Chen Dan, Tang Yaxiong, Zhang Bin
Department of Urology, Chengdu Seventh People's Hospital, Affiliated Cancer Hospital of Chengdu Medical College, Chengdu, 610041, China.
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Cancer. 2025 Jun 2;25(1):988. doi: 10.1186/s12885-025-14418-z.
Various systemic inflammation indices have emerged as prognostic markers for renal cell carcinoma (RCC); however, these indices have not been comprehensively integrated. In this study, we propose a novel systemic inflammation indice, the platelet-neutrophil-monocyte-lymphocyte ratio (PNMLR), aimed at more accurately assessing survival outcomes of patients with non-metastatic RCC.
We conducted a retrospective analysis of non-metastatic RCC patients who underwent nephrectomy between 2009 and 2013. Restricted cubic splines (RCS) were used to observe the relationship between PNMLR and disease-free survival (DFS) as well as overall survival (OS). Receiver operating characteristic curve and the Maximally Selected Log-Rank Statistic were employed to determine the optimal cutoff value of PNMLR. Patients were then divided into two groups based on the determined cutoff values and propensity score matching (PSM) was performed to balance baseline characteristics. After that, Kaplan-Meier curves and cox regression models were utilized to evaluate DFS and OS. Finally, the concordance index (c-index) of PLNMR (before PSM) in predicting DFS and OS was calculated and compared with other systemic inflammation indices.
A total of 1163 patients were included. RCS showed a significant association between PNMLR and DFS as well as OS (both p < 0.001). The optimized PNMLR cutoff was 168. Patients with higher PNMLR exhibited larger tumor size (OR = 1.16, p = 0.028), higher Fuhrman grade (HR = 1.59, p = 0.001), and advanced pT stage (HR = 1.88, p = 0.003). After PSM, elevated PNMLR was associated with poorer DFS (HR = 1.56, p = 0.011) and OS (HR = 1.75, p = 0.004). The c-index of PNMLR for DFS and OS were 0.643 (95%CI, 0.596-0.689) and 0.669 (95%CI, 0.611-0.708) respectively, suggesting competitive predictive performance compared to other systemic inflammation indices.
PNMLR is a promising prognostic marker for non-metastatic RCC. However, its moderate discriminative ability suggests that PNMLR should be used in conjunction with other established clinical parameters. Further validation, particularly in independent, contemporary external cohorts, is essential to fully harness its clinical utility.
多种全身炎症指标已成为肾细胞癌（RCC）的预后标志物；然而，这些指标尚未得到全面整合。在本研究中，我们提出了一种新的全身炎症指标，即血小板-中性粒细胞-单核细胞-淋巴细胞比值（PNMLR），旨在更准确地评估非转移性RCC患者的生存结局。
我们对2009年至2013年间接受肾切除术的非转移性RCC患者进行了回顾性分析。使用受限立方样条（RCS）观察PNMLR与无病生存期（DFS）以及总生存期（OS）之间的关系。采用受试者工作特征曲线和最大选择对数秩统计量来确定PNMLR的最佳临界值。然后根据确定的临界值将患者分为两组，并进行倾向评分匹配（PSM）以平衡基线特征。之后，利用Kaplan-Meier曲线和Cox回归模型评估DFS和OS。最后，计算并比较PNMLR（PSM前）预测DFS和OS的一致性指数（c指数）与其他全身炎症指标。
共纳入1163例患者。RCS显示PNMLR与DFS以及OS之间存在显著关联（均p < 0.001）。优化后的PNMLR临界值为168。PNMLR较高的患者肿瘤体积较大（OR = 1.16，p = 0.028），Fuhrman分级较高（HR = 1.59，p = 0.001），且pT分期较晚（HR = 1.88，p = 0.003）。PSM后，PNMLR升高与较差的DFS（HR = 1.56，p = 0.011）和OS（HR = 1.75，p = 0.004）相关。PNMLR预测DFS和OS的c指数分别为0.643（95%CI，0.596 - 0.689）和0.669（95%CI，0.611 - 0.708），表明与其他全身炎症指标相比具有竞争性的预测性能。
PNMLR是一种有前景的非转移性RCC预后标志物。然而，其中等的判别能力表明PNMLR应与其他已确立的临床参数联合使用。进一步验证，特别是在独立的当代外部队列中，对于充分发挥其临床效用至关重要。
