Predictive value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in the prognosis of patients with muscular-invasive bladder cancer undergoing laparoscopic radical cystectomy
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摘要: 目的 探讨术前中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)对行腹腔镜下膀胱癌根治术(LRC)的肌层浸润性膀胱癌(MIBC)患者预后的预测价值。方法 分析2016—2019年在我院行LRC的118例MIBC患者的临床资料，根据术前外周血NLR、PLR分为高NLR组(NLR≥2.33，58例)与低NLR组(NLR＜2.33，60例)、高PLR组(PLR≥115.00，59例)与低PLR组(PLR＜115.00，59例)。采用Kaplan-Meier、log-rank法单因素分析各临床病理特点对患者的生存预后的影响，并比较各组生存曲线差异，Cox多因素回归分析影响MIBC患者预后的危险因素。结果 高NLR、PLR与T分期及淋巴结转移相关，高PLR还与肿瘤体积相关，差异有统计学意义(P＜0.05)。高NLR、PLR均能影响患者的OS，高NLR还与患者RFS相关，差异有统计学意义(P＜0.05)。此外，多因素回归分析显示只有高NLR和T分期是影响患者OS和RFS的独立危险因素。结论 术前高NLR、PLR与行LRC的MIBC患者的不良预后相关，可作为MIBC患者预后的预测指标。Abstract: Objective To investigate the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in the prognosis of muscle-invasive bladder cancer (MIBC) following laparoscopic radical cystectomy (LRC).Methods We retrospectively analyzed 118 MIBC patients who underwent LRC in the Affiliated Provincial Hospital of Anhui Medical University from 2016 to 2019. The patients were divided into four groups, i. e. high NLR (NLR≥2.33, 58 cases) and low NLR (NLR < 2.33, 60 cases), high PLR (PLR≥115.00, 59 cases) and low PLR (PLR < 115.00, 59 cases). Kaplan-Meier and log-rank methods were used to analyze the impact of each clinicopathological feature on the survival and prognosis of patients. Differences in survival curves of each group were also compared. Cox multivariate regression analysis was used to analyze the risk factors that affect the prognosis of MIBC patients.Results High NLR and high PLR were significantly associated with pT stage and lymph node metastasis of bladder cancer (P< 0.05), and high PLR was also significantly associated with tumor volume (P< 0.05). Both high NLR and PLR showed significant impact on the patients' OS (P< 0.05), and high NLR was also significantly associated with the patients' RFS (P< 0.05). In addition, multivariate regression analysis revealed that high NLR and pT stage were independent risk factors for patients' OS and RFS.Conclusion Preoperative high NLR and high PLR are related to the poor prognosis of MIBC patients undergoing LRC, so they can be used as prognostic predictors in MIBC patients treated with LRC.
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表 1 NLR、PLR与膀胱肿瘤患者的临床病例资料
例(%)，X±S 危险因素 例数 NLR PLR NLR＜2.33 (n=58) NLR≥2.33 (n=60) P值 PLR＜115.00 (n=59) PLR≥115.00 (n=59) P值 年龄/岁 66.2±11.6 67.7±10.4 0.481 66.2±11.4 67.7±10.5 0.462 BMI 23.1±3.8 22.3±3.4 0.234 22.9±3.0 22.5±4.1 0.491 性别 男 104 50(86.2) 54(90.0) 0.524 53(89.9) 51(86.4) 0.569 女 14 8(13.8) 6(10.0) 6(10.1) 8(13.6) 吸烟 是 75 36(62.1) 39(65.0) 0.741 40(67.8) 35(59.3) 0.339 否 43 22(37.9) 21(35.0) 19(32.2) 24(40.7) 肿瘤单、多发 单发 89 40(69.0) 49(81.7) 0.109 42(71.1) 47(79.7) 0.285 多发 29 18(31.0) 11(18.3) 17(28.9) 12(20.3) 肿瘤大小 ＜3 cm 48 25(43.1) 23(38.3) 0.598 30(50.8) 18(30.5) 0.025 ≥3 cm 70 33(56.9) 37(61.7) 29(49.2) 41(69.5) 病理T分期 T2 89 49(84.5) 40(66.7) 0.025 50(84.7) 39(66.1) 0.019 T3~T4 29 9(15.5) 20(33.3) 9(15.3) 20(33.9) 淋巴结 阳性 21 5(8.6) 16(26.7) 0.010 6(10.2) 15(25.4) 0.030 阴性 97 53(91.4) 44(73.3) 53(89.8) 44(74.6) 
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表 2 Cox多因素分析
变量 OS RFS 95%可信区间 风险比 P值 95%可信区间 风险比 P值 吸烟 0.312~1.078 0.580 0.086 0.332~1.043 0.589 0.069 病理T分期 1.585~6.046 3.096 0.001 1.363~4.815 2.562 0.003 淋巴结转移 0.828~3.576 1.721 0.146 0.957~3.830 1.915 0.066 NLR 1.079~4.811 2.278 0.031 1.079~4.138 2.113 0.029 PLR 0.534~2.173 1.077 0.836 0.412~1.447 0.772 0.419
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