Clinical Research On The Relationship Between NLR,LMR,PLR And AGR And Prognosis Of Cervical Cancer

Background:Cervical cancer is the most common gynecological malignant tumor in the world,and its incidence ranks fourth among female malignant tumors,which seriously threatens women’s health.At present,the International Federation of Gynecology and Obstetrics（FIGO）staging system is the main evaluation standard for clinicians to predict the prognosis of cervical cancer patients,but the predictive ability of clinical staging is not satisfactory,especially in patients with advanced disease.Therefore,there is a need for a reliable and easily accessible prognostic biomarker to classify the risk of cervical cancer and the guide treatment.In recent years,more and more studies have shown that inflammatory indicators and nutritional indicators are related to the prognosis of tumors.Therefore,this paper selected NLR,LMR,PLR and AGR to explore the relationship between them and the prognosis of cervical cancer patients.Objective:Through a retrospective analysis of 153 cervical cancer patients who were treated in the First Hospital of Jilin University from January 2015 to December 2020,to investigate the prognostic significance of neutrophil to lymphocyte ratio（NLR）,lymphocyte to monocyte ratio（LMR）,platelet to lymphocyte ratio（PLR）,albumin to globulin ratio（AGR）in patients with cervical cancer.Methods:A total of 153 patients with cervical cancer treated in the First Hospital of Jilin University from January 2015 to December 2020 who met the inclusion criteria but did not meet the exclusion criteria were included in the study,and the survival outcomes were retrospectively analyzed and followed up.The clinicopathological data collected included:age of diagnosis,pathological type,FIGO stage,degree of tumor differentiation,neutrophil count,lymphocyte count,monocyte count,platelet count,hemoglobin level,serum albumin level,globulin level at initial diagnosis,NLR（neutrophil count/lymphocyte count）,LMR（lymphocyte count/monocyte count）,PLR（platelet count/lymphocyte count）,AGR（albumin/globulin）were calculated.To analyze the relationship between NLR,LMR,PLR,AGR and other clinicopathological factors and the prognostic significance of these factors in cervical cancer patients.Results:1.Relationship between NLR,LMR,PLR,AGR and clinicopathological factors:the incidence of low hemoglobin concentration（P=0.002）,high platelet count（P=0.001）,low LMR（P<0.001）and high PLR（P<0.001）was higher in the high NLR group.Patients with high LMR were more likely to have FIGO stage I～II（P=0.045）,high hemoglobin concentration（P=0.043）,high albumin level（P=0.003）,low neutrophil count（P<0.001）,low NLR（P<0.001）,and low PLR（P<0.001）.In the high PLR group,patients with age≤50 years（P<0.001）,FIGO stage III～IV（P=0.041）,low hemoglobin concentration（P<0.001）,high neutrophil count（P=0.002）,high NLR（P<0.001）and low LMR（P<0.001）were more common.Patients in the high AGR group had a higher incidence of high hemoglobin concentration（P=0.002）and low neutrophil count（P=0.009）.2.Univariate analysis showed that in different FIGO stages（P=0.039）,lymphocyte count（P<0.001）,albumin level（P=0.004）,NLR（P=0.012）,LMR（P<0.001）,PLR（P=0.035）and AGR（P=0.001）groups,PFS was statistically different.In different pathological types（P=0.040）,FIGO stage（P=0.003）,lymphocyte count（P=0.008）,albumin level（P=0.002）,NLR（P=0.016）,LMR（P=0.002）,PLR（P=0.032）and AGR（P=0.006）groups,there were significant differences in OS.3.Multivariate analysis showed that lymphocyte count（P=0.046）and AGR（P=0.011）were independent prognostic factors of PFS in patients with cervical cancer,while pathological type（P=0.001）,FIGO stage（P=0.004）and AGR（P=0.006）were independent prognostic factors of OS.Conclusion:1.Serum albumin level,NLR,LMR and PLR at initial treatment were correlated with PFS and OS in cervical cancer patients,but were not independent prognostic factors.2.Low lymphocyte count（≤1.11×10~9/L）and low AGR（≤1.31）were associated with recurrence and progression of cervical cancer,and were independent risk factors for PFS in cervical cancer patients.3.Pathological type,FIGO stage and AGR are independent prognostic factors of OS in patients with cervical cancer.Cervical cancer patients with non-squamous cell carcinoma,advanced FIGO stage（III～IV）and low AGR（≤1.31）at initial diagnosis have a shorter survival time and poor prognosis,and should pay close attention to disease changes.