assessed. Poor prognosis was characterised by the presence of metastasis or disease-specific mortality. Clinical characteristics such as age, gender, primary tumour size and location, and urinary metanephrine and normetanephrine levels, alongside NLR, PLR, and the PASS score as prognostic markers, were analysed. The prognostic value of the PASS score combined with NLR or PLR was evaluated using Receiver Operating Characteristic Curve (ROC), univariate, and multivariate regression analyses.
Sixty-four patients with better prognosis and 10 patients with poor prognosis were included in the analysis, with mean PASS scores of 4 and 9, respectively. Poor prognosis was significantly higher in patients with NLR Á 3.43 (Area Under Curve(AUC) = 0.761; 70% sensitivity, 82.8% specificity, 38.9% PPV and 94.7% NPV) and with PLR > 193.12 (AUC = 0.738; 70% sensitivity, 76.2% specificity, 30% PPV and 94% NPV). The PASS and preoperative NLR or PLR combination predicted poor prognosis significantly in the multivariate models (OR: 125; 95% CI: 6.25-∞; p = 0.001 for PASS ≥ 6 and NLR > 3.43 and OR: 28.57; 95% CI: 3-250; p = 0.003 for PASS ≥ 6 and PLR > 193.12).
As the roles of NLR and PLR in prediction of prognosis is gaining recognition, combining these with PASS score may improve preoperative stratification of prognosis and management of patients.
中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）最近在嗜铬细胞瘤和副神经节瘤（PPGLs）的评估中崭露头角。然而，它们与PASS量表的联合应用尚未得到探索。
我们的目标是研究NLR和PLR的预后价值，并将PASS评分纳入我们的分析。
评估了来自两个中心的74例经组织学确诊的嗜铬细胞瘤/副神经节瘤的数据。预后不良的特征为存在转移或疾病特异性死亡。分析了年龄、性别、原发肿瘤大小和位置、尿甲氧基肾上腺素和去甲氧基肾上腺素水平等临床特征，以及作为预后标志物的NLR、PLR和PASS评分。使用受试者操作特征曲线（ROC）、单因素和多因素回归分析评估PASS评分与NLR或PLR联合的预后价值。
分析纳入了64例预后较好的患者和10例预后较差的患者，其PASS评分平均值分别为4分和9分。NLR≥3.43（曲线下面积（AUC）=0.761；灵敏度70%，特异性82.8%，阳性预测值38.9%，阴性预测值94.7%）和PLR>193.12（AUC=0.738；灵敏度70%，特异性76.2%，阳性预测值30%，阴性预测值94%）的患者预后不良的比例显著更高。在多因素模型中，PASS与术前NLR或PLR联合显著预测了预后不良（对于PASS≥6且NLR>3.43，比值比（OR）：125；95%置信区间（CI）：6.25-∞；p=0.001；对于PASS≥6且PLR>193.12，OR：28.57；95%CI：3-250；p=0.003）。
随着NLR和PLR在预后预测中的作用得到认可，将它们与PASS评分相结合可能会改善患者术前的预后分层和管理。
