| Background and purpose:Prostate cancer has the characteristics of high incidence,rapid progress,rapid disease change,severe illness,poor prognosis,low treatment sensitivity,and high heterogeneity.Surgical treatment is the standard treatment method for early prostate cancer,which can inhibit tumor growth and improve long-term survival rate.Once prostate cancer patients undergoing surgical treatment have recurrence or metastasis,reoperation is of little significance,the disease can progress rapidly,and the patient's life is endangered.Therefore,finding effective biomarkers for operable prostate cancer has great clinical value for early prediction of prognosis,correction of clinical diagnosis and treatment,and adjuvant and remedial treatment for patients with poor prognosis.There are few reports about serum uric acid,neutrophil lymphocyte ratio(NLR)and prostate cancer,and the research results are still controversial.At present,there is no relevant analysis on the prognosis of patients with prostate cancer after radical prostatectomy with serum uric acid and NLR.Therefore,this study evaluates the prognosis of patients with prostate cancer and provides effective biomarkers for the prognosis of early prostate cancer.Method:A total of 200 patients with prostate cancer who underwent surgical treatment from January2015 to January 2017 of Henan University People's Hospital were collected.All patients underwent laparoscopic radical prostatectomy.The postoperative pathology was clearly diagnosed as prostate adenocarcinoma,and they had not received other related treatment before,such as endocrine therapy,chemoradiotherapy and immunotherapy.The biochemical data of the patients nearest to the surgery were collected,the preoperative NLR,serum uric acid,and prostate specific antigen(PSA)levels were recorded.The patients were followed up,and the recurrence and metastasis were observed by chest and abdomen CT,conventional organ ultrasound,whole body bone scan,tumor markers and other examinations.The primary endpoint of follow-up was death,and the secondary endpoint was recurrence and metastasis.The follow-up deadline was January30,2020.Receiver Operating Characteristic Curve(ROC)was used to analyze the value of serum uric acid and NLR in predicting the survival of prostate cancer,and the cutoff value was determined.The patients were grouped according to the cutoff value.The correlation between NLR,serum uric acid and clinical pathological factors(longest tumor diameter,PSA,age,Gleason score,clinical stage,lymph node metastasis,tumor stage,smoking history,tumor number)was analyzed by the X~2test or Fisher's exact probability method.Kaplan-Meier and Log-Rank analysis and Cox regression model were used to analyze the relationship between serum uric acid and NLR and overall survival(OS)and tumor progression time(TTP),and the independent influencing factors of TTP and OS were analyzed.Result:1.The follow-up time of patients was 36-60 months,with an average follow-up time of(45.6±5.6)months.The median follow-up time was 46 months.A total of 11 patients were lost to follow-up.189 patients were successfully followed up,and the successful follow-up rate was94.5%.A total of 13 patients died,all of which were cancer-specific deaths.A total of 19 cases progressed.2.ROC curve analysis results showed that the cutoff values of serum uric acid and NLR were 345umol/L and 2.21,respectively.The area under the curve of serum uric acid for predicting the survival of prostate cancer patients was 0.73(P=0.020),and the area under the curve of NLR to predict the survival of prostate cancer patients was 0.75(P=0.008).The area under the curve for predicting the survival of prostate cancer patients with serum uric acid combined with NLR was 0.82(P=0.000),the sensitivity was 62.5%,and the specificity was 81.1%.3.The regional lymph node metastasis of patients with high uric acid group and low uric acid group was statistically significant(P<0.05).The regional lymph node metastasis rate of high uric acid group(2.86%)was lower than that of patients with low uric acid group(20.17%)and the difference was statistically significant(P<0.05).There were statistically significant differences in regional lymph node metastasis,maximum tumor diameter,and tumor T stage between the high NLR group and the low NLR group(P<0.05).The regional lymph node metastasis rate in the low NLR group was lower than that in the high NLR group,and the proportion of tumor T stage T2was low than that in patients with high NLR group,the maximum tumor diameter was smaller than that in patients with high NLR group,and the difference was statistically significant(P<0.05).4.The incidence of recurrence and metastasis in patients with high uric acid group during follow-up period(1.43%)was lower than that in patients with low uric acid group(15.13%),the difference was statistically significant(X~2=9.145,P=0.002).During the follow-up period of patients with high NLR group,the incidence of internal recurrence and metastasis events(17.18%)was higher than that in patients with hypouric acid group(3.03),and the difference was statistically significant(X~2=11.339,P=0.01).The mortality rate of patients with high uric acid group during the follow-up period(0.0%)was lower than that of patients with low uric acid group(9.24%),the difference was statistically significant(X~2=6.870,P=0.009),the mortality during the follow-up period of patients with high NLR group(11.11%)Were higher than those in the hypouric acid group(1.01%),and the difference was statistically significant(X~2=8.775,P=0.003).5.Kaplan-Meier method and log-rank test showed that the cumulative TTP rate during the follow-up period of the low uric acid group was lower than that of the high uric acid group,and the cumulative TTP rate of the high NLR group was lower than that of the low NLR group,the difference was statistically significant(Logrank X~2=9.332,11.421,P=0.002,0.001),and the cumulative OS rate during the follow-up period of the low uric acid group was lower than that of the high uric acid group,and the cumulative OS rate of the high NLR group was lower than that of the low NLR group,the difference was statistically significant(Logrank X~2=6.591,7.645,P=0.010,0.006).6.Cox multivariate analysis showed that age,regional lymph node metastasis,tumor stage(T),PSA level,Gleason score,serum uric acid level,and NLR were independent influencing factors of TTP and OS in patients with prostate cancer(P<0.05).Prostate cancer patients with aged?60 years,regional lymph node metastasis,T2,PSA?10ng/ml,Gleason score?4 points,low uric acid and high NLR have an increased risk of recurrence,metastasis and death.Conclusion:1.The long-term prognosis of early prostate cancer treated by laparoscopic radical prostatectomy is good.Preoperative peripheral blood uric acid and NLR levels have certain value in predicting the prognosis of operable prostate cancer.The combination of the two has a higher predictive value.As a potential biomarker for prognosis of prostate cancer,early monitoring of serum uric acid and NLR before surgery can be used to evaluate the prognosis of patients after prostate cancer.2.Preoperative blood uric acid level and NLR are closely related to pathological characteristics of prostate cancer.Peripheral blood uric acid levels are associated with lymph node metastasis in prostate cancer.Lymph node metastasis rates are higher in patients with low uric acid levels.Peripheral blood NLR levels are related to tumor size and regional lymph node metastasis.Patients with high NLR have higher regional lymph node metastasis rates,larger tumor diameters,and higher tumor stages.3.Peripheral blood uric acid level and NLR are closely related to the prognosis of operable prostate cancer during follow-up period.Preoperative blood uric acid level decrease and NLR increase are risk factors for poor prognosis of operable prostate cancer patients during follow-up period.Compared with patients with high uric acid,patients with low uric acid had shorter TTP and OS,and compared with patients with low NLR,patients with high NLR had shorter TTP and OS.4.Preoperative uric acid,preoperative NLR,age,regional lymph node metastasis,tumor staging,PSA,Gleason score are all independent factors affecting prognosis of operable prostate cancer.Operable prostate cancer patients with age?60,regional lymph node metastasis,T2,PSA?10ng/ml,Gleason score?4,NLR>2.21 and uric acid?345umol/L have an increased risk of recurrence,metastasis,and death. |
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