摘要
背景与目的:越来越多的证据提示炎症在肿瘤的发展演进中起着重要的作用,术前外周血淋巴细胞与单核细胞比值(lymphocyte-to-monocyte ratio,LMR)和白蛋白被证明是各种肿瘤的独立预后因素。探讨LMR和白蛋白在传统临床预后预测模型的基础上对肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)预后评估的应用价值。方法:回顾性分析2012-2015年在广西医科大学第一附属医院行RCC根治术或肾部分切除的147例ccRCC患者的临床资料。外周血LMR和白蛋白于术前1周收集,LMR采用中位数3.42,白蛋白用40 g/L作为截点。采用单因素分析和COX回归模型,分析LMR和白蛋白及其他临床因素与患者预后的关系。将LMR和白蛋白结合传统预测指标TNM分期及Fuhrman分级进行分析。采用C指数预测LMR和白蛋白对RCC预后的准确性;同时,采用LMR、白蛋白、TNM分期和Fuhrman分级构建列线图,预测患者的生存率。结果:术前低LMR和低白蛋白是患者总生存期(overall survival,OS)的独立危险因素(P=0.001和P<0.001)。低LMR与高Fuhrman分级(P=0.006)和肿瘤坏死(P=0.039)密切相关;低白蛋白与高Fuhrman分级(P<0.001)和高Mayo临床分期、大小、分级和坏死(stage, size, grade and necrosis,SSIGN)分数(P=0.001)有关。单因素分析提示LMR、白蛋白、TNM分期、Fuhrman分级、肿瘤大小、肿瘤坏死与OS相关;COX回归模型提示LMR和白蛋白是OS的独立预后因素(HR=0.370,95%CI:0.145~0.942,P=0.037;HR=0.325,95%CI:0.136~0.775,P=0.011)。将LMR和白蛋白结合传统预测指标TNM分期及Fuhrman分级进行分析后,C指数上升;列线图构建结果发现可以预测RCC患者术后3和5年的生存率。结论:术前外周血LMR和白蛋白是ccRCC患者术后的独立预后因素,将其纳入常规的临床病理学参数中,可以提高ccRCC患者术后预后评估的精准性。
Background and purpose: Growing evidence indicates that inflammation plays an important role in the development and progression of tumors. Preoperative lymphocyte-to-monocyte ratio(LMR) and serum albumin have been estimated as independent prognostic factors of various cancers. This study aimed to investigate the relationship between LMR or serum albumin and the prognosis of patients with clear cell renal cell carcinoma(ccRCC). Methods: Data of 147 patients who underwent radical or partial nephrectomy from 2012 to 2015 were retrospectively studied at a single tertiary academic center. Preoperative LMR and serum albumin were calculated 1 week before surgical intervention. Patients were categorized using a median value of LMR cutoff of 3.42. Dichotomization of serum albumin was according to the lower range of normal measurement at 40 g/L. The relationship between LMR or serum albumin with other clinical factors and overall survival(OS) was analyzed using univariate analysis and COX regression model. LMR and serum albumin combined with TNM stage and Fuhrman grade were used for further analysis. The influences of the LMR and serum albumin on the predictive accuracy were investigated using the Harrell concordance index. A nomogram, which predicted the 3-and 5-year survival rates for patients with ccRCC, was established by incorporating LMR and serum albumin into a prognostic model with TNM stage and Fuhrman grades. Results: LMR and serum albumin were independent prognostic factors for OS(P=0.001). Low LMR was significantly associated with high Fuhrman grade(P=0.006) and the presence of tumor necrosis(P=0.039). Low serum albumin was significantly correlated with high Fuhrman grade(P<0.001) and high Mayo clinic stage, size, grade and necrosis(SSIGN) score(P=0.001). Multivariate analysis identified low LMR and low serum albumin as independent prognostic factors for patient’s OS(HR=0.37;95% CI: 0.145-0.942;P=0.037;HR=0.325;95% CI: 0.136-0.775;P=0.011). The C-index rose when LMR and serum albumin were combined with TNM stage and Fuhrman grade. A nomogram predicted the 3-and 5-year survival rates for patients with ccRCC. Conclusion: Incorporating LMR and serum albumin into traditional clinicopathological analysis can improve the predictive value for patients with ccRCC after surgery intervention.
作者
徐明彬
赵雨桐
黎承杨
赵嘉闻
马晨俊
廖乃凯
杨占斌
程继文
XU Mingbin;ZHAO Yutong;LI Chengyang;ZHAO Jiawen;MA Chenjun;LIAO Naikai;YANG Zhanbin;CHENG Jiwen(Department of Urology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2019年第11期887-898,共12页
China Oncology
关键词
肾癌
淋巴细胞与单核细胞比值
白蛋白
预后
列线图
Renal cell carcinoma
Lymphocyte-to-monocyte ratio
Serum albumin
Prognosis
Nomogram