Effect Of Preoperative Systemic Inflammatory Response Index And Fibrinogen On Tumor Prognosis After Nephrectomy

Objective:Symptomatic inflammatory response index(SIRI),as a new inflammatory marker,includes neutrophils,monocytes and lymphocytes in peripheral blood,It is calculated as(neutrophils/lymphocytes)*monocytes,reflecting three different inflammatory and immune pathways in the body,and studies have suggested that SIRI may be associated with tumor prognosis.Fibrinogen(FIB)is a common indicator of blood coagulation function in the traditional sense,which is also elevated in the acute stage of systemic inflammatory response.In recent years,a number of studies have found that FIB is involved in the occurrence and development of tumors.The aim of this study was to explore the clinical value of preoperative systemic inflammatory response index and fibrinogen in prognosis evaluation of patients with renal cancer,so as to develop a better treatment plan for patients with renal cancer.Method:The clinical and postoperative follow-up data of patients with renal cancer admitted to our hospital and undergoing surgical treatment from January 2011 to December 2014 were retrospectively analyzed.The receiver operating characteristic curve(ROC)applied to determine the best cut-off value of SIRI and FIB.The differences between the clinical characteristics of the low SIRI group and the high SIRI group and the low FIB group and the high FIB group were analyzed;the Kaplan-Meier method was used to calculate the survival rate,The log-rank test was used to compare the difference of survival rate between the groups.The Cox proportional hazards regression model was used to determin the prognostic factors of renal cancer.All 5-year survival rate independent prognostic indicators,including Fuhrma rating,SIRI value,and FIB value,were used to establish a nomograph to predict 5-year survival.Result:A total of 188 renal cancer patients were collected in this study,The ROC curve determined that the optimal cut-off values of SIRI and FIB were 1.81 and 3.42g/L.All patients were divided into high SIR group,low SIRI group,high FIB group and low FIB group.Preoperative SIRI level was closely correlated with tumor size,TNM stages,Fuhrman grade,lymph node metastasis and history of hypertension between groups(P<0.05),which was statistically significant.Preoperative FIB level was closely correlated with age,TNM stages,Fuhrman grade,lymph node metastasis,and hypertension between groups(P<0.05),which was statistically significant.Cox multivariate regression analysis showed that SIRI >1.81,FIB >3.42 g/L and Fuhrman grade were independent risk factors affecting the prognosis of renal cancer.The C-index was 0.816(95%CI: 0.751-0.880),which could predict the 5-year survival rate of patients after surgery.Conclusion:Preoperative Siri and FIB have a certain effect on the survival of patients after nephrectomy,SIRI and FIB were independent risk factors for renal cancer prognosis,Patients with high preoperative Siri and FIB often indicate poor prognosis,The two indicators have a positive effect on predicting survival status of patients after operation,and can be used as specific indicators for predicting prognosis of patients with renal cell carcinoma,Combined with conventional clinicopathological parameters,a new model can be constructed to improve the accuracy of prognosis prediction of patients after nephrectomy.