中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值评价TACE后肝细胞癌患者预后

目的探讨中性粒细胞与淋巴细胞比值(NLR)和血小板与淋巴细胞比值(PLR)预测TACE后肝细胞癌(HCC)患者预后的价值。方法分析95例接受TACE治疗的BCLC分期B期的HCC患者资料,根据NLR、PLR值预测患者预后ROC曲线的界值,将其分成高值组和低值组。观察TACE术前、术后3天、术后1个月NLR和PLR变化及NLR、PLR值与术后生存期的相关性。结果术后3天NLR高于术前(P0.05),术后3天PLR低于术前(P0.05)。术后1个月,NLR回落至接近术前水平(P0.05),PLR上升至接近术前水平(P0.05)。术前NLR≥2.51组中位总生存期(OS)短于NLR2.51组(13.40个月vs 26.83个月;Z=5.24,P0.05);术前PLR≥96.84组中位OS短于PLR96.84组(17.27个月vs 28.83个月;Z=3.06,P0.05)。术后3天NRL≥5.17组中位OS短于NLR5.17组(15.20个月vs 25.07个月;Z=3.32,P0.05);术后3天PLR≥100.65组中位OS短于PLR100.65组(14.87个月vs 25.07个月;Z=3.54,P0.05)。术前NLR水平、肿瘤最大径、AFP水平、AST水平、ALB水平是影响HCC患者TACE治疗预后的独立危险因素。结论 TACE治疗HCC前后NLR、PLR值与TACE后患者预后有关,可作为评估HCC患者预后的指标。     

术前外周血血小板计数及血小板与淋巴细胞的比值与肾细胞癌预后的关系

目的:探讨术前外周血血小板(PLT)计数及血小板与淋巴细胞的比值(PLR)与肾细胞癌(RCC)预后的关系。方法:回顾性分析2006年1月～2013年12月1 340例经病理确诊的RCC患者的临床资料及随访资料。应用Kaplan-Meier法及Log-rank检验进行单因素分析,应用Cox比例风险回归模型对可能影响RCC预后的因素进行多因素分析,从而验证在众多影响RCC患者预后的因素中术前外周血PLT计数及PLR是否是RCC预后的独立影响因素。结果:术后获访并符合条件的患者1 125例,随访时间1～143个月,中位随访时间74个月。应用受试者工作特征曲线法确定PLR的最佳截点为146.86。术前外周血PLT计数升高组(300×109/L)和非升高组(≤300×109/L)患者的1、3、5、7、10年总生存率(OS)分别为93.5%、71.2%、63.6%、51.4%、43.6%和98.1%、93.1%、88.9%、83.6%、80.1%,两组比较差异有统计学意义(χ2=100.39,P0.001)。高PLR组(PLR≥146.86)和低PLR组(PLR146.86)患者的1、3、5、7、10年OS分别为95.5%、83.8%、74.9%、65.0%、57.4%和98.6%、93.7%、91.3%、87.1%、84.9%,两组比较差异有统计学意义(χ2=79.21,P0.001)。Cox多因素分析结果显示,年龄、肿瘤大小、术时远处转移、术前外周血PLT计数、PLR、pT分期(2010)、Fuhrman分级、ECOG评分是影响RCC预后的独立影响因素(P0.05)。结论:术前外周血PLT计数升高及高PLR均是RCC患者预后不良的独立影响因素。     

术前血小板/淋巴细胞比值与肝癌预后的关系

目的:探讨术前血小板/淋巴细胞比值(PLR)与肝癌预后的关系。方法:回顾性分析行手术治疗的256例肝癌患者的临床资料。根据患者术前PLR水平,绘制PLR诊断肿瘤复发的受试者工作特征(ROC)曲线,确定PLR界值,分析术前外周血PLR水平分与患者临床病理因素及预后的关系。结果:PLR诊断肿瘤ROC曲线下面积为0.625(95%CI=0.544~0.706),灵敏度为0.53,特异度为0.70,界值为131.81。患者术前外周血PLR水平与术前血清白蛋白、Child-Pugh分级、是否伴有腹水、血管侵犯、TNM分期等临床病理因素有关(均P0.05)。Cox风险模型分析显示,TNM分期(HR=1.441,95%CI=1.721~2.635,P0.001)、PLR(HR=1.737,95%CI=1.317~2.291,P0.001)为肝癌预后的独立影响因素,而PLR(HR=1.893,95%CI=1.434~2.497,P0.001)为肝癌复发的独立影响因素。生存分析显示,低PLR患者术后1、3、5年无瘤生存率(81.2%、53.3%、29.6%)明显高于PLR患者(62.4%、30.4%、11.6%)。结论:术前PLR可以作为肝癌患者的预后指标,高PLR水平患者术后复发率高、预后差。     

术前外周血NLR和PLR与原发性胃癌病程进展的关系

目的:探讨外周血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)与原发性胃癌病程进展的关系。方法:回顾性分析2015年2月—2016年2月收治的188例原发性胃癌患者的临床资料,分析肿瘤不同浸润深度、淋巴结分期及TNM分期组间患者NLR值和PLR值的差异及相关性。结果:原发性胃癌不同浸润深度、淋巴结分期及TNM分期患者NLR值和PLR值差异均有统计学意义(P0.001);高NLR组、PLR组胃癌患者肿瘤浸润深度、淋巴结分期和TNM分期均较低NLR组、PLR组高,差异有统计学意义(P0.001);NLR与PLR呈明显正性相关(r=0.379,P0.001);多重线性回归进一步分析显示上述因素对术前NLR、PLR有显著影响(P0.05)。结论:术前外周血NLR和PLR升高对胃癌进展具有一定的预测价值,NLR值和PLR值越高提示胃癌病程越晚,预后越差。     

淋巴细胞与单核细胞比值在肝细胞癌患者中的预后价值分析

背景与目的:通过实验室血样进行评估系统性炎症的临床意义已在多种癌症中被证实。肝细胞癌(HCC)是一种炎症驱动型癌症,炎症已被证实与分化不良、微血管侵犯和微转移相关。本研究旨在探讨淋巴细胞/单核细胞比值(LMR)对HCC患者术后的预后评估价值。方法:回顾性分析2012年1月—2016年12月在南京中医药大学附属南京医院行根治性肝切除术的88例HCC患者的资料。通过ROC曲线分析LMR评估HCC预后的性能,并将其与中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)进行比较。分析LMR与HCC患者临床病理因素的关系,以及与无病生存率(DFS)、总生存率(OS)的关系。用Cox回归模型分析DFS和OS的危险因素。结果:ROC曲线确定LMR最佳诊断界值为2.87,曲线下面积(AUC)为0.757,其评估HCC预后的性能大于NLR(AUC=0.687)和PLR(AUC=0.583)。根据LMR界值将患者分为高LMR组(LMR2.87)与低LMR组(LMR≤2.87)。高LMR组中肿瘤数3的例数明显少于低LMR组(P=0.048);高LMR组的DFS与OS均明显优于低LMR组(均P0.05);在分期分层(BCLCA/B、BCLCC/D;CNLCⅠ/Ⅱ、CNLCⅢ/Ⅳ)比较结果显示,除了在CNLCⅠ/Ⅱ期组患者中,高LMR组与低LMR组的DFS无统计学差异(P=0.132),在其他分期组患者中,高LMR组患者的DFS与OS均明显优于低LMR组(均P0.05)。LMR为DFS的独立影响因素(P=0.001),而BCLC分期(P=0.000)和LMR(P=0.000)为OS的独立影响因素,此外,对LMR、PLR与NLR以连续性变量形式进行校正后,仅LMR具有预后价值(P=0.001)。结论:LMR是HCC患者术后DFS和OS的独立预后因素,且评估价值可能优于NLR和PLR。用LMR结合HCC分期对患者进行危险分级,可能做出更为精准的评估。     

术前中性粒细胞淋巴细胞百分比升高提示乳腺癌患者预后不良

目的中性粒细胞淋巴细胞百分比(NLR)是一项简单检测全身炎症反应和免疫状态的指标。本研究旨在探讨NLR对乳腺癌患者的临床意义。方法回顾性分析213例在佛山市禅城区中心医院接受根治手术的乳腺癌患者,分析其临床病例特点及生存预后。NLR的最佳截点采用受试者工作特征曲线(ROC)分析,采用Kaplan-Meier法分析总体生存(OS)与无病生存(DFS),单因素及多因素Cox回归模型用于评估各临床因素与预后的相关性。结果本组研究NLR最佳的截点是2.2。两组患者在组织分级、T分期、TNM分期之间的分别上无统计学差异。高NLR组(NLR≥2.2)的OS(5年OS分别为59.6%和78.9%,P=0.001)及DFS(5年DFS分别为56.7%和78.0%,P=0.001)较差。此外,影响OS的独立预后因素分别为组织分级、T分期和NLR,而组织分级、T分期和NLR是影响DFS的独立预后因素。结论术前NLR升高对于接受根治手术的乳腺癌患者提示总体预后及无病生存期较差。但其运用于个体化危险评估尚需未来更多的临床研究。     

术前血小板与淋巴细胞比值对肝癌切除术后患者预后价值的Meta分析

背景与目的：肝癌是最常见的恶性肿瘤之一,一直以来影响着人类健康。肝切除术是肝癌首选的治疗方式,但术后复发率高、生存期短严重影响手术疗效。随着肿瘤相关炎症的研究不断深入,包括血小板与淋巴细胞比值（PLR）在内的一系列全身炎症指标被逐步提出,并被认为是可用于预测恶性肿瘤患者预后的标志物。近年来,研究发现术前PLR可作为预测肝癌切除术后患者预后的评价指标,但各研究结果间存在较大争议,本研究旨在通过Meta分析的方法评价术前PLR与肝癌切除术后患者预后的关系,以期为肝癌临床治疗提供参考依据。 方法：检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据库、中国生物医学数据库中截至2020年3月11日公开发表的涉及PLR与肝细胞癌的相关研究,对文献进行筛选及数据提取后,以危险比（HR）及其95%置信区间（CI）作为效应指标,以Stata 12.0软件进行Meta分析。 结果：最终26项研究,总计12 288例患者纳入本研究。Meta分析结果显示,术前高PLR与肝癌患者肝切除术后总生存期（OS）缩短相关（HR=1.03,95% CI=1.01~1.04,P<0.001）,术前PLR升高可预示术后较差的无瘤生存期（DFS）或无复发生存期（RFS）（HR=1.05,95% CI=1.02~1.07,P<0.001）。亚组分析显示,对于BCLC 0或A期患者,术前PLR可预测其OS缩短（HR=1.47,95% CI= 1.17~1.80,P<0.05）,但与DFS/RFS无关（HR=1.16,95% CI=0.91~1.48,P=0.227）;术后接受局部消融治疗、经动脉化疗栓塞术等抗癌治疗的患者,其较差的OS也与术前PLR有关（HR=1.07,95% CI=1.030~1.109,P<0.001）。进一步探究PLR有效临界值取值范围时发现,临界值取值<100时,术前PLR与患者OS及DFS/RFS无关（HR=1.12,95% CI=0.88~1.41,P=0.365;HR=1.26,95% CI= 0.93~1.72,P=0.135）。异质性分析及发表偏倚检验发现,异质性来源于各研究纳入患者肿瘤分期不同、PLR临界值取值不同及纳入研究间存在明显的发表偏倚（Egger''s检验：P>|t|=0.000）相关,通过剪补法,增加了11项研究后,结果仍较为稳定地显示术前高PLR与较差的OS相关。 结论：术前PLR可作为预测肝癌切除术患者预后不良的生物指标,其有效预测临界值取值应大于100。上述结论需要未来高质量、多中心、前瞻性研究进一步验证,以使得PLR能更好地被应用于临床。     

内脏脂肪面积与肾癌病理分型及分级的相关性

目的 研究内脏脂肪面积(VFA)、皮下脂肪面积(SFA)以及肾周脂肪面积(PFA)与肾细胞癌(RCC)病理分型和Fuhrman分级之间的相关性。方法 回顾性分析2015年1月至2018年12月重庆医科大学附属第一医院收治的212例行肾切除或者肾部分切除术患者的病例资料。术前CT测量VFA、SFA及PFA值,肾周脂肪百分比以肾周脂肪面积占总脂肪组织面积的比例计算,即PFA%=PFA/(VFA+SFA)×100%。分析各脂肪面积参数和临床常见指标(如年龄、性别、体质指数、肿瘤大小和T分期)与RCC病理分型和肿瘤分级的相关性。结果 透明细胞肾细胞癌(ccRCC)组患者VFA(P=0.002)和年龄(P=0.001)均高于非透明细胞肾细胞癌(non-ccRCC)组;高级别肿瘤组患者PFA%(P=0.032)、肿瘤最大径(P0.001)和T分期(P0.001)均高于低级别肿瘤组。多因素Logistic回归分析显示,VFA(OR=1.007,95%CI:1.001～1.013,P=0.029)和年龄(OR=1.041,95%CI:1.015～1.067,P=0.002)与ccRCC病理亚型相关,PFA%(OR=2.590,95%CI:1.111～6.060,P=0.028)、肿瘤最大径(OR=1.037,95%CI:1.020～1.055,P0.001)和T分期(OR=5.025,95%CI:2.127～14.280,P0.001)与高级别肿瘤均相关。结论 VFA与ccRCC病理亚型关系密切,且高PFA%与较高的Fuhrman分级相关。     

术前中性粒/淋巴细胞比值在阴茎癌患者预后评估中的价值

目的:探讨术前中性粒/淋巴细胞比值(NLR)在阴茎癌患者预后评估中的价值。方法:回顾性分析1998~2013年在青岛大学附属医院泌尿外科行手术治疗的37例阴茎癌患者的资料。分析NLR与患者临床病理特征之间的关系,比较两组患者无进展生存率(PFS)和总生存率(OS)的差异。应用Kaplan-Meier法和Logrank检验进行生存分析,应用Cox比例风险回归模型进行独立危险因素分析。结果:高、低NLR组在年龄和淋巴结转移上的差异有统计学意义(P=0.04,P=0.008)。淋巴结转移(P0.001,P0.001)、远处转移(P=0.002,P=0.002)、病理分期(P0.001,P0.001)、NLR(P0.001,P=0.022)分别与PFS和OS显著相关。多因素分析证实淋巴结转移、病理分期和NLR是影响PFS的独立危险因素(P=0.001,P=0.021,P=0.033)。结论:NLR是影响阴茎癌患者无复发生存率的独立危险因素,术前NLR≥2.3的患者预后差。     

术前中性粒细胞与淋巴细胞比值对乳腺癌改良根治术预后的影响

目的:探讨术前外周血中性粒细胞/淋巴细胞比值(NLR)对乳腺癌改良根治术患者预后的影响。方法:回顾分析沈阳军区总医院普通外科2002年1月—2005年1月收治的180例行改良根治术的乳腺癌患者的临床资料,根据术前外周血中性粒细胞/淋巴细胞的比值(NLR)分为两组,以NLR=6.0为分界值,采用卡方检验分析NLR与临床病理特征的关系,采用Kaplan-Meier预后曲线和COX回归模型分析NLR与乳腺癌临床病理特征及预后的关系。结果:术前高NLR与乳腺癌肿瘤大小、淋巴结转移、TNM分期相关(P<0.05)。Kaplan-Me ie r预后曲线提示术前高NLR组无进展生存期和总生存期均显著低于低NLR组(P<0.05)。单因素和多因素COX回归分析提示术前高NLR、肿瘤大小、淋巴结转移以及TNM分期与乳腺癌无进展生存期和总生存期显著相关(P<0.05)。结论:术前高NLR是影响乳腺癌改良根治术后生存期的独立危险因素。     

Validation of the World Health Organization/International Society of Urological Pathology grading for Chinese patients with clear cell renal cell carcinoma

BackgroundThis study aimed to compare the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading system and the Fuhrman grading system and to verify the WHO/ISUP grade as a prognostic parameter of clear cell renal cell carcinoma (ccRCC) in a Chinese population.MethodsThe study consisted of 753 ccRCC patients treated with curative surgery between 2010 and 2018 at Xiangya Hospital Central South University (Changsha, China). All pathologic data were retrospectively reviewed by two pathologists. Cancer-specific survival (CSS) and recurrence-free survival (RFS) were examined as clinical outcomes.ResultsAccording to the WHO/ISUP grading system (ISUP group), nephrectomy type, pT stage and WHO/ISUP grade were independent risk factors for CSS (P<0.0001, P=0.0127 and P<0.0001, respectively) and RFS (P<0.0001, P=0.0077, and P<0.0001, respectively). In the Fuhrman group, nephrectomy type, pT stage and Fuhrman grade were independent risk factors for CSS (P<0.0001, P=0.0004, and P<0.0001, respectively) and RFS (P<0.0001, P=0.0001, and P<0.0001, respectively). The C-index for CSS and RFS using the Fuhrman grading system was 0.6323 and 0.6342, respectively, and that using the WHO/ISUP grading system was 0.6983 and 0.7005, respectively, both higher than the former (P=0.0185, and P=0.0172, respectively). In addition, upgrading from Fuhrman grade 2 to ISUP grade 3 resulted in worse CSS and RFS for ccRCC patients (P=0.0033 and P =0.0003, respectively).ConclusionsWe first verified correlations between the postoperative prognosis and WHO/ISUP grade of ccRCC in a Chinese population and confirmed that the ability to predict clinical outcomes with the WHO/ISUP grading system was superior to that with the Fuhrman grading system.     

Preoperative neutrophil-lymphocyte ratio predicts death among patients with localized clear cell renal carcinoma undergoing nephrectomy

ObjectivesThe neutrophil-lymphocyte ratio (NLR) is an indicator of the systemic inflammatory response. An increased pretreatment NLR has been associated with adverse outcomes in other malignancies, but its role in localized (M0) clear cell renal cell carcinoma (ccRCC) remains unclear. As such, we evaluated the ability of preoperative NLR to predict oncologic outcomes in patients with M0 ccRCC undergoing radical nephrectomy (RN).Methods and materialsFrom 1995 to 2008, 952 patients underwent RN for M0 ccRCC. Of these, 827 (87%) had pretreatment NLR collected within 90 days before RN. Metastasis-free, cancer-specific, and overall survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate models were used to analyze the association of NLR with clinicopathologic outcomes.ResultsAt a median follow-up of 9.3 years, 302, 233, and 436 patients had distant metastasis, death from ccRCC, and all-cause mortality, respectively. Higher NLR was associated with larger tumor size, higher nuclear grade, histologic tumor necrosis, and sarcomatoid differentiation (all, P<0.001). A NLR≥4.0 was significantly associated with worse 5-year cancer-specific (66% vs. 85%) and overall survival (66% vs. 85%). Finally, after controlling for clinicopathologic features, NLR remained independently associated with risks of death from ccRCC and all-cause mortality (hazard ratio for 1-unit increase: 1.02, P< 0.01).ConclusionsOur results suggest that NLR is independently associated with increased risks of cancer-specific and all-cause mortality among patients with M0 ccRCC undergoing RN. Accordingly, NLR, an easily obtained marker of biologically aggressive ccRCC, may be useful in preoperative patient risk stratification.     

Immunoexpression status and prognostic value of mTOR and hypoxia-induced pathway members in primary and metastatic clear cell renal cell carcinomas

The need for effective targeted therapies for renal cell carcinomas (RCCs) has fueled the interest for understanding molecular pathways involved in the oncogenesis of kidney tumors. Aiming to analyze the expression status and prognostic significance of mTOR and hypoxia-induced pathway members in patients with clear cell RCC (ccRCC), tissue microarrays were constructed from 135 primary and 41 metastatic ccRCCs. Immunoexpression levels were compared and correlated with clinicopathologic parameters and outcome. PTEN levels were significantly lower in primary and metastatic ccRCCs compared with benign tissues (P<0.001). Levels of phos-AKT, phos-S6, and 4E-binding protein-1 (4EBP1) were higher in metastatic ccRCC (P≤0.001). For phos-S6 and 4EBP1, levels were higher in primary ccRCC compared with benign tissues (P<0.001). c-MYC levels were higher in metastatic ccRCC (P<0.0001), and incremental p27 levels were observed in benign, primary ccRCC, and metastatic ccRCC (P<0.0001). HIF-1α levels were significantly higher in primary and metastatic ccRCCs compared with benign tissues (P<0.0001). In primary ccRCC, levels of all mTOR and hypoxia-induced pathway members were significantly associated with pT stage (P≤0.036), p27 levels with Fuhrman grade (P=0.031), and 4EBP1, p27, and HIF-1α levels with tumor size (P≤0.025). Tumor size, HIF-1α, and phos-S6 levels were associated with disease-specific survival (DSS) (P≤0.032) and tumor progression (P≤0.043). In conclusion, both mTOR and hypoxia-induced pathways were activated in primary and metastatic ccRCC. PTEN loss seems to be an early event during tumorigenesis. Tumor size, HIF-1α, and phos-S6 expression were found to be independent predictors of both DSS and tumor progression in primary ccRCC.     

Tumor VEGF expression correlates with tumor stage and identifies prognostically different groups in patients with clear cell renal cell carcinoma

ObjectivesVascular endothelial growth factor (VEGF) is a potent inducer of tumor angiogenesis and represents the key element in the pathogenesis of clear cell renal cell carcinoma (ccRCC). The aim of this study was to investigate the use of tumor VEGF expression as a parameter to identify tumor stage and prognostically different patient groups.Methods and materialsWe retrospectively collected clinical data of 137 patients treated with partial or radical nephrectomy at our institutions for organ-confined, locally advanced, and metastatic ccRCCs between 1984 and 2013. Tumor cell VEGF immunohistochemical expression was compared with pathological and clinical features including age, sex, tumor stage, and Fuhrman grade. Comparison of VEGF expression levels between tumor stages was performed via Kruskal-Wallis nonparametric test. Survival analysis was conducted via Kaplan-Meier product-limit method, and Mantel-Haenszel log-rank test was employed to compare survival among groups.ResultsMedian age at diagnosis was 61 years (range: 33–85 y). Tumor stage was pT1N0M0 in 67 patients (49%), pT2N0M0 in 5 (4%), and pT3N0M0 in 25 (18%), while 40 patients (29%) had metastatic tumors at diagnosis. Fuhrman nuclear grade was G1 in 22 patients (16%), G2 in 60 (44%), G3 in 33 (24%), G4 in 13 patients (9%), and unknown in 9 patients. Tumor VEGF was differentially expressed among different stages (P<0.001) and in low (G1–2) and high (G3–4) Fuhrman grade tumors (P<0.001). No significant differences were found when stratifying by sex (P = 0.06) or age (P = 0.29). Median overall survival (OS) from partial or radical nephrectomy was 161 months (range: 1–366). We observed a significantly longer OS in patients with low (<25%) vs. high (>25%) VEGF expression levels (median OS 206 vs. 65 mo, P<0.001).ConclusionsOur data show that tumor cell VEGF expression is significantly associated with tumor stage and Fuhrman grade and is able to predict patient outcome, suggesting a potential use of this parameter in identifying prognostically different patients with ccRCC.     

High expression of CXC chemokine receptor 6 associates with poor prognosis in patients with clear cell renal cell carcinoma

Purpose

Accumulating evidence indicates that CXC chemokine receptor 6 (CXCR6) has a crucial role in cancer development and progression, however, its role in clear cell renal cell carcinoma (ccRCC) remains obscure. The aim of this study is to investigate the prognostic value of CXCR6 expression in patients with ccRCC following surgery.

Leibovich score is the optimal clinico-pathological system associated with recurrence of non-metastatic clear cell renal cell carcinoma

PurposeTo determine the optimal post-operative risk stratification system associated with survival following surgery for clear cell renal cell carcinoma (ccRCC): tumour grade, tumour stage, Leibovich 2003, Leibovich 2018, Kattan, Stage, size, grade and necrosis (SSIGN) or UCLA Integrated Staging System (UISS) scores.Methods542 patients with non-metastatic ccRCC who underwent nephrectomy 2008?2018 were reviewed. Primary outcome was recurrence-free survival (RFS), with secondary outcomes cancer-specific survival (CSS) and overall survival (OS).ResultsAll systems were significantly associated with RFS, CSS and OS by Kaplan-Meier and unadjusted Cox-regression. ROC analysis identified that Leibovich 2003, Leibovich 2018A or B and SSIGN were optimally association with 5year RFS (AUC (Area under curve) 0.87, 0.86, 0.86 and 0.86), but Leibovich 2003 or 2018A offered additional information on adjusted regression analysis (HR 1.24, P = 0.02; HR 1.17, P = 0.04). ROC analysis identified that Leibovich 2018B, Leibovich 2003, SSIGN and UISS were equally associated with 5 year OS (AUC 0.76, 0.74, 0.73 and 0.72). UISS added additional explanation of the variance in OS on adjusted regression analysis (HR 1.96, P = 0.002). A novel combination of Leibovich 2003 score and Eastern Co-operative Oncology Group (ECOG) performance status improved 5 year OS association compared to the Leibovich 2003 alone (AUC 0.78, P = 0.001), without affecting association with 5year RFS (AUC 0.87, P = 0.75).ConclusionsAll systems were robust tools associated with RFS, CSS and OS in ccRCC. In our cohort, the Leibovich 2003 and Leibovich 2018A scores may be better associated with RFS compared to other strategies. The UISS, Leibovich 2018B or Leibovich 2003 combined with ECOG performance status may stratify OS better than other modalities.     

NLR和PLR在腹膜透析相关性感染中的诊断价值探讨

目的探讨外周血中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)对腹膜透析相关性感染的诊断及预测价值。方法回顾性分析71例腹膜透析并发相关感染的患者及102例同期入院行腹膜功能及透析充分性评估的维持性腹膜透析患者的临床资料,分别按照是否发生腹膜透析相关性感染、NLR及PLR的最佳截断值进行分组,分析NLR、PLR等指标与腹膜透析相关性感染的关系。应用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价NLR、PLR、NLR联合PLR对腹膜透析相关性感染的诊断及预测价值。结果相关性分析提示腹膜透析相关性感染与NLR、PLR、腹透液白细胞计数及hs-CRP呈正相关(均P<0.01);而与血清白蛋白、血镁、血磷呈负相关(均P<0.01)。NLR与腹膜透析相关性感染、PLR、腹透液白细胞计数及hs-CRP呈正相关(均P<0.01);与血镁及血清白蛋白呈负相关(均P<0.01);与血磷无相关性(P>0.05)。PLR与腹膜透析相关性感染、NLR、腹透液白细胞计数及hs-CRP呈正相关(均P<0.01);与血镁、血磷及血清白蛋白呈负相关(均P<0.05)。单因素Logistic回归显示低血清白蛋白(OR=0.808,95%CI 0.748~0.874,P<0.01)、低血镁(OR=0.001,95%CI 0.000~0.015,P<0.01)、低血磷(OR=0.324,95%CI 0.165~0.635,P=0.01)、高hs-CRP(OR=1.246,95%CI 1.149~1.351,P<0.01)、高NLR(OR=1.570,95%CI 1.315~1.815,P<0.01)、高PLR(OR=1.010,95%CI 1.006~1.014,P<0.01)是腹膜透析相关性感染的危险因素;多因素分析显示低血清白蛋白(OR=0.837,95%CI 0.704~0.995,P=0.043)、高hs-CRP(OR=1.296,95%CI 1.149~1.461,P<0.01)及高NLR(OR=1.522,95%CI 1.055~2.195,P=0.025)是腹膜透析相关性感染的危险因素。从ROC曲线可以看出,NLR、PLR、NLR联合PLR及hs-CRP诊断腹膜透析相关性感染的敏感度分别为64.8%、53.5%、94.4%、93.0%,特异度分别为87.3%、87.3%、98.0%、90.2%。结论与腹膜透析未发生相关性感染的患者相比,腹膜透析相关感染人群的NLR、PLR、腹透液白细胞计数及hs-CRP水平明显升高,而白蛋白、血镁、血磷明显降低。且高NLR、高hs-CRP、低血清白蛋白是腹膜透析相关性感染危险因素。此外,NLR联合PLR对腹膜透析相关性感染的临床诊断敏感性及特异性均优于hs-CRP。     

术前外周血炎性指标联合糖蛋白抗原19-9对结肠癌早期诊断及预后评估的价值

目的探讨术前外周血炎性相关指标中性粒细胞-淋巴细胞计数比值（NLR）、血小板-淋巴细胞计数比值（PLR）联合糖蛋白抗原19-9（CA19-9）对结肠癌早期诊断及预后评估的应用价值。 方法选取2015年5月至2017年3月宜宾市第二人民医院收治的189例结肠癌患者为结肠癌组,另选取同期健康体检志愿者72例为对照组。受试者均进行外周血常规检查并计算NLR及PLR比值,采用电化学发光法检测血清CA19-9水平,受试者工作特征曲线（ROC）分析NLR、PLR、CA19-9对结肠癌的诊断效能。根据NLR、PLR、CA19-9以及联合检测结果分为阳性组与阴性组,采用Kaplan-Meier法分析不同检测指标对结肠癌患者预后评估的应用价值。 结果与对照组相比,结肠癌组患者NLR、PLR比值及CA19-9水平均显著升高（P<0.05）;ROC分析显示NLR曲线下面积（AUC）为0.787,敏感度为62.96%,特异度为79.17%,准确性为67.43%;PLR检测的AUC为0.776,敏感度为65.61%,特异度为76.39%,准确性为68.58%;CA19-9 AUC为0.735,敏感度为61.90%,特异度为84.72%,准确性为68.20%;三项联合检测敏感度为91.01%,特异度为97.22%,准确性为92.72%;Kaplan-Meier分析显示NLR、PLR、CA19-9及联合检测阳性组患者OS均分别显著低于各阴性组（P<0.05）,仅联合检测风险比（HR）最高,HR=2.188（χ²=15.167,P<0.001,95%CI=1.310~3.656）。 结论NLR、PLR联合CA19-9检测可提高临床早期诊断结肠癌的敏感度及准确性,且三项联合检测对结肠癌患者预后评估具有重要指导意义。     

评估应用术前PLR、NLR及AGR预测乳腺癌患者预后的价值

目的探究术前血小板淋巴细胞比值（PLR）、中性粒细胞淋巴细胞比值（NLR）及白蛋白球蛋白比值（AGR）在评估乳腺癌患者预后中的价值。 方法选取2013年1月至2017年12月收治的1184例浸润性乳腺癌女性患者为浸润性乳腺癌组,随机选取仅患乳腺纤维腺瘤的患者279例为乳腺纤维腺瘤组。收集患者一般资料、术后病理资料、血型、术前外周血血小板、中性粒细胞、淋巴细胞数量以及血清白蛋白和球蛋白水平,并计算得出PLR、NLR及AGR。应用受试者功能特征曲线下面积来评估三者预测乳腺癌患者预后的能力。本研究使用SPSS 20.0及MedCalc软件进行统计学分析和绘图,P<0.05代表差异具有统计学意义。 结果浸润性乳腺癌患者的术前PLR及NLR均值显著高于乳腺纤维腺瘤患者（P<0.05）,而AGR低于乳腺纤维腺瘤患者（P<0.05）。Cox比例回归风险分析显示,患者的诊断年龄、PLR、NLR、AGR、肿瘤直径、组织学分级、阳性淋巴结个数和分子分型均为乳腺癌的预后危险因素（P<0.05）。ROC曲线分析结果得出,PLR、NLR及AGR的最佳诊断临界值分别为147.4、2.9及1.7。应用术前PLR（AUC=0.796,P<0.001）、NLR（AUC=0.716,P<0.001）及AGR（AUC=0.748,P<0.001）预测乳腺癌患者预后均有价值,且PLR价值更高。 结论术前PLR、NLR及AGR对乳腺癌患者预后的判断均具价值,三者相比,PLR价值更高,有望成为判断乳腺癌患者预后的补充指标。     

Inflammatory factor-based prognostic risk stratification for patients with metastatic castration-resistant prostate cancer treated with docetaxel

To develop a simple inflammatory factor-based prognostic risk stratification system for patients with metastatic castration-resistant prostate cancer (mCRPC) receiving docetaxel as the initial treatment, we reviewed the data of 399 consecutive patients who received first-line docetaxel chemotherapy between January 2013 and June 2019 retrospectively. The optimal cut-off values for the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in terms of survival were calculated by ROC curves. Patients were stratified into favourable (lower NLR and lower PLR), intermediate (higher NLR and lower PLR, or lower NLR and higher PLR) and poor (higher NLR and higher PLR) groups. Kaplan–Meier curves were drawn to evaluate overall survival (OS) and progression-free survival (PFS). The ROC curve analysis determined the cut-offs for the NLR and PLR to be 2.355 and 104.275 respectively. Multivariate Cox regression analysis showed that being in the poor patient group (NLR ≥2.355 and PLR ≥104.275) was an independent prognostic risk factor and Kaplan–Meier curves analysis revealed that respondents with NLR <2.355 and PLR <104.275 had significantly longer OS and PFS. So it can be concluded that concurrently high NLR and PLR values are predictors for poor chemotherapy outcomes after androgen deprivation therapy failure in patients with mCRPC.