术前中性粒细胞淋巴细胞比值与淋巴细胞单核细胞比值评估非肌层浸润性膀胱癌预后的临床价值
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摘要
目的探讨术前中性粒细胞淋巴细胞比值(NLR)与淋巴细胞单核细胞比值(LMR)作为接受经尿道膀胱肿瘤电切术的非肌层浸润性膀胱癌(NMIBC)患者预后评估方法的价值。方法对2011年9月至2017年1月新疆医科大学附属第一医院行经尿道膀胱肿瘤电切术(TURBT)且新诊断为非肌层浸润性膀胱癌的270例患者资料进行回顾性分析。NLR和LMR是通过在TURBT前确定且完整的血常规检测结果计算而来,患者据此分为低NLR组(<2.4,172例)和高NLR组(≥2.4,98例)以及低LMR组(<4,98例)和高LMR组(≥4,172例)。用Kaplan-Meier法绘制各临床因素无复发生存曲线,并用Log-rank检验比较各组内的生存曲线;用Cox多因素分析影响非肌层浸润性膀胱癌预后的独立危险因素。结果 NLR与肿瘤数量、病理分级、肿瘤T分期、复发、进展有关(P<0.05);LMR与性别、年龄有关(P<0.05)。单因素分析结果提示NLR、肿瘤数量、肿瘤大小、病理分级、肿瘤T分期与患者的无复发生存时间有关(P<0.05)。多因素分析提示NLR、肿瘤数量、病理分级、肿瘤T分期是影响肿瘤复发的因素。结论术前NLR是影响非肌层浸润性膀胱癌患者术后无复发生存时间的独立危险因素,可以作为判断预后的一项指标。高NLR的非肌层浸润性膀胱癌患者复发率较低NLR的更高。
Objective To explore the value of preoperative neutrophil-lymphocyte ratio(NLR)and lymphocyte-monocyte ratio(LMR)in predicting the prognosis of patients with non-muscle invasive bladder cancer(NMIBC).Methods Clinical data of NMIBC patients treated with transurethral resection of bladder tumor(TURBT)were retrospectively analyzed.According to the preoperative NLR and LMR,the patients were divided into 4 groups:low NLR group(<2.4,n=172),high NLR group(≥2.4,n=98),low LMR group(<4,n=98)and high LMR group(≥4,n=172).The recurrence-free survival curves were made with Kaplan-Meier method,and compared with log-rank test.The independent risk factors influencing the prognosis of patients were analyzed with Cox multivariate analysis.Results NLR was related to tumor number,pathological grade,T stage,recurrence and progression(P<0.05).LMR was related to gender and age.The results of univariate analysis indicated that NLR,tumor number,tumor size,pathological grade and T stage were related to the non-recurrence survival(P<0.05).Multivariate analysis indicated that NLR,tumor number,pathological grade and T stage were the factors influencing tumor recurrence.Conclusion Preoperative NLR is an independent risk factor influencing postoperative recurrence-free survival of NMIBC patients,which can be used as a prognostic indicator.Patients with high NLR has higher recurrence rate than patients with low NLR.
Objective To explore the value of preoperative neutrophil-lymphocyte ratio(NLR)and lymphocyte-monocyte ratio(LMR)in predicting the prognosis of patients with non-muscle invasive bladder cancer(NMIBC).Methods Clinical data of NMIBC patients treated with transurethral resection of bladder tumor(TURBT)were retrospectively analyzed.According to the preoperative NLR and LMR,the patients were divided into 4 groups:low NLR group(<2.4,n=172),high NLR group(≥2.4,n=98),low LMR group(<4,n=98)and high LMR group(≥4,n=172).The recurrence-free survival curves were made with Kaplan-Meier method,and compared with log-rank test.The independent risk factors influencing the prognosis of patients were analyzed with Cox multivariate analysis.Results NLR was related to tumor number,pathological grade,T stage,recurrence and progression(P<0.05).LMR was related to gender and age.The results of univariate analysis indicated that NLR,tumor number,tumor size,pathological grade and T stage were related to the non-recurrence survival(P<0.05).Multivariate analysis indicated that NLR,tumor number,pathological grade and T stage were the factors influencing tumor recurrence.Conclusion Preoperative NLR is an independent risk factor influencing postoperative recurrence-free survival of NMIBC patients,which can be used as a prognostic indicator.Patients with high NLR has higher recurrence rate than patients with low NLR.
引文
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[15]MORIZAWA Y,MIYAKE M,SHIMADA K,et al.Neutrophilto-lymphocyte ratio as a detection marker of tumor recurrence in patients with muscle-invasive bladder cancer after radical cystectomy[J].Urol Oncol,2016,34(6):257.e11-257.e17.
[16]KAWAHARA T,FURUYA K,NAKAMURA M,et al.Neutrophil-to-lymphocyte ratio is a prognostic marker in bladder cancer patients after radical cystectomy[J].BMC Cancer,2016,16(1):185.
[17]MANO R,BANIEL J,SHOSHANY O,et al.Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non-muscleinvasive bladder cancer[J].Urol Oncol,2015,33(2):67.e1-67.e7.
[18]OZYALVACLI M E,OZYALVACLI G,KOCAASLAN R,et al.Neutrophil-lymphocyte ratio as a predictor of recurrence and progression in patients with high-grade pT1bladder cancer[J].Can Urol Assoc J,2015,9(3-4):E126.
[19]BASSETT J C,GORE J L,KWAN L,et al.Knowledge of the harms of tobacco use among patients with bladder cancer[J].Cancer,2015,120(24):3914-3922.
[20]YOSHIDA T,KINOSHITA H,YOSHIDA K,et al.Prognostic impact of perioperative lymphocyte-monocyte ratio in patients with bladder cancer undergoing radical cystectomy[J].Tumour Biol,2016,37(8):10067-10074.
[2]BURGER,MAXIMILIAN,CATTO,et al.Epidemiology and risk Factors of urothelial bladder cancer[J].Eur Urol,2013,63(2):234-241.
[3]PARAMANATHAN A,SAXENA A,MORRIS D L.A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours[J].Surg Oncol,2014,23(1):31-39.
[4]MANTOVANI A,ALLAVENA P,SICA A,et al.Cancer-related inflammation[J].Nature,2008,454(7203):436-444.
[5]KUBO T,ONO S,UENO H,et al.Impact of the perioperative neutrophil-to-lymphocyte ratio on the long-term survival following an elective resection of colorectal carcinoma[J].Int J Colorectal Dis,2014,29(9):1091-1099.
[6]李金鹏,胡善亮,陈华,等.NLR对肝癌TACE患者预后影响的分析[J].中华肿瘤防治杂志,2013,20(7):522-525.
[7]AZAB B,BHATT V R,PHOOKAN J,et al.Usefulness of the neutrophil-to-lymphocyte ratio in predicting short-and long-term mortality in breast cancer patients[J].Ann Surg Oncol,2012,19(1):217-224.
[8]周文杰,吴骏,李晓东,等.术前单核细胞淋巴细胞比值对食管胃结合部癌患者术后生存的影响[J].中华肿瘤杂志,2017,39(3):178-183.
[9]BUISAN O,ORSOLA A,AREAL J,et al.Low pretreatment neutrophil-to-lymphocyte ratio predicts for good outcomes in patients receiving neoadjuvant chemotherapy before radical cystectomy for muscle invasive bladder cancer[J].Clin Genitourin Cancer,2017,15(1):145.
[10]TAN Y G,EWC E,HUANG H H,et al.High neutrophil-tolymphocyte ratio predicts worse overall survival in patients with advanced/metastatic urothelial bladder cancer[J].Int J Urol,2017,25(3):232-238.
[11]白云金,蒲春晓,韩平,等.中性粒细胞/淋巴细胞比值在肌层浸润性膀胱癌预后评估中的价值[J].现代泌尿外科杂志,2015,20(1):15-17.
[12]ZHANG G M,ZHU Y,LUO L,et al.Preoperative lymphocytemonocyte and platelet-lymphocyte ratios as predictors of overall survival in patients with bladder cancer undergoing radical cystectomy[J].Tumour Biol,2015,36(11):1-7.
[13]KU J H,KANG M,KIM H S,et al.The prognostic value of pretreatment of systemic inflammatory responses in patients with urothelial carcinoma undergoing radical cystectomy[J].Br J Cancer,2015,112(3):461-467.
[14]LIU J,GENG Q,CHEN S,et al.Nomogram based on systemic inflammatory response markers predicting the survival of patients with resectable gastric cancer after D2gastrectomy[J].Oncotarget,2016,7(25):37556-37565.
[15]MORIZAWA Y,MIYAKE M,SHIMADA K,et al.Neutrophilto-lymphocyte ratio as a detection marker of tumor recurrence in patients with muscle-invasive bladder cancer after radical cystectomy[J].Urol Oncol,2016,34(6):257.e11-257.e17.
[16]KAWAHARA T,FURUYA K,NAKAMURA M,et al.Neutrophil-to-lymphocyte ratio is a prognostic marker in bladder cancer patients after radical cystectomy[J].BMC Cancer,2016,16(1):185.
[17]MANO R,BANIEL J,SHOSHANY O,et al.Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non-muscleinvasive bladder cancer[J].Urol Oncol,2015,33(2):67.e1-67.e7.
[18]OZYALVACLI M E,OZYALVACLI G,KOCAASLAN R,et al.Neutrophil-lymphocyte ratio as a predictor of recurrence and progression in patients with high-grade pT1bladder cancer[J].Can Urol Assoc J,2015,9(3-4):E126.
[19]BASSETT J C,GORE J L,KWAN L,et al.Knowledge of the harms of tobacco use among patients with bladder cancer[J].Cancer,2015,120(24):3914-3922.
[20]YOSHIDA T,KINOSHITA H,YOSHIDA K,et al.Prognostic impact of perioperative lymphocyte-monocyte ratio in patients with bladder cancer undergoing radical cystectomy[J].Tumour Biol,2016,37(8):10067-10074.