术前预后营养指数及中性粒－淋巴细胞比值在非肌层浸润性膀胱癌患者复发中的预测价值

目的:探究术前预后营养指数（prognostic nutritional index，PNI）和中性粒-淋巴细胞比值（neutrophil-lymphocyte ratio，NLR）对于非肌层浸润性膀胱癌（non-muscular invasive bladder cancer，NMIBC）患者在术后复发中的预测价值。方法:回顾性分析我院2016年01月-2019年12月期间182例住院行手术治疗的 NMIBC患者，根据术前1周内血常规和生化的结果计算PNI值和NLR值，并根据ROC曲线确定术前PNI和NLR的最佳临界值，分别分析PNI、NLR与NMIBC患者病理特征以及术后复发的关系。结果:根据ROC曲线，确定本研究中高PNI组（≥47.18）116例，低PNI组（＜47.18）66例，高NLR组（≥2.50）77例，低NLR组（＜2.50）105例；PNI组在年龄、复发及病理T分期上存在明显差异，P＜0.05；NLR组在复发、病理T分期上存在明显差异，P＜0.05；Kaplan-Meier生存曲线显示，低PNI组RFS显著差于高PNI组（P＜0.001），高NLR组RFS显著差于低NLR组（P＜0.001）；Cox单因素分析结果提示:患者的吸烟史、肿瘤分期、组织学分级、PNI＜47.18、NLR≥2.50是影响NMIBC患者复发的危险因素；Cox多因素分析结果提示:患者的吸烟史、肿瘤分期、PNI＜47.18、NLR≥2.50是影响NMIBC患者复发的独立危险因素；Pearson相关性分析显示PNI与NLR值在NMIBC患者中存在负相关（P＜0.001）；低PNI/高NLR与患者术后复发、高PNI/低NLR与患者术后未复发具有相关性（P＜0.001）。结论:术前PNI、NLR是预测NMIBC患者术后复发的有效指标，47.18、2.50可分别作为PNI、NLR的最佳分界值，低PNI、高NLR是NMIBC复发的独立危险因素，同时具有低PNI、高NLR患者更易出现术后复发，联合使用PNI、NLR两项指标，可以更有效地预测NMIBC患者术后复发。

The predictive value of preoperative PNI and NLR for recurrence of non-muscular invasive bladder cancer

Objective:To investigate the predictive value of preoperative prognostic nutritional index (PNI) and neutrophil lymphocyte ratio (NLR) in postoperative recurrence of non-muscular invasive bladder cancer (NMIBC).Methods:The clinical data of 182 patients with NMIBC who underwent surgical treatment in our hospital from January 2016 to December 2019 were analyzed retrospectively.The PNI and NLR values were calculated according to the results of the patient's one week preoperative examination,and the best critical values of PNI and NLR were determined according to the receiver operating characteristic (ROC) curve.The relationship between PNI,NLR and pathological features and postoperative recurrence of NMIBC patients were analyzed respectively.Results:According to the ROC curve analysis，116 cases were in the high PNI group,66 in the low PNI group,77 in the high NLR group and 105 in the low NLR group.Compared with the high PNI group，the difference in age,recurrence and pathological T stage in the low PNI group was statistically significant（P＜0.05）.The recurrence and pathological T stage in the high NLR group were significantly different from those in the low NLR group（P＜0.05）.Survival curve showed that RFS in the low PNI group was significantly worse than that in the high PNI group (P＜0.001),and the RFS of high NLR group was significantly worse than that of low NLR group.Univariate Cox regression analysis showed that smoking history,tumor stage,histological grade,PNI<47.18 and NLR≥2.50 were risk factors for recurrence in patients with NMIBC,and multivariate Cox regression analysis showed that smoking history,tumor stage,PNI<47.18 and NLR≥2.50 were independent risk factors for recurrence in patients with NMIBC.Pearson correlation analysis showed that there was a negative correlation between PNI and NLR（P＜0.001）.Low PNI/and high NLR are associated with recurrence,high PNI/and low NLR with no recurrence（P＜0.001）.Conclusion:Preoperative PNI and NLR have crucial clinical significance in patients with NMIBC,47.18,2.50 can be regarded as the best cut-off value of PNI and NLR.Low PNI and high NLR are independent risk factors for postoperative recurrence in patients with NMIBC.Patients with low PNI/and high NLR are more likely to recurrence.Combined use of PNI and NLR can predict the recurrence of patients more effectively.