中性粒细胞-淋巴细胞比值联合白蛋白-球蛋白比值在预测非肌层浸润性膀胱癌预后价值

Prognostic value of neutrophil-lymphocyte ratio combined with albumin-globulinratio in non-muscular invasive bladder cancer

目的探讨中性粒细胞-淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)与白蛋白-球蛋白比值(albumin-globulin ratio,AGR)在预测经尿道膀胱肿瘤切除术(transurethral resection of bladder tumors,TURB)治疗非肌层浸润性膀胱癌(non-muscleinvasive bladder cancer,NMIBC)复发的临床价值。方法选取青海大学附属医院2011年2月-2013年12月期间收治的271例择期行TURB治疗的NMIBC患者,收集患者术前1周的AGR、NLR水平,采用受试者工作特征(receiver operating characteristic,ROC)曲线对AGR、NLR水平进行最佳截断值的处理,并根据最佳截断值进行分组。结果复发组年龄、AGR、NLR值均高于无复发组,差异比较具有统计学意义(P<0.05);复发组肿瘤直径(≥3 cm)、肿瘤数量(多发)、伴发原位癌(是)、肿瘤分期(G3),病理分期(T 1)比例均高于无复发组,差异比较具有统计学意义(P<0.05);AGR的曲线下面积(area under curve,AUC)为0.866,最佳截断值为1.71(95%CI:0.819~0.904);NLR的AUC为0.785,最佳截断值为2.37(95%CI:0.731~0.832)。高AGR组(≥1.71)的复发率低于低AGR组(<1.71)(P<0.05);低NLR组(≤2.37)的复发率低于高NLR组(>2.37)(P<0.05);AGR(<1.71,OR:5.621,95%CI:1.324~9.454)、NLR(>2.37,OR:2.105,95%CI:1.381~3.171)、AGR<1.71且NLR>2.37(OR:7.587,95%CI:4.587~11.684)均为NMIBC复发的独立危险因素(P<0.05);AGR≥1.71且NLR≤2.37(OR:0.787,95%CI:0.358~0.917)为NMIBC复发的保护因素(P<0.05)。结论AGR与NLR均为NMIBC复发的独立危险因素,但是AGR联合NLR可能增加评估复发的准确性。

Objective To explore the clinical value of neutrophil-lymphocyte ratio(NLR)and albumin-globulin ratio(AGR)in predicting recurrence of non-myometrial invasive bladder cancer(NMIBC)treated by transurethral resection of bladder tumors(TURB).Methods Two hundred and seventy-one patients with NMIBC who were treated by TURB in our hospital from February 2011 to December 2013 were selected.AGR and NLR levels were collected one week before operation.The receiver operating characteristic(ROC)curve was used to process the best truncation values of AGR and NLR levels,and grouped according to the best truncation values.Results Age,AGR and NLR of relapse group were higher than those of non-relapse group and the difference was statistically significant(P<0.05).Tumor diameter(≥3 cm),number of tumor(multiple),concomitant carcinoma in situ(yes),tumor stage(G3),pathological stage(T1)of relapse group were higher than those of non-relapse group and the difference was statistically significant(P<0.05).AUC of AGR was 0.866 and the best truncation value was 1.71(95%CI:0.819~0.904).The AUC of NLR was 0.785 and the best truncation value was 2.37(95%CI:0.731~0.832).The re currence rate of high AGR group(≥1.71)was lower than that of low AGR group(<1.71)(P<0.05).The recurrence rate of low NLR group(≤2.37)was lower than that of high NLR group(>2.37)(P<0.05).AGR(<1.71,OR:5.621,95%CI:1.324~9.454),NLR(>2.37,OR:2.105,95%CI:1.381~3.171),AGR<1.71 and NLR>2.37(OR:7.587,95%CI:4.587~11.684)were independent risk factors for recurrence of NMIBC(P<0.05).AGR≥1.71 and NLR≤2.37(OR:0.787,95%CI:0.358~0.917)were protective factors for recurrence of NMIBC(P<0.05).Conclusion Both AGR and NLR are independent risk factors for recurrence of NMIBC,but combination of AGR and NLR may increase the accuracy of recurrence assessment.