Relationship Between Preoperative Peripheral Blood PLR And NLR And Postoperative Pathology And Prognosis In Patients With Esophageal Squamous Cell Carcinoma

Objective: China belongs to the high incidence area of esophageal cancer in the world with high morbidity and mortality.Esophageal cancer is mainly divided into squamous cell carcinoma and adenocarcinoma.Squamous cell carcinoma is the main type of esophageal cancer in China,accounting for more than 90%.At present,TNM stage is the main prognostic indicator of esophageal cancer,but patients often need postoperative pathological results to determine the staging,while preoperative clinical staging is usually carried out through medical history,physical examination and auxiliary examination.Usually through clinical staging to guide the implementation of surgical or non-operative treatment,but the accuracy is often poor,other molecular markers are needed to assist in the accuracy of judgment,and then guide the choice of treatment and improve the prognosis of patients.In recent years,it has been found that long-term chronic inflammatory stimulation is one of the factors leading to the occurrence and development of malignant tumors.The platelet to lymphocyte ratio(PLR)and the neutrophil to lymphocyte ratio(NLR)have been proved to be related to the prognosis of lung cancer,breast cancer,gastric cancer,liver cancer and other malignant tumors.Therefore,we intend to explore its prognostic relationship with ESCC patients,and explore whether it can optimize preoperative staging of esophageal cancer and serve as an effective indicator to assist in prognosis judgment.It can supplement the existing prognosis evaluation system and provide a simple and reliable basis for accurate individualized treatment of esophageal cancer patients.Methods: The clinical data of patients who underwent radical resection of esophageal cancer in the thoracic surgery department of our hospital from January 2015 to December 2017 were collected retrospectively,and the postoperative recurrence and progression-free survival of the patients were investigated through follow-up.According to the inclusion and exclusion criteria,143 cases were selected as the object of study.Meanwhile,blood routine indexes of 80 healthy people who underwent physical examination in our hospital during the same period were collected as the control.The best cut-off value of PLR and NLR before operation was determined by drawing ROC curve.Based on this,the enrolled patients were divided into low-value group and high-value group,and the differences in clinical factors,pathological data and prognosis of the two groups were compared.T test is used to compare measurement data,and Chi-Square test or Fisher’s accurate test is used for counting data.Kaplan-Meier method was used to draw the survival curve,and log-rank test was used to conduct univariate survival analysis for the related factors that may affect the prognosis of patients.Finally,the independent factors affecting prognosis were identified by multivariate analysis by Cox regression.SPSS22.0 data analysis software was used for statistical calculation.Results: Compared with normal controls,neutrophils,platelets,NLR and PLR were higher in ESCC patients,and lymphocyte count was decreased.According to the ROC curve drawn,the best cut-off values of PLR and NLR were 121,2.02 respectively.The results showed that there were statistical differences in T stage,N stage and TNM stage and tumor recurrence rate between PLR high value group and low value group(P<0.05),and similar conclusions were obtained by NLR grouping.Therefore,whether it is PLR value or NLR value,the high values of these indexes before operation in patients with ESCC often indicate that the tumor stage is later or the disease is more severe,more likely to recur after surgery.Further survival curves showed that postoperative PFS was longer in patients with low PLR or NLR than in those with high-value group(P<0.01).Univariate analysis showed that tumor differentiation,TNM stage,preoperative PLR≥121and NLR≥2.02 were risk factors affecting postoperative PFS in patients after radical resection of esophageal cancer.Finally,multivariate analysis indicated that tumor differentiation,TNM stage and preoperative PLR were independent risk factors affecting postoperative PFS in ESCC patients.Conclusion: Preoperative peripheral blood PLR and NLR are related to postoperative pathology and prognosis of ESCC patients,which may be used as a supplement for preoperative staging and prognosis judgment of patients in the future to guide clinical treatment.