术前血小板与淋巴细胞比值作为阴茎癌腹股沟淋巴结转移的预测指标

Preoperative platelet-to-lymphocyte ratio as a predictor of inguinal lymph node metastasis in penile cancer.

作者信息

Passaro Francesco, Tufano Antonio, Spena Gianluca, Izzo Alessandro, Scarlata Flavio Antonino, Barone Biagio, Napolitano Luigi, Pezone Gabriele, Alvino Pierluigi, Aveta Achille, Pandolfo Savio Domenico, Cilio Simone, Romano Lorenzo, Di Bello Francesco, Calarco Alessandro, Leonardi Rosario, Buonerba Carlo, Perdonà Sisto

机构信息

Department of Urology, Istituto Nazionale Tumori IRCCS, "Fondazione G. Pascale", Naples.

Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II".

出版信息

Arch Ital Urol Androl. 2025 Mar 28;97(1):13428. doi: 10.4081/aiua.2025.13428.

DOI:10.4081/aiua.2025.13428

PMID:40162815

Abstract

BACKGROUND

Penile cancer (PC) is a rare malignancy with poor prognosis. To date, reliable preoperative biomarkers for lymph node status and prognosis are still lacking. This study aims to explore the potential role of preoperative platelet-to-lymphocyte ratio (PLR) as a predictor of inguinal lymph node invasion in PC patients.

METHODS

Retrospective analysis was conducted on anamnestic, clinical, and laboratory data of PC patients who underwent surgical treatment between January 2016 and October 2023. Inguinal lymphadenectomy was performed as per EAU guidelines. PLR, calculated as the ratio between platelet-to-lymphocyte values obtained from preoperative blood analyses, was assessed within 30 days before surgery. Patients were categorized into pN- (no lymph node metastasis) and pN+ (lymph node metastasis confirmed pathologically). Statistical analyses included Kruskal-Wallis and Mann-Whitney U tests, univariate logistic regression, and ROC curve analysis with Youden index, assuming p<0.05 as statistically significant.

RESULTS

Overall, 60 PC patients were retrospectively involved in the study. A total of 36 (60%) patients reported ILN metastases, confirmed by inguinal lymphadenectomy (pN+), while no ILN metastases (pN-) were reported in 24 (40%) patients. The AUC for predicting ILN metastasis by preoperative PLR was 0.71 (p=0.014). According to the ROC curve analysis and the Youden Index, a cut-off for PLR was set at 122.4. On Univariable logistic regression analysis, the presence of T stage ≥ 2 (OR = 3.21; 95% CI: 1.43-7.47, p=0.011), lymphovascular invasion (OR = 3.78; 95% CI: 1.56-5.90, p=0.003), clinical node-positive disease (OR = 19.86; 95% CI: 5.91-41.03, p<0.001) and PLR ratio > 122.4 (OR = 7.22; 95% CI: 1.41-22.71, p=0.0148) were independent predictors of pN+ disease.

CONCLUSIONS

The current study confirms the relationship between cancer and inflammation. When elevated preoperatively, PLR may be associated with inguinal lymph node invasion in PC patients.

摘要

背景

阴茎癌（PC）是一种预后较差的罕见恶性肿瘤。迄今为止，仍缺乏用于评估淋巴结状态和预后的可靠术前生物标志物。本研究旨在探讨术前血小板与淋巴细胞比值（PLR）作为PC患者腹股沟淋巴结侵犯预测指标的潜在作用。

方法

对2016年1月至2023年10月期间接受手术治疗的PC患者的既往史、临床和实验室数据进行回顾性分析。根据欧洲泌尿外科学会（EAU）指南进行腹股沟淋巴结清扫术。PLR通过术前血液分析获得的血小板与淋巴细胞值之比计算得出，在手术前30天内进行评估。患者分为pN-（无淋巴结转移）和pN+（病理证实有淋巴结转移）两组。统计分析包括Kruskal-Wallis检验、Mann-Whitney U检验、单因素逻辑回归以及采用约登指数的ROC曲线分析，以p<0.05为具有统计学意义。

结果

总体而言，本研究共纳入60例PC患者。共有36例（60%）患者经腹股沟淋巴结清扫术证实有腹股沟淋巴结转移（pN+），而24例（40%）患者未报告有腹股沟淋巴结转移（pN-）。术前PLR预测腹股沟淋巴结转移的AUC为0.71（p=0.014）。根据ROC曲线分析和约登指数，将PLR的截断值设定为122.4。在单因素逻辑回归分析中，T分期≥2（OR = 3.21；95%CI：1.43 - 7.47，p=0.011）、淋巴管侵犯（OR = 3.78；95%CI：1.56 - 5.90，p=0.003）、临床淋巴结阳性疾病（OR = 19.86；95%CI：5.91 - 41.03，p<0.001）以及PLR比值>122.4（OR = 7.22；95%CI：1.41 - 22.71，p=0.0148）是pN+疾病的独立预测因素。