术前中性粒细胞与淋巴细胞比值(NLR)对非肌层浸润性膀胱癌术后的预后评估价值

The value of preoperative neutrophils to lymphocytes ratio in evaluating the prognosis after surgery for non-muscle-invasive bladder cancer

目的探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)是否可作为非肌层浸润性膀胱肿瘤(NMIBC)经尿道膀胱肿瘤电切术(TURBT)的预后指标。方法回顾性分析297例行TURBT患者的临床病理资料。通过受试者可操作特征性曲线(ROC曲线)确定NLR截断值,将NMIBC患者分为低NLR组(NLR <1.51)和高NLR组(NLR≥1.51),并分析2组患者之间的临床病理特征。使用Kaplan-Meier曲线评估2组患者无复发生存期(RFS)和无进展生存期(PFS)的生存曲线,并通过Log-rank检验进行比较。使用Cox回归模型进行单变量及多变量生存分析,评价NLR值对NMIBC患者预后的预测价值。结果低NLR组和高NLR组的肿瘤复发率分别为18.46%(24/130)和44.91%(75/167),肿瘤进展率分别为4.93%(7/142)和18.06%(28/155),2组比较差异有统计学意义(P<0.05)。Kaplan-Meier生存分析结果显示,低NLR组具有较好的RFS和PFS。NLR值可以作为NMIBC患者无复发生存时间(HR=2.290,P<0.05)及肿瘤无进展生存时间(HR=2.637,P<0.05)的独立预测因素。结论术前NLR是影响非肌层浸润性膀胱癌患者术后复发和进展的独立危险因素,可作为判断患者预后的指标。

Objective To investigate whether the ratio of mononuclear cells to lymphocytes(NLR)in preoperative peripheral blood can be used as a survival index for non-muscle-invasive bladder tumor(NMIBC)by transurethral resection of bladder tumor(TURBT).Methods The clinical and pathological data of 297 patients were retrospectively analyzed.The NLR truncation value was determined by the relative operating characteristic curve(ROC)analysis.The NMIBC patients were divided into low NLR group(NLR<1.51)and high NLR group(NLR≥1.51),and the clinical and pathological features were analyzed between two groups.Kaplan‐Meier curve was used to evaluate the survival curves of the two groups of patients relapse free survival(RFS)and progress free survival(PFS),and the results were compared by the log-rank test.Univariate and multivariate Cox regression analyses were plotted to assess the prognostic value of NLR in NMIBC patients.Results The tumor recurrence rates in the low NLR group and the high NLR group were 18.46%(24/130)and 44.91%(75/167),and the tumor progression rates were 4.40%(7/142)and 17.81%(28/155),respectively(P<0.05).Kaplan‐Meier survival analysis showed that the lower NLR group had better RFS and PFS.NLR value was used as an independent predictive factor for NMIBC patients with relapse free survival(HR=2.229,P<0.05)and progress free survival(HR=2.637,P=0.025).Conclusion Preoperative NLR is independent risk factor for recurrence and progression in patients with non-myoinvasive bladder cancer,and can be used as a prognostic indicator.