术前中性粒细胞与淋巴细胞比值对非肌层浸润性膀胱癌患者预后的评估价值

Relationship between neutrophil/lymphocyte ratio and prognosis of non-muscular invasive bladder cancer

目的:研究术前外周血中中性粒细胞/淋巴细胞比值(NLR)与非肌层浸润性膀胱癌(NMIBC)患者术后预后的关系。方法:回顾性分析2003年1月~2011年12月收治的472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)确定NLR截断值,将NMIBC患者分为低NLR组(NLR≤2.32)和高NLR组(NLR>2.32),分析两组患者之间的临床病理特征。使用Kaplan-Meier曲线评估两组患者的生存曲线并通过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值对于NMIBC患者预后的预测价值。结果:低NLR组的总生存时间的中位值为82.0个月,高NLR组的总生存时间的中位值为67.0个月,两者差异有统计学意义(P=0.004)。Kaplan-Meier生存分析结果显示低NLR组与较好的总体生存时间(OS)和较好肿瘤特异性生存时间(CSS)均显著相关。NLR值可以作为预测NMIBC患者总体生存时间(风险比例,1.877;95%CI:1.363~2.583;P<0.001)及肿瘤特异性生存时间(风险比例,13.820;95%CI:3.145~60.730;P<0.001)的独立预测因素。结论:NLR≤2.32与NMIBC患者较好的总体生存时间和较好的肿瘤特异性生存时间均显著相关,而且是NMIBC患者预后的独立预测因子,因此可以为患者预后提供参考。

Objective:To investigate the relationship between preoperative neutrophil to lymphocyte ratio(NLR)and prognosis in non-muscle invasive bladder cancer(NMIBC)patients undergoing transurethral resection of bladder tumor(TURBT).Methods:We retrospectively collected data of 472 eligible patients who were diagnosed as having NMIBC and received TURBT between January 2003 and December 2011.The association of NLR with clinicopathological characteristics was further analyzed by dichotomizing our sample into those with NLR ≤2.32(low NLR group)and those with NLR>2.32(high NLR group),based on the receiver operating characteristic curve(ROC)analysis.Overall survival(OS)and cancer specific survival(CSS)were estimated by KaplanMeier analysis,and the log-rank test was used to compare differences between groups.Univariate and multivariate Cox regression analyses were plotted to assess the prognostic value of NLR in NMIBC patients.Results:The median OS was 82.0 months in the low NLR group,and 67.0 months in the high NLR group(OS:P=0.004).Kaplan-Meier survival analysis revealed that lower NLR was significantly correlated with greater OS and greater CSS.NLR was shown to be an independent predictor for OS(hazard ratio [HR],1.877;95% confidence interval[CI],1.363-2.583;P<0.001)and CSS(hazard ratio [HR],13.820;95% confidence interval[CI],3.45 to60.730;P<0.001).Conclusions:NLR ≤2.32 was independently associated with greater OS and CSS in patients with NMIBC undergoing TURBT and may serve as a valuable prognostic factor for the therapeutic decision making.