| Objective: To study the preoperative changes of PLR(platelet-to-lymphocyte ratio),NLR(neutrophil-to-lymphocyte ratio),HGB(Hemoglobin),HCT(Hematocrit)and various blood lipid indexes(TC,TG,HDL-C and LDL-C)in patients with bladder urothelial carcinoma,to explore the clinical significance of relevant indexes,and to analyze their correlation with bladder urothelial carcinoma and its clinicopathological staging and clinical application value.Methods: From June 2013 to June 2018,294 patients with bladder urothelial carcinoma who were diagnosed by pathology after surgery were selected from the urology department of the Affiliated Hospital of Southwest Medical University,There were 237 males and 57 females,with an average age of 63.56 years;According to WHO 2004 bladder urothelial carcinoma malignancy grading method,the patients with confirmed bladder urothelial carcinoma were classified according to clinical pathology,Among them,146 patients were low-grade bladder urothelial carcinoma(115 males and31 females,with an average age of 61.56 years),and 148 patients of high-grade bladder urothelial carcinoma(122 males and 26 females,with an average age of65.53 years).Fifty-six patients underwent open surgery were classified clinically and pathologically according to the UICC TNM staging method of the 6th edition in 2002(22 cases in T1 stage,20 cases in T2 stage,11 cases inT3 stage and 3 cases in T4 stage).140 healthy subjects(59 males,81 females,average age 61.55 years)and 129 normal lipid subjects(55 males and 74 females,average age 61.21 years)were selected as healthy control group,Preoperative platelet count,lymphocyte count,neutrophil count,hemoglobin,hematocrit and blood lipid indexes(TC,TG,HDL-C,LDL-C)were collected;Collect clinical pathological grading and staging information;The values of NLR and PLR before operation were calculated.Draw the ROC curve,and calculate the area under the curve of PLR?NLR?HGB?HCT?TG and HDL-C.The optimal critical values of PLR?NLR?HGB?HCT?TG and HDL-C was determined by the maximum Youden index.To analyze the possible correlation between PLR and NLR and bladder urothelial carcinoma and their correlation with the clinicopathological staging of bladder urothelial carcinoma.The levels of hemoglobin,hematocrit and blood lipids in bladder urothelial carcinoma group and corresponding healthy control group were compared.To analyze the possible correlation between these indicators and bladder urothelial carcinoma and the possible correlation between them and the clinicopathological grading of bladder urothelial carcinoma.Univariate and multivariate Logistic regression analysis and Pearson correlation analysis were used to study the correlation risk between PLR,NLR,HGB,HCT and lipid index and bladder urothelial carcinoma,as well as the correlation risk between them and the pathological grade of bladder urothelial carcinoma.To evaluate whether PLR,NLR,HGB,HCT and serum lipid indexes are risk factors for bladder urothelial carcinoma,and whether they are risk factors for pathological grading of bladder urothelial carcinoma.Results: 1.The PLR,NLR,hemoglobin and hematocrit of bladder urothelial carcinoma patients were significantly different from the corresponding healthy control group(P < 0.01),The levels of PLR and NLR in patients with bladder urothelial carcinoma group were significantly higher than those in healthy control group,while those in hemoglobin and hematocrit were significantly lower than those in healthy control group.2.The blood lipid index(TG ? HDL-C)of the patients with bladder urothelial carcinoma were statistically different from the corresponding healthy control group(P < 0.05),in which the TG levels of the patients with bladder urothelial carcinoma were significantly higher than those of the healthy control group,while the HDL-C levels were significantly lower than those of the healthy control group.3.There were significant differences in PLR and NLR between patients with bladder urothelial carcinoma of different pathological grades and stages.(P <0.05),The PLR and NLR indices in the high-level pathological group were significantly higher than those in the low-level pathological group,while the pathological staging of tumors in the high-level PLR and NLR groups was later,the greater the possibility of local infiltration and distant metastasis,the worse the prognosis.4.There were significant differences in hemoglobin and hematocrit between different pathological grades of bladder urothelial carcinoma(P <0.05),among which the levels of hemoglobin and hematocrit in high grade bladder cancer group were significantly lower than those in low grade bladderurothelial carcinoma group.5.There was no significant difference in blood lipid between different pathological grades of bladder urothelial carcinoma(P(29)0.05).6.The ROC curves of PLR,NLR,HGB and HCT were drawn and the area under the curve of PLR,NLR,HGB and HCT was calculated.The sensitivity and specificity of PLR were 34.7% and 93.6% when the optimum critical value was 161.95.The area under the curve of NLR was 0.639 and the optimum critical value was 3.188.The sensitivity and specificity were 41.8%and 95.7% respectively.The area under the curve of PLR+NLR combined index was 0.641%.The sensitivity and specificity of HGB were 38.9% and98.6% when the optimum critical value was 119.5g/L,and 38.2% and 99.3%when the area under the curve of HCT was 0.672 and the optimum critical value was 37%.The area under the TG curve was 0.639,and the sensitivity and specificity were 34.0% and 100% respectively at the optimal critical value of1.625 mmol/L.When the area under the curve of HDL-C was 0.697 and the optimal critical value was 1.125 mmol/L,the sensitivity and specificity were47.6% and 94.6% respectively.ROC curve analysis showed that PLR,NLR and TG levels increased.The decreased levels of HGB,HCT and HDL-C have clinical significance in affecting bladder urothelial carcinoma,while the combined detection of PLR and NLR had more clinical value than that of single index(PLR and NLR).7.Univariate and multivariate Logistic risk factors analysis was used to analyze the correlation between inflammatory index,hemochrome index and lipid index on the pathologic grading of bladderurothelial carcinoma and bladder urothelial carcinoma.The results showed that:(1)PLR,NLR and TG levels were positively correlated with bladder urothelial carcinoma,while HGB,HCT and HDL-C levels were negatively correlated with bladder urothelial carcinoma.Among them,High PLR,low HGB and low HCT are risk factors for the development of bladder urothelial carcinoma;high NLR,high TG and low HDL-C were independent risk factors for bladder urothelial carcinoma.(2)The pathological grade of bladder urothelial carcinoma was positively correlated with PLR and NLR.Negative correlation with HGB and HCT levels;There was no correlation with blood lipid level.High PLR,low HGB and low HCT were risk factors for the pathologic grade of bladder urothelial carcinoma.High NLR is an independent risk factor affecting the pathological grade and stage of bladder urothelial carcinoma.8.The correlation coefficients of PLR,NLR,HGB,HCT and blood lipid level were calculated by Pearson correlation analysis.The results showed that:(1)PLR is negatively correlated with HGB,HCT,TC,HDL-C and LDL-C level.(2)NLR is negatively correlated with HGB,HCT,TC,HDL-C and LDL-C level.(3)HGB and HCT are positively correlated with TC,HDL-C and LDL-C level.The correlation coefficients of PLR,NLR,HGB,HCT and Blood lipid levels in patients with bladder urothelial carcinoma at different pathological levels were calculated by Pearson correlation analysis.The results showed that:(1)PLR is negatively correlated with HGB,HCT,TC,LDL-C level.(2)NLR is negatively correlated with HGB,HCT,TC,HDL-C and LDL-C level.(3)HGB is positivelycorrelated with TC,TG,HDL-C and LDL-C level.HCT is positively correlated with TC,TG,HDL-C and LDL-C level.Conclusion:1.Inflammation indicators PLR and NLR can reflect the status of the body's immune function and tumor pathology situation.(1)The combined detection of PLR+NLR has more clinical value than that of one single indicator(PLR and NLR)in sensitivity.(2)According to the statistical analysis between patients with bladder urothelial carcinoma and healthy controls,and between patients with different pathological grades of bladder urothelial carcinoma,the results showed that patients with bladder urothelial carcinoma were often infected before surgery,and the higher the degree of pathological malignancy,the more serious the infection.Through Pearson correlation analysis and Logistic regression analysis,the results showed that PLR was positively correlated with the pathological grading and staging of bladder urothelial carcinoma,and high PLR was a risk factor for bladder urothelial carcinoma.When the optimal critical value of PLR index was 161.95,the sensitivity and specificity were 34.7% and 93.6%respectively.NLR is correlated with the pathological grading and staging of bladder urothelial carcinoma,and high NLR is an independent risk factor for bladder urothelial carcinoma.When the optimal critical value of NLR was3.188,the sensitivity and specificity were 41.8% and 95.7% respectively.2.According to the statistical analysis between patients with bladder urothelial carcinoma and healthy controls and between patients with different pathological grades of bladder urothelial carcinoma,the results showed that patients withbladder urothelial carcinoma often had anemia of different degrees during the disease period,and the higher the pathological malignancy,the more severe the anemia.Pearson correlation analysis and Logistic risk factors analysis showed that HGB and HCT were negatively correlated with the grade of bladder urothelial carcinoma,and low HGB and low HCT were risk factors affecting the grade of bladder urothelial carcinoma.The sensitivity and specificity were38.9% and 98.6% respectively when the optimal critical value of HGB index was 119.5g/L.The sensitivity and specificity of HCT were 38.2% and 99.3%,respectively,when the optimal critical value of HCT was 37%.3.According to the statistical analysis between patients with bladder urothelial carcinoma and healthy controls and between patients with different pathological grades of bladder urothelial carcinoma,different types of abnormal changes of blood lipid metabolism are often observed in patients with bladder urothelial carcinoma.Pearson correlation analysis and Logistic risk factors analysis showed that there was a negative correlation between HDL-C level and bladder urothelial carcinoma,and low HDL-C level was a risk factor for bladder urothelial carcinoma.There was a positive correlation between serum lipid TG level and bladder urothelial carcinoma,and high TG was an independent risk factor for bladder urothelial carcinoma.When the optimal critical value of TG was 1.625mmol/L,the sensitivity was 34.0% and the specificity was 100%.When the optimal critical value of HDL-C was 1.125 mmol/L,the sensitivity and specificity were 47.6% and 94.6% respectively.The serum lipid level was notrelated to the grade of bladder urothelial carcinoma.4.Patients with Bladder urothelial carcinoma often have different degrees of inflammation,anemia and abnormal changes in blood lipids.Pearson correlation analysis showed that NLR and HGB,HCT,TC,HDL-C and LDL-C were negatively correlated according to the inflammation index,hemoglobin index and blood lipid index.That is,The more severe the degree of inflammation in patients with bladder urothelial carcinoma,the more severe the degree of anemia,and the lower the levels of blood lipid TC,HDL-C,and LDL-C.And the higher the degree of pathological malignancy in patients with bladder urothelial carcinoma,the more significant the above-mentioned situation.The results of this study indicated that the preoperative inflammatory index,hemochrome index and serum lipid level of patients with bladder urothelial carcinoma were different from that of the normal group,and this change was also related to the degree of clinicopathological grading and staging of bladder urothelial carcinoma.Preoperative and postoperative detection of inflammatory index,hemoglobin index and lipid level regularly,for the monitoring of bladder urothelial carcinoma,has a certain clinical guiding significance.Timely correction of the inflammatory status of patients,improvement of anemia,and regulation of blood lipid levels are of certain value in improving the therapeutic effect and long-term quality of life of patients with bladder urothelial carcinoma. |
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