Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (3): 262-271.doi: 10.24920/003668

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术前中性粒细胞与淋巴细胞比值预测可切除泌尿系肿瘤预后的价值:系统综述和荟萃分析

王站,王旭,王文达,郑国洋,郭浩,张玉石()   

  1. 中国医学科学院 北京协和医院医学院,北京协和医学院泌尿外科,北京 100730
  • 收稿日期:2020-01-08 出版日期:2020-09-30 发布日期:2020-09-25
  • 通讯作者: 张玉石 E-mail:beijingzhangyushi@126.com

Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Predicting Prognosis of Surgically Resectable Urinary Cancers: Systematic Review and Meta-Analysis

Wang Zhan,Wang Xu,Wang Wenda,Zheng Guoyang,Guo Hao,Zhang Yushi()   

  1. Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2020-01-08 Online:2020-09-30 Published:2020-09-25
  • Contact: Zhang Yushi E-mail:beijingzhangyushi@126.com

摘要:

目的 术前中性粒细胞与淋巴细胞比值(NLR)与多种恶性肿瘤的预后密切相关,但是,NLR对可切除泌尿系肿瘤预后的影响尚不确定。因此,此系统综述和荟萃分析旨在探讨术前NLR在预测可切除泌尿系肿瘤预后方面的价值。
方法 我们通过检索Embase、PubMed/MEDLINE和Cochrane数据库,依据纳入和排除标准筛选文献,最终纳入25项研究,其中包括15950例受试对象。采用风险比(HRs)及其95%可信区间(CIs)评估术前NLR与可切除泌尿系肿瘤患者的总生存期(OS)及肿瘤特异性生存期(CSS)的关系。
结果 结果表明对于患有可切除泌尿系恶性肿瘤的患者,术前NLR能预测其预后。NLR越高,患者的OS(HR=1.40,95%CI:1.26~1.54,P<0.001)和CSS越短(HR=1.43,95%CI:1.27~1.59,P<0.001)。此外,不论患者种族或术前NLR阈值高低,术前NLR升高均能提示肾细胞癌(OS:HR=2.06,95%CI=1.54~2.76,P=0.131;CSS:HR=2.46,95%CI=1.46~4.16,P=0.178)、上尿路上皮癌(OS:HR=1.91,95%CI=1.50~2.42,P=0.616;CSS:HR=1.84,95%CI=1.41~2.39,P=0.001)、膀胱癌(OS:HR=1.09,95%CI=1.02~1.17,P<0.001;CSS:HR=1.05,95%CI=1.01~1.09,P=0.163)和前列腺癌(OS:HR=1.69,95%CI=1.19~2.41,P=0.714)预后较差。
结论 术前NLR升高能够作为预测泌尿系可切除恶性肿瘤不良预后的指标,包括肾癌、膀胱癌、前列腺癌和上尿路上皮癌。

关键词: 泌尿系肿瘤, 中性粒细胞与淋巴细胞比值, 炎性生物标志物, 预后因素, 荟萃分析

Abstract:

Objective Accumulated evidence has suggested that there is a close association between preoperative neutrophil-to-lymphocyte ratio (NLR) and prognosis of various malignant tumors. However, the relationship between NLR and surgically resectable urinary cancers remains contradictory. Therefore, we performed this systematic review and meta-analysis to explore whether preoperative NLR could predict the prognosis of surgically resectable urinary cancers.
Methods After searching the Embase, PubMed/MEDLINE and Cochrane databases and screening the articles, we finally included 25 studies involving 15950 patients. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were extracted to assess the association between preoperative NLR and the overall survival (OS) and cancer-specific survival (CSS) of surgically resectable urinary cancers.
Results The pooled results revealed that an elevated preoperative NLR could predict a worse OS (HR=1.40, 95%CI: 1.26-1.54, P<0.001) and CSS (HR=1.43, 95%CI: 1.27-1.59, P<0.001) in urinary cancers. In addition, our analyses also suggested that high preoperative NLR was associated with worse prognosis in renal cell carcinoma (OS: HR=2.06, 95%CI: 1.54-2.76, P=0.131; CSS: HR=2.46, 95%CI: 1.46-4.16, P=0.178), upper tract urothelial carcinoma (OS: HR=1.91, 95%CI: 1.50-2.42, P=0.616; CSS: HR=1.84, 95%CI: 1.41-2.39, P=0.001), bladder cancer (OS: HR=1.09, 95%CI: 1.02-1.17, P<0.001; CSS: HR=1.05, 95%CI: 1.01-1.09, P=0.163) and prostate cancer (OS: HR=1.69, 95%CI: 1.19-2.41, P=0.714). Regardless of the participants’ race or the cutoff value of the preoperative NLR, the results remained valid.
Conclusion Elevated preoperative NLR could predict a worse prognosis in surgically resectable urinary cancers, namely, renal cell carcinoma, bladder cancer, prostate cancer and upper tract urothelial carcinoma.

Key words: urinary cancers, neutrophil-to-lymphocyte ratio, inflammatory biomarkers, prognostic factors, meta-analysis

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