前列腺癌根治术前NLR、LMR水平变化及其对预后的评估价值

Changes of neutrophil-lymphocyte ratio and lymphocyte/monocyte ratio levels and their value in evaluating the prognosis of prostate cancer before radical resection

目的探讨前列腺癌根治术前中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞/单核细胞比值(LMR)水平变化及其对预后的评估价值。方法回顾性分析2013年1月至2020年12月在陕西省人民医院泌尿外科行前列腺癌根治术的124例患者的临床资料。术前所有患者均检测中性粒细胞、淋巴细胞、单核细胞水平,并计算NLR、LMR水平;术后所有患者均随访2年,选择单因素和多因素Cox风险比例模型分析前列腺癌患者的术后无复发生存期(RFS)的影响因素。以NLR、LMR均数为标准区将患者分为高NLR组、低NLR组和高LMR组、低LMR组,绘制KaplanMeier生存曲线,分析NLR、LMR对前列腺癌患者预后的预测价值。结果单因素Cox风险比例模型分析结果显示,年龄≥75岁、合并高血压、有饮酒史、TNMⅢ~Ⅳ期、Gleason评分≥8分、术前PSA、术后切缘、NLR>4.77、LMR<2.83均为术后RFS的独立危险因素(P<0.05);Cox多因素风险比例模型分析结果显示,年龄≥75岁、合并高血压、有饮酒史、TNMⅢ~Ⅳ期、术前PSA、术后切缘、NLR>4.77、LMR<2.83为术后RFS的独立危险因素(P<0.05);高NLR组及低LMR组患者的RFS明显低于低NLR组与高LMR组患者,差异均有统计学意义(P<0.05)。结论治疗前NLR、LMR能够作为前列腺癌患者预后评估的指标,治疗前高NLR、低LMR水平的前列腺癌患者的预后较差。

Objective To investigate the changes of neutrophillymphocyte ratio(NLR)and lymphocyte/monocyte ratio(LMR)in patients with prostate cancer before radical resection and their prognostic evaluation value.Methods The clinical data of 124 patients who underwent radical prostatectomy in Department of Urology,Shaanxi Provincial People's Hospital from January 2013 to December 2020 were retrospectively analyzed.Neutrophil,lymphocyte,and monocyte levels were detected in all patients before surgery,and NLR and LMR were calculated.All patients were followed up for 2 years after surgery,univariate and multivariate Cox proportionalhazards models were used to analyze the influencing factors of postoperative recurrencefree survival(RFS)in patients with prostate cancer.Based on the mean of NLR and LMR,they were divided into high NLR group,low NLR group,high LMR group,and low LMR group.The KaplanMeier survival curve was drawn to analyze the predictive value of NLR and LMR on the prognosis of patients with prostate cancer.Results Univariate Cox proportionalhazards model showed that age≥75 years old,combination with hypertension,history of alcohol consumption,TNMⅢ-Ⅳstage,Gleason score≥8,preoperative PSA,postoperative resection margin,NLR>4.77,LMR<2.83 were independent risk factors for postoperative RFS(P<0.05).Multivariate Cox proportionalhazards model results showed that age≥75 years old,combination with hypertension,history of alcohol consumption,TNMⅢ-Ⅳstage,preoperative PSA,postoperative resection margin,NLR>4.77,LMR<2.83 were independent risk factors for postoperative RFS(P<0.05).The RFS of patients in the high NLR group and low LMR group was significantly lower than those in the low NLR group and high LMR group,and the differences were statistically significant(P<0.05).Conclusion NLR,LMR before treatment can be used as indicators to evaluate the prognosis of prostate cancer patients.The prognosis of prostate cancer patients with high NLR and low LMR levels before treatment is poor.