炎症指标在肾透明细胞癌的病理分级及临床分期中的作用

目的:研究炎症相关指标在肾透明细胞癌(ccRCC)的病理分级及临床分期中的作用。方法:收集2017年10月～2018年10月在我院就诊的314例术后病理证实为ccRCC患者的相关资料。分析ccRCC患者术前血中炎症指标[白细胞计数(WBC)、中性粒细胞数目(NC)、淋巴细胞数目(LC)、中性粒/淋巴细胞比值(NLR)以及超敏C反应蛋白(hs-CRP)]与病理分级、临床分期之间的关系。结果:314例ccRCC患者中,男220例,女94例;低级别ccRCC 241例,高级别ccRCC 73例;局限性ccRCC 295例,进展性ccRCC 19例。结果显示,高级别ccRCC组和低级别ccRCC组LC、NLR、hs-CRP比较差异有统计学意义(P0.05),进展性ccRCC组的hs-CRP高于局限性ccRCC组(P0.05)。结论:ccRCC患者术前血中炎症相关指标,尤其是hs-CRP与肿瘤的病理分级、临床分期密切相关,而LC、NLR与肿瘤的病理分级有关,这提示术前炎症指标有望成为ccRCC病理分级及临床分期的分层指标。     

肾透明细胞癌的CT纹理分析及强化特征与其病理分级的相关性研究

目的:探讨CT纹理分析及强化特征与肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)患者Fuhrman病理分级的相关性。方法:选择武警湖北省总队医院2012年5月—2020年5月经手术病理证实为ccRCC患者156例,根据Fuhrman病理分级,分为低级别组(G_1~G_2)119例和高级别组(G_3~G_4)37例,比较不同病理级别ccRCC患者纹理分析参数(平均灰度值、标准差)与强化特征参数[肿瘤CT值(tumor CT attenuation value,TAV)、绝对强化值(absolute enhancement value,AEV)、相对强化率[肿瘤相对皮质强化率(tumor to cortex ratio,TCR)、肿瘤相对动脉强化率(tumor to artery ratio,TAR)]的差异,应用受试者工作特征(ROC)特征性曲线分析各指标对高级别ccRCC患者的诊断价值,采用Spearman相关性分析各指标与ccRCC患者病理分级的相关性,采用logistic回归分析筛查高级别ccRCC患者的影响因素。结果:与低级别组比较,高级别组患者平均灰度值、标准差明显升高,TAV、AEV、TCR、TAR值明显下降,差异均有统计学意义(P0.05);Spearman相关性分析示,平均灰度值、标准差与Fuhrman病理分级高低呈正相关(r_s=0.211,P=0.001;r_s=0.205,P=0.005);TAV、AEV、TCR和TAR与Fuhrman病理分级高低呈负相关(r_s=-0.245,P=0.015;r_s=-0.206,P=0.008;r_s=-0.315,P=0.001;r_s=-0.218,P=0.018);ROC曲线示,平均灰度值、标准差与TAV、AEV、TCR和TAR对高级别Fuhrman病理分级的ccRCC患者具有诊断价值(P0.05),其中TCR的诊断效能最大,其曲线下面积(AUC)为0.745;多因素logistic回归分析示肿瘤不规整、肿瘤7 cm、平均灰度值8.01、TCR≤0.54是ccRCC患者高Fuhrman病理分级的独立预测因子(P0.05)。结论:肿瘤CT纹理参数和强化特征参数升高与高级别ccRCC患者相关,有助于术前预测肿瘤侵袭性,对临床决策具有重要参考价值。     

降钙素原对中晚期肺癌患者化疗期间感染的诊断效率

目的研究肺癌患者化疗期间外周血降钙素原(PCT)水平,以了解细菌感染情况和诊断效率。方法采用电化学发光法测定肺癌患者血清PCT,结合白细胞计数和细菌培养,比较PCT对细菌感染的灵敏度、特异性和诊断效率。将患者按照PCT水平分为0.25 ng/ml、0.25~0.50 ng/ml、0.50 ng/ml共3个等级组。结果对照组PCT均值为(0.14±0.06)ng/ml,肺癌患者化疗期间外周血PCT的3个等级组的例数分别为37例、6例和7例,其均值分别为(0.15±0.09)ng/ml、(0.33±0.10)ng/ml和(4.29±3.31)ng/ml。0.25 ng/ml组血清PCT水平与对照组比较差异无统计学意义(t=0.526、P0.05);0.25~0.5 ng/ml组较0.25 ng/ml组PCT水平升高,差异具有统计学意义(t=4.186、P0.01)、0.50 ng/ml组较0.25~0.50 ng/ml组PCT水平升高,差异具有统计学意义(t=3.163、P0.01)。以血清0.50 ng/ml为基线,PCT0.5 ng/ml为阳性,肺癌患者化疗期间的细菌感染率为16.00%。检测血清PCT对细菌感染诊断的灵敏度为75.00%、特异性为97.62%、阳性预测值为85.71%、阴性预测值为95.35%和诊断效率为94.00%。结论血清PCT水平是细菌感染的重要指标,其诊断效率高,3个等级组有明确的基线界限,分为正常、可疑感染和明确感染,对应分别推荐为不使用抗菌药物、可使用抗菌药物和强烈建议使用抗菌药物,对肺癌患者化疗期间的早期临床诊治、合理用药具有指导意义。     

新型生物标志物可溶性髓样细胞触发受体-1在重症肺炎早期诊断中的应用价值

目的探究血清可溶性髓样细胞触发受体-1(sTREM-1)在重症肺炎早期诊断中的应用价值。方法2021年6月到2021年12月于吉林大学第二医院就诊的60例肺炎患者纳入研究组,其中重症40例(重症肺炎组)和轻症20例(普通肺炎组)。以及同期门诊体检者15例纳入健康对照组。研究组患者均于入院24 h内使用肺炎严重程度指数(PSI)评分进行评估;分别采用电化学发光法、散射比浊法、酶联免疫吸附实验(ELISA)检测血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)和sTREM-1水平。比较重症肺炎组、普通肺炎组及健康对照组研究对象入组24 h内血清sTREM-1水平,并比较重症肺炎组和普通肺炎组研究对象入组24 h内血清PCT、hs-CRP水平及PSI评分。采用Pearson相关性分析探讨血清sTREM-1和hs-CRP水平与PSI评分的相关性;采用Spearson相关性探讨血清PCT水平与PSI评分的相关性。绘制受试者工作特征曲线(ROC)及应用MedCalc软件比较曲线下面积(AUC)比较血清sTREM-1、PCT和hs-CRP对重症肺炎早期诊断的价值。结果重症肺炎组、普通肺炎组以及健康对照组血清sTREM-1表达水平(4864.81±1314.53 pg/ml、1144.58±571.01 pg/ml、509.11±43.70 pg/ml)差异有统计学意义(F=109.292、P<0.001),其中重症肺炎组较普通肺炎组和健康对照组显著升高(t=10.981、P<0.001,t=9.264、P<0.001)。重症肺炎组患者血清PCT、hs-CRP水平以及PSI评分均高于普通肺炎组,差异有统计学意义(Z=-3.360、P=0.001,t=2.047、P=0.048,t=4.878、P<0.001)。血清sTREM-1、PCT和hs-CRP诊断重症肺炎的AUC分别为1.00、0.86和0.68(95%CI:1.00~1.00、0.73~0.98、0.51~0.86);分别以2916.92 pg/ml、0.31 ng/ml和32.14 mg/L为截断值时约登指数最大,对应的敏感性分别为100%、85%和85%,特异性分别为100%、81%和50%。sTREM-1诊断重症肺炎的AUC与hs-CRP、PCT差异均有统计学意义(Z=3.463、P<0.001,Z=2.220、P=0.026);hs-CRP与PCT差异无统计学意义(Z=1.454、P=0.146)。PSI评分与血清sTREM-1(r=0.641、P<0.001)、PCT(r=0.540、P=0.001)呈正相关,与血清hs-CRP无相关性(r=0.269、P=0.124)。结论肺炎患者血清sTREM-1升高,以重症患者升高更为显著,且其与PSI评分呈正相关;检测血清sTREM-1水平有助于早期诊断重症肺炎,且其特异性及敏感性高,均优于PCT和hs-CRP,有望成为新的早期诊断重症肺炎的生物标志物。     

胸腺肽α_1对血液透析患者微炎症状态的影响

目的:探讨胸腺肽α1对维持性血液透析患者(maintenance hemodialysis,MHD)微炎症状态的影响。方法:60例维持性血液透析患者,随机分为治疗组30例和对照组30例,两组均进行规律血液透析,治疗组加用胸腺肽α1皮下注射,每次1.6mg,每周2次,共用4周;监测用药前后两组血清炎症因子[高敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)]水平的改变。同时选择30例体检健康者监测血清炎症因子水平,作为健康对照组。结果:与健康对照组比较,长期血液透析患者hs-CRP、IL-6及TNF-α水平均显著升高(P<0.01);在给胸腺肽α1治疗4周后,治疗组血清hs-CRP水平(3.45±2.60)mg/L、IL-6水平8.07±4.30)pg/ml、TNF-α水平(13.89±5.0)ng/ml均较治疗前[分别依次为(5.36±4.12)mg/L、(16.31±5.12)pg/ml、(21.50±9.06)ng/ml]明显下降,差异均有统计学意义(P<0.05)。对照组hs-CRP、IL-6及TNF-α水平治疗前后比较,差异无统计学意义。结论:维持性血液透析患者普遍存在微炎症状态,胸腺肽α1可改善MHD患者微炎症状态。     

中性粒细胞CD64指数联合降钙素原和超敏C反应蛋白对新生儿宫内细菌感染的诊断价值

目的探讨中性粒细胞CD64指数联合降钙素原（PCT）、超敏C反应蛋白（hs-CRP）对新生儿宫内细菌感染的诊断价值。 方法选取2017年8月至2018年8月海口市妇幼保健院新生儿科收治的有宫内细菌感染高危因素的新生儿共138例作为研究对象,根据感染结局分为感染组（28例）和非感染组（110例）,采用流式细胞术检测中性粒细胞CD64指数,采用免疫荧光快速定量检测血清PCT和hs-CRP水平;观察两组患者中性粒细胞CD64指数、PCT、hs-CRP表达,并采用受试者工作特征曲线（ROC曲线）分析联合检测对新生儿宫内细菌感染的诊断价值。 结果感染组患儿中性粒细胞CD64指数[（0.89 ± 0.25）%]、PCT [（2.24 ± 0.53）ng/ml]和hs-CRP水平[（21.25 ± 2.37）mg/L]均显著高于非感染组新生儿[CD64指数：（0.26 ± 0.08）%、PCT：（0.42 ± 0.09）ng/ml、hs-CRP：（6.37 ± 1.33）mg/L],差异均有统计学意义（t = 22.475、P < 0.001,t = 34.459、P < 0.001,t = 44.171、P < 0.001）;ROC曲线分析显示,CD64指数+ PCT + hs-CRP联合检测曲线下面积为0.897,敏感性为85.71%、特异性为92.73%、准确度为91.30%,高于两指标联合检测及单独指标检测;且3指标联合检测误诊率（7.27%）和漏诊率（14.29%）也较低。 结论中性粒细胞CD64指数和PCT可作为新生儿宫内细菌感染早期诊断检测指标,而CD64指数、PCT和hs-CRP三者联合检测可显著提高诊断的敏感性、特异性和准确度。     

膀胱癌组织及血清中内皮抑素表达的意义

目的　探讨原发性膀胱癌患者血清内皮抑素水平和组织表达与肿瘤分级、分期的关系。　方法　采用免疫组织化学方法检测 4 5例膀胱癌组织及 12例正常膀胱组织中内皮抑素表达情况。ELISA法检测 5 8例膀胱癌患者术前血清内皮抑素水平 ,4 3例健康者血清作对照。　结果　浅表性膀胱癌组内皮抑素表达率 6 1.5 % ,浸润性癌组为 90 .6 % ,正常膀胱组织为 33.3%。膀胱癌患者血清内皮抑素 4 6 .3ng/ml,显著高于对照组的 2 9.8ng/ml(P <0 .0 1)。局部浸润性膀胱癌患者血清内皮抑素 4 8.6ng/ml,显著高于浅表性癌组的 31.1ng/ml(P <0 .0 1) ;远处转移组血清内皮抑素 6 9.8ng/ml,显著高于局部浸润组 (P <0 .0 1) ;浅表性癌组与对照组血清内皮抑素水平差异无显著性意义。G3级肿瘤患者血清内皮抑素水平显著高于G1和G2 级 (P <0 .0 1)。　结论　膀胱癌患者血清内皮抑素水平和组织表达显著增高 ,并与肿瘤分级、分期相关 ,检测内皮抑素表达及血清水平有助于判断膀胱癌的恶性程度。     

血清同型半胱氨酸与胃癌分期的相关性研究

目的:通过比较不同病理分期胃癌患者的同型半胱氨酸(Hcy)水平,探讨血清Hcy与胃癌及病理分期的相关性。方法:选取2014年3月—2015年6月于山东大学齐鲁医院住院的胃癌患者138例,根据美国癌症联合会第七版胃癌分期指南分为4组:Ⅰ期(n=34)、Ⅱ期(n=33)、Ⅲ期(n=58)、Ⅳ期(n=13),并以同时期入院的良性胃疾病患者为对照(n=90),比较良性胃疾病与胃癌及各分期间Hcy及肿瘤标志物水平差异,分析Hcy与胃癌不同病理分期的相关性。采用单循环酶法测定血清Hcy水平。结果:良性胃疾病患者血清Hcy水平(12.31±3.22)μmol/L,胃癌患者(16.19±4.84)μmol/L,胃癌患者血清Hcy水平显著升高(P<0.05)。血清Hcy水平随胃癌临床分期增高逐渐升高,其中I期(13.94±4.07)μmol/L,Ⅱ期(15.49±4.09)μmol/L,Ⅲ期(17.10±4.79)μmol/L,Ⅳ期(19.81±5.77)μmol/L,各分期差异有统计学意义(P<0.05)。相关性分析证实,血清Hcy与病理分期呈正相关(r=0.503,P<0.001)。在校正了其他胃癌危险因素后,Logistic回归分析显示,血清Hcy仍是胃癌发生的独立危险因素(OR=1.208,P=0.003)。结论:血清Hcy水平与胃癌及临床病理分期密切相关,伴随临床分期进展Hcy水平明显升高,对判定胃癌病情发展有重要价值。     

血清甲状腺球蛋白及促甲状腺素在分化型甲状腺癌预后判断中的意义

目的探讨血清甲状腺球蛋白(thyroglobulin,Tg)及促甲状腺素(thyrotropin,TSH)在分化型甲状腺癌预后判断中的意义。方法分化型甲状腺癌患者112例,检测112例患者术前血清Tg和TSH水平。采用Kaplan-Meier生存分析和COX多因素回归模型分析不同病理参数与患者平均总生存期和平均无进展生存期的关系。结果血清Tg≥20 ng/ml和TSH≥2.5 mIU/L的患者其T分期为3/4的比例和淋巴转移率较高(P0.05),Tg≥20 ng/ml的患者其肿瘤体积显著大于Tg20 ng/ml的患者(P0.05),不同TSH水平患者之间肿瘤大小比较差异无统计学意义(P0.05)。TNM不同分期患者血清Tg和TSH水平比较差异有统计学意义(P0.05)。Tg≥20 ng/ml和TSH≥2.5 mIU/L的患者5年生存率分别为79.9%和82.8%,无进展生存率分别为71.0%和73.3%,均显著低于Tg20 ng/ml和TSH2.5 mIU/L的患者(P0.05)。肿瘤大小、T分期、淋巴转移、远处转移、Tg水平、TSH水平是分化型甲状腺癌5年生存率的独立危险因素。结论高Tg和TSH水平与分化型甲状腺癌患者不良预后有关。     

神经内科危重症患者不同致病菌所致颅内感染的脑脊液生化及常规指标差异

目的分析神经内科不同致病菌所致颅内感染的脑脊液生化及常规检测指标,为治疗颅内感染提供理论依据。 方法选取2013年1月至2018年1月于重庆市开州区人民医院就诊的106例神经内科危重症患者为研究对象,其中并发颅内感染者为研究组（59例）,非颅内感染者为对照组（47例）。研究组患者根据是否出现昏迷分为未昏迷组（38例）和昏迷组（21例）,根据感染类型分为化脓性组（21例）、结核性组（20例）和病毒性组（18例）。应用生化分析仪、ELISA法和速率散射免疫比浊法检测患者脑脊液和血液上清液降钙素原（PCT）、C-反应蛋白（CRP）和神经元特异性烯醇化酶（NSE）水平。 结果化脓性组、结核性组和病毒性组患者脑脊液及血清PCT、CRP和NSE水平均显著高于对照组患者（P均< 0.05）。病毒性组患者血清和脑脊液NSE水平[（15.68 ± 6.15）μg/L、（17.06 ± 3.25）μg/L）]显著高于化脓性组患者[（11.36 ± 3.54）μg/L、（10.65 ± 3.61）μg/L]和结核性组患者[（12.63 ± 4.26）μg/L、（12.89 ± 4.33）μg/L）]（P均< 0.05）。化脓性组患者血清和脑脊液PCT[（0.86 ± 0.34）ng/ml、（0.72 ± 0.33）ng/ml]和CRP水平[（8.55 ± 2.4）ng/ml、（8.68 ± 2.57）ng/ml]均高于病毒性组和结核性组患者,差异均有统计学意义（P均< 0.05）。昏迷组患者脑脊液和血清PCT、CRP和NSE水平均高于未昏迷组患者和对照组,差异均有统计学意义（P均< 0.05）。 结论神经内科并发颅内感染者脑脊液和血清PCT、CRP和NSE水平能够反映颅内感染病情,为颅内感染的诊断和治疗提供可靠依据。     

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.     

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.     

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.     

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。     

The predictive and prognostic values of serum amino acid levels for clear cell renal cell carcinoma

Objectives

To investigate the predictive and prognostic values of the logistic regression model based on the serum amino acid levels.

p21-Activated kinase 4 predicts early recurrence and poor survival in patients with nonmetastatic clear cell renal cell carcinoma

Backgroundp21-Activated kinase 4 (PAK4), a serine/threonine kinase implicated in the cytoskeleton organization to orchestrate cell morphology, adhesion, and motility, is associated with angiogenesis and vessel branching, which are important events in the progression of clear cell renal cell carcinoma (ccRCC). We investigated the effect of PAK4 expression on recurrence and survival among patients with nonmetastatic ccRCC following surgery.MethodsPAK4 expression was assessed, using immunohistochemistry, in 376 patients with nonmetastatic ccRCC after nephrectomy, where data of 187 patients were obtained from 2013 to 2014 and of 189 patients were obtained from 2008. Kaplan-Meier and Cox regression analyses were used to associate PAK4 expression with overall survival and recurrence-free survival.ResultsOverall, 41.2% and 36.5% of specimens exhibited high PAK4 expression in 2 cohorts. Patients with high PAK4 expression were prone to possess high Fuhrman grade and tumor necrosis. Moreover, high PAK4 intensity was significantly associated with poor overall survival and recurrence-free survival. PAK4 expression remained an independent adverse prognosticator after adjusting for other well-established factors. Furthermore, in subgroups stratified by Fuhrman grade or T category, patients with high PAK4 intensity had an increased risk of recurrence and death. After adjusting for age, high PAK4 expression was an adverse prognostic marker in subgroup of low Fuhrman grade and in subgroup of early T category.ConclusionPAK4 expression is an independent adverse prognostic biomarker for recurrence and survival among patients with low-risk ccRCC after nephrectomy.     

Cellular fibronectin in patients with transitional cell carcinoma of the bladder

Various tumor markers for transitional cell carcinoma (TCC) of the bladder have been described, but none of them are used in clinical routine. Fibronectin, a glycoprotein, seems to play a very important role in both the progression and invasion of cancer. The aim of this study was to evaluate cellular fibronectin (cFN) in the urine and blood of patients with TCC of the bladder and to determine its possible role as a tumor marker and prognostic factor. Morning urine samples and blood were collected from 20 patients (8 women, 12 men, mean age 69.9 years) before they underwent transurethral resection of bladder tumors (TURB). Twenty patients (10 women, 10 men, mean age 63.4 years) with nonmalignant urological disorders were recruited as the control group. Determination of cFN in plasma and urine was performed by using a newly developed time-resolved fluorescence immunoassay (TRFIA). Patients with nonmalignant diseases had mean cFN plasma levels of 404 ng/ml (range 181-746 ng/ml). Patients with TCC of the bladder showed significantly higher cFN plasma levels of 686 ng/ml (range 274-1999 ng/ml, p<0.05). Subdivided according to the TNM system, muscle-invasive bladder tumors (n=5) demonstrated higher cFN plasma levels (mean 944 ng/ml) than superficial bladder tumors (n=15, mean 463 ng/ml). There were no differences of plasma cFN concentrations concerning tumor grade and also no differences in urine levels between the different groups. We found a significant difference (p<0.04) of cFN plasma levels between patients with TCC of the bladder and the control group. The difference in cFN plasma levels between pTa/pT1 and >or=pT2 tumors indicates a clinically useful potential of this tumor marker for preoperative staging and postoperative follow-up. Our data underline the important but still unclear role of cFN as a tumor marker in TCC, and this will be the focus of future studies.     

Valor pronóstico de la invasión microvascular en la predicción de la supervivencia en el carcinoma de células renales

ObjectiveTo assess microvascular tumor invasion and other clinical and histological parameters as potential prognostic factors in surgically treated renal cell carcinoma.Materials and methodsSurgical specimens from 238 consecutive patients who underwent radical or partial surgery between 1990 and 2006 were retrospectively evaluated. The series included clinically localized or metastatic renal cell carcinoma (pT1-4; N0-1; M0-1). Disease-free and cancer-specific survival assessments were the end points with median follow-up of 75 months (range 1-189 months). Variables studied included: age, sex, tumor size, TNM 2010 classification, Fuhrman grade, histological subtype and microvascular tumor invasion.ResultsMicrovascular tumor invasion was observed in 79 patients (33,2%) and was significantly associated with age (P = .010), tumor size (P = .000), Fuhrman grade (P = .000), pT stage 2010 (P = .000), N stage 2010 (P = .000) and M stage 2010 (P = .000). Multivariate analyses determined that sex, Fuhrman grade, pT stage 2010 and histological subtipe were independent prognostic factors of disease-free survival, while sex, Fuhrman grade, pT stage 2010, M stage 2010, histological subtype and microvascular invasion were prognostic factors for cancer-specific survival.ConclusionsOur study shows that microvascular tumor invasion is an independent prognostic factor for cancer-specific survival in surgically treated patients with renal cell carcinoma.     

Prognostic value of serum immunosuppressive acidic protein in renal cell carcinoma

BACKGROUND: To determine whether the immunosuppressive acidic protein (IAP) could be a useful marker for renal cell carcinoma (RCC), serum IAP levels were compared with clinicopathological features in RCC patients. Furthermore, IAP cutoff level to predict the recurrence was determined using receiver operating characteristics (ROC) curve analysis. PATIENTS AND METHODS: Between January 1994 and December 1998, pretreatment serum IAP was measured in 123 consecutive patients with PCC at Kitasato University Hospital. Ninety-eight patients were received radical surgery and 86 patients were performed as clinically curable renal cell carcinoma (pT1-pT3N0M0). ROC curve analysis was utilized to set the cutoff value of IAP for prediction of cancer recurrence. Significance of prognostic factors in RCC recurrence was analyzed by Cox proportional hazard model. RESULTS: The mean age of the 123 patients was 58.6 years (range 33 to 90, median 59). The mean follow-up period was 24.8 months (range 1 to 78, median 26). The median IAP levels were 447 ug/ml in stage I, 629 ug/ml in stage II, 588 ug/ml in stage III and 1,150 ug/ml in stage IV (p < 0.05). Tumor size and venous involvement were significantly associated with IAP concentrations (p < 0.05). However, tumor grade did not correlate with IAP level. Of 86 patients with clinically curable tumor, 79 patients were disease-free after median follow-up of 27 months. Using ROC curve analysis, IAP cutoff level for prediction of cancer recurrence was set at 620 ug/ml. Disease-free survival rate in patients with preoperative IAP levels of 620 ug/ml or lower was 98.5% (67/68) at 27 months postoperatively, whereas that in patients with IAP greater than 620 ug/ml was 75.0% (12/18). This difference was statistically significant (p < 0.05). Results of multivariate analysis revealed that preoperative IAP and pT stage were statistically significant factors for tumor recurrence after radical surgery (p < 0.05). CONCLUSIONS: The present study indicates that preoperative IAP level is a useful prognostic marker in patients with RCC. In particular, patients with clinically curable tumors (pT1-3N0M0), whose preoperative IAP levels greater then 620 ug/ml may have high risk for recurrence after radical nephrectomy.