术前外周血淋巴细胞/单核细胞比值与高级别T1期膀胱癌电切术后生存时间的相关性分析
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摘要
目的研究术前外周血淋巴细胞/单核细胞比值(LMR)与高级别T1期膀胱癌电切术后生存时间的相关性,旨在为更好的治疗高级别T1期膀胱癌患者提供有效的理论依据。方法回顾性分析2007年5月至2012年5月行经尿道膀胱肿瘤切除术,术后经病理明确诊断为高级别T1期膀胱癌180例患者的临床资料。利用受试者工作特征(ROC)曲线,最终确定LMR的截点值为4. 34,以4. 34为切割点,分为高LMR组(LMR≥4. 34)和低LMR组(LMR<4. 34)。分析不同LMR比值与高级别T1期膀胱癌电切术后患者肿瘤大小、灌注化疗、肿瘤数量、肾积水等临床病理特征以及术后生存时间的相关性,采用Cox多因素分析影响高级别T1期膀胱癌电切术后生存时间的独立危险因素。结果 2组患者性别比、年龄、吸烟史、肿瘤大小、围手术期输血、灌注化疗中比较差异无统计学意义(P> 0. 05),而肿瘤数量、肾积水、肿瘤复发、肿瘤进展2组患者存在明显差异(P <0. 05)。单因素分析:不同性别以及有无吸烟史对患者无复发生存时间以及总生存时间无明显影响(P> 0. 05),而年龄大小、肿瘤数量、肿瘤大小、有无肾积水、围手术期输血、灌注化疗以及LMR值对患者无复发生存时间以及总生存时间存在明显影响性(P <0. 05)。Cox多因素结果显示:肾积水、LMR <4. 34是影响高级别T1期膀胱癌患者术后生存时间的独立危险因素[HR=2. 119(1. 347～3. 333)、HR=1. 868(1. 221～2. 859)],灌注化疗是提高高级别T1期膀胱癌患者术后生存时间的保护因素[HR=0. 558(0. 448～0. 695)]。结论术前LMR值能反映高级别T1期膀胱癌患者电切术后生存时间,能作为评价高级别T1期膀胱癌患者电切术后预后的指标,LMR值下降提示高级别T1期膀胱癌患者电切术后预后不良。
Objective To investigate the relationship between the preoperative peripheral blood lymphocytes/mononuclear cell ratio( LMR) and survival time in patients with advanced stage T1 bladder cancer after transurethral resection in order to provide theoretical basis for effective treatment of advanced bladder cancer. Methods The clinical data about 180 patients with high grade stage T1 bladder cancer after transurethral resection of bladder tumor who were diagnosed by pathology and treated in our hospital from May 2007 to May 2012 were retrospectively analyzed. The receiver operating characteristic curve( ROC) was used to ultimately determine the cutoff value of LMR as 4. 34. According to the cutting point,the patients were divided into the high LMR group( LMR ≥4. 34) and the low LMR group( LMR < 4. 34). The relationship between different LMR ratios and tumor size,tumor number,hydronephrosis and postoperative survival time was analyzed. The multivariate Cox analysis was used to investigate the independent risk factors influencing survival time of patients with T1 high grade bladder cancer after transurethral resection. Results There were no significant differences in the gender,age,smoking history,tumor size,perioperative blood transfusion,perfusion chemotherapy between the two groups( P > 0. 05),however,there were significant differences in the number of tumor,hydronephrosis,lymph node metastasis,recurrence and progression of tumor between two groups( P < 0. 05). The single factor analysis showed that the sex and smoking history had no significant effects on relapse free survival time and overall survival time( P > 0. 05),but patient's age,tumor number,tumor size,renal water,perioperative blood transfusion,infusion chemotherapy,lymph node metastasis and LMR value were closely correlated with relapse free survival time and overall survival time( P < 0. 05). The multivariate Cox regression analysis showed that hydronephrosis and LMR < 4. 34 were the independent risk factors of survival time of patients with T1 high grade bladder cancer after surgery[Hr = 2. 119( 1. 347～3. 333) and Hr = 1. 868( 1. 221～2. 859) ],moreover,the infusion chemotherapy was a protective factor for improving the postoperative survival time of patients with high-grade stage T1 bladder cancer [Hr =0. 558( 0. 448～0. 695) ]. Conclusion The value of preoperative LMR can reflect the survival time of patients with high grade T1 bladder cancer after transurethral resection of bladder cancer,which can be regarded as an index of evaluation of postoperative prognosis in patients with advanced stage T1 bladder cancer after transurethral resection of bladder cancer. Moreover the decrease of LMR value suggests that the prognosis of patients with high grade stage T1 bladder cancer after transurethral resection is poor.
Objective To investigate the relationship between the preoperative peripheral blood lymphocytes/mononuclear cell ratio( LMR) and survival time in patients with advanced stage T1 bladder cancer after transurethral resection in order to provide theoretical basis for effective treatment of advanced bladder cancer. Methods The clinical data about 180 patients with high grade stage T1 bladder cancer after transurethral resection of bladder tumor who were diagnosed by pathology and treated in our hospital from May 2007 to May 2012 were retrospectively analyzed. The receiver operating characteristic curve( ROC) was used to ultimately determine the cutoff value of LMR as 4. 34. According to the cutting point,the patients were divided into the high LMR group( LMR ≥4. 34) and the low LMR group( LMR < 4. 34). The relationship between different LMR ratios and tumor size,tumor number,hydronephrosis and postoperative survival time was analyzed. The multivariate Cox analysis was used to investigate the independent risk factors influencing survival time of patients with T1 high grade bladder cancer after transurethral resection. Results There were no significant differences in the gender,age,smoking history,tumor size,perioperative blood transfusion,perfusion chemotherapy between the two groups( P > 0. 05),however,there were significant differences in the number of tumor,hydronephrosis,lymph node metastasis,recurrence and progression of tumor between two groups( P < 0. 05). The single factor analysis showed that the sex and smoking history had no significant effects on relapse free survival time and overall survival time( P > 0. 05),but patient's age,tumor number,tumor size,renal water,perioperative blood transfusion,infusion chemotherapy,lymph node metastasis and LMR value were closely correlated with relapse free survival time and overall survival time( P < 0. 05). The multivariate Cox regression analysis showed that hydronephrosis and LMR < 4. 34 were the independent risk factors of survival time of patients with T1 high grade bladder cancer after surgery[Hr = 2. 119( 1. 347～3. 333) and Hr = 1. 868( 1. 221～2. 859) ],moreover,the infusion chemotherapy was a protective factor for improving the postoperative survival time of patients with high-grade stage T1 bladder cancer [Hr =0. 558( 0. 448～0. 695) ]. Conclusion The value of preoperative LMR can reflect the survival time of patients with high grade T1 bladder cancer after transurethral resection of bladder cancer,which can be regarded as an index of evaluation of postoperative prognosis in patients with advanced stage T1 bladder cancer after transurethral resection of bladder cancer. Moreover the decrease of LMR value suggests that the prognosis of patients with high grade stage T1 bladder cancer after transurethral resection is poor.
引文
1 Matulewicz RS,Sharma V,Mc Guire BB,et al. The effect of surgical duration of transurethral resection of bladder tumors on postoperative complications:An analysis of ACS NSQIP data. Urol Oncol,2015,33:19-24.
2 陈令秋,乙从亮,杨登伦,等. TURBT对非肌层浸润性膀胱癌复发的影响.实用癌症杂志,2015,30:783-785.
3 蔡芳震,马潞林.根治性全膀胱切除术的治疗进展.临床泌尿外科杂志,2015,30:758-762.
4 曾蜀雄,宋瑞祥,于晓雯,等.膀胱癌根治术后早期并发症及其危险因素分析.临床泌尿外科杂志,2015,30:104-106.
5 伍大权,黄新生.喉部良恶性病变患者外周血淋巴细胞/单核细胞比值及意义.临床耳鼻咽喉头颈外科杂志,2017,31:835-838.
6 王秀娟,苑中甫,邱海峰,等.术前外周血淋巴细胞/单核细胞比值与上皮性卵巢癌患者预后的关系.现代妇产科进展,2016,25:654-657.
7 丛喜亮,李森,薛英威.术前外周血淋巴细胞/单核细胞比值对Ⅱ~Ⅲ期老年胃癌患者预后的影响.中华胃肠外科杂志,2016,19:1144-1148.
8 钱门龙,万闹,殷航,等.淋巴细胞与单核细胞比值在乳腺癌患者预后评估中的价值.肿瘤学杂志,2017,23:185-188.
9 陈朝晖,王志平.膀胱癌相关分子标志物的研究进展.现代泌尿生殖肿瘤杂志,2015,7:257-259.
10 耿僡临,石素胜.胃肠胰神经内分泌肿瘤分子生物学研究进展.癌症进展,2016,14:1207-1209.
11 王猛,滕晓东.肌层浸润性膀胱癌的分子分型研究进展.中华病理学杂志,2017,46:439-442.
12 孙利,宋迎春.淋巴细胞与单核细胞比值对上皮性卵巢癌预后价值的临床分析.临床肿瘤学杂志,2016,21:909-912.
13 Lee S M,Russell A,Hellawell G. Predictive value of pretreatment inflammation-based prognostic scores(neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,and lymphocyte-to-monocyte ratio)for invasive bladder carcinoma. Korean Journal of Urology,2015,56:749-755.
14 张爱岐,金时,曹守波,等.淋巴细胞/单核细胞比值对恶性肿瘤患者预后评估的研究进展.实用肿瘤学杂志,2017,31:188-192.
15 周淑娟,周郁鸿,马泳泳,等.淋巴细胞单核细胞比值在弥漫大B细胞淋巴瘤随访中的意义.临床血液学杂志,2016,30:200-203.
16 许彭鹏,钱樱,陈秋生,等.外周血淋巴与单核细胞绝对计数比值在滤泡性淋巴瘤中的预后意义.中国癌症杂志,2016,26:861-865.
17 徐玉秀,张勇刚,许春玲,等.淋巴细胞单核细胞比值对原发胃肠弥漫大B细胞淋巴瘤患者的临床特征和预后影响.中国实验血液学杂志,2016,24:1404-1409.
18 Watabe Y,Onidani K,Matsumoto N,et al. Preoperative peripheral blood lymphocyte-to-monocyte ratio is a prognostic indicator in oral squamous cell carcinoma:a retrospective study in a single institution. Nippon Koku Geka Gakkai Zasshi,2017,63:185-192.
19 曾祥义,彭涛.外周血淋巴细胞/单核细胞比值与高血压性脑出血血肿扩大的关系.中国临床神经外科杂志,2017,22:7-10.
20 Yoshida T,Kinoshita H,Yoshida K,et al. Prognostic impact of perioperative lymphocyte-monocyte ratio in patients with bladder cancer undergoing radical cystectomy. Tumour Biology the Journal of the International Society for Oncodevelopmental Biology Medicine,2016,37:10067.
21 Zhang GM,Zhu Y,Luo L,et al. Preoperative lymphocyte-monocyte and platelet-lymphocyte ratios as predictors of overall survival in patients with bladder cancer undergoing radical cystectomy. Tumor Biology,2015,36:1-7.
2 陈令秋,乙从亮,杨登伦,等. TURBT对非肌层浸润性膀胱癌复发的影响.实用癌症杂志,2015,30:783-785.
3 蔡芳震,马潞林.根治性全膀胱切除术的治疗进展.临床泌尿外科杂志,2015,30:758-762.
4 曾蜀雄,宋瑞祥,于晓雯,等.膀胱癌根治术后早期并发症及其危险因素分析.临床泌尿外科杂志,2015,30:104-106.
5 伍大权,黄新生.喉部良恶性病变患者外周血淋巴细胞/单核细胞比值及意义.临床耳鼻咽喉头颈外科杂志,2017,31:835-838.
6 王秀娟,苑中甫,邱海峰,等.术前外周血淋巴细胞/单核细胞比值与上皮性卵巢癌患者预后的关系.现代妇产科进展,2016,25:654-657.
7 丛喜亮,李森,薛英威.术前外周血淋巴细胞/单核细胞比值对Ⅱ~Ⅲ期老年胃癌患者预后的影响.中华胃肠外科杂志,2016,19:1144-1148.
8 钱门龙,万闹,殷航,等.淋巴细胞与单核细胞比值在乳腺癌患者预后评估中的价值.肿瘤学杂志,2017,23:185-188.
9 陈朝晖,王志平.膀胱癌相关分子标志物的研究进展.现代泌尿生殖肿瘤杂志,2015,7:257-259.
10 耿僡临,石素胜.胃肠胰神经内分泌肿瘤分子生物学研究进展.癌症进展,2016,14:1207-1209.
11 王猛,滕晓东.肌层浸润性膀胱癌的分子分型研究进展.中华病理学杂志,2017,46:439-442.
12 孙利,宋迎春.淋巴细胞与单核细胞比值对上皮性卵巢癌预后价值的临床分析.临床肿瘤学杂志,2016,21:909-912.
13 Lee S M,Russell A,Hellawell G. Predictive value of pretreatment inflammation-based prognostic scores(neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,and lymphocyte-to-monocyte ratio)for invasive bladder carcinoma. Korean Journal of Urology,2015,56:749-755.
14 张爱岐,金时,曹守波,等.淋巴细胞/单核细胞比值对恶性肿瘤患者预后评估的研究进展.实用肿瘤学杂志,2017,31:188-192.
15 周淑娟,周郁鸿,马泳泳,等.淋巴细胞单核细胞比值在弥漫大B细胞淋巴瘤随访中的意义.临床血液学杂志,2016,30:200-203.
16 许彭鹏,钱樱,陈秋生,等.外周血淋巴与单核细胞绝对计数比值在滤泡性淋巴瘤中的预后意义.中国癌症杂志,2016,26:861-865.
17 徐玉秀,张勇刚,许春玲,等.淋巴细胞单核细胞比值对原发胃肠弥漫大B细胞淋巴瘤患者的临床特征和预后影响.中国实验血液学杂志,2016,24:1404-1409.
18 Watabe Y,Onidani K,Matsumoto N,et al. Preoperative peripheral blood lymphocyte-to-monocyte ratio is a prognostic indicator in oral squamous cell carcinoma:a retrospective study in a single institution. Nippon Koku Geka Gakkai Zasshi,2017,63:185-192.
19 曾祥义,彭涛.外周血淋巴细胞/单核细胞比值与高血压性脑出血血肿扩大的关系.中国临床神经外科杂志,2017,22:7-10.
20 Yoshida T,Kinoshita H,Yoshida K,et al. Prognostic impact of perioperative lymphocyte-monocyte ratio in patients with bladder cancer undergoing radical cystectomy. Tumour Biology the Journal of the International Society for Oncodevelopmental Biology Medicine,2016,37:10067.
21 Zhang GM,Zhu Y,Luo L,et al. Preoperative lymphocyte-monocyte and platelet-lymphocyte ratios as predictors of overall survival in patients with bladder cancer undergoing radical cystectomy. Tumor Biology,2015,36:1-7.