| Objective:Cytoreductive nephrectomy is one of the effective treatment for metastatic renal cell carcinoma,due to the trauma of surgery and the advancement of drug treatment,not all patients with metastatic kidney cancer are suitable for debulking surgery,and we urgently need more indicators to help us screen patients.Platelet-to-lymphocyte ratio(PLR)and neutrophi-lymphocyte ratio(NLR)have been confirmed to have prognostic value in non-metastatic kidney cancer,prostate cancer and other urinary tumors.The Systemic immune-inflammation Index(SII)is a relatively new indicator of peripheral blood inflammation,which is the ratio of platelet count × neutrophils to lymphocytes,It has also been shown to be associated with the prognosis of multiple solid tumors.This article aims to explore the clinical value of preoperative NLR,PLR,and SII in the prognosis evaluation of patients with metastatic renal cell carcinoma(MRCC),so as to better evaluate the prognosis,and then screen suitable patients with metastatic renal cancer for cytoreductive nephrectomy.Method:The clinical case data of 80 patients diagnosed with metastatic renal cell carcinoma with cytoreductive nephrectomy by imaging and pathology in the Department of Urology of Qingdao University Hospital from January 2012 to December 2016 were retrospectively analyzed.According to the results of the latest blood routine in the week before surgery,the NLR,PLR,SII were obtained for each patient.X-tile software was used to calculate the optimal cut-off value of peripheral blood inflammation indicators,patients were divided into high-level group and low-level group,The survival rate was calculated using Kaplan-Meier method,and the difference in survival rate between groups was compared by Log-rank test.Cox proportional hazard regression model was used to understand the effects of inflammatory indicators and clinicopathological features on survival and prognosis of patients.Result:X-tile software was used to calculate the best cut-off values of NLR,PLR and SII as 2.7,161.0 and 734.1,respectively.According to these values,NLR,PLR and SII were divided into high level group and low level group,respectively,and statistical analysis was conducted.High NLR,PLR,and SII values were associated with worse pathological grade(Fuhrman grade)(P < 0.05),but not with patient gender,lung metastasis,or clear cell carcinoma.Higher NLR level was also associated with worse T staging(P < 0.05).Higher PLR levels were also associated with greater tumor maximum diameter(P < 0.05).High SII level was also associated with older age,larger maximum tumor diameter,and worse T stage(P < 0.05).Univariate analysis suggested that NLR,PLR,SII,Fuhrman grade,T stage and clear cell carcinoma were influencing factors for overall survival(OS)of MRCC patients undergoing cytoreductive nephrectomy(P < 0.05).The patient’s gender,age,lung metastasis,and maximum tumor diameter were not related to OS.Multivariate Cox regression analysis showed that among NLR,PLR and SII,only SII was an independent factor for OS(HR=5.087,95%CI= 2.218-11.665,P < 0.05).At the same time,clear cell carcinoma and Fuhrman grade were also independent influencing factors of OS(P < 0.05).Conclusion:High preoperative SII levels are an independent risk factor for poor prognosis in patients with MRCC,and can be used as a specific indicator for predicting the prognosis of in patients with metastatic kidney cancer undergoing cytoreductive nephrectomy,and its prognostic value may be better than other inflammatory indicators.High preoperative SII values suggest poor survival outcomes in patients with MRCC undergoing cytoreductive nephrectomy. |
