Giacomo Musso, Natalie Birouty, Andrea Salonia, Giuseppe Garofano, Mai Dabbas, Margaret F Meagher, Kit L Yuen, Benjamin Baker, Cesare Saitta, Dattatraya Patil, Hajime Tanaka, Masaki Kobayashi, Shohei Fukuda, Francesco Montorsi, Alberto Briganti, Umberto Capitanio, Alessandro Larcher, Giuseppe Rosiello, Yasuhisa Fujii, Viraj A Master, Ithaar H Derweesh
{"title":"中性粒细胞与淋巴细胞、血小板与淋巴细胞和肾炎细胞比值升高与肾癌术后主要并发症的关系：优化Charlson合并症指数和术前预测模型的途径","authors":"Giacomo Musso, Natalie Birouty, Andrea Salonia, Giuseppe Garofano, Mai Dabbas, Margaret F Meagher, Kit L Yuen, Benjamin Baker, Cesare Saitta, Dattatraya Patil, Hajime Tanaka, Masaki Kobayashi, Shohei Fukuda, Francesco Montorsi, Alberto Briganti, Umberto Capitanio, Alessandro Larcher, Giuseppe Rosiello, Yasuhisa Fujii, Viraj A Master, Ithaar H Derweesh","doi":"10.1016/j.urology.2025.06.052","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the predictive value of De Ritis ratio (DRR), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) for major post-operative complications following Renal Cell Carcinoma (RCC) surgery, and to assess their predictive utility in addition to Charlson Comorbidity Index (CCI).</p><p><strong>Methods: </strong>We conducted a multicenter retrospective analysis of patients who underwent surgery for M0 RCC. Primary outcome was the occurrence of major complication (Clavien-Dindo >2). Optimal thresholds for DRR, NLR, and PLR were identified using Akaike Information Criterion (AIC). Multivariable logistic regression (MVA) assessed associations between biomarkers and complications, adjusting for CCI, estimated glomerular filtration rate (eGFR), tumor size, surgery type, pT/pN stage, R.E.N.A.L. score. Predictive performance was evaluated using the Area under Curves (AUC) from ROC curves. Internal validation was performed with 1000-sample bootstrapping.</p><p><strong>Results: </strong>Among 4122 patients, 198 (4.8%) experienced major complications [urinary leak (n = 90, 35.7% of all major complications), bleeding/hematoma (n = 38, 15.1%), and cardiac events (n = 15, 6.0%)]. AIC identified thresholds of 2.3 for elevated DRR (EDRR), 2.7 for NLR (ENLR), and 200 for PLR (EPLR). 191 (4.6%), 1243 (30.2%), and 684 (16.6%) patients had elevated EDRR, ENL, and EPLR. On MVA, all three biomarkers independently predicted major complications: EDRR [Odds ratio (OR) = 3.06, P = .02], ENLR (OR = 1.25, P = .01), EPLR (OR = 1.30, P = .01). AUCs were 0.63 for CCI alone, 0.77 with additional covariates, and 0.85 for the model with all biomarkers. Bootstrapped AUC for the full model was 0.77.</p><p><strong>Conclusion: </strong>Preoperative DRR, NLR, and PLR improve prediction of major complications after RCC surgery in addition to CCI. Our findings point towards an enhanced model to risk stratify and optimize patient outcomes in RCC surgery.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Elevated Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte, and De Ritis Ratios With Major Complications After Surgery for Renal Cell Carcinoma: A Pathway to Optimize Charlson Comorbidity Index and Preoperative Predictive Modeling.\",\"authors\":\"Giacomo Musso, Natalie Birouty, Andrea Salonia, Giuseppe Garofano, Mai Dabbas, Margaret F Meagher, Kit L Yuen, Benjamin Baker, Cesare Saitta, Dattatraya Patil, Hajime Tanaka, Masaki Kobayashi, Shohei Fukuda, Francesco Montorsi, Alberto Briganti, Umberto Capitanio, Alessandro Larcher, Giuseppe Rosiello, Yasuhisa Fujii, Viraj A Master, Ithaar H Derweesh\",\"doi\":\"10.1016/j.urology.2025.06.052\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the predictive value of De Ritis ratio (DRR), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) for major post-operative complications following Renal Cell Carcinoma (RCC) surgery, and to assess their predictive utility in addition to Charlson Comorbidity Index (CCI).</p><p><strong>Methods: </strong>We conducted a multicenter retrospective analysis of patients who underwent surgery for M0 RCC. Primary outcome was the occurrence of major complication (Clavien-Dindo >2). Optimal thresholds for DRR, NLR, and PLR were identified using Akaike Information Criterion (AIC). Multivariable logistic regression (MVA) assessed associations between biomarkers and complications, adjusting for CCI, estimated glomerular filtration rate (eGFR), tumor size, surgery type, pT/pN stage, R.E.N.A.L. score. Predictive performance was evaluated using the Area under Curves (AUC) from ROC curves. Internal validation was performed with 1000-sample bootstrapping.</p><p><strong>Results: </strong>Among 4122 patients, 198 (4.8%) experienced major complications [urinary leak (n = 90, 35.7% of all major complications), bleeding/hematoma (n = 38, 15.1%), and cardiac events (n = 15, 6.0%)]. AIC identified thresholds of 2.3 for elevated DRR (EDRR), 2.7 for NLR (ENLR), and 200 for PLR (EPLR). 191 (4.6%), 1243 (30.2%), and 684 (16.6%) patients had elevated EDRR, ENL, and EPLR. On MVA, all three biomarkers independently predicted major complications: EDRR [Odds ratio (OR) = 3.06, P = .02], ENLR (OR = 1.25, P = .01), EPLR (OR = 1.30, P = .01). AUCs were 0.63 for CCI alone, 0.77 with additional covariates, and 0.85 for the model with all biomarkers. Bootstrapped AUC for the full model was 0.77.</p><p><strong>Conclusion: </strong>Preoperative DRR, NLR, and PLR improve prediction of major complications after RCC surgery in addition to CCI. Our findings point towards an enhanced model to risk stratify and optimize patient outcomes in RCC surgery.</p>\",\"PeriodicalId\":23415,\"journal\":{\"name\":\"Urology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-06-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.urology.2025.06.052\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urology.2025.06.052","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Association of Elevated Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte, and De Ritis Ratios With Major Complications After Surgery for Renal Cell Carcinoma: A Pathway to Optimize Charlson Comorbidity Index and Preoperative Predictive Modeling.
Objective: To evaluate the predictive value of De Ritis ratio (DRR), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) for major post-operative complications following Renal Cell Carcinoma (RCC) surgery, and to assess their predictive utility in addition to Charlson Comorbidity Index (CCI).
Methods: We conducted a multicenter retrospective analysis of patients who underwent surgery for M0 RCC. Primary outcome was the occurrence of major complication (Clavien-Dindo >2). Optimal thresholds for DRR, NLR, and PLR were identified using Akaike Information Criterion (AIC). Multivariable logistic regression (MVA) assessed associations between biomarkers and complications, adjusting for CCI, estimated glomerular filtration rate (eGFR), tumor size, surgery type, pT/pN stage, R.E.N.A.L. score. Predictive performance was evaluated using the Area under Curves (AUC) from ROC curves. Internal validation was performed with 1000-sample bootstrapping.
Results: Among 4122 patients, 198 (4.8%) experienced major complications [urinary leak (n = 90, 35.7% of all major complications), bleeding/hematoma (n = 38, 15.1%), and cardiac events (n = 15, 6.0%)]. AIC identified thresholds of 2.3 for elevated DRR (EDRR), 2.7 for NLR (ENLR), and 200 for PLR (EPLR). 191 (4.6%), 1243 (30.2%), and 684 (16.6%) patients had elevated EDRR, ENL, and EPLR. On MVA, all three biomarkers independently predicted major complications: EDRR [Odds ratio (OR) = 3.06, P = .02], ENLR (OR = 1.25, P = .01), EPLR (OR = 1.30, P = .01). AUCs were 0.63 for CCI alone, 0.77 with additional covariates, and 0.85 for the model with all biomarkers. Bootstrapped AUC for the full model was 0.77.
Conclusion: Preoperative DRR, NLR, and PLR improve prediction of major complications after RCC surgery in addition to CCI. Our findings point towards an enhanced model to risk stratify and optimize patient outcomes in RCC surgery.
期刊介绍：
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
