Murat AKAND, Ali Furkan BATUR, Muhammed Furkan AYDOĞAN, Muslu Kazım KÖREZ, Murat GÜL, Mehmet KAYNAR, Özcan KILIÇ, Serdar GÖKTAŞ

Non-metastatik berrak hücreli renal karsinomalı hastalarda De Ritis oranı (aspartat aminotransaminaz/ alanin aminotransaminaz) ve sistemik inflamatuar belirteçlerin prognostik değeri

Amaç: Bu çalışmada cerrahi olarak tedavi edilen nonmetastatik berrak hücreli renal hücreli karsinom (bhRHK) olgularının preoperatif aspartat aminotransaminaz/alanin aminotransaminaz (De Ritis Oranı - DRO) değerinin prognozu etkileyip etkilemediği ve histopatolojik değişkenlerle ilişkisi değerlendirilmiştir. İkinci amaç da, aynı grup hastalarda nötrofil lenfosit oranı (NLO), trombosit lenfosit oranı (PLO) ve lenfosit monosit oranı (LMO) değerleri ile prognoz ve progresyonsuz sağkalım (PS) arasındaki ilişkiyi değerlendirmekti. Gereç ve Yöntemler: Kliniğimizde 2009-2019 yılları arasında parsiyel veya radikal nefrektomi uygulanan 118 metastatik olmayan bhRHK vakasının tıbbi kayıtları incelenerek çalışmaya alındı. DRO, NLO, PLO ve LMO ve gruplar arasındaki progresyon farkını değerlendirmek için log-rank testleri ile Kaplan-Meier analizi yapıldı. Ayrıca, progresyon öngörücülerini belirlemek için tek ve çok değişkenli Cox regresyon analizleri yapıldı. Bulgular: Hastaların %22,9'unda metastaz ve %6'sında lokal nüks saptandı. Ortanca takip süresi 26 aydı. Tek değişkenli Cox regresyon analizi, tümör boyutunun, invazyon (varlığı), patolojik evre (3+4) ve NLO seviyesinin (≥ 1,98) PS için istatistiksel olarak anlamlı öngörücüler olduğunu gösterdi. Ancak DRO, PS için istatistiksel olarak anlamlı bir öngörücü değildi (p>.05). Tartışma ve Sonuç: bhRHK prognozunda prediktif parametre olarak DRR değeri için anlamlı bir değer bulamadık. Ancak, NLO'deki artış kötü prognoz ile ilişkili bulundu. Bu nedenle prediktif nomogramlarda NLO kullanımı prognozun belirlenmesine olumlu katkı sağlayabilir.

Anahtar Kelimeler:

De Ritis oranı, Berrak hücreli, Renal hücreli kanser, Böbrek kanseri

Prognostic value of De Ritis Ratio (aspartate aminotransaminase/ alanine aminotransaminase) and Systemic Inflammatory Markers in patients with non-metastatic clear cell renal cell carcinoma

Aim: This study evaluates whether the preoperative aspartate aminotransaminase/ alanine aminotransaminase (De Ritis Ratio - DRR) value affects the prognosis and has a relationship with histopathological variables of non-metastatic clear cell renal cell carcinoma (ccRCC) cases surgically treated. The second aim was to assess the association between neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR) values with prognosis, and progression-free survival (PFS) in the same group of patients. Materials and Methods: We reviewed the medical records of 118 non-metastatic ccRCC cases that underwent partial or radical nephrectomy (2009-2019). Kaplan-Meier analysis with log-rank tests was performed to evaluate the difference in progression between DRR, NLR, PLR, and LMR and groups. Moreover, univariate and multiple Cox proportional hazard analyses were performed to identify the predictors of progression. Results: Metastases and local recurrence were detected in 22.9% and 6% of the patients, respectively. Our median follow-up period was 26 months. The univariate Cox regression analysis was showed that the tumor size, invasion (presence), pathological stage (3+4), and NLR level (≥ 1.98)) were statistically significant predictors for PFS. However, DRR was no statistically significant predictor for PFS (p>.05). Conclusion: We did not find any significant value for the DRR value as a predictive parameter in ccRCC prognosis. The increase in NLR is associated with a poor prognosis. Therefore, the use of NLR in predictive nomograms may contribute positively to the determination of prognosis.

Keywords:

De Ritis ratio; clear cell; renal cell cancer; kidney cancer; prognosis,

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