Prognostic Value Of Combined Plasma Fibrinogen And Neutrophil To Lymphocyte Ratio In Non-metastatic Clear Cell Renal Cell Carcinoma

Background and purposeRenal cancer,also known as renal cell carcinoma?RCC?,is a malignant tumor derived from renal parenchymal urinary tubule epithelium.Its morbidity worldwide accounts for 2.2%of adult malignant tumors.Both morbidity and mortality have appeared Upward trend in recent years.Among various pathological types of renal cell carcinoma,clear cell renal cell carcinoma?cc RCC?is the most common subtype,accounting for 75%-80%of RCC.About 25%-30%of RCC patients have developed locally advanced or metastatic tumor at the time of treatment.Although targeted drug therapy has achieved certain effects,more drug clinical trials are ongoing,but the overall prognosis of locally advanced and metastatic renal cancer is still poor.The first choice of treatment for non-metastatic renal cancer is still surgical treatment,with radical nephrectomy or partial nephrectomy preferred.Among the patients who received surgical treatment early,20-30%of patients still found early recurrence or metastasis during follow-up.Therefore,in view of the high recurrence of renal cancer after surgery,seeking better predictive indicators and formulating personalized treatment and follow-up programs are also the research directions that many scholars are committed to.Fibrinogen?Fib?,a glycoprotein synthesized,is an important substance involved in the blood coagulation process,which is secreted by liver cells.However,in recent years,its value in participating in the progression of malignant tumors and affecting the prognosis has been continuously valued.Neutrophil-lymphocyte ratio?NLR?,as an indicator reflecting the body's inflammatory state,has been continuously confirmed as an effective indicator for the prognosis of various malignant tumors.Fib and NLR,as a laboratory test index,have the advantages of easy access and low cost.Many scholars have found that different preoperative Fib and NLR levels have a certain predictive effect on the prognosis of non-metastatic renal cancer.Based on Fib and NLR as indicators to reflect the prognosis of malignant tumors have certain limitations..In recent years,some scholars have used fibrinogen combined with neutrophil lymphocyte ratio?F-NLR score?as a new predictive index,and in a variety of malignant tumors have shown obvious predictive value.The F-NLR score,as a new predictor,has not yet been reported in renal cancer prognosis studies.This study aims to explore the prognostic impact of F-NLR score on non-metastatic cc RCC patients.MethodsThis study retrospectively collected renal cancer patients hospitalized in the urology department of the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2014.And we selected 210 patients with non-metastasis who underwent radical nephrectomy or partial nephrectomy cc RCC patients'medical history data and follow-up.The ROC curve determines the optimal cutoff value of fibrinogen and NLR.According to the optimal cut-off point,Fib is divided into low Fib group,high Fib group,and NLR is divided into low NLR group and high NLR group.Then determine the F-NLR score grouping:low Fib and low NLR group?F-NLR 0 point?,high Fib or high NLR group?F-NLR 1 point?,high Fib and high NLR group?F-NLR 2 points?.Chi-square test analyzes the correlation between F-NLR score and clinical pathological characteristics of patients.Kaplan-Meier method was used to perform single-factor survival analysis and to draw disease-free survival?DFS?and overall survival?OS?survival curves,calculate survival rate,and use Log-rank method for difference test.Cox regression analysis method was used for multi-factor survival analysis and to determine the independent risk factors affecting the prognosis of renal clear cell carcinoma.Results1.According to the ROC curve of Fib and NLR on survival results,determine the best cut-off point of Fib is 3.80g/L and the best cut-off point of NLR is 2.35.107cases?51.0%?in F-NLR 0 group,73 cases?34.7%?in F-NLR 1 group,30 cases?14.3%?in F-NLR 2 group.2.The F-NLR score is closely related to the patient's age,history of hypertension,clinical symptoms,tumor size,tumor necrosis,pathological T stage,and Fuhrman classification?P<0.05?.3.Results of single factor analysis:clinical symptoms,tumor necrosis,tumor diameter,T stage,Fuhrman classification,Fib,NLR,F-NLR scores are risk factors that affect patients'DFS and OS.4.Multi-factor analysis results:tumor necrosis,T stage,Fuhrman classification,F-NLR score?0 points,2 points?are independent risk factors for patients with DFS and OS?P<0.05?.5.The 5-year disease-free survival rates of F-NLR 0 points,1 point,and 2 points were 94.4%,82.2%,and 40.0%?P<0.001?respectively,and the 5-year overall survival rates were 97.2%,87.7%,and 56.7%,respectively.?P<0.001?.6.The F-NLR score was negatively correlated with DFS and OS in p T_1-2,Fuhrman I-II or Fuhrman III-IV stratification?P<0.05?.In p T_3-4,it was negatively correlated with DFS?P=0.047?,but not significantly different from OS?P=0.077?.ConclusionAmong non-metastatic cc RCC patients,the high F-NLR score before surgery is an independent risk factor for the prognosis of DFS and OS,and it is expected to become a convenient and inexpensive new indicator to predict the prognosis of cc RCC.