中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2019, Vol. 41 ›› Issue (5): 622-629.doi: 10.3881/j.issn.1000-503X.11227

• 论著 • 上一篇    下一篇

术前外周血淋巴细胞与单核细胞比值评估T1期非肌层浸润型膀胱癌预后的临床价值

王清海1,纪建磊1,李红1,贺平丽1,宋丽霞1,赵阳1,王洪阳1,黄涛1,孙晓霞1,曹延炜1,董震1,石冰冰2()   

  1. 1 青岛大学附属医院肾脏移植科,山东青岛 266000
    2 中国医学科学院 北京协和医学院 北京协和医院泌尿外科,北京 100730
  • 收稿日期:2019-02-01 出版日期:2019-10-30 发布日期:2019-11-08
  • 通讯作者: 石冰冰 E-mail:shibbpumch@126.com
  • 基金资助:
    青岛大学医学部临床医学+X(临床医学+X 2018)

Preoperative Lymphocyte-to-monocyte Ratio Predicts Prognosis in Patients with Stage T1 Non-muscle Invasive Bladder Cancer

WANG Qinghai1,JI Jianlei1,LI Hong1,HE Pingli1,SONG Lixia1,ZHAO Yang1,WANG Hongyang1,HUANG Tao1,SUN Xiaoxia1,CAO Yanwei1,DONG Zhen1,SHI Bingbing2()   

  1. 1 Department of Kidney Transplantation,Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China
    2 Department of Urology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
  • Received:2019-02-01 Online:2019-10-30 Published:2019-11-08
  • Contact: Bingbing SHI E-mail:shibbpumch@126.com
  • Supported by:
    Supported by the Medicine Department of Qingdao University(Clinical Medicine + X 2018)

摘要:

目的 评估术前外周血淋巴细胞与单核细胞比值(LMR)在评估T1期非肌层浸润型膀胱癌(NMIBC)患者术后预后中的临床价值。方法 纳入行经尿道膀胱肿瘤切除术治疗的T1期NMIBC患者215例,收集临床资料,随访并记录患者无病生存(DFS)和总生存(OS)情况。作术前LMR与患者预后关系的受试者工作特征(ROC)曲线,确定LMR的最佳分界值,将患者分为低LMR组(LMR<3.86,n=77)和高LMR组(LMR≥3.86,n=138);采用Kaplan-Meier生存曲线比较不同LMR水平患者的累积DFS率和OS率,COX比例风险回归模型分析影响患者DFS和OS的因素。 结果 215例T1期NMIBC患者随访2~92个月,DFS率为59.07%,OS率为65.12%。Kaplan-Meier曲线示,低LMR组患者累积DFS率(χ 2=4.784,P=0.029)与累积OS率(χ 2=7.146,P=0.008)均明显低于高LMR组。肿瘤大小≥3 cm(HR=1.398,95%CI:1.042~1.875,P=0.025)、病理G3级(HR=1.266,95%CI:1.026~1.563,P=0.028)、LMR≥3.86(HR=2.347,95%CI:1.080~5.101,P=0.031)是影响T1期NMIBC患者DFS的独立因素;肿瘤大小≥3 cm(HR=1.228,95%CI:1.015~1.484,P=0.034)、病理G3级(HR=1.366,95%CI:1.017~1.834,P=0.038)、LMR<3.86(HR=2.008,95%CI:1.052~3.832,P=0.035)是影响T1期NMIBC患者OS的独立因素。结论 术前外周血LMR水平是影响T1期NMIBC患者预后的独立因素,低水平LMR患者术后的NMIBC进展风险与死亡风险更高。

关键词: 淋巴细胞, 单核细胞, T1期, 非肌层浸润型膀胱癌, 预后

Abstract:

Objective To investigate the clinical value of preoperative lymphocyte-to-monocyte ratio(LMR)in evaluating the prognosis of patients with stage T1 non-muscle invasive bladder cancer(NMIBC).Methods A total of 215 patients with stage T1 NMIBC who underwent transurethral resection of bladder tumor were enrolled.Clinical data were collected.Patients were followed up and their disease-free survival(DFS)and overall survival(OS)were recorded.The receiver operating characteristic(ROC)curve of preoperative LMR in detecting patient prognosis was used to determine the optimal cut-off value for LMR.Patients were divided into low LMR group(LMR <3.86,n=77)and high LMR group(LMR ≥ 3.86,n=138).Kaplan-Meier survival curves were explored to compare cumulative DFS and OS rates in patients with different LMR levels,and COX proportional hazards regression model was used to analyze factors associated with DFS and OS.Results All these 215 patients with T1 stage NMIBC were followed up for 2-92 months,and the DFS rate was 59.07% and OS rate was 65.12%.Kaplan-Meier curves showed that the cumulative DFS rate(χ 2=4.784,P=0.029)and cumulative OS rate(χ 2=7.146, P=0.008)in the low LMR group were significantly lower than those in the high LMR group.Tumor size ≥ 3 cm(HR=1.398,95% CI:1.042-1.875,P=0.025),pathological grade G3(HR=1.266,95% CI:1.026-1.563,P=0.028),and LMR ≥ 3.86(HR=2.347,95% CI:1.080-5.101,P=0.031)were independent factors associated with DFS in patients with stage T1 NMIBC.In addition,tumor size ≥ 3 cm(HR=1.228,95% CI:1.015-1.484,P=0.034),pathological grade G3(HR=1.366,95% CI:1.017-1.834,P=0.038),and LMR<3.86(HR=2.008,95% CI:1.052-3.832,P=0.035)were independent factors associated with OS in patients with T1 stage NMIBC. Conclusion Preoperative LMR is an independent factor associated with patients’ prognosis in T1 stage NIMBC.Patients with low LMR tend to have higher risk of NMIBC progression and death.

Key words: lymphocyte, monocyte, T1 stage, non-muscle invasive bladder cancer, prognosis

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