Identification of the best complete blood count-based predictors for bladder cancer outcomes in patients undergoing radical cystectomy.
Identification of the best complete blood count-based predictors for bladder cancer outcomes in patients undergoing radical cystectomy.
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DOI：
10.1038/bjc.2015.432
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发表时间：
2016-01-19
影响因子：
8.8
通讯作者：
Kulkarni GS
中科院分区：
文献类型：
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作者：
Bhindi B;Hermanns T;Wei Y;Yu J;Richard PO;Wettstein MS;Templeton A;Li K;Sridhar SS;Jewett MA;Fleshner NE;Zlotta AR;Kulkarni GS
我们试图确定哪种基于全血细胞计数（CBC）的生物标志物的简约组合最有效地预测膀胱癌（BC）根治性膀胱切除术（RC）患者的肿瘤预后。使用我们的机构RC数据库（1992-2012），基于预处理测量评估了9个基于cbc的标记物（包括绝对细胞计数和比率）。结果指标为无复发生存期（RFS）、癌症特异性生存期（CSS）和总生存期（OS）。使用时间相关的受体操作特征曲线来表征每种生物标志物。基于cbc的生物标志物，以及一些临床预测因子，然后被考虑纳入基于Akaike信息标准的预测多变量Cox模型。我们的队列包括418名患者。中性粒细胞淋巴细胞比率（NLR）是唯一满足纳入所有模型标准的生物标志物，独立预测RFS （HR每1-log单位=1.52,95% CI= 1.17-1.98， P=0.002）、CSS （HR=1.47, 95% CI= 1.20-1.80， P<0.001）和OS （HR=1.56, 95% CI= 1.16-2.10， P=0.004）。血红蛋白也能独立预测CSS（每1 g/dl HR= 0.91, 95% CI= 0.86-0.95， P<0.001）和OS (HR=0.90, 95% CI= 0.88-0.93， P<0.001)，但不能预测RFS。在研究的CBC生物标志物中，NLR是预测RFS最有效的标志物，而NLR和血红蛋白是预测CSS和OS最有效的标志物。NLR和血红蛋白是很有前途的、具有成本效益的、独立的生物标志物，可用于预测肺癌后的肿瘤预后。各种基于cbc的生物标志物已分别被证明可预测BC膀胱切除术患者的肿瘤预后。我们的研究评估了这些生物标志物，并确定NLR是预测RFS的最佳基于cbc的生物标志物，而NLR和血红蛋白是预测CSS和OS最有效的生物标志物。
We sought to determine which parsimonious combination of complete blood count (CBC)-based biomarkers most efficiently predicts oncologic outcomes in patients undergoing radical cystectomy (RC) for bladder cancer (BC). Using our institutional RC database (1992–2012), nine CBC-based markers (including both absolute cell counts and ratios) were evaluated based on pre-treatment measurements. The outcome measures were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Time-dependent receiver-operating characteristics curves were used to characterise each biomarker. The CBC-based biomarkers, along with several clinical predictors, were then considered for inclusion in predictive multivariable Cox models based on the Akaike Information Criterion. Our cohort included 418 patients. Neutrophil–lymphocyte ratio (NLR) was the only biomarker satisfying criteria for inclusion into all models, independently predicting RFS (HR per 1-log unit=1.52, 95% CI=1.17–1.98, P=0.002), CSS (HR=1.47, 95% CI=1.20–1.80, P<0.001), and OS (HR=1.56, 95% CI=1.16–2.10, P=0.004). Haemoglobin was also independently predictive of CSS (HR per 1 g/dl=0.91, 95% CI=0.86–0.95, P<0.001) and OS (HR=0.90, 95% CI=0.88–0.93, P<0.001), but not RFS. Among CBC biomarkers studied, NLR was the most efficient marker for predicting RFS, whereas NLR and haemoglobin were most efficient in predicting CSS and OS. NLR and haemoglobin are promising, cost-effective, independent biomarkers for predicting oncologic BC outcomes following RC. Various CBC-based biomarkers have separately been shown to be predictive of oncologic outcomes in patients undergoing cystectomy for BC. Our study evaluated these biomarkers, and determined that NLR is the best CBC-based biomarker for predicting RFS, whereas NLR and haemoglobin are most efficient for predicting CSS and OS.