阴茎癌患者术前淋巴细胞与单核细胞比值与临床病理特征及预后的相关研究

Relationship of preoperative blood lymphocyte-to-monocyte ratio with the clinicopathological features and prognosis of penile cancer

目的外周血淋巴细胞与单核细胞比值(LMR)与阴茎癌患者的预后关系报道较少。文中旨在探讨阴茎癌患者术前外周血LMR与临床病理特征及预后的关系。方法回顾性分析2000年1月至2018年1月就诊于南昌大学第一附属医院泌尿外科并接受手术治疗的44例阴茎癌患者的临床病理资料,分为低LMR组(LMR<3.4,n=21)、高LMR组(LMR≥3.4,n=23)。统计分析患者的临床病理特征,运用Log-Rank单因素分析影响阴茎癌患者预后的因素,并采用Kaplan-Meier法绘制生存曲线,采用Cox回归模型分析影响预后的危险因素。结果 Long-Rank单因素分析结果显示,肿瘤直径、细胞分级及LMR是影响阴茎癌患者肿瘤无复发生存期的危险因素(P<0.05),术后淋巴结转移、侵犯神经、LMR是影响阴茎癌患者总生存期的危险因素(P<0.05)。高LMR组患者肿瘤无复发中位生存期较低LMR组明显延长(26个月vs 7个月,P=0.010),中位总生存期亦明显延长(73个月vs 29个月,P=0.045)。Cox回归模型结果显示,术前LMR是阴茎癌患者肿瘤无复发生存期及总生存期的预后危险因素(P<0.05)。高LMR组肿瘤复发风险较低LMR组明显降低(HR=0.398,95%CI:0.174～0.909),总生存期延长(HR=0.428 95%CI:0.185～0.994)。结论术前高LMR值阴茎癌患者有着更好的肿瘤无复发生存期及总生存期,术前LMR值作为评估阴茎癌患者预后生存具有一定的临床价值。

Objective This study aimed to investigate the relationship of the preoperative blood lymphocyte-to-monocyte ratio(LMR)with the clinicopathological features and prognosis of penile cancer.Methods We collected the clinicopathological data on 44 cases of penile cancer treated by surgery in our hospital between January 2000 and January 2018.Based on the preoperative LMR,we divided the patients into a low-LMR(LMR<3.4,n=21)and a high-LMR group(LMR≥3.4,n=23),compared the clinicopathological features between the two groups of patients,performed log-rank univariate analysis on the prognostic factors,and investigated the independent risk factors affecting the prognosis using the Kaplan-Meier survival curve and COX regression model.Results Log-rank univariate analysis revealed that the tumor diameter,cell grade and LMR were the risk factors affecting the recurrence-free survival(RFS)(P<0.05)and that postoperative lymph node metastasis,invasion of nerves and LMR were those affecting the overall survival(OS)of the penile cancer patients(P<0.05).The median RFS was significantly longer in the high-LMR than in the lowMR group(26 vs 7 months,P=0.010),and so was the median OS(73 vs 29 months,P=0.045).COX multivariate survival analysis showed preoperative LMR to be the risk factor affecting RFS and OS of the patients(P<0.05).The tumor recurrence rate was significantly lower(HR=0.398,95%CI:0.174-0.909)and the OS rate markedly higher(HR=0.428,95%CI:0.185-0.994)in the high-LMR than in the low-LMR group.Conclusion Penile cancer patients with a higher LMR have longer RFS and OS and are less susceptible to tumor invasion of the nerves.Preoperative LMR plays a valuable role in predicting the postoperative survival of penile cancer patients.