术前外周血炎症指标对转移性肾癌的预后价值  

PROGNOSTIC VALUE OF PREOPERATIVE PERIPHERAL BLOOD INFLAMMATORY MARKERS FOR METASTATIC RENAL CELL CARCINOMA

作　　者：李翔宇 毛昕[1] 张庆松 裴兴超 LI Xiangyu;MAO Xin;ZHANG Qingsong;PEI Xingchao(Department of Urology,The Affiliated Hospital of Qingdao University,Qingdao 266100,China)

机构地区：[1]青岛大学附属医院泌尿外科,山东青岛266100

出　　处：《青岛大学学报（医学版）》2023年第6期821-825,共5页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金资助项目(82100285)。

摘　　要：目的探究血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)和系统免疫炎症指数(SII)对行减瘤手术的转移性肾细胞癌(MRCC)病人的预后价值。方法回顾性分析2012年1月—2016年12月于青岛大学附属医院泌尿外科确诊MRCC并行减瘤手术的80例病人的临床病理资料。使用X-tile软件计算外周血炎症指标的最佳截点值,据此将病人分为高数值组和低数值组,比较两组间差异,并采用单因素分析和多因素Cox回归分析了解炎症相关指标等临床病理特征对病人预后的影响。结果NLR、PLR、SII的最佳截点值分别为2.7、161.0、734.1。高NLR、PLR、SII数值均与更差的Fuhrman分级相关(χ^(2)=4.863~17.875,P<0.05)。单因素分析显示,Fuhrman分级(χ^(2)=6.045,P=0.014)、T分期(χ^(2)=3.969,P=0.046)、是否为透明细胞癌(χ^(2)=9.743,P=0.002)、NLR(χ^(2)=17.025,P<0.001)、PLR(χ^(2)=8.441,P=0.004)、SII(χ^(2)=44.345,P<0.001)是行减瘤手术的MRCC病人总体生存期(OS)的影响因素。多因素Cox回归分析显示,SII(HR=5.087,95%CI=2.218~11.665,P<0.05)、是否为透明细胞癌(HR=0.487,95%CI=0.258~0.918,P<0.05)、Fuhrman分级(HR=1.684,95%CI=1.019~2.782,P<0.05)是MRCC病人OS的的独立影响因素。结论术前高SII数值提示行减瘤手术的MRCC病人较差的生存结局。Objective To explore the prognostic value of the platelet-to-lymphocyte ratio(PLR),neutrophil-to-lymphocyte ratio(NLR),and systemic immune-inflammation index(SII)in patients with metastatic renal cell carcinoma(MRCC)undergoing cytoreductive surgery.Methods We retrospectively analyzed the clinical data of 80 patients diagnosed with MRCC undergoing cytoreductive surgery in the Department of Urology of The Affiliated Hospital of Qingdao University from January 2012 to December 2016.Using X-tile 3.6.1 software,the optimal cut-off values of the peripheral blood inflammatory markers were determined to divide the patients into high-level and low-level groups for comparison analysis.Univariable and multivariable Cox regression analyses were performed to determine the influence of inflammatory indicators and other clinicopathological features on patient prognosis.Results The optimal cut-off values of NLR,PLR,and SII were 2.7,161.0,and 734.1,respectively.High NLR,PLR,and SII values were all significantly associated with a worse Fuhrman grade(χ^(2)=4.863-17.875,P<0.05).The univariable analysis showed that Fuhrman grade(χ^(2)=6.045,P=0.014),T stage(χ^(2)=3.969,P=0.046),being clear cell carcinoma or not(χ^(2)=9.743,P=0.002),NLR(χ^(2)=17.025,P<0.001),PLR(χ^(2)=8.441,P=0.004),and SII(χ^(2)=44.345,P<0.001)were influencing factors for the overall survival(OS)of patients with MRCC undergoing cytoreductive surgery.The multivariable Cox regression analysis showed that SII(HR=5.087,95%CI=2.218-11.665,P<0.05),Fuhrman grade(HR=1.684,95%CI=1.019-2.782,P<0.05),and being clear cell carcinoma or not(HR=0.487,95%CI=0.258-0.918,P<0.05)were independent factors affecting the OS of the patients.Conclusion Preoperative high levels of SII suggest a poor survival outcome in patients with MRCC undergoing cytoreductive surgery.

关 键 词：癌 肾细胞 肿瘤转移 血小板计数 淋巴细胞计数 中性粒细胞计数 系统免疫炎症指数 预后 

分 类 号：R737.11[医药卫生—肿瘤] R446.113[医药卫生—临床医学]