炎症标志物对肌层浸润性膀胱癌患者接受不同新辅助治疗方案疗效预测分析

Value of inflammatory biomarkers in predicting the outcome of patients with muscle-invasive bladder cancer receiving different neoadjuvant treatment regimens

摘要:

目的 探讨炎症标志物对肌层浸润性膀胱癌患者接受新辅助治疗效果的预测价值。方法 回顾性分析2020年1月至2023年2月于重庆医科大学附属第一医院泌尿外科就诊并接受新辅助治疗的肌层浸润性膀胱癌患者临床资料，分析中性粒细胞与淋巴细胞比值 （neutrophil-to-lymphocyte ratio，NLR）、衍生中性粒细胞与淋巴细胞比值（derived neutrophil-lymphocyte ratio，dNLR）和全身免疫炎症指数（systemic immune-inflammation index，SII）等炎症标志物对新辅助治疗效果的影响，应用受试者工作特征（receiver operating characteristic，ROC）曲线确定最佳截断值，从而将患者分为高、低亚组，通过对比分析各亚组间患者相关临床、病理参数及新辅助治疗效果差异。进一步比较炎症指标的高、低对患者接受新辅助治疗效果的影响。结果 临床、病理参数在炎症指标高、低亚组间差异无统计学意义（P>0.05）。而在炎症指标高、低亚组中，患者接受新辅助治疗的客观缓解率（objective response rate，ORR）、疾病控制率（disease control rate，DCR）差异有统计学意义（P<0.05），并且更高的炎症指标与更差的疗效相关。此外，4种新辅助治疗方案间，患者的ORR、DCR差异无统计学意义（P>0.05）。结论 新辅助治疗前外周血炎症指标NLR、dNLR和SII可以作为判断新辅助疗效的潜在指标。

Abstract:

Objective To investigate the value of inflammatory biomarkers in predicting the efficacy of neoadjuvant therapy in patients with muscle-invasive bladder cancer.Methods A retrospective analysis was performed for the clinical data of patients with muscle-invasive bladder cancer who attended Department of Urology，The First Affiliated Hospital of Chongqing Medical University，from January 2020 to February 2023 and received neoadjuvant therapy. The influence of related inflammatory biomarkers on the efficacy of neoadjuvant therapy was analyzed，including neutrophil-to-lymphocyte ratio（NLR），derived neutrophil-to-lymphocyte ratio（dNLR），and systemic immune-inflammation index（SII），and the receiver operating characteristic（ROC） curve was used to determine the optimal cut-off values. Then the patients were divided into high and low inflammatory biomarker subgroups to investigate the differences in clinicopathological parameters and the efficacy of neoadjuvant therapy. Finally，a comparative analysis was performed to investigate the influence of inflammatory biomarkers on the outcome of patients receiving neoadjuvant therapy.Results There were no significant differences in clinicopathological parameters between the high and low inflammatory biomarker subgroups（P>0.05）. There were significant differences in objective response rate（ORR） and disease control rate（DCR） after neoadjuvant therapy between the high and low inflammatory biomarker subgroups（P<0.05），and higher levels of inflammatory biomarker were associated with a less favorable therapeutic outcome. In addition，there were no significant differences in ORR and DCR between the four neoadjuvant treatment regimens（P>0.05）.Conclusion The peripheral blood inflammatory biomarkers NLR，dNLR，and SII before neoadjuvant therapy can be used as potential indicators to judge the efficacy of neoadjuvant therapy.