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 研究目的：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睾丸癌预测及其预后评估中的应用价值。材料与方法：2008年至2017年间，对所有接受根治性睾丸切除术的睾丸肿瘤患者的临床资料进行回顾性分析。提取患者基线特征（年龄、肿瘤分期、肿瘤标志物等）以及术前常规血液检验结果，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）、淋巴细胞比率（lymphocyte ratio, LR）与中性粒细胞比率（neutrophil ratio, NR）；此外，计算中性粒细胞与淋巴细胞比率（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岁与30.50±11岁。肿瘤组的平均红细胞分布宽度、中性粒细胞比率与中性粒细胞与淋巴细胞比率均显著高于对照组（P<0.001）；而对照组的淋巴细胞比率与平均血小板体积显著高于肿瘤组（P<0.001）。淋巴细胞比率、中性粒细胞比率、红细胞分布宽度、平均血小板体积及中性粒细胞与淋巴细胞比率的受试者工作特征（Receiver Operating Characteristic, ROC）分析结果见表3。红细胞分布宽度与中性粒细胞比率的截断值分别为13.7（曲线下面积（Area Under the Curve, AUC）：0.687，灵敏度42.2%，特异度84.8%）与55.3（曲线下面积0.693，灵敏度72.2%，特异度62%）。肿瘤组中性粒细胞与淋巴细胞比率的曲线下面积为0.711，截断值为1.78，灵敏度81.8%，特异度55.4%（AUC=0.711，P<0.001）；其与红细胞分布宽度联合应用时，具备最佳的鉴别诊断潜能，可作为辅助工具用于睾丸肿瘤的预测及其预后评估。结论：通过常规开展的经济实惠的血液检验获取的多项全身炎症标志物，可作为术前睾丸肿瘤标志物的辅助补充指标，提供增量式的预测与预后评估信息。