术前外周血中性粒细胞与淋巴细胞比值评估高级别 T1期膀胱癌预后的临床价值  

Preoperative neutrophil-lymphocyte ratio predicts clinical outcome in patients with high grade T1 bladder cancer

作　　者：秦川[1] 杜智勇[1] 申忠华[1] 唐刚[1] 陈斐然[1] 梁恩利[1] 胡海龙[1] 田大伟[1] 吴长利[1] 

机构地区：[1]天津医科大学第二医院泌尿外科 天津市泌尿外科研究所 天津市泌尿外科基础医学重点实验室,300211

出　　处：《中华泌尿外科杂志》2016年第9期685-689,共5页Chinese Journal of Urology

基　　金：天津市应用基础与前沿技术研究计划（14JCYBJC26300）

摘　　要：目的：探讨术前外周血中性粒细胞与淋巴细胞比值（ neutrophil-lymphocyte ratio，NLR）作为高级别T1期膀胱癌患者术后预后评价方法的临床价值。方法回顾性分析2004年1月至2014年12月行经尿道膀胱肿瘤切除术（ TURBT），且术后病理诊断为高级别T1期膀胱癌的307例患者的性别、年龄、吸烟史、肿瘤数量和大小、肾积水情况、NLR、术后灌注化疗、围手术期输血等指标。根据患者术前外周血NLR分为低NLR组（NLR≤2．42，197例）和高NLR组（NLR＞2．42，110例）。所有患者均为首发尿路上皮癌。采用Kaplan-Meier法单因素分析各临床病理特点对患者无复发生存期（ recurrence-free survival，RFS）和无进展生存期（ progression-free survival，PFS）的影响，并用Log-rank检验比较两组的生存曲线，采用Cox回归模型多因素分析影响高级别T1期膀胱癌预后的因素。结果本组307例随访1～123个月，平均71个月。 RFS为2～123个月，平均61．3个月；PFS为26～117个月，平均75．2个月。低NLR组和高NLR组的肿瘤复发率分别为19．2％（38／197）和34．5％（38／110），平均RFS分别为73．0个月（2～123个月）和67．5个月（1～122个月），肿瘤进展率分别为4.1％（8／197）和10．9％（12／110），两组比较差异有统计学意义（P＜0．01）。 Cox多因素生存分析结果显示NLR＞2．42（HR＝1．912，P＝0．007）、肾积水（HR＝2．485，P＜0．01）与肿瘤的复发和进展相关。结论术前NLR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，可作为判断患者预后的指标。高NLR的膀胱癌患者术后的复发率和进展率更高。Objective To assess the value of preoperative neutrophil-lymphocyte ratio （ NLR） for predict the prognosis in patients with high grade T1 bladder.Methods From January 2004 to December 2014, the data of 307 patients diagnosed as bladder cancer of Stage 1 and high grade after undergoing TURBT were analyzed, including gender, age, smoking status, tumor number and size, hydronephrosis, intravesical instillations and preoperative blood transfusion of 307 patients diagnosed as bladder cancer of stage 1 and high grade after undergoing TURBT were analyzed retrospectively.All patients were primary urothelial carcinoma.According to preoperative NLR,patients were divided into the low NLR group（ NLR≤2.42,n=197） and the high NLR group（NLR 〉2.42,n =110）.Recurrence-free survival （RFS） and progression-free survival （ PFS） were calculated according to the Kaplan-Meier model and compared by the log-rank model.Cox regression models were used for multivariate analyses of the association between NLR and bladder cancer, then the prognostic factors affecting RFS and PFS were evaluated.Result of these 307 patients, the low NLR group accounted for 64.2%（197/307）, and the high NLR group accounted for 35. 8%（110/307）.The mean follow-up period was 71（range, 1-123）months.The recurrence rate in the low NLR group and the high NLR group recurrence rate were 19.2%（ 38/197 ） and 34.5%（ 38/110 ） respectively, RFS were 73.0（range, 2-123）months and 67.5（range, 1-122）months respectively.The progression rates were 4.1%（8/197） and 10.9%（12/110） respectively.The recurrence and progression rates in the high NLR group is higher than those in the low NLR group（P〈0.01 and P=0.008）, and RFS was shorter（ P=0.002）.Multivariable Cox regression analysis showed that NLR〉2.42（P=0.007,HR=1.912）and hydronephrosis （P〈0.01, HR =2.485 ） are associated with higher risk of recurrence.Conclusion Elevated preoperative NLR is an independent predictor of RFS and PFS in patients with high grade

关 键 词：术前中性粒细胞与淋巴细胞比值 高级别T1期 膀胱癌 预后 

分 类 号：R737.14[医药卫生—肿瘤]