多种术前炎性、生化及营养指标对局限性肾透明细胞癌复发风险的预测价值

Predictive value of multiple preoperative inflammatory, biochemical, and nutritional indicators for recurrence risk in localized clear cell renal cell carcinoma: a single-center retrospective cohort study

摘要

目的 探讨多种术前炎性、生化及营养指标在预测局限性肾透明细胞癌（ccRCC）患者术后复发风险中的价值，并建立复发风险预测模型。方法 回顾性分析苏州大学附属第一医院泌尿外科2018年1月至2022年12月收治的337例局限性ccRCC患者的临床资料。收集患者性别、年龄、体质指数（BMI）、高血压、糖尿病、高脂血症、吸烟史、手术方式、肿瘤最大直径、Fuhrman分级、T分期及多项炎性、生化指标，包括中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、淋巴细胞/单核细胞比值（LMR）、系统免疫炎症指数（SII）、白蛋白/碱性磷酸酶比值（AAPR）、系统性炎症反应指数（SIRI）、谷草转氨酶/谷丙转氨酶比值（AAR）和预后营养指数（PNI）。随访截至2024年12月，根据是否复发分为复发组和未复发组，比较两组临床病理特征的差异。采用Cox多因素回归分析筛选独立影响因素，并基于此构建预测ccRCC复发的列线图模型，通过calibration校准曲线评估模型拟合度，并利用决策曲线分析（DCA）评估模型在复发风险预测中的临床获益。结果 随访期内共39例（11.57%）患者复发。复发组（39例）和未复发组（298例）的肿瘤直径、Fuhrman分级、T分期、NLR、LMR、SII、PNI、AAPR、SIRI、AAR等指标差异均有统计学意义（均P＜0.05）。Cox多因素分析显示，PNI为ccRCC术后复发的独立保护因素，而SIRI和AAR为ccRCC术后复发的独立危险因素。基于上述因素构建的列线图模型对1年、3年、5年复发风险具有良好的预测能力，校准曲线显示模型拟合度较好（χ²=3.590，P=0.309）。DCA显示该模型能提供较好的患者获益。结论 术前PNI、SIRI和AAR与局限性ccRCC术后复发密切相关，基于这些指标构建的预测模型可为临床个体化风险评估和随访管理提供参考。

Abstract

Objective To investigate the value of multiple preoperative inflammatory, biochemical, and nutritional indicators in predicting postoperative recurrence risk in patients with localized clear cell renal cell carcinoma (ccRCC), and to establish a recurrence risk prediction model. Methods Clinical data of 337 patients with localized ccRCC who underwent surgery in the Department of Urology at the First Affiliated Hospital of Soochow University from January 2018 to December 2022 were retrospectively analyzed. Patients information including gender, age, BMI, hypertension, diabetes, hyperlipidemia, smoking history, surgical approach, maximum tumor diameter, Fuhrman grade, T stage, and various inflammatory (NLR, PLR, LMR, SII, AAPR, SIRI, AAR) and nutritional indicators (PNI) were collected. Follow-up was conducted until December 2024. Patients were divided into recurrence and non-recurrence groups according to recurrence status, and clinicopathological characteristics were compared between the two groups. Cox multivariate regression analysis was used to identify independent risk factors, and a nomogram model for predicting ccRCC recurrence was constructed based on these factors. Model calibration was assessed using calibration curves, and clinical benefit was evaluated by decision curve analysis (DCA). Results During the follow-up period, 39 patients (11.57%) experienced recurrence. Significant differences were observed between the recurrence group (n=39) and non-recurrence group (n=298) in terms of tumor diameter, Fuhrman grade, T stage, NLR, LMR, SII, PNI, AAPR, SIRI, and AAR (P＜0.05). Cox multivariate analysis showed that PNI was an independent protective factor for postoperative recurrence of ccRCC, while SIRI and AAR were independent risk factors for postoperative recurrence of ccRCC. The nomogram model based on these factors demonstrated good predictive ability for 1-, 3-, and 5-year recurrence risk, and the calibration curve indicated good model fit (χ²=3.590, P=0.309). DCA indicated that the model provided favorable clinical benefit. Conclusion Preoperative PNI, SIRI, and AAR are closely associated with postoperative recurrence of localized ccRCC. The prediction model based on these indicators can provide a reference for individualized risk assessment and follow-up management in clinical practice.

关键词

肾透明细胞癌 / 炎性指标 / 营养指标 / 复发风险 / 预后预测

Key words

clear cell renal cell carcinoma / inflammatory indicators / nutritional indicators / recurrence risk / prognostic prediction

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基金资助

苏州市科技发展计划（民生科技）项目(SLJ201906)

苏州大学附属第一医院博习培育计划自然科学基金项目(BXQN2025004)