Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Sistemik İnflamatuar Belirteçlerin Post-Kemoterapi Retroperitoneal Rezidü Kitle Patolojisini Tahmin Etmedeki Rolü: Retrospektif Klinik Çalışma
The Role of Systemic Inflammatory Markers in Predicting Post-Chemotherapy Retroperitoneal Residual Mass Pathology: Retrospective Clinical Study
Abdullah GÜLa, Özgür EKİCİb, Salim ZENGİNa, Sinan AVCIc
aSağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Bursa, Türkiye
bNusaybin Devlet Hastanesi, Üroloji Kliniği, Mardin, Türkiye
cBursa Şehir Hastanesi, Üroloji Kliniği, Bursa, Türkiye
J Reconstr Urol. 2022;12(2):64-9
doi: 10.5336/urology.2022-89329
Article Language: TR
Full Text
ÖZET
 Amaç: Kemoterapi sonrası retroperitoneal lenf nodu diseksiyonu (RPLND) uygulanan metastatik seminom dışı germ hücreli testis tümörü (NSGCT) hastalarında, preoperatif inflamasyon belirteçleri (nötrofil/lenfosit oranı (NLR), platelet/lenfosit oranı (PLR)) ve görüntüleme bulgularının RPLND patolojisi ile ilişkili olup olmadığını araştırmaktır. Gereç ve Yöntemler: Kliniğimizde Ocak 2016-Şubat 2022 tarihleri arasında RPLND yapılmış hastalar geriye dönük tarandı. Preoperatif hematolojik ve biyokimyasal parametreler, bilgisayarlı tomografi (BT) bulguları, orşiektomi ve RPLND histopatoloji bulguları kaydedildi. Hastalar patolojisi canlı tümör/teratom olanlar Grup 1 ve benign (nekroz-fibroz) olanlar Grup 2 şeklinde ayrıldı. Gruplar arasında NLR, PLR, De Ritis oranı, serum tümör belirteçleri ve abdominopelvik BT'de saptanan ek büyük boyuttaki retroperitoneal lenf nodunun uzunluğu, hem orşiektomi öncesi, hem kemoterapi öncesi, hem de RPLND öncesi dönemlerde karşılaştırıldı. Bulgular: Toplamda13 hasta çalışmaya dahil edildi (Grup 1: 10 hasta, Grup 2: 3 hasta). Gruplar arasında yaş ortalaması benzerken, orşiektomi öncesi hematolojik ve serum belirteçleri açısından fark saptanmadı (p>0,05). Kemoterapi öncesi hematolojik ve serum belirteçleri 2 grupta da benzerken, abdominopelvik BT'deki en büyük lenfadenopati (LAP) boyutları Grup 1'de anlamlı düzeyde yüksekti (p=0,03). Benzer şekilde RPLND öncesi hematolojik ve serum belirteçleri 2 grupta da benzerken, abdominopelvik BT'deki en büyük LAP boyutları Grup 1'de anlamlı düzeyde yüksekti (p=0.03). Sonuç: RPLND tümör histolojisinin preoperatif öngörüsünde basit kan testlerinin kullanımı pratik gibi gözükse de, bu tahmin için henüz tümör boyutundan başka anlamlı parametre bulunamamıştır.

Anahtar Kelimeler: Nötrofil lenfosit oranı; platelet lenfosit oranı; De Ritis oranı; retroperitoneal tümörler; testis tümörleri
ABSTRACT
 Objective: To investigate whether preoperative inflammation markers (NLR, PLR) and imaging findings are associated with retroperitoneal lymph node dissection (RPLND) pathology in patients with metastatic non-seminomatous germ cell testicular tumor (NSGCT) who underwent RPLND after chemotherapy. Material and Methods: The data of the patients who underwent RPLND in our clinic between January 2016 and February 2022 were retrospectively analyzed. Preoperative hematological and biochemical parameters, computed tomography (CT) findings, orchiectomy and RPLND histopathology findings were recorded. The patients were divided into 2 groups according to RPLND pathology: Group 1 as viable tumor/teratoma and Group 2 as benign (necrosis-fibrosis) pathology. NLR, PLR, De Ritis ratio, serum tumor markers, and the length of the additional largest retroperitoneal lymph node detected on abdominopelvic CT between the groups were compared in the pre-orchiectomy, pre-chemotherapy and pre-RPLND periods. Results: A total of 13 patients were included in the study (Group 1: 10 patients and Group 2: 3 patients). While the mean age was similar between the groups, there was no difference in terms of hematological and serum markers before orchiectomy (p>0.05). While pre-chemotherapy hematological and serum markers were similar in both groups, the largest lymphadenopathy (LAP) sizes at abdominopelvic CT were significantly higher in Group 1 (p=0.03). Likewise, pre-RPLND hematological and inflammation markers were similar in both groups, while the largest LAP sizes at abdominopelvic CT were significantly higher in Group 1 (p=0.03). Conclusion: Although the use of blood test samples for preoperatively prediction of RPLND tumor histology seems practical, no significant parameter other than tumor size has yet been found.

Keywords: Neutrophil lymphocyte ratio; platelet lymphocyte ratio; De Ritis ratio; retroperitoneal neoplasms; testicular neoplasms
REFERENCES:
  1. Park JS, Kim J, Elghiaty A, Ham WS. Recent global trends in testicular cancer incidence and mortality. Medicine (Baltimore). 2018;97(37): e12390. [Crossref]  [PubMed]  [PMC] 
  2. Oldenburg J, Berney DM, Bokemeyer C, Climent MA, Daugaard G, Gietema JA, et al; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org; EURACAN. Testicular seminoma and non-seminoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33(4):362-75. [Crossref]  [PubMed] 
  3. Hendry WF, Norman AR, Dearnaley DP, Fisher C, Nicholls J, Huddart RA, et al. Metastatic nonseminomatous germ cell tumors of the testis: results of elective and salvage surgery for patients with residual retroperitoneal masses. Cancer. 2002;94(6):1668-76. [Crossref]  [PubMed] 
  4. Carver BS, Serio AM, Bajorin D, Motzer RJ, Stasi J, Bosl GJ, et al. Improved clinical outcome in recent years for men with metastatic nonseminomatous germ cell tumors. J Clin Oncol. 2007;25(35):5603-8. [Crossref]  [PubMed] 
  5. Templeton AJ, McNamara MG, ?eruga B, Vera-Badillo FE, Aneja P, Oca-a A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124. [Crossref]  [PubMed] 
  6. Gokcen K, Dundar G, Gulbahar H, Gokce G, Gultekin EY. Can routine peripheral blood counts like neutrophil-to-lymphocyte ratio be beneficial in prediagnosis of testicular cancer and its stages? J Res Med Sci. 2018;23:64. [Crossref]  [PubMed]  [PMC] 
  7. Ribnikar D, Stukalin I, Bedard PL, Hamilton RJ, Jewett M, Warde P, et al. The prognostic value of neutrophil-to-lymphocyte ratio in metastatic testicular cancer. Curr Oncol. 2020;28(1):107-14. [Crossref]  [PubMed]  [PMC] 
  8. Arıman A, Merder E. The prognostic importance of neutrophil-to-lymphocyte ratio in testicular cancer. Urologia. 2021;88(3):200-5. [Crossref]  [PubMed] 
  9. Gorgel SN, Akin Y, Koc EM, Kose O, Ozcan S, Yilmaz Y. Impact of increased aspartate aminotransferase to alanine aminotransferase (De Ritis) ratio in prognosis of testicular cancer. Investig Clin Urol. 2019;60(3):169-75. [Crossref]  [PubMed]  [PMC] 
  10. Guner E, Seker KG, Arikan Y, Huseynov C, Sam E, Ozdal OL. The utility of De Ritis Ratio in predicting prognosis in testicular cancer. Aktuelle Urol. 2020;51(3):285-9. [Crossref]  [PubMed] 
  11. Heidenreich A, Pfister D, Witthuhn R, Thüer D, Albers P. Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection. Eur Urol. 2009;55(1):217-24. [Crossref]  [PubMed] 
  12. Can C. Complications of surgical treatment in testicular cancers. Bulletin of Urooncology. 2008;3. [Link] 
  13. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436-44. [Crossref]  [PubMed] 
  14. Dennis LK, Lynch CF, Torner JC. Epidemiologic association between prostatitis and prostate cancer. Urology. 2002;60(1):78-83. [Crossref]  [PubMed] 
  15. Lin XC, Gao X, Lu GS, Song B, Zhang QH. Role of calcifying nanoparticles in the development of testicular microlithiasis in vivo. BMC Urol. 2017;17(1):99. [Crossref]  [PubMed]  [PMC] 
  16. Grivennikov SI, Karin M. Inflammation and oncogenesis: a vicious connection. Curr Opin Genet Dev. 2010;20(1):65-71. [Crossref]  [PubMed]  [PMC] 
  17. Rouprêt M, Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2020 Update. Eur Urol. 2021;79(1):62-79. [Crossref]  [PubMed] 
  18. Yuksel OH, Verit A, Sahin A, Urkmez A, Uruc F. White blood cell counts and neutrophil to lymphocyte ratio in the diagnosis of testicular cancer: a simple secondary serum tumor marker. Int Braz J Urol. 2016;42(1):53-9. [Crossref]  [PubMed]  [PMC] 
  19. Tan YG, Sia J, Huang HH, Lau WKO. Neutrophil-to-lymphocyte ratio independently predicts advanced pathological staging and poorer survival outcomes in testicular cancer. Investig Clin Urol. 2019;60(3):176-83. [Crossref]  [PubMed]  [PMC] 
  20. Şahin A, Toprak T, Kutluhan MA, Vural Y, Ürkmez A, Verit A. Increased neutrophil/lymphocyte ratio in testicular cancer. Arch Ital Urol Androl. 2019;91(2). [Crossref]  [PubMed] 
  21. Ilktac A, Dogan B, Ersoz C, Akcay M, Akbulut H. The relationship of neutrophil to lymphocyte ratio with testicular cancer. Int Braz J Urol. 2020;46(1):101-7. [Crossref]  [PubMed]  [PMC] 
  22. Bauzá Quetglas JL, Tienza Fernández A, Bertolo R, Sabaté Arroyo XA, Guimerà García J, Tubau Vida-a V, et al. The prognostic value of the neutrophil-to-lymphocyte ratio in patients with testicular cancer. Prog Urol. 2020;30(5):273-80. [Crossref]  [PubMed] 
  23. Bolat D, Aydoğdu Ö, Polat S, Yarımoğlu S, Bozkurt İH, Yonguç T, et al. Predictive value of preoperative neutrophil-to-lymphocyte ratio on the prognosis of germ cell testicular tumors. Turk J Urol. 2017;43(1):55-61. [Crossref]  [PubMed]  [PMC] 
  24. Fankhauser CD, Sander S, Roth L, Gross O, Eberli D, Sulser T, et al. Systemic inflammatory markers have independent prognostic value in patients with metastatic testicular germ cell tumours undergoing first-line chemotherapy. Br J Cancer. 2018;118(6):825-30. [Crossref]  [PubMed]  [PMC] 
  25. De Ritis F, Coltorti M, Giusti G. An enzymic test for the diagnosis of viral hepatitis; the transaminase serum activities. Clin Chim Acta. 1957;2(1):70-4. [Crossref]  [PubMed] 
  26. Su S, Liu L, Li C, Zhang J, Li S. Prognostic role of pretreatment de ritis ratio (aspartate transaminase/alanine transaminase ratio) in urological cancers: a systematic review and meta-analysis. Front Oncol. 2020;10:1650. [Crossref]  [PubMed]  [PMC] 
  27. Olcucu MT, Karamik K, Yilmaz K, Okuducu Y, Cakir S, Ates M. Preoperative inflammation markers and de ritis ratio in predicting clinical presentation and prognosis of patients with testicular germ cell tumors. J Coll Physicians Surg Pak. 2020;30(10):1041-6. [Crossref]  [PubMed] 
  28. Winter C, Pfister D, Busch J, Bingöl C, Ranft U, Schrader M, et al. Residual tumor size and IGCCCG risk classification predict additional vascular procedures in patients with germ cell tumors and residual tumor resection: a multicenter analysis of the German Testicular Cancer Study Group. Eur Urol. 2012;61(2):403-9. [Crossref]  [PubMed] 
  29. Vergouwe Y, Steyerberg EW, Foster RS, Sleijfer DT, Fosså SD, Gerl A, det al. Predicting retroperitoneal histology in postchemotherapy testicular germ cell cancer: a model update and multicentre validation with more than 1000 patients. Eur Urol. 2007;51(2):424-32. [Crossref]  [PubMed] 
  30. Leão R, Nayan M, Punjani N, Jewett MAS, Fadaak K, Garisto J, et al. A new model to predict benign histology in residual retroperitoneal masses after chemotherapy in nonseminoma. Eur Urol Focus. 2018;4(6):995-1001. [Crossref]  [PubMed] 

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