Abstract:

Objective　To assess the value of preoperative white blood cell to lymphocyte ratio (WLR) and p16 protein expression in the prediction of the survival outcomes of patients with penile cancer. Methods　This study is a retrospective cohort study. Ninety-one patients with penile cancer admitted to Xianyang First People's Hospital from January 2018 to January 2020 were selected as the study objects. All the patients took partial penectomy, and were followed up for 3 years after the surgery. According to their prognosis, they were divided into a survival group (58 cases) and a death group (33 cases). The survival group were (61.12±7.13) years old. The death group were (60.88±7.22) years old. The basic information and preoperative imaging results (tumor location, biggest tumor diameter, nerve invasion, lymph node metastasis, and cell differentiation) were compared between the two groups. The levels of vascular endothelial growth factor (VEGF) and tumor necrosis factor receptor-associated protein 1 (TRAP1) were detected. The p16 protein expression was assessed. The preoperative white blood cell to lymphocyte ratio (WLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) were calculated. The logistic regression analysis was employed to assess the determinants influencing patient survival. The predictive value of WLR and p16 for postoperative death in the patients was assessed by the receiver operating characteristic curve (ROC). t and χ² tests were applied. Results　There were no statistical differences in the basic information, tumor location, biggest tumor diameter, and cell differentiation between the two groups (all P>0.05). The proportions of the patients with nerve invasion, lymph node metastasis, and positive p16 protein expression in the death group were higher than those in the survival group [63.64% (21/33) vs. 32.76% (19/58), 57.58% (19/33) vs. 31.03% (18/58), and 66.67% (22/33) vs. 32.76% (19/58)], with statistical differences (χ²=8.140, 6.141, and 9.769; all P<0.05). The WLR, NLR, PLR, MLR, and levels of VEGF and TRAPl in the death group were higher than those in the survival group [(5.62±0.91) vs. (4.11±0.75), (5.27±0.88) vs. (3.91±0.71), (181.06±25.13) vs. (145.32±20.64), (0.58±0.20) vs. (0.32±0.12), (539.03±52.48) ng/L vs. (442.18±47.36) ng/L, and (58.01±6.63) ng/L vs. (45.25±5.82) ng/L], with statistical differences (t=8.537, 8.044, 7.331, 7.761, 9.016, and 9.556; all P<0.05). The logistic regression analysis indicated that preoperative nerve invasion, lymph node metastasis, p16 protein, VEGF, TRAPl, WLR, NLR, PLR, and MLR were important factors affecting the patients' prognosis (all P<0.05). The ROC demonstrated that the combination of WLR and p16 protein expression had a predictive accuracy of 0.943 (0.896-0.990) for patient death. Conclusion　Preoperative measurement of WLR and p16 can help assess the postoperative survival outcomes of patients with penile cancer.

Key words:

Penile cancer,  , Partial penectomy,  , White blood cell to lymphocyte ratio, p16 protein, Diagnostic efficacy

摘要：

目的　评估术前白细胞与淋巴细胞比值（WLR）及p16蛋白表达检测对阴茎癌患者生存情况的预测价值。方法　本研究为回顾性队列研究，选取2018年1月至2020年1月在咸阳市第一人民医院治疗的91例阴茎癌患者作为研究对象，所有患者均行阴茎部分切除术，术后对患者进行为期3年的随访，根据预后情况分为生存组（58例）和死亡组（33例）。生存组年龄（61.12±7.13）岁；死亡组年龄（60.88±7.22）岁。对比两组患者基线资料及术前影像学检查结果（肿瘤部位、肿瘤长径、神经侵犯、淋巴结转移、分化程度），测定血管内皮生长因子（VEGF）、肿瘤坏死因子受体相关蛋白1 （TRAP1），并检测切除组织中p16蛋白表达情况，计算术前WLR、外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）。通过logistic回归分析评估患者生存情况的影响因素，并利用受试者操作特征曲线（ROC）评估WLR联合p16蛋白表达对阴茎癌患者术后死亡的预测价值。统计学方法采用t检验、χ²检验。结果　两组患者基线资料及肿瘤部位、肿瘤长径、分化程度比较，差异均无统计学意义（均P>0.05）。死亡组神经侵犯、淋巴结转移及p16蛋白阳性表达占比均高于生存组［63.64%（21/33）比32.76%（19/58）、57.58%（19/33）比31.03%（18/58）、66.67%（22/33）比32.76%（19/58）］，差异均有统计学意义（χ²=8.140、6.141、9.769，均P<0.05）。死亡组患者术前WLR、NLR、PLR、MLR及VEGF、TRAPl水平均高于生存组［（5.62±0.91）比（4.11±0.75）、（5.27±0.88）比（3.91±0.71）、（181.06±25.13）比（145.32±20.64）、（0.58±0.20）比（0.32±0.12）、（539.03±52.48）ng/L比（442.18±47.36）ng/L、（58.01±6.63）ng/L比（45.25±5.82）ng/L］，差异均有统计学意义（t=8.537、8.044、7.331、7.761、9.016、9.556，均P<0.05）。logistic回归分析显示，阴茎癌患者术前肿瘤神经侵犯和淋巴结转移情况，以及p16蛋白、VEGF、TRAPl、WLR、NLR、PLR、MLR均是影响其预后的重要因素（均P<0.05）。ROC显示，WLR联合p16蛋白表达对患者死亡的预测准确度为0.943（0.896～0.990）。结论　术前检测WLR及p16蛋白表达有助于评估阴茎癌患者术后生存情况。

关键词:

阴茎癌, 阴茎部分切除术, 白细胞与淋巴细胞比值, p16蛋白, 诊断效能