血清TPS 联合NLR、AGR 对乳头状肾细胞癌预后的预测价值及与临床病理特征和预后的关系

Prognostic Value of Serum Peptide-specific Antigen and Neutrophils/lymphocytes Ratio, Albumin/globulin Ratio for PapillaryRenal Cell Carcinoma

[目的]探究血清组织多肽特异性抗原(TPS)、中性粒细胞/淋巴细胞比值(NLR)、白蛋白/球蛋白比值(AGR)对乳头状肾细胞癌(pRCC)预后的预测价值及与临床病理特征和生存时间的关系。[方法]选择134例pRCC患者作为研究对象,术前均行血常规检测,术后对全部患者的预后进行随访。绘制受试者工作曲线图(ROC)确定血清TPS、NLR、AGR的最佳截断值,根据最佳截断值进行分组,以χ2检验分析不同血清TPS、NLR、AGR组间临床病理特征构成差异,并应用Kaplan-Meier法绘制各项指标的总生存曲线并行Log-rank检验。对患者临床资料进行单因素分析,以Cox回归模型分析影响患者预后的独立因素。[结果]血清TPS、NLR、AGR预测预后的AUC分别为0.858(95%CI:0.760~0.947)、0.704(95%CI:0.481~0.926)、0.671(95%CI:0.393~0.940);血清TPS、NLR、AGR最佳截断值分别为89 U/L、2.8、1.22。高TPS组、高NLR组及低AGR组的肿瘤分级Ⅲ~Ⅳ级、肿瘤分期T_(3)~T_(4)及肿瘤最大径≥6.0 cm所占比例均明显高于低TPS组、低NLR组及高AGR组,差异有统计学意义(P<0.05)。pRCC患者3年总体无进展生存率为82.84%,低TPS组、低NLR组、高AGR组的3年无进展生存率均分别高于高TPS组、高NLR组及低AGR组,差异有统计学意义(P<0.05)。COX多因素分析显示,肿瘤分期≥Ⅲ期、TPS≥89.0 U/L、NLR≥2.8及AGR<1.22是影响pRCC患者预后的独立危险因素(P<0.05)。[结论]术前血清TPS、NLR、AGR联合检测对pRCC患者预后的预测价值较高,血清TPS、NLR异常升高且AGR异常降低患者的肿瘤分期等级更高,而无进展生存率更低。

[Objective]To investigate the prognostic value of serum tissue peptide-specific antigen(TPS),neutrophils/lymphocytes ratio(NLR),albumin/globulin ratio(AGR)in papillary renal cell carcinoma(pRCC).[Methods]A total of 134 pRCC patients were enrolled in the study.Routine blood tests were performed before surgery,and all patients were followed up after surgery.Receiver operating curve(ROC)was drawn to determine the optimal cut-off values of serum TPS,NLR and AGR for predicting prognosis of patients.The chi-square test was used to analyze the association of clinicopathological characteristics with serum TPS,NLR and AGR,the survival of patients was analyzed with Kaplan-Meier method.Cox regression model was used to analyze the independent factors affecting the prognosis of the patients.[Results]ROC curve analysis showed that the AUC of serum TPS,NLR and AGR in predicting prognosis were 0.858(95%CI:0.760~0.947),0.704(95%CI:0.481~0.926)and 0.671(95%CI:0.393~0.940),respectively.The optimal cut-off values of serum TPS,NLR and AGR were 89.0 U/L,2.8 and 1.22,respectively.The proportion of tumor gradeⅢ~Ⅳ,tumor stage T_(3)~T_(4) and tumor maximum diameter≥6.0 cm in high TPS group,high NLR group and low AGR group were significantly higher than those in low TPS group,low NLR group and high AGR group(P<0.05).The 3-year progression-free survival(PFS)rate of pRCC patients was 82.84%,and the 3-year PFS rate of the low TPS group,the low NLR group and the high AGR group were significantly higher than those of the high TPS group,the high NLR group and the low AGR group,respectively(P<0.05).Cox multivariate analysis showed that tumor stage≥Ⅲ,TPS≥89.0 U/L,NLR≥2.8 and AGR<1.22 were independent risk factors for poor prognosis of pRCC patients(P<0.05).[Conclusion]Preoperative serum TPS,NLR and AGR have higher prognostic value for pRCC patients and patients with elevated serum TPS and NLR and reduced AGR have higher tumor stage grade and lower progression-free survival.