| Research background and research purposesUrinary tumors are the fourth most common tumor in the recent global cancer statistics.As a classification of upper tract urothelial carcinoma accounts for only the 5-10% of all urothelial carcinoma.However,the initial clinical symptoms are not obvious,the clinical pathology stage is higher at the initial diagnosis,often accompanied by bladder cancer and other characteristics lead to its poor prognosis.Surgical treatment is currently the main treatment for this type of disease,the previous research results believe that postoperative tumor stage and postoperative pathological classification can assess the risk of prognosis of patients,but the evaluation results have hysteresis,and lack of quantifiable assessment results.On the contrary,the preoperative prognosis assessment and the specific prognosis score is conducive to the formulation of clinical decision-making and communication between doctors and patients.There is a close relationship between inflammation and tumor,which is the consensus of academic circles.The ratio of lymphocytes to monocytes(LMR)is a blood inflammatory marker that has been considered an independent prognostic factor in the prognostic study of various tumors.The results of the data are easy to obtain and do not add to the financial burden on patients.Some studies have concluded that inflammatory markers can be one of the directions for predicting the prognosis of tumors in the future clinically.The purpose of this study was to investigate the predictive value of preoperative peripheral blood LMR levels in patients with upper tract urothelial carcinoma(UTUC)after radical nephroureterectomy.And according to the possible prognostic factors to develop a predictive model that is easy to popularize clinically.As far as we know,the research on the prognostic value of LMR level in patients with UTUC is still in the minority,and the study of further adding LMR level to construct predictive model is still reported.We decided to follow up with UTUC patients at the center to assess their prognostic value.Research methodsThe clinical data of 146 cases of UTUC patients undergoing radical nephroureterectomy in our hospital from October 2011 to December 2015 were retrospectively analyzed.According to the selection of the best cutoff point by the Cutoff Finder,the correlation between LMR and related clinicopathological features was evaluated by chi-square test.The survival curve was plotted by Kaplan–Meier method and Log-rank test.The Cox regression model is used for multivariate analysis.According to the independent factors of prognosis,the authorization statistics software was used to construct the column chart of the 5-year tumor specific survival and the ROC curve related to survival time.Research resultsIn 146 patients,the optimal cutoff point for LMR to overall survival(OS)and cancer-specific survival(CSS)was 2.195.The patients were divided into low LMR Group(N=32,lmr<2.195)and High LMR Group(N=114,lmr>2.195).The level of LMR was significantly correlated with the pathological T stage of tumor(P<0.05).The 5-year overall survival rates in patients with high LMR group and low LMR Group were 83.5±7.6% and 28.6±26.9%,and the 5-year cancer-specific survival rates were 81.8±7.8% and 27.7±26.9%,the difference is statistically significant(P<0.001).Univariate analysis showed a significant correlation between low LMR levels and decreased OS and CSS rates(P<0.001).Multivariate analysis showed that Multifocality,pathological T stage and LMR levels were independent predictors of the prognosis of OS and CSS(P<0.05)in patients after radical nephroureterectomy of UTUC.The area under the ROC curve(AUC)in the nomograms model is 0.874,sensitivity 92.2%,specificity 73.3%.The index of concordance(C index)is 0.812(95% confidence interval : 0.743-0.88)ConclusionUTUC patients with lower preoperative LMR levels may indicate worse OS and CSS.This biomarker may contribute to the prognosis assessment and postoperative testing of UTUC patients. |
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