Preoperative Risk Classification Using Neutrophil-to-Lymphocyte Ratio and Albumin for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy.
Preoperative Risk Classification Using Neutrophil-to-Lymphocyte Ratio and Albumin for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy.
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使用中性粒细胞与淋巴细胞比率和白蛋白对接受根治性肾输尿管切除术治疗的上尿路尿路上皮癌进行术前风险分类
DOI：
10.2147/cmar.s274332
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发表时间：
2020
影响因子：
3.3
通讯作者：
Yang R
中科院分区：
文献类型：
--
作者：
Zhao Z;Xie S;Feng B;Zhang S;Sun Y;Guo H;Yang R
为了提高对接受根治性肾输尿管切除术（RNU）治疗的上尿路尿路上皮癌（UTUC）患者预后的术前预测，我们探索了各种术前实验室因素并建立了预后风险分层方法。我们回顾性分析了 2010 年 9 月至 2019 年 10 月期间接受 RNU 的 232 名 UTUC 患者，并分析了他们的综合临床病理数据和术前血液生物标志物。采用Kaplan-Meier分析、受试者工作特征（ROC）曲线分析和Cox回归分析来评估这些因素与预后之间的关系。中位随访时间和年龄分别为 24 个月和 68.5 岁。在单变量和多变量分析中，术前中性粒细胞与淋巴细胞比率升高（NLR > 3.44）和白蛋白降低（ALB < 39.8 g/L）与无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）呈负相关。根据 NLR 和 ALB 将患者分为三组：低风险组（NLR 既不升高也不降低 ALB）、中风险组（NLR 升高或 ALB 降低）和高风险组（NLR 升高但 ALB 降低）。他们的 5 年 PFS 率分别为 77.8%、52.6% 和 32.3%；他们的5年CSS率分别为97.7%、71.4%和32.9%；他们的 5 年 OS 率分别为 92.7%、70.4% 和 29.2%（均 P < 0.0001）。 ROC曲线分析显示NLR联合ALB具有更准确的预后价值（P < 0.05）。使用 NLR 和 ALB 进行的术前风险分类被确定为 UTUC 患者的独立预后因素。 NLR 和 ALB 的结合可能有助于在 RNU 之前确定最合适的治疗方案。
To improve the preoperative prediction of the outcomes of patients diagnosed with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), we explored various preoperative laboratory factors and established a prognostic risk stratification method. We retrospectively reviewed 232 UTUC patients who underwent RNU from September 2010 to October 2019 and analyzed their comprehensive clinicopathologic data and preoperative blood-based biomarkers. Kaplan–Meier analysis, receiver-operating characteristic (ROC) curves analysis and Cox regression analysis were performed to assess the relationship between these factors and the prognosis. The median follow-up and age were 24 months and 68.5 years, respectively. Preoperative elevated neutrophil-to-lymphocyte ratio (NLR > 3.44) and decreased albumin (ALB < 39.8 g/L) were negatively correlated with progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) in both univariate and multivariate analyses. Patients were sorted into three groups based on their NLR and ALB: the low-risk group (neither elevated NLR nor decreased ALB), intermediate-risk group (either elevated NLR or decreased ALB) and high-risk group (elevated NLR and decreased ALB). Their 5-year PFS rates were 77.8%, 52.6% and 32.3%; their 5-year CSS rates were 97.7%, 71.4% and 32.9%; and their 5-year OS rates were 92.7%, 70.4% and 29.2%, respectively (all P < 0.0001). ROC curves analysis showed that NLR plus ALB had a more accurate prognostic value (P < 0.05). Preoperative risk classification using NLR and ALB was identified as an independent prognostic factor for patients with UTUC. The combination of NLR and ALB may help to determine the most appropriate treatment options before RNU.