Prognostic Analysis And Establishment Of Prognostic Model Based On Neutrophils And Related Factors Before Treatment Of Nasopharyngeal Carcinoma

Objective:To investigate the relationship between neutrophils and neutrophils to lymphocytes rate(NLR)before treatment and the prognosis of nasopharyngeal carcinoma(NPC),and to establish neutrophils to lymphocytes rate(NLR)related nomogram to predict the survivals of patients with NPC.Methods:A total of 747 patients with NPC were collected from January 2005 to January2015 in our hospital.Kaplan Meier survival analysis was used to curve of OS,PFS and DMFS,as well as the comparisons,were calculated by the log-rank test.Univariable and multivariable Cox regression analyses were used to analyze the gender,age,different chemotherapy methods(neoadjuvant chemotherapy,concurrent chemotherapy,adjuvant chemotherapy),TNM staging(AJCC staging)(according to AJCC 7th edition of 2008 American Cancer Alliance,stages before 2008 were restaged by the staging criteria.)neutrophil to lymphocyte ratio(NLR),neutrophil,hemoglobin platelet and monocyte before treatment and performed to predict the independent risk factors of OS,PFS and DMFS of NPC.The optimal truncation value of NLR affecting the prognosis was determined by using receiver operating characteristic(ROC).Nomogram model was constructed and verified by R3.6.0software.Results:In 747 patients with NPC,N stage(p=0.01),NLR(p=0.037)were independent factors of distant metastasis time of NPC.The independent factors influencing overall survival were gender(p=0.024),age(p=0.019),N stage(p=0.006),AJCC stages(0.003)adjuvant chemotherapy(AC)(p=0.016),NLR(p=0.036).The predictions of the prognostic model demonstrated good consistency with the actual results.At the same time,compared with the tumor node metastasis(TNM)staging system,our models also show better accuracy and stability.Conclusions:In patients with NPC,pre-treatment elevated NLR predicted poor OS,PFS,and DMFS.The nologram with NLR was better in predicting the overall survival of patients with NPC,and the nologram was better than clinical staging.