Clinical Analysis Of Related Factors Affecting The Prognosis Of Concurrent Chemoradiotherapy For Local Advanced Cervical Squamous Cell Carcinoma

Objective: To investigate the factors affecting the prognosis of concurrent chemoradiotherapy for local advanced cervical squamous cell carcinoma(FIGO stage II to III).In this study,we aimed to provide theoretical basis for predicting prognosis and individualized treatment for patients with cervical squamous cell carcinomaMethods: A retrospective analysis of 161 patients with locally advanced cervical squamous cell carcinoma(FIGO stage II to III)confirmed by histopathology who treated with concurrent chemoradiotherapy from January 1,2013 to August 31,2015 in Liaoning Cancer Hospital was conducted.The predictive indicators related to the prognosis of concurrent advanced chemoradiotherapy for locally advanced cervical squamous cell carcinoma was analyzed.Results: The age range of 161 patients was from 27 to 79 years,with an average age of 53 years.The overall follow-up time was from 8.5 months to 91.8 months and the median follow-up time was 52.1 months.There were 74 patients(46.0%)in FIGO stage II patients and 87 patients(54.0%)in stage III patients.Hematological indicators: The average value of Neutrophil to Lymphocyte Ratio(NLR)is 2.95(0.63-8.85);the average value of Platelet to Lymphocyte Ratio(PLR)is 182.74(53.06-675.00).According to Receiver Operating Characteristic(ROC)curve,the optimal cut-off value of NLR predicting overall survival rate(OS)and progression-free survival rate(PFS)for patients are 2.42(OS: AUC = 0.620,sensitivity is 72.5%,specificity is 50.9%,P = 0.015;PFS: AUC = 0.614,sensitivity is 69.4%,specificity is 53.9%,P = 0.013).The optimal cut-off value of PLR for predicting OS was 149.55(AUC=0.618,sensitivity is 76.5%,specificity is 47.3%,P=0.016).The optimal cut-off value of PLR for predicting PFS was 110.76(AUC = 0.589,sensitivity is 93.1%,specificity is 24.7%,P = 0.051).No correlation was found between age,number of childbirths,family history of tumors,tumor size,tumor appearance,pelvic lymph node metastasis and parauterine involvement in the prognosis of cervical cancer.Univariate analysis showed that the 3-year OS and 3-year PFS of the low NLR(≤2.42)group were higher than those of the high NLR(>2.42)group(OS: 84.1% VS 67.0%,P = 0.009;PFS: 73.9 % VS 49.5%,P = 0.008);The 3-year OS and PFS of the low PLR group were significantly higher than those of the high PLR group(OS(≤149.55 group VS >149.55 group): 84.4% VS 67.0%,P = 0.008;PFS(≤110.76 group VS >110.76 group): 83.3% VS 54.1%,P = 0.008).Other factors: FIGO stage II and III cervical squamous cell carcinoma patients’ survival rate decreases as the stage increases(OS: 85.1% VS 64.0%,P = 0.001;PFS: 70.3% VS 51.2%,P = 0.021);The survival rate of cervical squamous cell carcinoma patients increased with the degree of differentiation(OS: 50.0% VS 77.9% VS 84.9%,P <0.001;PFS: 37.5% VS 66.2% VS 77.4%,P <0.001);the survival rate of the low CA125(<35.0U/m L)group was significantly higher than the high CA125(>35.0U/m L)group(OS: 84.4% VS 59.4%,P = 0.004;PFS: 69.8% VS 43.8%,P = 0.004).In Cox survival regression analysis,PLR is an independent factor that affects the overall survival time in advanced cervical squamous cell carcinoma undergoing concurrent chemoradiotherapy(HR = 2.423,P = 0.026)and the independent prognosis of overall survival rate of concurrent chemoradiotherapy in advanced cervical squamous cell carcinoma factors included FIGO stage,degree of differentiation and CA125.Only the degree of differentiation is an independent prognostic factor affecting the progressionfree survival of cervical squamous cell carcinoma.In this study,NLR had no independent predictive effect on the prognosis of locally advanced cervical squamous cell carcinoma treated with concurrent chemoradiotherapy.Conclusion: This study found that PLR,FIGO stage,differentiation degree and CA125 are independent prognostic factors in patients with locally advanced cervical squamous cell carcinoma undergoing concurrent chemoradiotherapy.Only the degree of differentiation is the independent factor that affects disease-free survival of the patients.We found that PLR was not independent factor effecting on prognosis of concurrent chemoradiotherapy in patients with locally advanced cervical squamous cell carcinoma.Compared with NLR,PLR may have a greater effect on the prognosis of patients with locally advanced cervical squamous cell carcinoma.PLR is easy to detect and obtain in clinical practice.It can be used to comprehensively assess the prognosis of cervical cancer risk stratification and detection with other factors such as FIGO stage.Patients with poor prognosis can be closely followed up and discovered the occurrence of adverse outcomes early in order to improve the survival time and quality of life of patients.