Predictive and prognostic impact of preoperative complete blood count based systemic inflammatory markers in testicular cancer

ABSTRACT Purpose To determine the utility of preoperative complete blood count (CBC) based systemic inflammatory markers in the prediction of testicular cancer and its prognosis. Material and Methods Between 2008-2017 the data of all testicular tumor patients undergoing radical orchiectomy were retrospectively analyzed. Patient baseseline characteristics (age, tumor stage, tumor markers, etc.) and results of routine preoperative blood tests including mean platelet volume (MPV), red cell distribution width (RDW), lymphocyte ratio (LR) and neutrophil ratio (NR) were retrieved. In addition, neutrophil to lymphocyte ratio (NLR) was calculated. Results Mean age of the tumor and control group was 36.0±15 and 30.50±11 years, respectively. Mean RDW, NR and NLR were significantly higher in the tumor group with p values<0.001; whereas LR and MPV were significantly higher in the control group (p<0.001). Receiver Operating Characteristic (ROC) analyses of LR, NR, RDW, MPV, and NLR are shown in Table-3. The cut off values for RDW and NR were found as 13,7 (Area under the curve (AUC): 0.687, sensitivity = 42.2%, specificity = 84.8%) and 55.3 (AUC:0.693, sensitivity 72.2%, specificity 62%), respectively. Area under the curve for NLR in tumor group was 0.711, with a threshold value of 1.78 and sensitivity=81.8% and specificity=55.4% (AUC:0.711/sig<0.001) that together with RDW exhibited the best differential diagnosis potential which could be used as an adjuvant tool in the prediction of testicular tumor and its prognosis. Conclusion Several systemic inflammatory markers, which are obtained by routinely performed cost-effective blood tests, could demonstrate incremental predictive and prognostic information adjuvant to preoperativly achieved testiscular tumor markers.

摘要 目的 探讨基于术前全血细胞计数（complete blood count, CBC）的全身炎症标志物在预测睾丸癌及其预后中的应用价值。材料与方法 回顾性分析2008年至2017年所有接受根治性睾丸切除术的睾丸肿瘤患者的临床资料。提取患者基线特征（年龄、肿瘤分期、肿瘤标志物等）及术前常规血液检测结果，包括平均血小板体积（mean platelet volume, MPV）、红细胞分布宽度（red cell distribution width, RDW）、淋巴细胞比值（lymphocyte ratio, LR）、中性粒细胞比值（neutrophil ratio, NR），并计算中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio, NLR）。结果 肿瘤组与对照组的平均年龄分别为36.0±15岁和30.50±11岁。肿瘤组的平均RDW、NR及NLR均显著高于对照组（均p<0.001）；而对照组的LR与MPV显著高于肿瘤组（p<0.001）。LR、NR、RDW、MPV及NLR的受试者工作特征（receiver operating characteristic, ROC）分析结果见表3。RDW与NR的截断值分别为13.7（曲线下面积（area under the curve, AUC）=0.687，灵敏度=42.2%，特异度=84.8%）和55.3（AUC=0.693，灵敏度=72.2%，特异度=62%）。肿瘤组NLR的曲线下面积为0.711，截断值为1.78，灵敏度81.8%，特异度55.4%（AUC=0.711，p<0.001）；其中NLR联合RDW展现出最优的鉴别诊断效能，可作为预测睾丸肿瘤及其预后的辅助工具。结论 多项通过常规低成本血液检测获取的全身炎症标志物，可作为术前睾丸肿瘤标志物的补充，为睾丸癌的预测与预后评估提供增量信息。