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

doi:10.24920/003668

摘要/Abstract

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

Wang Zhan, Wang Xu, Wang Wenda, Zheng Guoyang, Guo Hao, Zhang Yushi. Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Predicting Prognosis of Surgically Resectable Urinary Cancers: Systematic Review and Meta-Analysis[J].Chinese Medical Sciences Journal, 2020, 35(3): 262-271.

图/表 8

Author	Year	Country	Tumor type	No. of Patients	Age (yrs)	Gender (M:F)	Cut-off value	Follow-up (months)	Outcomes	Analysis type
Son et al.^[9]	2018	Korea	UTUC	1137	69 (61-74)^*	825:312	3.3	39.1 (18.3-63.8)^*	RFS, CSS	UV, MV
Azuma et al.^[25]	2013	Japan	UTUC	137	69.4 (40-88)	106:31	2.5	60.9 (1.9-187.3)	RFS, CSS	UV, MV
Kohada et al.^[11]	2018	Japan	UTUC	148	71 (64-78)^*	112:36	3	35.5 (12-66)^*	RFS, CSS	UV, MV
Tanaka et al.^[21]	2014	Japan	UTUC	665	70 (62-76)^*	493:172	3	28 (14-57)^*	RFS, CSS	UV, MV
Cao et al.^[16]	2017	China	UTUC	656	68 (39-88)	290:366	2.4	46 (12-144)	IVRFS, CSS	UV, MV
Cheng et al.^[18]	2016	China	UTUC	195	68±10.3	79:116	2.7	36	OS, CSS	UV, MV
Luo et al.^[22]	2014	China	UTUC	234	N	102:132	3	40.7±23.8	MFS, CSS	UV, MV
Tan et al.^[7]	2018	China	UTUC	717	67 (59-74)^*	408:309	2.5	42 (18-76)^*	OS, DFS, CSS, MFS	MV
Dalpiaz et al.^[23]	2014	Austria	UTUC	202	69.3 (32-85)	122:80	2.7	45 (0-199)	CSS, OS	UV, MV
Vartolomei et al.^[13]	2017	Austria	UTUC	2274	69 (61-76)	1527:747	2.7	40 (20-76)	RFS, CSS	UV, MV
Byun et al.^[19]	2016	Korea	RCC	1284	55.9±12.9	913:371	3.7	39 (19-69)^*	RFS, CSS	MV
Widz et al.^[2]	2020	Poland	RCC	196	61 (24-85)^*	116:80	2.69	68 (44.5-78)	OS	UV, MV
Agizamhann et al.^[12]	2018	China	RCC	82	37 (2-71)	33:49	2.45	31 (2-108)	OS, DFS	UV, MV
Chen et al.^[5]	2019	China	RCC	414	56.3 (24-80)	257:157	2.17	69.2 (1-151)	OS, CSS	MV
Wen et al.^[20]	2015	China	RCC	327	56 (3-86)	211:116	1.7	43 (0-97)	OS, DFS	UV, MV
Hu et al.^[15]	2017	China	RCC	484	56 (21-81)	278:206	2.78	36	OS	UV, MV
Gu et al.^[17]	2016	China	RCC	103	56 (16-79)	71:32	4.1	19.9 (10.8-35.1)^*	OS	UV, MV
Pichler et al.^[24]	2013	Austria	RCC	678	N	N	3.3	44 (0-130)	OS, CSS	UV, MV
Jang et al.^[3]	2016	Korea	Pca	2067	66 (61-70)	N	1.76	78 (65-6)^*	BCRFS, CSS, OS	UV, MV
Sun et al.^[8]	2018	China	Pca	226	N	N	2.31	24 (1-73)	OS, DFS	UV, MV
Viers et al.^[26]	2014	USA	Bca	899	69 (62-76)^*	723:176	2.7	130.8 (99.6-166.8)^*	DFS, CSS, OS	UV, MV
Tan et al.^[14]	2017	Singapore	Bca	84	67 (37-82)	63:21	2.7	30.1 (3.2-161.7)	DFS, OS	UV, MV
Kang et al.^[4]	2017	Korea	Bca	1551	65 (57-72)^*	1302:249	2	52 (27-82)^*	OS	UV, MV
Rajwa et al.^[10]	2018	Poland	Bca	144	N	N	3	14 (7-40)^*	OS, CSS	UV, MV
Vartolomei et al.^[6]	2018	Italy	Bca	1046	70 (29-91)	864:182	3	26 (10-47)^*	OS, DFS, CSS	MV

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