The Study On The Correlation Between NLR,LMR,SIRI And EGFR Gene Mutation In Non-small Cell Lung Cancer

BackgroundWorldwide,lung cancer is the leading cause of morbidity and mortality in cancer patients.For Chinese men,lung cancer accounted for 21.9% of male malignant tumors in 2018,ranking first.For Chinese women,lung cancer accounted for 13.3% of the total number of female malignancies,ranking second.In contrast to the decline in western countries,the incidence of lung cancer patients in China is increasing and tends to be younger.Lung cancer is mainly divided into two categories according to histological classification,which are non-small cell lung cancer and small cell lung cancer.Non-small cell lung cancer(NSCLC)accounts for about 85% of the total number of lung cancer patients.Two-thirds of NSCLC patients are already in stage III / IV at the time of diagnosis.The Erb B signaling pathway is increased in malignant tumors of epithelial origin,including lung cancer,breast cancer,and gastric cancer.Epidermal growth factor receptor(EGFR)is a transmembrane tyrosine kinase receptor and belongs to the Erb B receptor family.With the development of medical level in recent years,molecular targeted therapy can be applied to EGFR driver gene mutations for patients with advanced lung cancer.Epidermal growth factor receptor(EGFR)tyrosine kinase inhibitor(TKIs)therapy has become the first-line treatment for most EGFR-positive patients.Compared with standard chemotherapy,the emergence of targeted therapy has profound effects on controlling disease,alleviating symptoms and prolonging life.NSCLC patients have a high EGFR mutation rate,and approximately 30% to 40% of NSCLC patients have EGFR mutations.The determination of EGFR mutation status is very important for the classification and treatment of lung cancer patients.However,for some patients,it is difficult to determine the EGFR mutation status due to expensive testing or insufficient tumor samples.Some studies have found that radiological characteristics and serum tumor markers such as CEA are associated with EGFR mutation.Therefore,it is of great significance and potential clinical scientific value to explore new and promising biomarkers to identify EGRF mutation status.The cellular environment where tumor cells reside is called the tumor microenvironment,which consists of borders,blood vessels,lymph vessels,extracellular matrix,stromal cells,immune/inflammatory cells,etc.Inflammation is involved in the NSCLC tumor microenvironment and play an important role in tumor progression and metastasis.Neutrophils,lymphocytes,monocytes,and cytokines produced by these immune cells may contribute to the accumulation of EGFR mutations.The neutrophil-lymphocyte ratio(NLR),lymphocyte-monocyte ratio(LMR),and systemic inflammation response index(SIRI)in peripheral blood are indicators of inflammation established by several immune cells.These inflammatory indicators are closely related to a variety of malignant tumors and have certain value in prediction,efficacy and prognosis of patients with malignant tumors.Studies have shown that higher NLR,SIRI levels or lower LMR levels before treatment indicate a poor prognosis for patients with lung cancer.Most researchers have explored the correlation between inflammation indicators and the diagnosis,treatment,and prognosis of patients with NSCLC,and there have been few studies on the correlation between EGFR mutation status and inflammatory indicators in NSCLC patients.Using a retrospective analysis method,we have studied the correlation between EGFR gene mutation status and the inflammatory indicators of NLR,LMR,and SIRI.ObjectiveTo study the correlation between the epidermal growth factor receptor(EGFR)gene mutation status and the inflammatory indicators of NLR,LMR,SIRI in NSCLC patients,and the clinical pathological characteristics of patients.MethodsThe data of patients diagnosed as non-small cell lung cancer for the first time by histopathological diagnosis in the First Affiliated Hospital of Henan University from January 2016 to October 2019 were collected through retrospective analysis.After screening by inclusion and exclusion criteria,a total of 136 patients with non-small cell lung cancer were included.The correlation between EGFR gene mutation and the above three inflammatory indicators and clinicopathological features was determined by comparing the differences between EGFR mutant patients and wild-type patients in various clinical indicators,three immune cells in peripheral blood and various inflammation indicators.Results1.There were statistically significant differences in terms of gender,smoking history,and pathological type between EGFR wild-type patients and mutant patients(P <0.05).The frequency of EGFR mutation in female patients was higher than that in male patients.The frequency of EGFR mutation in patients with no smoking history was higher than that in patients with smoking history.The frequency of EGFR mutations in patients with adenocarcinoma was higher than that in patients with non-adenocarcinoma.Multivariate regression analysis showed that histological type of adenocarcinoma could be used as an independent risk factor for EGFR mutation in patients with NSCLC(P <0.05).2.There was statistically significant difference between EGFR wild type and mutant type in NLR,LMR and SIRI(P <0.05).The LMR of EGFR mutant patients before treatment was higher than that of wild type patients,and the NLR and SIRI of EGFR mutant patients before treatment were lower than wild type patients.Compared with NLR and SIRI,the area under the ROC curve(AUC)of LMR was the largest(0.625),with a sensitivity of 36.6% and specificity of 86.2% when the cutoff value was 4.29.Conclusion1.EGFR mutation in patients with NSCLC is related to gender,smoking history,and histological type.Women,patients with no smoking history,and adenocarcinoma patients are more prone to EGFR mutation.Adenocarcinoma can be used as an independent risk factor for EGFR mutation.2.LMR,NLR,SIRI are associated with EGFR mutation in NSCLC patients.The LMR of EGFR mutant patients before treatment is higher than that of EGFR wild type patients.A higher LMR level indicates a higher probability of being diagnosed with EGFR mutation;The NLR and SIRI of EGFR mutant patients before treatment are lower than those of EGFR wild type patients.A higher NLR level or a higher SIRI level indicate a lower probability of being diagnosed with EGFR mutation.LMR has certain predictive value for EGFR mutations and is superior to SIRI and NLR.