术前中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值对肾透明细胞癌的预后评估价值

目的:探究术前外周血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)在评估肾透明细胞癌(ccRCC)患者预后的作用。方法:回顾性分析2001年12月—2010年12月在我院接受手术治疗的352例肾细胞癌(RCC)患者的临床资料,年龄25~82岁,平均(55.1±12.2)岁;随访时间1~200个月,平均(106.1±35.1)个月;中位总生存期(OS)为104个月,中位无复发生存期(RFS)为101个月。通过受试者工作特征曲线(ROC)确定NLR及PLR的最佳临界值并进行分组,通过Kaplan-Meier法和Cox回归对RCC患者中的NLR及PLR进行预后分析。结果:按最佳临界值NLR<2.05(155例)及≥2.05(197例)、PLR<140(236例)及PLR≥140(116例)对患者进行分组。高NLR及PLR与大肿瘤直径(P=0.026,P=0.019)、高肿瘤TNM分期(P=0.003,P<0.001)、高肿瘤Fuhrman分级(P=0.021,P=0.008)及转移或复发有关(P<0.001,P<0.001)。相比于单独使用NLR或PLR,联合NLR及PLR能够更有效地预测OS及RFS。Cox多因素分析结果提示高NLR(P<0.001)、高PLR(P=0.004)、患者年龄≥60岁(P<0.001)、大肿瘤直径(P=0.043)、高肿瘤TNM分期(P<0.001)、高肿瘤Fuhrman分级(P<0.001)与患者OS相关,并且高NLR(P=0.012)、高PLR(P=0.014)、高肿瘤TNM分期(P<0.001)、高肿瘤Fuhrman分级(P=0.002)与患者RFS相关。结论:术前NLR及PLR是ccRCC患者术后OS及RFS的独立预后因素。高NLR、PLR预示着ccRCC患者较高的复发转移风险及较差的生存预后。

Value of preoperative neutrophil-lymphocyte ratio and platelet-lymphocyte ratio for prognostic evaluation of renal clear cell carcinoma

Objective:To explore the role of the preoperative peripheral blood neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)in evaluating the prognosis of patients with clear cell renal cell carcinoma(ccRCC).Methods:The clinical data of 352 ccRCC patients who received surgical treatment from December 2001 to December 2010 were retrospectively analyzed.Among the patients,the age ranged from 25 to 82(55.1±12.2)years old.Their median overall survival(OS)is 104 months,and their median recurrence-free survival(RFS)is 101 months.The cutoff values of NLR and PLR were determined by the receiver-operating characteristic(ROC)curve.The prognostic analysis of NLR and PLR was performed with Kaplan-Meier curve method and Cox regression model.Results:NLR<2.05(155 cases)and≥2.05(197 cases),PLR<140(236 cases)and PLR≥140(116 cases)were grouped according to the ideal cutoff value.Higher NLR and PLR were associated with larger tumor size(P=0.026,P=0.019),higher tumor stage(P=0.003,P<0.001),higher tumor Fuhrman grade(P=0.021,P=0.008),metastasis or recurrence(P<0.001,P<0.001).Kaplan-Meier analysis suggested that patients with NLR≥2.05 or PLR≥140 had a poor outcome in OS(P<0.001,P<0.001)and RFS(P<0.001,P<0.001).Combination of NLR and PLR could predict OS and RFS more efficiently compared with single NLR or PLR.Cox analysis results suggested that higher NLR(P<0.001),higher PLR(P=0.004),patient age≥60 years old(P<0.001),larger tumor size(P=0.043),higher tumor stage(P<0.001),higher tumor Fuhrman grade(P<0.001)were related to OS,and higher NLR(P=0.012),higher PLR(P=0.014),higher tumor stage(P<0.001),higher tumor Fuhrman grade(P=0.002)were related to RFS.Conclusion:Preoperative NLR and PLR are independent prognostic biomarkers for OS and RFS in ccRCC patients.Patients with high NLR and high PLR have higher risks of recurrence and metastasis,along with poorer prognosis than those with low NLR and PLR.