术前炎症指标对未触及腹股沟淋巴结的pT1a期阴茎鳞癌患者淋巴结转移的预测价值  

Predictive value of preoperative inflammatory markers for lymph node metastasis in patients with pT1a stage penilesquamous carcinoma without palpable inguinal lymph nodes

作　　者：宋振 闫会林 张卫杰 张志昱 钱涛[1] 王国成[1] 欧阳骏[2] SONG Zhen;YAN Huiin;ZHANG Weijie;ZHANG Zhiyu;QIAN Tao;WANG Guocheng;OUYANG Jun(Department of Urology,Taixing People's Hospital,Taixing 225400;Department of Urology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]泰兴市人民医院泌尿外科,江苏泰兴225400 [2]苏州大学附属第一医院泌尿外科,江苏苏州215000

出　　处：《南京医科大学学报（自然科学版）》2024年第5期661-665,680,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省自然科学基金(BK20190175)。

摘　　要：目的:探讨3种术前炎症指标对未触及腹股沟淋巴结的p T1a期阴茎鳞癌患者发生淋巴结转移的预测价值。方法:收集苏州大学附属第一医院和泰兴市人民医院2012年1月—2023年6月收治的103例p T1a期阴茎鳞癌患者的临床资料,根据术后病理有无发生腹股沟淋巴结转移分为淋巴结转移组及非淋巴结转移组。比较两组间年龄、体重指数、高血压、糖尿病、肿瘤直径、中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、淋巴细胞/单核细胞比值(lymphocyte-to-monocyte ratio,LMR)及术后病理分级的差异。采用单因素和多因素Logistic回归分析筛选出淋巴结转移的独立危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线比较炎症指标对p T1a期阴茎癌患者发生淋巴结转移的预测价值以及在调整灵敏度为100%后各炎性指标对淋巴结转移的预测效能。结果:(1)腹股沟淋巴结转移组24例(23.3%),非淋巴结转移组79例(76.7%),两组在NLR(P<0.001)、PLR(P=0.035)和LMR(P <0.001)方面差异有统计学意义;(2)多因素分析结果显示,NLR(P=0.045)和LMR(P=0.021)是pT1a期阴茎鳞癌发生腹股沟淋巴结转移的独立危险因素;(3)ROC曲线分析结果显示,NLR、LMR和NLR+LMR的曲线下面积分别为0.833、0.816、0.835。NLR的最佳截断值为2.33,灵敏度为95.8%,特异度为68.4%;LMR的最佳截断值为3.80,灵敏度为79.2%,特异度为78.5%;NLR+LMR联合检测的灵敏度为83.3%,特异度为74.7%;(4)当调整灵敏度为100%时,NLR和LMR对pT1a期阴茎鳞癌腹股沟淋巴结转移的预测特异度为50.6%和2.5%,截断值为1.79和11.01。结论:NLR和LMR为pT1a期阴茎鳞癌发生腹股沟淋巴结转移的独立预测因素。NLR>2.33和LMR<3.80时提示患者淋巴结转移风险极大,推荐行淋巴结清扫手术,提高患者的生存率。Objective:To investigate the predictive value of three preoperative inflammatory markers for lymph node metastasis in patients with pTla stage penile squamous carcinoma without palpable inguinal lymph nodes.Methods:Clinical data of 103 patients with pTla stage penile squamous carcinoma admitted to the First Affiliated Hospital of Soochow University and Taixing People's Hospital from January 2012 to June 2023 were collected.Patients were divided into lymph node metastasis group and non-lymph node metastasis group based on postoperative pathological findings of inguinal lymph node involvement.Differences in age,body mass index(BMI),hypertension,diabetes mellitus,tumor diameter,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),lymphocyte-to-monocyte ratio(LMR),and postoperative pathological grading were compared between the two groups.Independent risk factors for lymph node metastasis were screened using univariate and multivariate logistic regression analyses.Receiver operating characteristic(ROC)curves were performed to compare the predictive value of inflammatory markers for lymph node metastasis in patients with pTla stage penile squamous carcinoma,and the predictive efficacy of each inflammatory markersfor lymph node metastasis was evaluated after adjusting sensitivity to 100%.Results:There were 24 cases(23.3%)in the inguinal lymph node metastasis group and 79 cases(76.7%)in the non-lymph node metastasis group.The differences between the two groups were statistically significant in terms of NLR(P<0.001),PLR(P=0.035),and LMR(P<0.001).Multivariateanalysis showed that NLR(P=0.045)and LMR(P=0.021)were independent risk factors for inguinal lymph node metastasis in pTla stage penile cancer.ROC curve analysis results showed that the area under the curve for NLR,LMR,and NLR+LMR were 0.833,0.816,and 0.835 respectively.The optimal cut-off value for NLR was 2.33,with a sensitivity of 95.8%and a specificity of 68.4%;the optimal cut-off value for LMRwas 3.80,with a sensitivity of 79.2%and a specificity o

关 键 词：阴茎癌 鳞状细胞癌 炎症指标 淋巴结转移 预测 

分 类 号：R737.27[医药卫生—肿瘤]