| Objective: To explore the predictive value of platelet-to-lymphocyte ratio(PLR)for first-line chemotherapy in small cell lung cancer.Methods: Patients with small cell lung cancer who received first-line chemotherapy in the Fourth Hospital of Hebei Medical University from 2014.1.1 to 2018.12.31 were selected to exclude patients with hematological diseases,infectious diseases,immune system diseases,other malignant tumors and those who received surgery,concurrent or sequential radiotherapy,immunotherapy and targeted drug therapy in first-line treatment.Lymphocyte count,platelet count,sex,age,smoking history,tumor location,clinical stage,efficacy evaluation after two cycles of chemotherapy,efficacy evaluation after four cycles of chemotherapy and PFS were collected by consulting electronic medical records.A total of 59 patients were included in this study.1.The Wilcoxon rank sum test was used to compare PLR0 before chemotherapy,PLR2 after 2 cycles of chemotherapy and PLR4 after 4 cycles of chemotherapy.The results showed that PLR0 and PLR2 had statistical difference,PLR4 and PLR0 and PLR2 had no significant difference.2.The optimal critical values of PLR0 and PLR2 were obtained by drawing the Receiver Operation Curve(ROC).According to the optimal critical values of PLR0 and PLR2,59 patients were divided into high PLR0 group before chemotherapy,low PLR0 group,high PLR2 group after chemotherapy and low PLR2 group.3.Chi-square test was used to compare the differences of various clinical factors in high PLR0 group,low PLR0 group and high PLR2 group and low PLR2 group after chemotherapy.4.Patients were grouped according to changes in PLR values after chemotherapy,and the patient's PFS was analyzed by log-rank test.5.Gender,age,location,stage,PLR0 and PLR2 of patients were included in COX regression model to analyze the risk factors of PFS.Results:1.Clinical featuresA total of 59 patients were enrolled,22(37.3%)were ?65 years old,37(62.7%)were <65 years old;48(81.4%)were male and 11(18.6%)were female;34 were smokers(57.6%),24 were non-smokers(42.4%);30 cases of left lung cancer(50.9%),29 cases of right lung cancer(49.2%);43 cases of extensive stage(72.9%),16 cases of limited period(27.1%);first-line chemotherapy There were no CR patients,including PR in 46 patients(78.0%),SD in 9 patients(15.3%),PD in 4 patients(6.8%),PR in 26 patients(44.1%)after 4 cycles of chemotherapy,and SD in 14 patients.(33.7%),PD 19 cases(32.2%).2.Changes in PLR values before and after chemotherapyBy comparing PLR0,PLR2 and PLR4 with Wilcoxon rank sum test,it is found that PLR2 and PLR0 have statistical differences(Z=-2.023,P < 0.05),while PLR4 has no statistical significance with PLR0 and PLR2,so PLR0 and PLR2 are selected for study.3.PLR threshold determinationThe critical value of PLR in this study was obtained by plotting the ROC curve: when PLR0 was 161,the AUC value was the largest,the sensitivity was 074,the specificity was 0.71,and the area under the ROC curve was 0.736,P<0.05 was statistically significant;After PLR2=171,the AUC value was the largest,the sensitivity was 0.67,the specificity was 0.88,and the area under the ROC curve was 0.72.P<0.05 was statistically significant.Therefore,this study will use 161 and 171 as the optimal thresholds for PLR0 and PLR2,respectively.4.Relationship between PLR and clinical features of patientsThere was no significant difference between PLR0 and patient age,gender,smoking history,tumor location,and 2-cycle chemotherapy(P>0.05).The tumor evaluation(P=0.04)and the efficacy of 4-cycle chemotherapy(P=0.01)There was a correlation;the proportion of high PLR0 in patients with limited and extensive periods was 37.5%(6/16)and 67.4%(29/43),respectively.The proportion of high PLR0 in the PR and SD groups after 4 cycles of chemotherapy.42.3%(11/26)and 57.1%(8/14),respectively,significantly lower than 84.%(16/19)in the PD group.After 2 cycles of chemotherapy,there was no significant difference between PLR2 and patient age,gender,smoking history,tumor location,tumor stage and 2-cycle chemotherapy efficacy(P>0.05).However,the proportion of high PLR2 in PD group was 73.7%(14/19),significantly higher than 23.1%(6/26)and 28.6%(4/14)in the PR and SD groups(P=0.01).5.Analysis of PLR changes before and after chemotherapy and PFS of patientsAccording to the PLR value before and after chemotherapy,all patients were divided into 4 groups: Low PLR0 before chemotherapy and low PLR2 after chemotherapy were 1 group 1;Low PLR0 before chemotherapy and high PLR2 after chemotherapy were 2 group;3 group were high PLR0 before chemotherapy and low PLR2 after chemotherapy;High PLR0 before chemotherapy and high PLR2 after chemotherapy were 4 groups.The results showed that the median PFS of patients with low PLR before and after chemotherapy was longer,and the median PFS of patients with high PLR before and after chemotherapy was shorter(P < 0.01),suggesting that the change of PLR value before and after chemotherapy may have some predictive value for PFS.6.The relationship between clinical factors,PLR and PFSThe patient's gender,age,tumor location,tumor stage,PLR0,and PLR2 values were included in the COX regression model to analyze the risk factors affecting PFS after chemotherapy.The results showed that the P value was >0.05 in gender,age,tumor location,tumor stage,and PLR0 analysis,and there was no statistical significance.The P <0.05 in the PLR2 analysis was statistically significant,PLR2(P=0.002)was an independent predictor of PFS.Conclusions:1.The optimal threshold values of PLR0 and PLR2 values before chemotherapy were 161 and 171,respectively,which can be used as the optimal threshold for patients with small cell lung cancer in this study.2.PLR0 was correlated with tumor stage,and PLR0 and PLR2 could be used as predictors of the efficacy of first-line chemotherapy in patients with small cell lung cancer.Low PLR0 and low PLR2 represent better efficacy and longer PFS;High PLR2 can be used as an independent predictor of PFS in SCLC patients,which may be helpful in screening high-risk relapse population,and these patients should receive more attention in the treatment process. |
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