术前外周血淋巴细胞/单核细胞比值与高级别T1期膀胱癌电切术后生存时间的相关性分析

Correlation between the ratio of peripheral blood lymphocytes/monocytes and the survival time of patients with advanced stage T1 bladder cancer after transurethral resection

目的研究术前外周血淋巴细胞/单核细胞比值(LMR)与高级别T1期膀胱癌电切术后生存时间的相关性,旨在为更好的治疗高级别T1期膀胱癌患者提供有效的理论依据。方法回顾性分析2007年5月至2012年5月行经尿道膀胱肿瘤切除术,术后经病理明确诊断为高级别T1期膀胱癌180例患者的临床资料。利用受试者工作特征(ROC)曲线,最终确定LMR的截点值为4. 34,以4. 34为切割点,分为高LMR组(LMR≥4. 34)和低LMR组(LMR<4. 34)。分析不同LMR比值与高级别T1期膀胱癌电切术后患者肿瘤大小、灌注化疗、肿瘤数量、肾积水等临床病理特征以及术后生存时间的相关性,采用Cox多因素分析影响高级别T1期膀胱癌电切术后生存时间的独立危险因素。结果 2组患者性别比、年龄、吸烟史、肿瘤大小、围手术期输血、灌注化疗中比较差异无统计学意义(P> 0. 05),而肿瘤数量、肾积水、肿瘤复发、肿瘤进展2组患者存在明显差异(P <0. 05)。单因素分析:不同性别以及有无吸烟史对患者无复发生存时间以及总生存时间无明显影响(P> 0. 05),而年龄大小、肿瘤数量、肿瘤大小、有无肾积水、围手术期输血、灌注化疗以及LMR值对患者无复发生存时间以及总生存时间存在明显影响性(P <0. 05)。Cox多因素结果显示:肾积水、LMR <4. 34是影响高级别T1期膀胱癌患者术后生存时间的独立危险因素[HR=2. 119(1. 347～3. 333)、HR=1. 868(1. 221～2. 859)],灌注化疗是提高高级别T1期膀胱癌患者术后生存时间的保护因素[HR=0. 558(0. 448～0. 695)]。结论术前LMR值能反映高级别T1期膀胱癌患者电切术后生存时间,能作为评价高级别T1期膀胱癌患者电切术后预后的指标,LMR值下降提示高级别T1期膀胱癌患者电切术后预后不良。

Objective To investigate the relationship between the preoperative peripheral blood lymphocytes/mononuclear cell ratio (LMR) and survival time in patients with advanced stage T1 bladder cancer after transurethral resection in order to provide theoretical basis for effective treatment of advanced bladder cancer. MethodsThe clinical data about 180 patients with high grade stage T1 bladder cancer after transurethral resection of bladder tumor who were diagnosed by pathology and treated in our hospital from May 2007 to May 2012 were retrospectively analyzed.The receiver operating characteristic curve (ROC) was used to ultimately determine the cutoff value of LMR as 4.34.According to the cutting point,the patients were divided into the high LMR group (LMR≥4.34) and the low LMR group (LMR<4.34).The relationship between different LMR ratios and tumor size,tumor number, hydronephrosis and postoperative survival time was analyzed.The multivariate Cox analysis was used to investigate the independent risk factors influencing survival time of patients with T1 high grade bladder cancer after transurethral resection. ResultsThere were no significant differences in the gender,age,smoking history,tumor size, perioperative blood transfusion,perfusion chemotherapy between the two groups ( P >0.05),however,there were significant differences in the number of tumor,hydronephrosis, lymph node metastasis,recurrence and progression of tumor between two groups ( P <0.05).The single factor analysis showed that the sex and smoking history had no significant effects on relapse free survival time and overall survival time ( P >0.05),but patient’s age, tumor number,tumor size,renal water,perioperative blood transfusion,infusion chemotherapy,lymph node metastasis and LMR value were closely correlated with relapse free survival time and overall survival time ( P <0.05).The multivariate Cox regression analysis showed that hydronephrosis and LMR<4.34 were the independent risk factors of survival time of patients with T1 high grade bladder cancer after surgery[Hr=2.119(1.347~3.333) and H r =1.868(1.221~2.859)],moreover, the infusion chemotherapy was a protective factor for improving the postoperative survival time of patients with high-grade stage T1 bladder cancer [H r =0.558(0.448~0.695)]. ConclusionThe value of preoperative LMR can reflect the survival time of patients with high grade T1 bladder cancer after transurethral resection of bladder cancer,which can be regarded as an index of evaluation of postoperative prognosis in patients with advanced stage T1 bladder cancer after transurethral resection of bladder cancer.Moreover the decrease of LMR value suggests that the prognosis of patients with high grade stage T1 bladder cancer after transurethral resection is poor.