The Research Of Prognostic Value Of Peripheral Blood Neutrophil Lymphocyte Ratio And Platelet Lymphocyte Ratio In Patients With Small Cell Lung Cancer

Objective:2014 global statistics showed that the incidence of lung cancer accounted for 14% of men,women accounted for 13%.The mortality rate of male who have lung cancer was 28%,female 26%.In China,lung cancer accounts for 20% of all malignant tumors.Only 16.1% patients with lung cancer in our country can survive more than 5 years.Lung cancer was pathologically divided into small cell lung cancer(SCLC)and non-small cell lung cancer(NSCLC).Among all the patients with lung cancer,about 12%-15% of them were diagnosed small cell lung cancer.As the pathological type of Small cell lung cancer has the characteristics of short doubling time,strong invasiveness,poorly differentiated,high degree of malignancy,sensitivity to radiotherapy and chemotherapy,easy to local recurrence and distant metastasis,it has the worst prognosis.Five-year survival rate of SCLC is only 6%,and it’s lower than NSCLC.The median survival time of the untreated patients with SCLC is only 2-4 month.In recent years,for the treatment of SCLC,there weren’t any significant curative targeted drugs.Research shows that tumor development is closely related with inflammation.Peripheral blood neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)are systemic inflammatory reaction indexes and have relationship with prognosis of various tumors.This study through a retrospective analysis of 172 cases of first confirmed and untreated SCLC patients with peripheral blood neutrophil count lymphocyte count,platelet count and clinical data including general conditions,clinical manifestations,treatment,and laboratory data such as sodium levels,hemoglobin level,serum albumin level,tumor markers to explore the relationship between the above factors and prognosis,and to find the prognostic factors of SCLC,and then provide a scientific basis for the evaluation and individualized treatment of SCLC.Methods:172 cases of SCLC patients were sected from the initial histopathologic diagnosis of SCLC from October 2010 to December 2013 in Affiliated Hospital of Chengde Medical University.All the cases were confirmed SCLC by pathological histopathology or cytology.Recording patients’ gender,age,smoking history,drinking history,clinical manifestation,clinical stage,KPS score,treatment measures and other clinical data,and blood routine at first admission(neutrophils,lymphocytes and platelet count),biochemical(sodium level,hemoglobin level,serum albumin level),tumor markers(CEA)and other laboratory test indexes.Spss19.0 was used for statistical analysis.The Kaplan-Meier method was applied to draw survival curve and calculate the survival rate of 6 months,12 months and 24 months and 36 months respectively.The patients with SCLC were divided into two groups of limited and extensive period,the survival curve was plotted and the survival rate was calculated at different time.The survival rate of the two groups was compared by Log-rank test.The patients were divided into low NLR group and high NLR group with NLR mean 3.86 as the critical value.And then,they were divided into low PLR group and high PLR group with PLR mean 191 as the critical value.The survival rates of the patients in different groups at 6 months,12 months,and 24 months,and 36 months were compared respectively by Log-rank test.Univariate survival analysis was used to analyze the prognostic factors.COX’s proportional hazards model was employed for multivariate analysis.P<0.05 was considered to represent a statistical difference.Results:1.172 patients with small cell lung cancer were analyzed retrospectly.Four cases among them were out of touch until the deadline.The lost rate is 2.3%.The overall median survival of patients is 13.34 months,(95%CI:11.22~14.78 months).The survival rate of 6 months,12 months,24 months and 36 months was 80.8%,55.2%,23.8%,9.1%.The median survival time for patients with localized SCLC patients was 15.25 months,while the median survival time for patients with extensive SCLC patients was 12.25 months,and there is significant difference in P<0.01 between the two groups.Low NLR group and high NLR median survival time was 15.42 months and 11.25 months,the difference of P<0.01 was significant between the two groups.Low PLR group and high PLR median survival time was 15.40 months and 13.00 months,the difference of P<0.01 was significant between the two groups.2.Univariate analysis of prognostic factors of 172 patients with SCLC including age,gender smoking,drinking,KPS score,whether hemoptysis at first diagnosis,pleural effusion,clinical stage,with or without brain metastasis,bone metastasis,liver metastasis,adrenal metastasis,surgery,radiotherapy and chemotherapy,curative effect,sodiumion levels,hemoglobin,serum albumin level,the level of CEA,NLR,PLR.The main results are as following: among all factors,age,KPS score,clinical stages,bone metastasis,liver metastasis,with or without operation,chemotherapy and radiotherapy,treatment efficacy,sodiumion levels,NLR,PLR after grouping comparison,the differences between the two groups have statistical meaning(P<0.05).These factors affect the survival of small cell lung cancer patients.3.We selected the factors which are statistically significant after univariate analysis,then take them as covariate factors enter the COX proportional hazard model respectively.Multivariate analysis showed that age,KPS score,surgery,radiotherapy,chemotherapy,NLR,PLR were independent significant prognostic factors.4.NLR,PLR were analyzed after combined with stratified clinical parameters.The median survival time in low NLR group and low PLR group is longer than in high NLR,PLR group in each layer.The difference is statistical significance in part of the facters.Conclusion:1.The study shows that age,KPS score,NLR and PLR were independent prognostic risk factors for patients with SCLC.Otherwise,the surgery,radiotherapy,chemotherapy were protective factors for SCLC patients.Therefore,individualized treatment can improve the survival time of patients with SCLC.2.The patients with poor prognosis usually with higher NLR and PLR.The NLR and PLR were independent prognostic risk factors for patients with SCLC.NLR and PLR as an indicator of the degree of inflammatory response and immune status can be used as a reference index to predict the prognosis of SCLC patients.