术前外周血中性粒细胞与淋巴细胞的比值和肾癌预后的关系

Association of neutrophil-to-lymphocyte ratio with the prognosis in patients with renal cell carcinoma

目的 探讨术前外周血中性粒细胞计数、淋巴细胞计数以及两者比值（neutrophil-to-lymphocyte ratio,NLR）与肾癌患者预后的关系.方法 回顾性分析2008年1月至2012年12月1 325例病理确诊为肾癌患者的临床病理资料及术后随访资料.采用受试者工作特征曲线法确定NLR最佳临界值,根据临界值将患者分为高NLR组和低NLR组.采用Kaplan-Meier法计算生存率,Log-rank检验比较高NLR组和低NLR组间的生存率差异.对患者年龄、症状、T分期、转移情况、病理类型及Fuhrman分级等进行单因素分析,采用Cox多因素回归分析影响肾癌患者预后的独立因素.结果 本组1 325例中1 220例获随访,随访率92.1％.随访时间2～ 87个月,中位时间40个月.1 220例的3、5年总生存率（overall survival,OS）分别为91.3％、86.9％,3、5年无复发生存率（recurrence free survival,RFS）分别为88.2％、85.8％.NLR最佳临界值为2.7,NLR≥2.7为高NLR组,NLR＜2.7为低NLR组.低NLR组和高NLR组5年OS分别为91.4％、87.3％,差异有统计学意义（χ2=78.556,P ＜0.05）;5年RFS分别为89.6％、71.9％,差异有统计学意义（χ2 =58.111,P＜0.05）.在153例伴有远处转移的肾癌患者中,低NLR和高NLR组患者的5年生存率分别为58.9％和22.6％,差异有统计学意义（P＜0.05）.单因素分析结果显示,年龄＞ 65岁、有临床症状、有糖尿病病史、中性粒细胞计数≥4.5、淋巴细胞计数＜1.7、NLR≥2.7、伴有转移、高T分期、高Fuhrman分级是患者不良预后的影响因素（P＜0.05）.Cox多因素分析结果显示,年龄＞65岁、NLR≥2.7、高T分期、伴有转移是肾癌患者不良预后的独立因素（P＜0.05）.结论 高NLR是肾癌患者不良预后的独立危险因素.

Objective To explore prognostic factors of renal cell carcinoma and investigate the association of neutrophil-to-lymphocyte ratio （NLR） with the prognosis of renal cell carcinoma （RCC） in patients who received nephrectomy treatment.Methods We retrospectively reviewed the records of 1325 patients with renal cell carcinoma who underwent nephrectomy between January,2008 and December,2012.We retrospectively analyzed the clinicopathologic characteristics of patients.The optimal cutoff value for NLR was determined using receiver operating characteristic curve （ROC） analysis.We defined them as high NLR group when NLR ≥ 2.7 and low NLR group when NLR 〈 2.7.Overall survival （OS） and recurrence free survival （RFS） were estimated using the Kaplan-Meier method and compared using the logrank test.Multivariate models were used to analyze the association of NLR with clinicopathologic outcomes.Results By the end of the study, 1220 cases were followed up.The follow-up rate was 92.1%.Mean follow-up was 40 months （range 2 months to 87 months）.The three-year and five-year overall survival rate were 91.3% and 86.9%, respectively.Meanwhile the three-year and five-year recurrence free survival rate were 88.2% and 85.8% ,respectively.2.7 was selected as the optimal cutoff value to differentiate between low NLR and high NLR.A NLR ≥2.7 was significantly associated with worse 5-year overall survival and worse 5-year recurrence free survival than a NLR 〈2.7,91.4% vs 87.3% ,89.6% vs 71.9% （P 〈0.05）.Age 〉65, presentation mode with symptom, higher tumor stage, higher Fuhrman grade,histologic subtype,neutrophil count ≥ 4.5, lymphocyte count 〈 1.7, NLR ≥ 2.7 significantly correlated with poor OS on univariate analysis.Multivariate analysis revealed that higher tumor stage, preoperative NLR ≥ 2.7 at diagnosis were poor independent prognostic factors for OS of renal cell carcinoma.Conclusion High NLR was independent poor predictor of renal cell carcinoma.