Correlation Analysis Of NLR?PLR Combining With CGA?CD56 In Gastrointestinal Pancreatic Neuroendocrine Neoplasms Prognosis

Research Background:Neuroendocrine neoplasm is a group of rare heterogeneous tumors originated from peptidergic neuron and neuroendocrine cells.It can occur in multiple organs including lung?thymus?gastrointestinal tract?pancreas?kidney and so on,among which gastrointestinal pancreatic neuroendocrine neoplasm were the most common[1].In recent years,the detection rate of the disease has been on the rise due to advances in laboratory examinations?endoscopy and the increasing awareness of the disease.SEER^[2]in American reported a five-fold increase in the incidence of GEP-NENs over the past30years.Domestic coverage of GEP-NENs is also increasing.Epidemiological survey data shows that the incidence of GEP-NENs presents a gradual upward trend in Chengdu area^[3].Neutrophil?lymphocytes and platelets,as important laboratory indicators of the inflammatory system,stimulate tumor proliferation and metastasis by releasing various factors,which have been proved to play an important role in the occurrence and development of tumor and lymph node metastasis.Furthermore,inflammation markers can affect the prognosis of tumor patients.CgA and CD56,as an important immunohistochemical marker of neuroendocrine tumor,are rarely connected with prognosis of GEP-NENs.In this paper,115 patients with pathologically confirmed GEP-NENs admitted to the affiliated Zhong Da hospital of southeast university from March 2013 to May 2018 were enrolled.To investigate the expression of NLR/PLR and CgA/CD56 in GEP-NENs patients and the relationship with clinico pathological characteristics,the pathological data and preoperative blood routine were retrospectively analyzed.Correlation between NLR?PLR combining with CgA?CD56in gastrointestinal pancreatic neuroendocrine neoplasms with prognosis were further analyzed.Purpose:To analysis neutrophil-to-lymphocyte ration and platelet-to-Lymphocyte combining with CgA/CD56 in gastrointestinal pancreatic neuroendocrine neoplasms prognosis.Method:1.A total of 115 patients clinicopathological and preoperative blood routine data with GEP-NENs confirmed by pathology who visited our hospital from March 2013to May 2018 were collected.Name?gender?age?clinical manifestations?tumor diameter?primary site?pathology grade?G1/G2/G3??TNM grade?vascular nerves invasion?lymph nodes and distant metastases?neutrophil count?lymphocyte count and platelet count were included.The samples were all from endoscopic treatment or surgical resection of the lesion.2.To evaluate the cut-off value of NLR/PLR for GEP-NENs with the help of ROC curve,NLR and PLR greater than their corresponding cut-off values were defined as positive.The correlation between NLR/PLR and the clinicopathological features of patients with GEP-NENs was analyzed.The correlation between NLR/PLR and prognosis were further analyze.3.CgA/CD56 expression in 115 patients with GEP-NENs was determined by immunohistochemistry.According to the immunohistochemical semi-quantitative scoring criteria,CgA/CD56 was divided into high and low expression groups.The correlation between CgA/CD56 and the clinicopathological features and prognosis in patients with GEP-NENs were analyzed.4.Combining blood routine and immunohistochemistry,NLR/PLR positive and CgA/CD56 high expression were defined as double positive,NLR/PLR negative and CgA/CD56 low expression were defined as double negative,something in between were defined as single positive.5.Kaplan-meier method were performed with Single-factor survival analysis and draw a survival curve.Survival rates varied among groups were analyzed through Log-rank check.Multivariate prognostic analysis was performed with Cox regression.Results:The cut-off value of NLR/PLR were 2.235 and 131.54.NLR was associated with tumor site,PLR was associated with tumor stage and vascular nerve invasion.High CgA expression patients accounted for 56.5%,high CD56 expression patients accounted for 74.8%.The expression level of CgA was related to the metastasis?TNM stage?grade?vascular nerve invasion?lymph node metastasis?tumor site and diameter.The expression of CD56 had nothing to do with clinicopathologic feature in GEP-NENs.CgA expression level was associated with CD56 expression?P<0.05,r=0.28?.Univariate prognostic analysis showed,tumor site?size and grading?G1/G2/G3??TNM stage?CgA expression level affected prognosis.The expression of CD56?NLR and PLR were not related with the prognosis of GEP-NENs.Blood routine combining immunohistochemical indexes were used to analysis the survival and prognosis showing that joint detection of NLR+CD56?PLR+CD56?NLR+CgA had nothing to with GEP-NENs prognosis.The prognosis was best when PLR+CgA double negative,single positive was followed,double positive was the worst prognosis.Multivariate prognostic analysis showed that the tumor grading?size?site were independent factor affecting prognosis.However,CgA expression and PLR+ CgA combining detection showed no statistically significant difference in multivariate prognostic analysis?P=0.158?0.986?.Conclusion:Expression of CgA was associated with prognosis,CgA low expression was associated with better prognosis,patients with CgA low expression combining with PLR<131.54 had the best prognosis.Inflammatory indicator PLR combining with immunohistochemical CgA plays an important role in the prognosis evaluation of GEP-NENs.