The Relationship Between Peripheral Blood Neutrophil And Platelet To Lymphocyte Ratio In The Treatment And Prognosis Of Patients With Locally Advanced Nasopharyngeal Carcinoma

Objective:Individual differences existed in the prognosis of patients with locally advanced nasopharyngeal carcinoma,the purpose of this study is to investigate the relationship between the neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)and prognosis in nasopharyngeal carcinoma patients with locally advanced stage.Methods:Patients with locally advanced nasopharyngeal carcinoma who were diagnosed in our hospital from July 2015 to December 2016 were randomly divided into routine chemotherapy group and Chrono chemotherapy group.All patients were treated with TPF induction chemotherapy and cisplatin concurrent chemoradiotherapy.TPF induction chemotherapy regimen for 2 cycles,21 days per cycle.The conventional chemotherapy group specific usage:docetaxel 75mg/m2,infusion,d1;cisplatin 75mg/m2,infusion,dl;5-fluorouracil 750mg/m2/d,continuous intravenous pumping,dl-d5(120hours).The chrono-chemotherapy group specific usage:docetaxel 75mg/m2,infusion,d1,(03:30-04:30);cisplatin,75mg/m2,continuous intravenous pumping,dl-d5(10:00-22:00);5-fluorouracil 750mg/m2/d continuous intravenous pumping,dl-d5(22:00-10:00).Concurrent chemotherapy:cisplatin chemotherapy for 2 cycles(d1,d22).Specifically:the conventional chemotherapy group:Cisplatin:100mg/m2,infusion,d1.The chrono-chemotherapy group:Cisplatin:100mg/m2 continuous intravenous pumping,dl(10:00-22:00).Concurrent radiotherapy with intensity modulated radiotherapy(IMRT),6MV-X source,GTVnx 69.96-73.92Gy/33f,PTVnx 69.96Gy/33f,PGTVnd 69.96Gy/33f,PTV1 60.06Gy/33f,PTV2 50.96Gy/28f,for 7-8 weeks.Patients with N3 and patients who had not reached CR after 3 months of radiotherapy were recommended to be treated with adjuvant chemotherapy.The absolute values of neutrophils,lymphocytes and platelets before chemotherapy were calculated,and NLR and PLR were calculated.The relationship between NLR and PLR and prognosis of patients with locally advanced nasopharyngeal carcinoma were studied by statistical analysis.And to explore whether there is difference between the treatment group and the conventional treatment group in each group in order to guide the choice of treatment methods for patients with locally advanced nasopharyngeal carcinoma.Results:1.A total of 108 cases were included in the analysis.The analysis of the clinical characteristics of patients shows patients have higher NLR and PLR in stage IVa/b compared with stage ?,the difference was statistically significant(p=0.010);The patients were divided into high NLR and low NLR group in 2.65,immediate effect in primary tumor,lymph-node metastatic and overall disease were not statistically significant(p=0.593;p=0.206;p=0.210).After 3 months of radiotherapy,there was no statistical significance in primary tumor efficacy,lymph-node efficacy and overall disease efficacy in two groups(p=0.209;p=0.423;p=0.126).In 159.60,the patients were divided into high PLR group and low PLR group.The difference in lymph-nodes immediate effect was statistically significant(p=0.029)and no difference in primary tumor and overall immediate effect(p=0.593,p=0.295)between two groups.After 3 months of radiotherapy,the difference in primary tumor efficacy and overall efficacy were statistically significant(p=0.012,p=0.027).There was no significant difference in lymph nodes between two groups(p=0.276).3.There was no difference in the immediate efficacy of conventional chemotherapy and chrono-chemotherapy in high and low NLR group(p=0.527,p=0.108).This result also exists in the high and low PLR group.(p=0.242,p=0.336).There were no statistically significant difference in two NLR group and PLR group between routine group and chrono group after 3 months radiotherapy(p=0.285;p=0.328;p=0.934;p=0.897).Conclusion:1.Both NLR and PLR were related to tumor stage,the later the clinical stage was,the higher the NLR and PLR.NLR was poor predictive value in short-term efficacy,need expand the data and further study.PLR may be a predictor of short-term efficacy in patients with locally advanced nasopharyngeal carcinoma.Patients with high PLR had poor short-term outcome.The short-term effects of the patients in the high and low NLR and PLR groups were not statistically different between the routine and the chrono-chemotherapy groups.