To Investigate The Relationship Between Lymphovascular Invasion And Preoperative NLR And LMR In Colorectal Cancer Without Distant Metastasis

Background and ObjectiveIn the past 10 years,the relationship between tumor and inflammation has been a hot spot for clinical researchers.Inflammatory cells that are unbalanced in the body can participate in the formation of the tumor microenvironment and promote its spread.The neutrophils and monocytes infiltrating in the tumor environment can promote the formation of tumor blood vessels and assist in the invasion and metastasis of cancer cells.The reduction of lymphocytes in tumor tissue and surrounding causes the immune system to weaken the ability to recognize cancer cells and promote its infiltration of lymph nodes and surrounding tissues.A large number of clinical reports have found that higher neutrophil to lymphocyte ratio(NLR),lower lymphocyte to monocyte ratio(LMR)are associated with metastasis and poor prognosis of multiple malignancies.This study was designed to investigate the relationship between preoperative neutrophil lymphocyte ratio,lymphocyte-monocyte ratio and postoperative pathological findings of lymphovascular invasion in colorectal cancer without distant metastasis.Materials and MethodsA retrospective analysis of 214 patients with radical surgery for colorectal cancer from January 2014 to October 2018 in the Department of General Surgery,Second Affiliated Hospital of Zhengzhou University.Preoperative neutrophil count,lymphocyte count,and monocyte count were obtained.The patient’s pathological information was collected,and according to the presence or absence of lymphovascular invasion,it was divided into 56 cases with lymphovascular invasion group and 158 cases with non-lymphovascular invasion group;receiver operating characteristic curve(ROC curve)was done by using SPSS,and the most approximated Youden index obtained NLR and LMR thresholds;the patients were divided into high NLR group and low NLR group,high LMR group and low LMR group by threshold to explore the relationship between NLR and LMR and postoperative pathological factors.single factor and multivariate analysis vessels The relationship between tumor thrombus and preoperative NLR,LMR and clinical pathological data.We used the univariate and multivariate analytical method to calculate the relationship between lymphovascular invasion and preoperative NLR,LMR and other clinical or pathological data.Results(1)From the ROC curve,the threshold of NLR and LMR are 2.71 and 2.99,respectively.According to the threshold,the high NLR group and the low NLR group,the high LMR group and the low LMR group are classified.(2)The difference was statistically significant in preoperative high NLR group and low NLR group in tumor long diameter,T stage,N stage and TNM stage(P<0.05).There were no differences in primary site,differentiation degree and pathological type(P>0.05).The difference was statistically significant in tumor long diameter,T-stage,N-stage and TNM staging between high LMR group and low LMR group(P<0.05).There were no significant differences in primary site,differentiation degree and pathological type(P>0.05).(3)In the single factor analysis,the long diameter,differentiation,T stage,N stage,preoperative high NLR and preoperative low LMR were significantly associated with vascular invasion(P<0.05).There was no significant correlation between age,gender,history of hypertension,history of diabetes,history of chronic hepatitis,primary site,pathological type,CEA,CA19-9 and lymphovascular invasion(P>0.05).In multivariate logistic regression analysis,T stage,N stage,preoperativehigh NLR and low LMR were independent risk factors for lymphovascular invasion in patients with colorectal cancer.Conclusions(1)Preoperative high NLR and low LMR suggest that patients with CRC have a higher risk of lymphovascular invasion,which can improve the accuracy of preoperative judgment of vascular invasion.(2)NLR and LMR values are easy to obtain,easy to operate,and economical.Preoperative high NLR and low LMR values suggest a late clinical stage.(3)For patients with stage II CRC who did not have significant lymph node metastasis,it was suggested that there is no lymphovascular invasion to provide recommendations for preoperative adjuvant treatment of CRC.(4)Knowledge of the correlation of NLR and LMR with CRC lymphovascular invasion may have support in CRC prevention.