Analysis Of The Value Of The Total Number Of Peripheral Blood White Blood Cells And Their Subgroup Ratio Before Primary Treatment In Predicting The Prognosis Of Epithelial Ovarian Cancer

Background:Epithelial ovarian cancer is a common gynecological malignancy,known as"silent killer",leading the mortality rate of gynecological malignancies.Epithelial ovarian cancer has insidious onset and is lack of typical clinical symptoms,effective screening methods and diagnostic methods in the early stage.Therefore,most patients are in the middle and advanced stage of ovarian cancer and have not received treatment at the best time.In addition,epithelial ovarian cancer is prone to metastasis,recurrence and drug resistance after recurrence^[1].Therefore,the five-year survival rate of epithelial ovarian cancer is only 40%-45%^[2].How to improve the prognosis of epithelial ovarian cancer patients and improve the therapeutic effect of epithelial ovarian cancer has become a thorny issue in the treatment of epithelial ovarian cancer.The correlation between inflammation and the occurrence and development of malignant tumors was first confirmed by Virchow in 1863^[3].With the deepening of studies on the relationship between inflammation and tumor,the relationship between the counting levels of peripheral blood leukocyte subgroups:neutrophils,lymphocytes,monocytes,eosinophils and basophils,as well as their ratios,and the occurrence,development and prognosis of epithelial ovarian cancer has become clear^[4],but there is still no consensus.Therefore,by collecting the clinical and case data of epithelial ovarian cancer patients,and analyzing the total number of white blood cells and their subgroup ratio,as well as the clinical case data,this project evaluated the value of each indicator in judging the prognosis of epithelial ovarian cancer patients.Objective:Analysis of peripheral blood WBC（total number of white blood cells）and the ratios of different subgroups in the classification of white blood cells in patients with epithelial ovarian cancer before initial treatment:NLR（neutrophils absolute value/lymphocyte absolute value）,the MLR（monocyte absolute value/lymphocyte absolute value）,MNM（lymphocyte absolute valueⅹabsolute value of neutrophil/10⁴）,LMR（lymphocyte absolute value/monocyte absolute value）and epithelial ovarian cancer patients with postoperative PFS（progression-free survival）,OS（overall survival）,the relationship between the effects of initial former WBC,NLR,MLR,MNM,LMR,the value of the evaluation of the prognosis of patients with epithelial ovarian cancer.Methods:1.Collect strictly in conformity with the inclusion criteria and exclusion criteria,108 cases of epithelial ovarian cancer patients with clinical data,case,clinical data including:patient age,before the first routine blood in the absolute value of white blood cells（WBC）,neutrophils（Neu）,lymphocyte（Lym）the absolute value of absolute value of absolute value of mononuclear cells（Mom）,and calculate the number of number of neutrophils,lymphocytes,monocytes ratio between the number three:NLR,MLR,MNM,LMR value.Patients included in the study were followed up for survival outcomes,and the corresponding progression-free survival（PFS）and overall survival（OS）were recorded.2.SPSS17.0 software was used for statistical analysis of the above data.The survival and follow-up outcomes of 108 patients were input:survival or death and pre-treatment values of MLR,NLR,MNM,LMR and WBC,the receiver operating characteristic curve（ROC）of the above parameters were drawn,and the area under the curve was calculated.The optimal cutoff points of MLR,NLR,MNM,LMR and WBC values before treatment were determined according to the maximum principle of the Youden index（sensitivity+specificity-1）.The efficacy analysis of the combined diagnosis of epithelial ovarian cancer was performed according to the AUC value,and the data of 108 patients included in the study were divided into:High MLR value group（>0.218）and low MLR value group（≤0.218）,high NLR value group（>2.36）and low NLR value group（≤2.36）,high MNM value group（>0.000202075）and low MNM value group（≤0.000202075）,high LMR value group（>2.64）and low LMR value group（≤2.64）,high WBC value group（>6.645）and low WBC value group（≤6.645）.3.According to the follow-up of patients survival outcome:progression-free survival and overall survival（months）,in order to draw the parameters of the high and low group and treated first before age（>57 vs.≤57 years of age）of progression-free survival and overall survival curve,line of the log-rank test sheet factor analysis,P<0.05 the parameters in turn into the COX proportional hazards models multi-factor analysis,evaluation of the high and low group of epithelial ovarian cancer patients with postoperative progression-free survival and overall survival,seeking the parameter influence of hemangiopericytoma in progression-free survival and overall survival in patients with ovarian cancer risk factors.Results:1.ROC curve:Before the initial treatment,the area under the curve of MLR,NLR,MNM,LMR and WBC was 0.566,0.547,0.610,0.563 and 0.621,respectively.The optimal cut-off points for predicting the postoperative survival time of epithelial ovarian cancer patients were 0.218,2.36,0.000202075,2.64 and 6.645,respectively.The sensitivity for evaluating the postoperative survival of epithelial ovarian cancer patients was 62.7%,43.4%,33.7%,89.0%and 41.0%,respectively.The specificity was 60.0%,72.0%,88.0%,34.6%and 84.0%respectively.2.In the ROC curves of MLR,NLR,MNM,LMR and WBC before the initial treatment,0.5<AUC<0.7,with low accuracy.ROC analysis was conducted on the efficacy of the above parameters in the combined diagnosis of epithelial ovarian cancer.Considering the AUC<0.7,the t-test was conducted between the groups with high and low values of each parameter.The results showed that the P value of the groups with high and low values of the above parameters was<0.01,showing a significant difference.3.Progress-free survival univariate analysis results:age before primary treatment>57 years old,MLR>0.218,NLR>2.36,WBC>6.645,LMR≤2.64 were correlated with progress-free survival of epithelial ovarian cancer patients（P<0.05）.There was no significant difference in progression-free survival between the high MNM group and the low MNM group（P>0.05）.4.Progresation-free survival multivariate analysis results:MLR>0.218,LMR≤2.64,and NLR>2.36 were risk factors for progresation-free survival in patients with epithelial ovarian cancer after surgery（P<0.05）.However,there was no significant difference between WBC>6.645 and pre-treatment age>57 years without progression in the multivariate analysis（P>0.05）.5.Univariate analysis of total survival:age before the first treatment was 57years old,MLR>was 0.218,NLR>was 2.36,WBC>was 6.645,and LMR≤2.64were closely related to total postoperative survival of epithelial ovarian cancer patients（P<0.05）.However,there was no significant difference in overall survival between the high MNM group and the low MNM group in univariate analysis（P>0.05）.6.Results of multivariate analysis of total survival:age before first treatment>57 years old,MLR>0.218and LMR≤2.64 were the risk factors affecting the total survival of patients with epithelial ovarian cancer after surgery（P<0.05）.However,there was no significant difference between NLR>2.36 and WBC>6.645 in the multivariate analysis of total survival（P>0.05）.Conclusions:1.MLR>0.218 has a high predictive value for progression-free survival and total survival after epithelial ovarian cancer.2.NLR>2.36 before primary treatment is a high risk factor affecting progression-free survival after epithelial ovarian cancer,and has a certain correlation with the total survival after epithelial ovarian cancer.3.There was no correlation between the high and low value of MNM before the initial treatment and the survival without progression or total survival after epithelial ovarian cancer.4.LMR≤2.64 before the initial treatment was of high predictive value for the non-progressive stage and total survival of epithelial ovarian cancer after surgery.5.There was a correlation between WBC>6.645 before primary treatment and survival without progression and total survival after epithelial ovarian cancer6.The pre-treatment age of>57 years,was a high risk factor affecting the total postoperative survival of epithelial ovarian cancer,which was correlated to the progression-free survival of epithelial ovarian cancer.