Xie Huadong, Huang Yuanbi, Ban Chengjie, Wei Wei, Tang Han, Huang Qingming, Su Zhengwei, Cheng Zhi, Liao Tianling, Liao Kangji, Zhou Liquan, Yi Xianlin
Department of Urology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Urology, Liuzhou Worker's Hospital, Liuzhou, Guangxi, China.
Front Oncol. 2025 Mar 11;15:1566848. doi: 10.3389/fonc.2025.1566848. eCollection 2025.
We evaluated the prognostic significance of the Lactate Dehydrogenase-to-Serum Albumin Ratio (LAR), Fibrinogen-to-Albumin Ratio (FAR), and Platelet-to-Lymphocyte Ratio (PLR) in patients with high-grade urothelial carcinoma (HGUC) of the bladder who underwent radical cystectomy (RC). These markers have been reported to be associated with the prognosis of various cancers.
A retrospective analysis was conducted on HGUC patients who underwent RC at Guangxi Medical University Cancer Hospital between January 2013 and June 2021. Optimal cutoff values for LAR, FAR, and PLR were established. Kaplan-Meier survival analysis was used to evaluate survival outcomes, while univariate and multivariable Cox regression analyses identified independent prognostic factors. A nomogram was developed to predict survival, with validation through time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).
A total of 180 patients were included, with a follow-up period ranging from 2 to 127 months (49.28 ± 37.87 months). The optimal cutoff values for LAR, PLR, and FAR were 4.46, 139.68, and 0.13, respectively. Multivariable Cox regression identified tumor stage, LAR, PLR, and FAR as independent prognostic factors. Specifically, Stage III (HR = 25.44, 95% CI: 5.20-124.35, p < 0.001) and Stage IV (HR = 11.28, 95% CI: 3.18-40.05, p < 0.001) were independent risk factors for poor survival. A low PLR (HR = 0.45, 95% CI: 0.27-0.76, p = 0.003), low FAR (HR = 0.51, 95% CI: 0.29-0.89, p = 0.018), and low LAR (HR = 0.39, 95% CI: 0.23-0.67, p < 0.001) were independently associated with improved survival. The nomogram demonstrated high accuracy in predicting 1-, 3-, and 5-year overall survival (OS), with area under the curve (AUC) values of 0.866, 0.84, and 0.831, respectively. Further validation confirmed the model's stability and clinical applicability.
LAR, PLR, and FAR are promising prognostic factors for HGUC of the bladder following RC, showing substantial potential for prognostic evaluation.
我们评估了乳酸脱氢酶与血清白蛋白比值（LAR）、纤维蛋白原与白蛋白比值（FAR）以及血小板与淋巴细胞比值（PLR）在接受根治性膀胱切除术（RC）的高级别膀胱尿路上皮癌（HGUC）患者中的预后意义。据报道，这些标志物与各种癌症的预后相关。
对2013年1月至2021年6月在广西医科大学附属肿瘤医院接受RC的HGUC患者进行回顾性分析。确定了LAR、FAR和PLR的最佳临界值。采用Kaplan-Meier生存分析评估生存结局，单因素和多因素Cox回归分析确定独立预后因素。绘制了列线图以预测生存情况，并通过时间依赖性受试者工作特征（ROC）曲线、校准图和决策曲线分析（DCA）进行验证。
共纳入180例患者，随访时间为2至127个月（49.28±37.87个月）。LAR、PLR和FAR的最佳临界值分别为4.46、139.68和0.13。多因素Cox回归分析确定肿瘤分期、LAR、PLR和FAR为独立预后因素。具体而言，Ⅲ期（HR = 25.44，95%CI：5.20 - 124.35，p < 0.001）和Ⅳ期（HR = 11.28，95%CI：3.18 - 40.05，p < 0.001）是生存不良的独立危险因素。低PLR（HR = 0.45，95%CI：0.27 - 0.76，p = 0.003）、低FAR（HR = 0.51，95%CI：0.29 - 0.89，p = 0.018）和低LAR（HR = 0.39，95%CI：0.23 - 0.67，p < 0.001）与生存改善独立相关。列线图在预测1年、3年和5年总生存（OS）方面显示出高准确性，曲线下面积（AUC）值分别为0.866、0.84和0.831。进一步验证证实了该模型的稳定性和临床适用性。
LAR、PLR和FAR是RC术后HGUC有前景的预后因素，在预后评估方面具有巨大潜力。
