术前血小板/淋巴细胞比值判断上尿路尿路上皮癌临床分期及预后的价值

The value of preoperative platelet to lymphocyte ratio in predicting of clinical stage and prognosis in upper tract urothelial carcinoma

背景与目的：血小板／淋巴细胞比值（platelet to lymphocyte ratio，PLR）被认为是反映机体内炎性反应的重要指标，PLR在上尿路尿路上皮癌中的临床价值国内外尚没有相关研究。本研究旨在探讨术前PLR在判断上尿路尿路上皮癌临床分期及预后的价值。方法：收集2007年1月至2012年3月单中心手术治疗的无远处转移的上尿路尿路上皮癌病例，术前、术后无瘤期及复发或转移期PLR。随访采用门诊与电话相结合。采用PLR=150：1为分界值将病例分为低PLR组和高PLR组，分析其与肿瘤分期、是否合并膀胱肿瘤、复发或转移、生存、肿瘤部位、术前血尿、术前肾积水、性别及年龄的关系。进一步分析不同PLR分组的无病生存时间、总生存时间。结果：共收集上尿路尿路上皮癌51例，术后中位随访时间21（9～51）个月，出现复发或转移20例（39．2％），中位无病生存时间15（2～51）个月，死亡9例（17．6％），中位生存时间21（9～51）个月。单因素分析显示术前PLR与肿瘤分期、生存率、血尿及性别具有相关性，P值分别为0．028、0．008、0．045、0．036。高PLR组更易发生器官非局限性肿瘤，术前PLR判断非器官局限性肿瘤的敏感性为57％、特异性为74％。Kaplan—Meier法生存分析显示，两组无病生存时间差异无统计学意义（P=0．155）、高PLR组总生存时间明显短于低PLR组（P=0．006）。Cox多因素生存分析显示仅肿瘤分期是总生存时间的独立影响因素（P=0．029）。结论：在上尿路尿路上皮癌中，术前PLR是判断非器官局限性肿瘤的潜在因素，高PLR组更易发生器官非局限性肿瘤。肿瘤分期是总生存时间的独立影响因素。

Background and purpose： Platelet to lymphocyte ratio （PLR） is an important factor reflected systematic inflammation. The clinical value of PLR has not been confirmed. The present study was to explore the value of preoperative PLR in predicting clinical stage and prognosis in upper tract urothelial carcinoma. Methods： Patients who underwent surgical therapy with postoperative pathology upper tract urothelial carcinoma without metastasis from Jan. 2007 to Mar. 2012, were collected. Following up was done by telephone and clinic work, 150 vs 1 was taken as the threshold value of PLR, and the association of PLR with tumor stage, whether suffered bladder cancer as comorbidity, recurrent or metastasis, overall survival, tumor lesion, preoperative hematuria, gender and age was analyzed. We further analyzed the association difference of disease free survival （DFS） time and overall survival （OS） time between different PLR groups. Results： Fifty-one cases of UTUC were collected, and the postoperative mean following up time is 21 （9-51） months. Twenty cases recurred or metastasis and 9 cases died. The mean DFS time was 15 （2-51） months,and the mean OS time was 21 （9-51） months. One-factor analysis of variance showed that preoperative PLR was associated with tumor stage, overall survival rate, hematuria and gender, and the P value were 0.028, 0.008, 0.045, 0.036 respectively. High PLR group was intended to be non-organ confined disease, the sensitivity was 57% and the specificity was 74%. Survival analysis by Kaplan-Meier method showed there is no statistical difference in DFS between high and low PLR groups （P=0.155）. But OS time in high PLR group was significantly less than that in low PLR group （P=-0.006）. Cox regression confirmed that only tumor stage is an independent prognostic factor of OS （P=0.029）. Conclusion： PLR has potential clinical value in predicting advanced stage disease and Cox regression confirmed that only tumor stage is an independent prognostic factor of OS.