Predictive Value Of Preoperative Plus Postoperative Neutrophil-lymphocyte Ratio And Glasgow Prognostic Score For Prognosis Of Lung Cancer

Background and purpose: Lung cancer has become the leading cause of new cancer incidence and death in China,among which non-small cell lung caner(NSCLC)accounts for more than 85% of all lung cancers.Early-stage non-small cell lung cancer has no obvious symptoms and is often at a clinically advanced stage when diagnosed,missing the best time for treatment.Recently,the existence value of peripheral blood-related indicators in the prognosis of NSCLC has been reported in the relevant literature.In this paper,we analyzed and summarized the clinical data of 126 NSCLC patients who underwent surgical treatment,and explored the value of pre/postoperative neutrophil-lymphocyte ratio(NLR)and Glasgow prognostic score(GPS)in assessing the prognosis of patients with NSCLC to provide a reference for clinical practice to improve the prognosis of NSCLC patients.Methods: Based on the inclusion and exclusion criteria,126 patients who attended the Affiliated Hospital of Qingdao University and were diagnosed with NSCLC from January 2016 to December 2018 were retrospectively selected,and all of them underwent radical lung cancer surgery with postoperative pathological confirmation of non-small cell lung cancer.The clinical data and follow-up information of all patients were collected for analysis.The NLR values of patients before and after surgery were plotted on the subjects’ working curves,and the maximum point of the Youden index was its optimal cut-off value.the optimal cut-off values of preoperative/postoperative NLR were 1.64(sensitivity 0.81 and specificity 0.746)and 2.05(sensitivity 0.540 and specificity 0.714),respectively.the PP-NLR was calculated in the following manner and method:preoperative NLR(> 1.64)and postoperative NLR(>2.05)were scored as 2;preoperative NLR(<1.64)and postoperative NLR(<2.05)were scored as 0;only one value was elevated and scored as 1.The GPS calculation method is as follows: preoperative CRP(>10mg/L)and ALB(<35g/L)scores are 2,one of the two indicators is abnormal(CRP>10mg/L or ALB<35mg/L)score is 1,and both indicators are normal(CRP<10mg/L and ALB>35g/L)score is 0.Survival analysis was performed by Kaplan-Meier method for different PP-NLR groups and GPS groups,and survival curves were plotted by Log-rank test.The GPS/PP-NLR scores were analyzed in relation to clinical parameters and pathological characteristics of the treatment using t-test,analysis of variance(ANOVA)Kruskal-Wallis rank sum test and chi-square test.Independent risk factors affecting OS in NSCLC patients were identified by univariate analysis and COX regression model.ROC curves were plotted,and the predictive value of GPS versus PP-NLR was compared by the area under the ROC curve.All data were analyzed using SPSS 26.0 statistical software.p < 0.05 was considered to be statistically significant.Results: 1.Kaplan-Meier survival analysis: The higher the PP-NLR score and GPS score the lower the survival rate of patients,but no significant difference was seen between the GPS=1 and GPS=2 groups.2.(1)Comparison of clinical data with different PP-NLR: 41 cases in the PP-NLR=0 group,48 cases in the PP-NLR=1 group,and 37 cases in the PP-NLR=2 group.Statistically significant differences were found between the three groups in smoking,T-stage,CPR,and albumin(all P<0.05);while no significant differences were found between the three groups in smoking,T-stage,CPR,and albumin(all P<0.05);and no significant differences were found between the three groups in smoking,T-stage,CPR,and albumin(all P<0.05);and no significant differences were found between the three groups in smoking,T-stage,CPR,and albumin(all P<0.05);and no significant differences were found between the three groups in smoking,T-stage,CPR,and albumin(all P> 0.05).(2)Comparison of clinical data with different GPS scores: 74 cases in the GPS=0 group and 52 cases in the GPS=1/2 group.The differences between the two groups were statistically significant in terms of pathological type,degree of differentiation,T-stage,N-stage,CPR,albumin,and uric acid(all P<0.05);while no significant differences were seen between the two groups in terms of gender,age,smoking,alcohol consumption,hypertension,location of onset,tumor type,CEA,hemoglobin,fasting glucose,LDL,HDL,total cholesterol,and triglycerides(all P >0.05).3.Multi-factor COX regression analysis showed that the P values of PP-NLR score,GPS score,and tumor T-stage were all <0.05,which were statistically significant and could be considered as independent prognostic factors for lung cancer.4.The ROC curves showed that PP-NLR had better prognostic test efficacy compared with GPS and T-stage.Conclusion: PP-NLR score and GPS score are independent prognostic indicators for patients with surgically resected NSCLC,and PP-NLR score showed better prognostic value than GPS.