中性-淋巴细胞比和预后营养指数在膀胱癌根治术患者预后评估中的价值
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摘要
目的探讨中性粒细胞与淋巴细胞比值(NLR)和预后营养指数(PNI)在膀胱癌根治术患者预后中的相关性。方法回顾性分析膀胱癌根治术患者213例,根据术前NLR和PNI,将其分为低NLR组(NLR<2.89)和高NLR组(NLR≥2.89),低PNI组(PNI<46.08)和高PNI组(PNI≥46.08)。分析预后相关因素:NLR、PNI、年龄、性别、组织学分级、病理T分期、肿瘤大小、肿瘤数目等。结果多因素分析结果显示:NLR(P=0.023)、PNI(P=0.038)、肾积水(P=0.014)、组织学分级(P=0.043)、病理T分期(P<0.001)是影响患者无进展生存期(PFS)的独立危险因素。NLR(P=0.008)、PNI(P=0.012)、年龄(P=0.029)、肾积水(P=0.002)、组织学分级(P=0.009)、病理T分期(P<0.001)是影响患者总生存期(OS)的独立危险因素;NLR≥2.89及PNI<46.08预示膀胱癌根治术患者的PFS和OS较短。结论 NLR和PNI是膀胱癌根治术患者预后的独立危险因素,高NLR和低PNI与患者预后不良相关。
Objective To explore the correlation between neutrophil-lymphocyte ratio(NLR) and prognostic nutritional index(PNI) in the prognosis of patients with bladder cancer undergoing radical cystectomy.Methods A retrospective study of 213 patients with bladder cancer who underwent radical cystectomy. According to the values of preoperative NLR and PNI,patients were divided into low NLR group(NLR<2.89) and high NLR group(NLR≥2.89), low PNI group(PNI<46.08) and high PNI group(PNI≥46.08). The potential prognostic factors were analyzed such as NLR, PNI, age, gender, histological grade, pathological T stage, tumor size, number of tumors, etc.Results Multivariate analysis showed that NLR(P=0.023), PNI(P=0.038), hydronephrosis(P=0.014)histological grade( P = 0. 043),and pathological T stage( P < 0. 001) were independent risk factors for progressionfree survival( PFS) of patients underwent radical cystectomy; NLR( P = 0. 008),PNI( P = 0. 012),age( P =0. 029),hydronephrosis( P = 0. 002),histological grade( P = 0. 009),pathological T stage( P < 0. 001) were independent risk factors for overall survival( OS) of patients underwent radical cystectomy. Patients with NLR≥2. 89 and/or PNI < 46. 08 predicted shorter progression-free survival and overall survival. Conclusion NLR and PNI are independent risk factors for the prognosis of patients underwent radical cystectomy. Higher NLR and lower PNI are associated with patients a poor prognosis.
Objective To explore the correlation between neutrophil-lymphocyte ratio(NLR) and prognostic nutritional index(PNI) in the prognosis of patients with bladder cancer undergoing radical cystectomy.Methods A retrospective study of 213 patients with bladder cancer who underwent radical cystectomy. According to the values of preoperative NLR and PNI,patients were divided into low NLR group(NLR<2.89) and high NLR group(NLR≥2.89), low PNI group(PNI<46.08) and high PNI group(PNI≥46.08). The potential prognostic factors were analyzed such as NLR, PNI, age, gender, histological grade, pathological T stage, tumor size, number of tumors, etc.Results Multivariate analysis showed that NLR(P=0.023), PNI(P=0.038), hydronephrosis(P=0.014)histological grade( P = 0. 043),and pathological T stage( P < 0. 001) were independent risk factors for progressionfree survival( PFS) of patients underwent radical cystectomy; NLR( P = 0. 008),PNI( P = 0. 012),age( P =0. 029),hydronephrosis( P = 0. 002),histological grade( P = 0. 009),pathological T stage( P < 0. 001) were independent risk factors for overall survival( OS) of patients underwent radical cystectomy. Patients with NLR≥2. 89 and/or PNI < 46. 08 predicted shorter progression-free survival and overall survival. Conclusion NLR and PNI are independent risk factors for the prognosis of patients underwent radical cystectomy. Higher NLR and lower PNI are associated with patients a poor prognosis.
引文
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[14] Tobert C M, Hamiltonreeves J M, Norian L A, et al. The emerging impact of malnutrition on surgical patients: literature review and potential implications on cystectomy for bladder cancer[J]. J Urol, 2017, 198(3):511-9.
[15] Cui J, Chen S, Bo Q, et al. Preoperative prognostic nutritional index and nomogram predicting recurrence-free survival in patients with primary non-muscle-invasive bladder cancer without carcinoma in situ[J]. Onco Targets Ther, 2017, 10:5541-50.
[2] Alfred W J, Lebret T, Compérat E M, et al. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer[J]. Eur Urol, 2017, 71(3):462-75.
[3] Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation[J]. Nature, 2008, 454(7203):436-44.
[4] Grivennikov S I, Greten F R, Karin M. Immunity, inflammation, and cancer[J]. Cell, 2010, 140(6):883-99.
[5] Miyamoto R, Inagawa S, Sano N, et al. The neutrophil-to-lymphocyte ratio (NLR) predicts short-term and long-term outcomes in gastric cancer patients[J]. Eur J Surg Oncol, 2018, 44(5):607-12.
[6] Suzuki R,Lin S H,Wei X, et al. Prognostic significance of pretreatment total lymphocyte count and neutrophil-to-lymphocyte ratio in extensive-stage small-cell lung cancer[J]. Radiother Oncol, 2018, 126(3):499-505.
[7] Feng Z,Wen H,Ju X, et al. The preoperative prognostic nutritional index is a predictive and prognostic factor of high-grade serous ovarian cancer[J]. BMC Cancer, 2018, 18(1):883.
[8] Peng D, He Z S, Li X S, et al. Prognostic value of inflammatory and nutritional scores in renal cell carcinoma after nephrectomy[J]. Clin Genitourin Cancer, 2017, 15(5):582-90.
[9] Viola A, Sarukhan A, Bronte V, et al. The pros and cons of chemokines in tumor immunology[J]. Trends Immunol, 2012, 33(10):496-504.
[10] Zhang X, Zhang W, Yuan X, et al. Neutrophils in cancer development and progression: roles, mechanisms, and implications(review)[J]. Int J Oncol, 2017, 49(3):857-67.
[11] Tang X, Wang S, An C, et al. Preoperative high neutrophil-to-lymphocyte ratio is associated with high-grade bladder cancer[J]. Anticancer Res, 2017, 37(8):4659-63.
[12] Rajwa P,?yczkowski M, Paradysz A, et al. Evaluation of the prognostic value of LMR, PLR, NLR, and dNLR in urothelial bladder cancer patients treated with radical cystectomy[J]. Eur Rev Med Pharmacol Sci, 2018, 22(10):3027-37.
[13] Onodera T,Goseki N,Kosaki G, et al. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients[J]. Nihon Geka Gakkai Zasshi, 1984, 85(9):1001-5.
[14] Tobert C M, Hamiltonreeves J M, Norian L A, et al. The emerging impact of malnutrition on surgical patients: literature review and potential implications on cystectomy for bladder cancer[J]. J Urol, 2017, 198(3):511-9.
[15] Cui J, Chen S, Bo Q, et al. Preoperative prognostic nutritional index and nomogram predicting recurrence-free survival in patients with primary non-muscle-invasive bladder cancer without carcinoma in situ[J]. Onco Targets Ther, 2017, 10:5541-50.