术前血小板与淋巴细胞比值及纤维蛋白原对上尿路尿路上皮癌患者预后的预测价值

Prognostic relevance of preoperative platelet-to-lymphocyte ratio and fibrinogen in patients with upper tract urothelial carcinoma

目的探讨术前血小板与淋巴细胞比值(PLR)及纤维蛋白原(FIB)对上尿路尿路上皮癌(UTUC)患者总生存期(OS)和无进展生存期(PFS)的预测价值。方法回顾性分析2014年1月—2019年8月兰州大学第二医院收治的182例UTUC患者的临床资料。采用受试者工作特征(ROC)曲线分析PLR及FIB最佳截断值,将患者分为低/高PLR组和低/高FIB组。采用Kaplan-Meier法绘制生存曲线,并用Log-rank检验差异。采用单因素和多因素Cox风险比例模型分析术前PLR及FIB与UTUC患者预后的关系。结果ROC曲线显示PLR及FIB最佳截断值分别为122.51和3.51 g/L。Kaplan-Meier并Log-rank检验结果显示,高PLR/FIB组OS及PFS均较低PLR/FIB组短,差异均有统计学意义(P<0.05)。单因素结果显示pT分期、肿瘤病灶、术前PLR和术前FIB水平与OS及PFS呈显著相关,而肿瘤分级只与OS相关。多因素分析显示FIB与OS(HR=2.727,95%CI:1.125~6.612,P=0.026)和PFS(HR=3.558,95%CI:1.822~6.949,P<0.001)显著相关。结论术前FIB水平对UTUC患者的OS及PFS预后的预测价值优于PLR,可作为独立预后因素,对UTUC患者预后判断具有意义。

Objective To explore the significance of preoperative platelet-to-lymphocyte ratio(PLR)and fibrinogen(FIB)in predicting the overall survival(OS)and progression-free survival(PFS)in patients with upper tract urothelial car-cinoma(UTUC).Methods Clinical data of 182 UTUC patients treated in our hospital during Jan.2014 and Aug.2019 were retrospectively analyzed.The patients were divided into low/high PLR group and low/high FIB group.The receiver operating characteristic(ROC)curve was drawn to determine the cut-off values of PLR and FIB.The OS and PFS were assessed with Kaplan-Meier analysis and the equivalences of the curve was verified with Log-rank test.The relationship between preoperative PLR and FIB and prognosis of UTUC patients was analyzed with univariate and multivariate Cox proportional hazard regre-ssion model.Results The optimal cut-off values of PLR and FIB were 122.51 and 3.51 g/L,respectively.The survival curve showed that the high PLR/FIB group had shorter OS and PFS than the low PLR/FIB group(P<0.05).Univariate analysis showed that pathological T stage,tumor lesions,preoperative PLR and FIB were significantly correlated with OS and PFS,while tumor grade was only correlated with OS.Multivariate analysis showed that FIB was significantly correlated with OS(HR=2.727,95%CI:1.125-6.612,P=0.026)and PFS(HR=3.558,95%CI:1.822-6.949,P<0.001).FIB was an independent risk factor for the prognosis of patients with UTUC.Conclusion Preoperative FIB is better than PLR in predicting OS and PFS,and it may become a biological factor to predict the prognostic factors in UTUC patients.