The Comparison And Analysis Of The Prognosis Factor In Small Cell Lung Cancer

BackgroundSmall cell lung cancer(SCLC)is a kind of neuroendocrine tumor of lung cancer,accounting for about 15-25%of lung cancer.It has an extremely aggressive nature with a poor prognosis,shorter tumor cell doubling time,early metastasis and transfer extensively,initial response rates to chemotherapy.Without treatment,the median survival time is 2-4 months.Existing studies showed a significant difference in the progression-free survival(PFS)and overall survival(OS)of SCLC between changes in NLR according to progression time.As well as lung cancer inflammation index(ALI)was associated with a poor prognosis of OS in SCLC.However,the prognostic value of inflammatory markers,including platelet-lymphocyte ratio(PLR)and monocyte-lymphocyte ratio(MLR),are not well understood in SCLC.Objective:In this study,we want to explore the relationship between routine blood results of SCLC before and after chemotherapy for the first time and clinicopathologic features of the age,sex,smoking history,clinical stage,tumor size,tumor location,clinical stage,tumor markers of carcinoembryonie antigen(CEA)and carcinoembryonie antigen(NSE),PFS.Though comparing the predictive value of hematology factor(NLR,PLR,MLR and ALI)in the PFS of SCLC,try to find out the best prognostic factor to use as a routine examination project and guide therapy.Patients and Methods:We retrospectively reviewed all patients diagnosed with SCLC between January 2012 and December 2015 in the cancer center of tumor minimally invasive treatment in Shandong Provincial Hospital.Age,sex,height,weight,smoking history,comorbidity,routine blood results recorded before and after chemotherapy for the first time,liver function,blood biochemistry,serum albumin,tumor markers of CEA and NSE,body mass index,pathological information,imaging materials and PFS were recorded.The NLR was calculated from the differential count though dividing the absolute neutrophil count by the absolute lymphocyte count.PLR was calculated from the differential count though dividing the absolute platelet count by the absolute lymphocyte count.MLR was calculated from the differential count though dividing the absolute monocyte count by the absolute lymphocyte count.ALI was calculated as the formula:(body mass index× albumin)/NLR.The optimal cutoff values for NLR?PLR?MLR and ALI were determined using time-dependent receiver operating curve(ROC)analysis.The NLR?PLR?MLR and ALI values were categorised into two groups to investigate the correlation of clinicopathological characteristics and prognosis of patients with SCLC?Survival analyses were performed using the Kaplan-Meier method and multivariate analysis of survival were performed using the Cox proportional hazards model.Statistical analyses were performed using SPSS 19.0 for windows software,and p<0.05 was considered to indicate statistical significance in the analyses.Results:Forty-two patients of SCLC were included in the study,28(66.7%)patients were male and 14(33.3%)were female.The median age was 58 years(range,41-71 years)and the average age was 57 years,30(71.4%)patients less than 60 years and 12(28.6%)patients longer than 60 years among it.The 26(61.9%)patients were current or ex-smokers and 16(38.1%)patients were not.The primary tumors located in the left lung were 17(40.5%)patients and 25(59.5%)patients were on the right lung.The average maximum diameter of primary tumors in SCLC patients were 4.52 cm(range,1.10?10.00cm).Among them 29(69.0%)patients less than 5 cm and 13(31.0%)patients longer than 5 cm.According to the American veterans hospital clinical stages,23(54.8%)patients were limited disease and 19(45.2%)patients were extensive disease.The average follow-up time of PFS was 5.2 months(range,1.5-16.5 months)and the median PFS was 4.5 months.There was no significant differences with SCLC patients of the NLR values before and after chemotherapy for the first time(NLR1 and NLR2)among the different clinicopathological characteristics.A significant differences of PLR1 values were elevated between sex,smoking history and tumor location(P= 0.002,0.016,0.032,respectively),at the same time a significant differences of PLR1 values were elevated between sex,smoking history and clinical stage(P= 0.027,0.010,0.024,respectively).The MLR1 values and ALII values were different just in different SCLC ages(P= 0.047,0.045,respectively).However,there was no significant differences of the MLR2 values and ALI2 values among the different clinicopathological characteristics,as well as PFS.According to the prognosis after two cycles of chemotherapy in quantitative data analyses with SCLC patients,the significant differences were elevated between different groups,including ages,tumor size,BMI,NLR1,MLR1,ALI1(P=0.010,0.000,0.039,0.001,0.002,0.000,respectively),but NLR1,MLR1,ALI1,PLR1 and PLR2 are not,as well as PFS.In qualitative data analyses,age,smoking history,tumor location,clinical stages,high blood pressure,diabetes and coronary heart disease have no significant differences.The optimal cutoff values for NLR1?PLR1 determined using time-dependent receiver operating curve(ROC)analysis were 2.69 and 0.31,which can regared as prognostic diagnostic indicators of SCLC,but not MLR1 and ALI1.The NLR1 and MLR1 values were categorised into two groups:low-NLR1 group(NLR1?2.69)and high-NLR1 group(NLR1>2.69),just the significant difference of tumour side was elevated;but there was no significant difference of clinicopathological characteristics and PFS between low-MLR1 group(MLR?0.31)and high-MLR1 group(MLR>0.31).Survival analyses were performed using the Kaplan-Meier method,which showed age,tumor size,NLR1,MLR1 were independent prognostic factors of PFS(P= 0.030,0.003,0.003,0.000,respectively).In multiple factors analysis,it's the tumor size,MLR1 could be regarded as the independent prognostic factors of PFS(P= 0.027,0.007,respectively)rather than PLR1 and ALI1.Conclusions:1.The values of NLR?MLR and ALI at diagnosis were the independent prognosis factors of PFS for SCLC,and MLR is better than NLR?ALI.The tumor size and MLR could be regarded as the independent prognostic factors of PFS,which could be a useful prognostic marker in clinical practice.2?The accuracy of NLR?MLR will decrease after treatment intervention,when it used to making a diagnosis and predicting prognosis of SCLC patients,so continuous variation trend of peripheral inflammation index should not be used for assessing the condition of the SCLC patients.