Clinical Research On Predictive Value Of NLR And PLR To Cancer-associated Venous Thromboembolism

Objective:This study discussed the clinical value of Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) for predicting venous thromboembolism (VTE) in malignant tumor patients.Methods:A retrospective cohort study was conducted from January 1,2013 to December 30, 2015 in The Military General Hospital of Beijing.190 malignant tumor patients were admitted to the oncology ward. Using the Hospital Information System and Medical Record Management System database, clinical data were retrospectively compared. We selected the eligible patients with a total of 48 cases of tumor combined with VTE as thrombosis group, and randomly selected the tumor patients without VTE in 2 years of tumor diagnosis with a total of 142 cases in the hospital during the same period as a control group. First, the two groups were compared in terms of age, sex, complications, tumor disease and tumor stage. After removing the confounding factors, we analyzed the two groups of patients with routine hematology at the time of initial diagnosis of tumor, got statistically significant indicators, and then got the defined value determined by ROC curve. According to the definition of the value, the 48 patients were divided into two groups, and we compared the clinical features of the tumor with VTE respectively. Finally, the multivariate analysis was statistically significant in the analysis indicators.Results:(1). We collected a total of 48 cases in the thrombosis group, including 28 males and 20 females. The age range was 45-86 years, and the median age was 63 years. And 142 cases were in the control group, including 72 males and 70 females. The range age was 30-82 years, and the median age was 57 years. There was no significant difference in age, sex, history of hypertension, history of coronary heart disease, history of diabetes and tumor stage between the two groups (P>0.05). Statistical analysis was performed on the two groups of patients with routine hematology at the time of initial diagnosis of tumor. There were no statistical differences between the number of lymphocytes platelets and PLR(P>0.05). There were statistically significant differences in the number of neutrophils and NLR, and they were all higher in the thrombosis group than in the control group (P<0.05). Making an analysis for the two groups of neutrophils and NLR by ROC curves, the area under the curve was 0.655 and 0.659 respectively. The evaluation boundary point was 4.35 and 2.76.(2). Comparing of two groups of patients in ECOG score, distant metastasis, and the time and position of thrombosis, there were no significant differences in high NLR group and low NLR group patients (P>0.05). But there was statistically difference in the state of tumor at the thrombosis time. Patients in high NLR group were prone to VTE in tumor progression, while the patients in low NLR were prone to VTE when the tumor was stable or relieved (P<0.05);(3). In high NLR group and low NLR group there was no significant difference in the level of fibrinogen (FIB) in the first 2 weeks before the occurrence of VTE (P> 0.05). But there was statistically difference in the level of D-D in the first 2 weeks before VTE.D-D increased in the 2 weeks before the occurrence of thrombosis in more patients of high NLR group (P<0.05);(4). There was statistically significant difference in the prognosis of VTE between high NLR group and low NLR group. In patients of high NLR group, the proportion of death or recurrence within 3 months is large, and the prognosis is poor. (P<0.05);(5). The logistic regression analysis was carried out on the base of neutrophil, NLR and D-D to be the independent variables, and the prognosis of VTE to be the dependent variable. The results showed that there was statistical difference between NLR and the dependent variable only. NLR=2.76 is independent risk factor for thrombosis prognosis (P<0.05). Conclusion:(1).After confounding factors such as history of hypertension, history of coronary heart disease, history of diabetes mellitus and tumor stage were excluded, NLR>2.76 at the time of initial diagnosis of tumor is the risk factor of VTE. When the D-dimer is raised, it should be highly alert to the occurrence of VTE in 2 weeks.(2).NLR is related to the prognosis of VTE in patients with malignant tumor. If NLR>2.76 at the time of initial diagnosis of tumor, VTE occurs easily in tumor progression. The proportion of death or recurrence within 3 months is large, and the prognosis is poor.(3) There was no significant correlation between PLR and VTE in patients with malignant tumor.