The Role Of Neutrophils And Lymphocyte Ratio(NLR) In Predicting The Prognosis Of Small Cell Lung Cancer Patients With Chemotherapy

Objectives: The clinical significance of peripheral blood neutrophils and lymphocyte ratio(neutrophils lymphocytes ratio,NLR)has been reported in patients with breast cancer,colorectal cancer and other malignant tumors,however,the study of small cell lung cancer is researched less.Simultaneously,Clinical studies on changes of NLR after chemotherapy are also rare.This study was designed to investigate the role of neutrophils and lymphocyte ratio(NLR)in predicting the prognosis of patients recieving chemotherapy with small cell lung cancer.Methods: Selected the native diagnosed small cell lung cancer patients from 2013.1.1 to 2015.12.31 in Hebei Medical University fourth hospital,excluding the patients with other malignancies,infectious diseases and immune system diseases,then,a total of 222 patients are selected.Among them,137 cases were limited stage,and 85 cases were extensive stage.Collected all these patients' White blood cell count(WBC),neutrophil count(NE),lymphocyte count(L),platelet count(PLT)of one week before chemotherapy and 2 weeks after the first cycle chemotherapy,tumor markers CEA of one week before chemotherapy and the patients' basic clinical data(gender,age,smoking history,primary tumor site,clinical stage,treatment,etc).Then calculated the NLR value.The progression-free survival(PFS)and the date of death(if progress or death)were obtained by electronic medical records and telephone follow-up.1 draw the receiver operator characteristic curve(ROC)to get the best cut-off value of the pre-chemotherapy NLR.Then divided all the 222 patients into two groups according to the result:the higher NLR group and lower NLR group.2 the correlation between pre-chemotherapy NLR level and their changes after chemotherapy and clinical factors.The Wilcoxon rank sum test was used to compare the differences in pre-chemotherapy NLR levels between various clinical factors.The differences in clinical factors between higher NLR group and lower NLR group were compared by chi-square test.The Wilcoxon rank test was used to compare the changes of blood routine before and after chemotherapy and the relationship between the changes of NLR and the clinical factors were compared by Wilcoxon rank test.3 the relationship between the level of NLR before chemotherapy and changes of NLR level before and after chemotherapy and the survival of patients.The Wilcoxon rank test was used to compare the PFS of higher NLR group and lower NLR group before chemotherapy.The chi-square test was used to compare the 1-year progress rate and 1-year survival rate of the two groups.The relationship between sex,age,clinical stage,pre-chemotherapy NLR and the risk factors of 1 year survival rate was analyzed.Patients were grouped according to the changes in NLR after chemotherapy.The patient's PFS was analyzed by Wilcoxon rank sum test.The 1-year survival rate of each group was analyzed by chi-square test.Results:1 The best cut-off value of NLR determined.According to the ROC curve pre-chemotherapy NLR got the best cut-off value of 3.56(AUC=0.856,P<0.05).2 Analysis of the correlation between pre-chemotherapy NLR level and its changes and clinical factors.2.1 Analysis of the correlation between pre-chemotherapy NLR level and clinical factors.The results showed that the level of pre-chemotherapy NLR was different in gender and clinical stage(P= 0.023 and <0.001),In male,extensive period patients with higher,but with age,primary tumor site had nothing to do.2.2 Comparison of clinical factors in high NLR and low NLR groups.The test results showed gender,age,smoking history and primary tumor6 location in the two groups has no difference,but clinical stage,CEA levels are different(P=0.003 and 0.039),and patients with NLR higher than 3.56 had a late stage(mostly extensive)and higher levels of CEA.2.3 Changes of blood parameters before and after chemotherapy.The results of this study showed that WBC,NE,PLT,NLR and PLR were decreased after chemotherapy(P<0.05).But lymphocytes increased,P=0.048,the difference was statistically significant.Further analysis showed that NLR levels were decreased in all groups of different sexes,different age groups,different primary tumor sites,different clinical stages after chemotherapy(P<0.05).3 The relationship between pre-chemotherapy NLR and NLR changes with survival.3.1 Analysis of pre-chemotherapy NLR and PFS,1-year progress rate and 1-year survival rate.Survival analysis showed that the median progression-free survival(PFS)was 7.7 months,the one-year rate was 72.91%,the 1-year survival rate was71.17%.In the m PFS and the 1-year progress rate,there was no significant difference between the higher NLR group and the lower NLR group(P=0.443 and 0.580).The 1-year survival rate was different in the two groups,the 1-year survival rate was lower in the patients with higher pre-chemotherapy NLR(P=0.021).3.2 Multivariate regression analysis of 1-year survival rate.Logistics multivariate regression analysis showed that clinical stage,pre-chemotherapy NLR value is risk factors of 1-year survival rate,but sex,age has nothing to do with the risk factor of 1-year survival rate.Patients of extensive period,pre-chemotherapy NLR>3.56 had lower 1-year survival rate.3.3 the results of the relationship between pre-chemotherapy NLR and changes(compared with the threshold)and PFS,1-year survival rate.The resault showed that,in the progressive patients after chemotherapy,m PFS in patients whose NLR decreased after chemotherapy slightly longer but not reached statistically significant(P= 0.852).The 1-year survival ratewas the lowest(57.14%)in patients with NLR higher than 3.56 before and after chemotherapy,and the 1-year survival rate(78.10%)was highest in patients with NLR lower than 3.56 before and after chemotherapy(P<0.05).1-year survival rate of patients whose NLR decreased after chemotherapy had a increasing trend.Conclusions:1 The best cut-off value of pre-chemotherapy NLR was 3.56,which could be used as the best prognostic value for the prognosis of small cell lung cancer.2 The patients with NLR>3.56 had worse prognosis than those with NLR<3.56.The m PFS in patients whose NLR decreased after chemotherapy has an upward trend,1-year survival rate has a down trend.Patients with NLR>3.56 after chemotherapy has the worst prognosis.3 NLR value can be used as a prognostic indicator of small cell lung cancer patients,and patients with higher NLR when newly diagnosed and after chemotherapy suggest poor prognosis,which may be conducive to screening high-risk recurrence of the population,and these patients should be given more attention in the course of treatment.But it still needs a large sample of prospective studies to explore the relationship between the NLR and its dynamic changes in patients with PFS and the overall survival of OS.