膀胱癌的预后与膀胱肿瘤的分期、分级、大小、多少、部位、年龄、复发时间和频率、有无原位癌等多种因素密切相关。其中肿瘤分级、分期在预后因素中占有重要地位，即便于此，仍然有新的预后标志物被发现，这些标志物要么检测价格昂贵，非高富帅所能承受，要么复杂难懂，需专业人员解释。来自西班牙的一个泌尿外科团队在本次EAU会议上介绍了他们的最新研究，通过计算患者中性粒细胞淋巴细胞比率（NLR）来预测全膀胱术后膀胱癌患者的预后，而NLR只需要通过临床最常用的血常规即可得出，方法简便易行，几乎不增加患者医疗费用。

　　该研究剔除术前、术后接受化疗以及存在感染因素等可能影响中性粒细胞和淋巴细胞数目的患者后，共回顾了93例全膀胱术后的膀胱癌患者，以NLR 2.7为临界值，将该值与其它诸如肿瘤分期、淋巴结转移范围、神经浸润、手术切缘和按年龄调整的死亡率等已确立的预后指标进行比较。研究发现术前术后NLR>2.7的患者中位生存期分别为29.6月（20.9~38.2月）和26.5月（19.0 ~ 34.1月），而术前术后NLR<2.7的患者中位生存期分别为39.5月（29.3 ~49.6月）和52.4月（40.8 ~ 63.9月）。研究结果认为术后NLR>2.7与患者中位生存期缩短相关，换句话说就是术后NLR>2.7的患者预后较差，该研究中术后NLR<2.7患者中位生存期接近于NLR>2.7患者的两倍。

　　中性粒细胞和淋巴细胞均属于白细胞，是机体抵抗外界刺激的重要组成部分，但他们有各自的特征。中性粒细胞是机体对抗感染的前锋和第一道防线，当机体受到微生物的侵入时，中性粒细胞能够吞噬并消化细菌。而淋巴细胞是机体免疫应答的重要细胞，主要通过诱导机体免疫反应杀伤效应细胞。当机体发生肿瘤性病变时，肿瘤周围浸润的中性粒细胞和淋巴细胞起一定的保护作用，随着肿瘤的进展，中性粒细胞和淋巴细胞的保护作用受到抑制或失效，平衡被打破，肿瘤变得不可抑制，甚至出现转移。该研究利用临床上最常见的检验指标中性粒细胞和淋巴细胞的比率来评估患者的预后可谓推陈出新、旧物新用，而且简便、便宜，是对预后因素评估指标的良好补充。

耿江  博士

　　医学博士，上海市第十人民医院泌尿外科主治医师，硕士生导师，毕业于复旦大学附属华山医院泌尿外科，美国北卡罗来纳州立大学教堂山分校博士后，美国杜克大学访问学者。目前承担国家自然科学基金及教育部博士点基金各一项，先后在国际知名杂志oncotarget等杂志发表文章10余篇。主攻膀胱肿瘤的诊治和前列腺癌的基础研究及临床治疗。

　　研究摘要

1044 Neutrophil-to-lymphocyte ratio as a prognostic factor for survival in patients with bladder cancer undergoing radical cystectomy

Jiménez Marrero P. ， Perez Sanchez M. ， Jorge Pérez N. ， González J.M. ， Kim Lee D. ， Marrero Umpierrez N. ， Hernández Hernández C. ， Hernández Escobar S. ， Marrero Dominguez R.

Introduction & Objectives：The inflammatory pathway may have an important role at the progression of multiple types of tumours. Recent studies have demonstrated the prognostic value in survival of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood samples.To assess the association between NLR and overall survival (OS) in patients undergoing radical cystectomy (RC) for bladder cancer.

Material & Methods：We performed a retrospective analysis of patients undergoing RC between 2010 and 2015 at our centre. The NLR data was gathered in peripheral blood samples one month prior RC and 4 months after surgical procedure. All patients treated with adjuvant or neoadjuvant chemotherapy were excluded as well as anyone with any infectious event. The cut off value was agreed on 2.7 for both ratios following previous studies upon this matter. The ratio results were then compared with other established survival variables such as Tumour stage and nodal stage， extracapsular nodalextension， perineural invasion， surgical margins and Age-adjusted Charlson Comorbidity index. SPSS v21 for windows was used for the analysis.

Results：A total of 93 patients met the inclusion criteria. Groups were comparable. Same number of patients 40 (43%) showed a NLR> 2.7 before and after RC. None of the other variables included in the study showed a statistically significant relationship with the ratios. The mean overall survival was 29.6 (20.9 - 38.2) and 26.5 (19.0-34.1) months for NLR>2.7 before and after RC respectively. Moreover for NLR < 2.7 mean overall survival was 39.5 (29.3-49.6) and 52.4 (40.8-63.9) months before and after RC respectively.

Conclusions：A high NLR after RC is associated with an adverse OS. The NLR is a readily available and inexpensive biomarker， and its addition to established prognostic scores for clinical decision making warrants further investigation. This study is in our knowledge the first study that analysed at the same cohort the NLR before and after RC.