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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 225 -231. doi: 10.3877/cma.j.issn.1674-3253.2024.03.005

临床研究

联合系统性免疫炎症指数和预后营养指数预测腹腔镜肾切除术后肾癌患者的预后
周慧宇1, 吕定阳1, 双卫兵1,†()   
  1. 1. 030001　太原，山西医科大学第一医院泌尿外科
  • 收稿日期:2023-11-11 出版日期:2024-06-01
  • 通信作者: 双卫兵
  • 基金资助:
    山西省新兴产业领导人才项目资助([2020]587号)

Combined systemic immune-inflammatory index and prognostic nutritional index predicts prognosis in patients with renal cell carcinoma undergoing laparoscopic nephrectomy

Huiyu Zhou1, Dingyang Lyu1, Weibing Shuang1,†()   

  1. 1. Department of Urology, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2023-11-11 Published:2024-06-01
  • Corresponding author: Weibing Shuang
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引用本文：

周慧宇, 吕定阳, 双卫兵. 联合系统性免疫炎症指数和预后营养指数预测腹腔镜肾切除术后肾癌患者的预后[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 225-231.

Huiyu Zhou, Dingyang Lyu, Weibing Shuang. Combined systemic immune-inflammatory index and prognostic nutritional index predicts prognosis in patients with renal cell carcinoma undergoing laparoscopic nephrectomy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 225-231.

目的

探讨联合系统性免疫炎症指数（SII）和预后营养指数（PNI）对腹腔镜肾切除术后肾细胞癌（RCC）患者的预后价值。

方法

回顾性分析2013年1月至2021年12月在山西医科大学第一医院接受腹腔镜肾切除术的633例RCC患者的临床资料。根据外周血细胞计数和血清白蛋白计算SII和PNI，使用X-tile软件确定最佳截断值，并构建SII-PNI评分。根据SII-PNI评分（0、1、2）将所有患者分为三组，分析各组之间临床病理特征的相关性。采用Kaplan-Meier曲线分析SII-PNI评分对RCC患者总生存期（OS）和无复发生存期（RFS）的影响，单因素和多因素Cox回归分析用于确定预后因素。受试者工作特征（ROC）曲线用于评估各指标的预测效能。

结果

最终共纳入了633例患者。结果显示，SII-PNI评分与年龄、吸烟史、糖尿病史、pT分期、Fuhrman分级、手术方式及肿瘤大小存在显著相关性（P均<0.05）。SII-PNI评分为0、1、2患者的3年OS分别为97.0%、89.5%和57.1%，3年RFS分别为95.1%、90.8%和78.6%，Kaplan-Meier曲线显示，SII-PNI评分低的患者OS和RFS明显优于SII-PNI评分高的患者（P<0.001）。单因素和多因素Cox分析显示，SII-PNI评分是OS（P<0.001）和RFS（P<0.001）的独立预后指标，且预测效能优于单独使用SII和PNI。

结论

术前SII-PNI评分可作为腹腔镜肾切除术后RCC患者的独立预后指标，有助于识别高危人群。

关键词: 系统性免疫炎症指数（SII）, 预后营养指数（PNI）, 肿瘤微环境, 肾细胞癌, 腹腔镜, 肾切除术, 预后
Objective

To investigate the prognostic value of a combination of systemic immune-inflammatory index (SII) and prognostic nutrition index (PNI) in patients with renal cell carcinoma (RCC) undergoing laparoscopic nephrectomy.

Methods

The clinical data of 633 cases with RCC undergoing laparoscopic nephrectomy in the First Hospital of Shanxi Medical University from January 2013 to December 2021 were retrospectively analyzed. SII and PNI were calculated based on peripheral blood cell count and serum albumin, the optimal cut-off values were determined using X-tile software, and SII-PNI scores were constructed. All patients were divided into three groups according to SII-PNI scores, and the correlation of clinicopathological features between the groups was analyzed. Kaplan-Meier curve was used to analyze the effects of SII-PNI score on overall survival (OS) and recurrence-free survival (RFS) of patients with RCC. Univariate and multivariate Cox regression analysis was used to determine prognostic factors. Receiver operating characteristic (ROC) curve was used to evaluate the prognostic efficacy of each indicator.

Results

A total of 633 patients were enrolled. The results showed that SII-PNI score was significantly correlated with age, smoking history, diabetes history, pT stage, Fuhrman grade, surgical method and tumor size (all P< 0.05). The 3-year OS of patients with SII-PNI scores of 0, 1, and 2 was 97.0%, 89.5%, and 57.1%, and the 3-year RFS was 95.1%, 90.8%, and 78.6%, respectively. Kaplan-Meier curve showed patients with low SII-PNI score had significantly better OS and RFS than those with high SII-PNI score (P<0.001). Univariate and multivariate Cox analysis further showed that SII-PNI score was an independent prognostic indicator of OS (P<0.001) and RFS (P<0.001), and was more predictive than SII and PNI alone.

Conclusion

Preoperative SII-PNI score can be used as an independent prognostic indicator for patients with RCC after laparoscopic nephrectomy.

Key words: Systemic immune-inflammatory index, Prognostic nutritional index, Tumor microenvironment, Renal cell carcinoma, Laparoscopy, Nephrectomy, Prognosis
表1 肾细胞癌患者不同SII-PNI评分组之间特征比较
临床病理特征 SII-PNI评分 P值
0分(n=529) 1分(n=76) 2分(n=28)
性别[例(%)]       0.103
男 336(63.5) 47(61.8) 22(78.6)  
女 193(36.5) 29(38.2) 06(21.4)  
年龄[例(%)]       0.024
≤65岁 408(77.1) 49(64.5) 18(64.3)  
> 65岁 121(22.9) 27(35.5) 10(35.7)  
BMI[kg/m2，(±s)] 25.04±3.25 24.84±4.39 24.29±2.74 0.402
吸烟史[例(%)]       0.043
无 396(74.9) 57(75.0) 15(53.6)  
有 133(25.1) 19(25.0) 13(46.4)  
糖尿病史[例(%)]       0.046
无 451(85.3) 63(82.9) 19(67.9)  
有 78(14.7) 13(17.1) 09(32.1)  
高血压病史[例(%)]       0.696
无 321(60.7) 44(57.9) 15(53.6)  
有 208(39.3) 32(42.1) 13(46.4)  
心血管病史[例(%)]       0.944
无 484(91.5) 69(90.8) 26(92.9)  
有 45(8.5) 7(9.2) 2(7.1)  
病理类型[例(%)]       0.790
透明细胞癌 488(92.2) 69(90.8) 25(89.3)  
非透明细胞癌 41(7.8) 7(9.2) 03(10.7)  
pT分期[例(%)]       <0.0010
T1 480(90.7) 60(78.9) 19(67.9)  
T2 42(7.9) 09(11.8) 04(14.3)  
T3 05(0.9) 5(6.6) 05(17.9)  
T4 02(0.4) 2(2.6) 00(0.0)  
Fuhrman分级[例(%)]       <0.0010
1 096(18.1) 08(10.5) 03(10.7)  
2 333(62.9) 36(47.4) 12(42.9)  
3 086(16.3) 26(34.2) 11(39.3)  
4 14(2.6) 6(7.9) 2(7.1)  
手术方式[例(%)]       0.007
肾部分切除 202(38.2) 20(26.3) 04(14.3)  
肾根治性切除 327(61.8) 56(73.7) 24(85.7)  
肿瘤大小[cm，(±s)] 4.1±2.1 5.2±2.9 5.5±2.9 <0.0010
图1　肾细胞癌患者不同SII-PNI评分组总生存期（a）和无复发生存期（b）的生存曲线　 图2　SII、PNI和SII-PNI评分预测肾细胞癌患者术后5年OS的ROC曲线注：SII=血小板计数（×109/L）×中性粒细胞计数（×109/L）/淋巴细胞计数（×109/L）；PNI=白蛋白水平（g/L）+5×淋巴细胞计数（109/L）；SII-PNI评分0分为SII≤801.6且PNI>44.4，1分为SII>801.6或PNI≤44.4，2分为SII >801.6且PNI≤44.4
表2 影响肾细胞癌患者总生存期和无复发生存期的Cox单因素分析
变量 总生存期单因素分析 无复发生存期的单因素分析
HR(95%CI) P值 HR(95%CI) P值
性别(男vs女) 1.983(0.982～4.004) 0.056 1.438(0.773～2.673) 0.251
年龄(岁)(≤65 vs >65) 0.539(0.295～0.985) 0.045 0.685(0.377～1.245) 0.214
BMI 0.922(0.834～1.019) 0.112 0.925(0.840～1.019) 0.114
吸烟史(无vs有) 0.307(0.171～0.552) <0.0010 0.491(0.277～0.870) 0.015
糖尿病史(无vs有) 0.407(0.216～0.765) 0.005 0.560(0.292～1.075) 0.081
高血压病史(无vs有) 0.942(0.519～1.711) 0.844 0.933(0.527～1.650) 0.810
心血管病史(无vs有) 1.370(0.425～4.420) 0.599 0.849(0.337～2.143) 0.730
病理类型(透明细胞癌vs非透明细胞癌) 0.332(0.154～0.713) 0.005 0.525(0.223～1.234) 0.140
pT分期   <0.0010   <0.0010
T1 1   1  
T2 4.767(2.288～9.930) <0.0010 4.457(2.231～8.903) <0.0010
T3 12.196(5.275～28.200) <0.0010 05.476(1.927～15.558) 0.001
T4 09.984(2.319～42.975) 0.002 12.408(3.671～41.940) <0.0010
Fuhrman分级   <0.0010   <0.0010
1 1   1  
2 1.508(0.505～4.504) 0.462 1.537(0.582～4.057) 0.385
3 05.288(1.768～15.817) 0.003 3.075(1.091～8.665) 0.034
4 13.368(3.876～46.106) <0.0010 12.109(3.925～37.358) <0.0010
手术方式(部分切除vs根治性切除) 0.216(0.085～0.547) 0.001 0.287(0.129～0.638) 0.002
肿瘤大小(cm) 1.331(1.218～1.454) <0.0010 1.357(1.247～1.477) <0.0010
NLR(≤3.0 vs >3.0) 0.162(0.090～0.291) <0.0010 0.314(0.174～0.566) <0.0010
PLR(≤200.6 vs >200.6) 0.137(0.075～0.252) <0.0010 0.225(0.118～0.427) <0.0010
SII(≤801.6 vs >801.6) 0.103(0.057～0.184) <0.0010 0.291(0.154～0.550) <0.0010
PNI(≤44.4 vs >44.4) 10.332(5.674～18.815) <0.0010 3.715(1.924～7.175) <0.0010
SII-PNI评分   <0.0010   <0.0010
0 1   1  
1 3.318(1.451～7.587) 0.004 2.245(1.070～4.711) 0.032
2 24.862(12.851～48.100) <0.0010 6.330(2.897～13.830) <0.0010
表3 影响肾细胞癌患者总生存期和无复发生存期的Cox多因素分析
变量 总生存期多因素分析 无复发生存期多因素分析
HR(95%CI) P值 HR(95%CI) P值
性别(男vs女)        
年龄(岁)(≤65 vs >65)        
BMI        
吸烟史(无vs有) 0.363(0.190～0.697) 0.002    
糖尿病史(无vs有) 0.435(0.215～0.882) 0.021    
高血压病史(无vs有)        
心血管病史(无vs有)        
病理类型(透明细胞癌vs非透明细胞癌) 0.423(0.185～0.965) 0.041    
pT分期        
T1        
T2        
T3        
T4        
Fuhrman分级   0.005    
1 1      
2 1.842(0.604～5.621) 0.283    
3 2.821(0.900～8.843) 0.075    
4 8.452(2.298～31.089) 0.001    
手术方式(部分vs根治)        
肿瘤大小(cm) 1.222(1.094～1.365) <0.001 1.325(1.213～1.447) <0.001
NLR(≤3.0 vs >3.0)        
PLR(≤200.6 vs >200.6)        
SII(≤801.6 vs >801.6)        
PNI(≤44.4 vs >44.4)        
SII-PNI评分   <0.001   <0.001
0 1   1  
1 2.497(1.061～5.880) 0.036 1.574(0.730～3.397) 0.247
2 13.534(6.810～26.899) <0.001 4.663(2.107～10.322) <0.001
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