| Objective:As an important part of laboratory examination,hematological markers are the focus of nursing assessment.This study aims to describe the epidemiological characteristics of laryngeal cancer,analyze the factors affecting the prognosis of laryngeal cancer and construct a prognostic prediction model,combined with a systematic screening of hematological markers,to provide a reference basis for clinical nursing condition observation,accurate formulation of treatment strategies,scientific assessment of patient prognosis,and implementation of personalized health education for laryngeal cancer patients from the perspective of the nursing assessment.Methods:This study consists of four parts.Part Ⅰ:Epidemiological study of laryngeal cancer based on the SEER database.The standardized incidence,mortality,and relative survival at 1,3,5,and 10 years for laryngeal cancer by sex,age,and race from 1975 to 2019 were collected through the SEER database for descriptive analysis,the annual percentage change(APC)in standardized incidence and mortality rates of laryngeal cancer and their 95%confidence intervals(95%CI)were calculated by Joinpoint trend analysis software,and the trends were plotted using Graph Pad Prism 9.4.0.P<0.05 was considered a statistically significant difference.Part Ⅱ:Analysis of prognostic factors and construction and validation of the predictive model for laryngeal cancer.The clinical data of 10729 patients with pathological diagnosis of laryngeal cancer from 2010 to 2015 were collected from the SEER database.The patients were randomly divided into a training set(n=7513)and a validation set(n=3216)according to the ratio of 7:3.The survival curves of each variable were plotted based on the Kaplan-Meier method,and the hazard ratio(HR)and 95%confidence interval(95%CI)of the training set were calculated using univariate and multivariate Cox proportional risk models to determine the relationship between the clinicopathological features and the overall survival(OS)of patients.The Nomogram model for predicting 1-year,3-year,and 5-year survival of laryngeal cancer was constructed using the training set.The ROC curve and the AUC values were used to measure the model discrimination;the calibration curve was used to check the model calibration to ensure the reliability of the model;the DCA curve was used to assess the clinical applicability and practical application value of the model.Part Ⅲ:The correlation between hematological markers and clinicopathological features of laryngeal cancer.Patients with laryngeal cancer admitted to the Department of Otolaryngology-Head and Neck Surgery from January 2011 to December 2017 were searched through the laryngeal cancer-specific database of the medical big data platform of the First Hospital of Shanxi Medical University.Clinical data such as patients’sex,age,clinical classification,T-stage,N-stage,pathological stage,smoking and drinking habits,blood routine,biochemical examination,and coagulation examination were collected to analyze the correlation between hematological markers and clinicopathological features,and all data were processed by SPSS 23.0 statistical software,and P<0.05 was considered a statistically significant difference.Part Ⅳ:The correlation between hematological markers and lymph node metastasis of laryngeal cancer.Patients with laryngeal cancer admitted to the Department of Otolaryngology-Head and Neck Surgery from January 2011 to December 2017 were searched through the laryngeal cancer-specific database of the medical big data platform of the First Hospital of Shanxi Medical University.Clinical data such as patients’sex,age,clinical classification,T-stage,N-stage,pathological stage,smoking and drinking habits,blood routine,biochemical examination,and coagulation examination were collected to analyze the correlation between clinicopathological features and hematological markers and lymph node metastasis,and all data were processed by SPSS 23.0 statistical software,and P<0.05 was considered a statistically significant difference.Results:Part Ⅰ:The overall decreasing trend of laryngeal cancer standardized incidence rate from 1975 to 2019,among which the decreasing trend was more obvious from1987 to 2017(APC=-2.4%,P<0.01);the standardized incidence rate of the male was higher than that of female;the standardized incidence rate of black was higher than that of white;the peak incidence was concentrated in the age group of 50-64 years and 65~+years.The overall decreasing trend of laryngeal cancer standardized mortality rate from 1975 to 2020,among which the decreasing trend was more obvious from1994 to 2020(APC=-2.2%,P<0.01);the standardized mortality rate of the male was higher than that of female;the standardized mortality rate of black was higher than that of white;the peak mortality was concentrated in the age group of 65~+years.2000to 2018 there was no significant change in the relative survival rates of laryngeal cancer at 1 year,3 years,5 years,and 10 years,with time change the relative survival rate of laryngeal cancer patients gradually decreased;the relative survival rate of the male slightly higher than that of female;the relative survival rate of white was higher than that of black;the relative survival rate of each survival stage in the age group below 50 years old showed a slowly increasing trend.Part Ⅱ:A total of 10729 patients were included in this part,randomly divided into a training set(n=7513)and validation set(n=3216)according to the ratio of 7:3,there was no statistical significance in all indexes between the two groups(P>0.05).By Log-Rank test,older age,black race,non-glottic type,histological gradeⅢandⅣ(poorly differentiated,undifferentiated),stage T4(tumor invasion of the larynx),stage N3(lymph node metastasis),stage M1(distant metastasis),and pathological stageⅣwere all associated with poorer survival(P<0.05).Univariate and multivariate Cox regression analysis showed that age,race,primary site,histological grade,TNM stage,and pathological stage were independent risk factors for laryngeal cancer prognosis(P<0.05).Based on the above clinicopathological features,models predicting 1-year,3-year,and 5-year survival rates of laryngeal cancer were constructed.The AUC values of 1-year,3-year,and 5-year training sets were 0.749,0.725,and 0.732,respectively,and the AUC values of 1-year,3-year,and 5-year validation sets were0.739,0.729,and 0.737,respectively.The fitting degree of 1-year and 5-year calibration curves of the training set and validation set is reasonable,and the fitting degree of 3-year calibration curves is high.The training set and validation set DCA to have a large net benefit interval area and strong clinical practicability of the model.Part Ⅲ:Clinical classification,T stage,and pathological stage were correlated with NLR level(P<0.05);Clinical classification and pathological stage were correlated with PLR level(P<0.05);Clinical classification,pathological stage,and smoking were correlated with LMR level(P<0.05);Age,T stage,N stage,and alcohol consumption were correlated with PLT level(P<0.05);T stage and N stage were correlated with PDW level(P<0.05);Sex,clinical classification were correlated with HB level(P<0.05);Age,clinical classification,and N stage were correlated with ALB level(P<0.05);Age,clinical classification,T stage,N stage,pathological stage,and alcohol consumption were correlated with PA level(P<0.05);Sex was correlated with APTT level(P<0.05);Clinical classification and T stage were correlated with FIB level(P<0.05);There was a significant difference in clinical classification between the low NLR group and the high NLR group(P<0.05);There was a significant difference in pathological stage between the low PLR group and the high PLR group(P<0.05);There were significant differences in clinical classification,T stage,and smoking between the low LMR group and the high LMR group(P<0.05);There were significant differences in age,T stage,N stage,pathological stage,smoking,and alcohol consumption between the low PLT group and the high PLT group(P<0.05);There was a significant difference in N stage between the low MPV group and the high MPV group(P<0.05);There were significant differences in T stage,N stage,and pathological stage between the low PDW group and the high PDW group(P<0.05);There was a significant difference in sex between the low HB group and the high HB group(P<0.05);There were significant differences in clinical classification and N stage between the low ALB group and the high ALB group(P<0.05);There was a significant difference in alcohol consumption between the low PA group and the high PA group(P<0.05).There were significant differences in clinical classification,N stage,and pathological stage between the low FIB group and the high FIB group(P<0.05).Part Ⅳ:There was no statistically significant difference between the N0 and N1-2 groups in the comparison of preoperative NLR,LMR,HB,PA,PT,and APTT(P>0.05);the preoperative PLR,PLT,and FIB were higher in the N1-2 group than in the N0 group,and the difference was statistically significant(P<0.05);the preoperative MPV,PDW,and ALB were lower in the N1-2 group than in the N0group,and the difference was statistically significant(P<0.05);the lymph node metastasis rate of patients with T1,T2 stages was lower than that of T3,T4 stages,and the difference was statistically significant(P<0.01);the lymph node metastasis rate of patients with supraglottic type was the highest,followed by subglottic type,and the glottic type was the lowest,and the difference between the three groups was statistically significant(P<0.01);The lymph node metastasis rate in the high PLT group was higher than that in the low PLT group,and the difference was statistically significant(P<0.05).The lymph node metastasis rate in the low MPV group was higher than that in the high MPV group,and the difference was statistically significant(P<0.05).The lymph node metastasis rate in the low PDW group was higher than that in the high PDW group,and the difference was statistically significant(P<0.05).The lymph node metastasis rate in the low ALB group was higher than that in the high ALB group,and the difference was statistically significant(P<0.05).The lymph node metastasis rate in the high FIB group was higher than that in the low FIB group,and the difference was statistically significant(P<0.05).Among patients with supraglottic type,the lymph node metastasis rate in the high PLT group was higher than that in the low PLT group,and the difference was statistically significant(P<0.05);the lymph node metastasis rate in the low MPV group was higher than that in the high MPV group,and the difference was statistically significant(P<0.05);the lymph node metastasis rate in the low PDW group was higher than that in the high PDW group,and the difference was statistically significant(P<0.05);the lymph nodes metastasis rate in the high FIB group was higher than that in the low FIB group,and the difference was statistically significant(P<0.05).In patients with T3 and T4 stages,the lymph node metastasis rate in the low ALB group was higher than that in the high ALB group,and the difference was statistically significant(P<0.05).Conclusion:1.The standardized incidence and mortality rates of laryngeal cancer showed an overall decreasing trend from 1975 to 2019,but showed some differences between sex,age,and race;middle-aged and elderly men are still a high-risk group for laryngeal cancer incidence and mortality,and active and effective prevention and control strategies should be developed,targeted treatment and care measures should be taken to reduce the risk of laryngeal cancer incidence and mortality and improve the long-term survival rate of laryngeal cancer patients.2.An individualized,visualized Nomogram model for predicting the survival rate of laryngeal cancer patients at 1 year,3 years,and 5 years based on clinicopathological features was successfully established.The model with good consistency,high accuracy,and clinical applicability,can be used to predict and evaluate the preoperative prognosis of laryngeal cancer patients and has some clinical promotion value.3.Increased levels of NLR,PLR,PLT,and FIB and decreased levels of LMR,PDW,and ALB were positively correlated with poor clinicopathological features of laryngeal cancer patients,providing sensitive indicators to assist physicians in preoperatively determining patient prognosis.In clinical work,nursing staff should pay attention to the monitoring of relevant hematological markers.4.Increased levels of PLR,PLT,and FIB and decreased levels of MPV,PDW,and ALB were positively correlated with lymph node metastasis in patients with laryngeal cancer.Hematological markers have a certain reference value for assessing lymph node metastasis and predicting the prognosis of laryngeal cancer patients.Nursing staff can use hematological markers as early warning indicators for disease observation and prognosis assessment,and provide a reference basis to assist in the formulation of surgical plans,treatment and care strategies,and personalized follow-up plans. |
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