| Objective:Increasing evidence suggests that there is a close relationship between systemic inflammation and cancer development,progression and metastasis.The NLR(Neutrophil-Lymphocyte Ratio,NLR)has an influence on the prognostic of various advanced and localized cancers including esophageal squamous cell carcinoma,gastric cancer,hepatocellular carcinoma laryngeal cancer,bladder cancers and Non-small Cell Lung Cancer.This article aims to investigate the relationship between the NLR and in lung adenocarcinomaMaterials and Methods:1.Collect materials:215 patients who underwent surgical resection and proved to be lung adenocarcinoma in the First Affiliated Hospital of Dalian Medical University between July 2006 to December 2010 were collected.The study cohort included 91 men(42.3%)and 124 women(57.7%).Among the 215 patients,212(98.6%)underwent lobectomy,3(1.4%)underwent wedge resection of lung.Record patients’ age,smoking history,tumor differentiation,pleural invasion,N stage,TNM stage and the neutrophil count,lymphocyte count,platelet count,CEA(carcino-embryonic antigen),C211(Cytokerantin-19-fragment CYFRA21-1)and fibrinogen in the last peripheral blood tests which were collected before surgery.2.Determine the cut-off value of the NLR:The NLR is the ratio of the neutrophil count and lymphocyte count.Use SPSS 17.0 to draw the ROC curve(also known as diagnostic characteristic curve)of the 215 patients’ preoperative NLR.The area under the curve of the NLR’s ROC was 0.63.which meant using the NLR to predict the 215 cases of lung adenocarcinoma patients’ recurrence was significant(P=0.001).When taking into account the sensitivity and specificity,we chose 1.785 as the cut-off value of the NLR.Among the 83 patients whose NLR≥1.785,there were 48 patients relapsed(57.8%)and 35 patients without recurrence(42.2%),while among the 132 patients whose NLR<1.785,there were 45 patients relapsed(34.1%)and 87 patients without recurrence(65.9%),the difference was statistically significant(P=0.001).Thus,choosing NLR=1.785 as the cut-off value.Divide the 215 patients into two groups according to the cut-off value of NLR,that were:1.NLR≥1.785 group(high NLR)in total 83 cases;2.NLR<1.785 group(low NLR group)in total 132 cases.3.Analyze the relationship between the NLR and the clinical prognosis:use chi-square test to identify the relationship between the NLR and patients’ clinical and pathological features.The 5-year OS(Overall Survival)and 5-year DFS(Disease-free Survival)are calculated by Kaplan-Meier.Univariate analysis use Log-Rank test.To identify the independent prognostic factors of OS and DFS,multivariate analysis was conducted using a Cox proportional hazard model.All statistical analyses were performed using SPSS 17.0,and p values<0.05 were considered to be significant.Results:1.Comparison of the two groups in terms of sex,smoking history,platelets and tumor differentiation,all the differences were statistically significant(P<0.05);While the two groups in terms of age,CEA,C211,fibrinogen,pleural invasion,N stage and TNM stage,the differences were not statistically significant(P>0.05).2.Among the 83 patients whose NLR≥1.785,there were 48 patients relapsed(57.8%)and 35 patients without recurrence(42.2%),while among the 132 patients whose NLR<1.785,there were 45 patients relapsed(34.1%)and 87 patients without recurrence(65.9%),the difference was statistically significant(P=0.001).3.Among the 215 patients,the 5-year OS of the NLR≥1.785 group was lower than the NLR<1.785 group(55.4%vs 77.5%,P<0.001);Subgroup analysis showed that,NLR≥1.785 group compared with NLR<1.785 group:①Among the 139 patients with Stage I,the 5-year OS of the NLR≥1.785 group was lower(66.1%vs 89.6%,P<0.001);②Among the 76 patients with Stage II-III,the 5-year OS of the NLR>1.785 group was lower(37.5%vs 50.8%,P=0.017);③Among the 57 patients without pleural invasion,the 5-year OS of the NLR≥1.785 group was lower(73.7%vs 94.1%,P=0.01);④Among the 158 patients with pleural invasion,the 5-year OS of the NLR≥1.785 group was lower(50%vs 70.3%,P<0.001);⑤Among the 144 patients with N0,the 5-year OS of the NLR≥1.785 group was lower(64.8%vs 90.5%,P<0.001);⑥Among the 71 patients with N1-2,the 5-year OS of the NLR≥1.785 group was lower(38%vs 50.9%,P=0.02);⑦ Among the 67 patients with well-moderate tumor differentiation,the 5-year OS of the NLR≥1.785 group was lower(56.1%vs 84%,P<0.001).4.Among the 215 patients,the 5-year DFS of the NLR≥1.785 group was lower than the NLR<1.785 group(46.9%vs 67.2%,P<0.001);Subgroup analysis showed that,NLR≥1.785 group compared with NLR<1.785 group:① Among the 139 patients with Stage I,the 5-year DFS of the NLR≥1.785 group was lower(58.7%vs 86.3%,P<0.001);②Among the 158 patients with pleural invasion,the 5-year DFS of the NLR≥1.785 group was lower(40.6%vs 61.5%,P=0.002);③ Among the 144 patients with N0,the 5-year DFS of the NLR≥1.785 group was lower(58%vs 85.5%,P<0.001);④Among the 67 patients with well-moderate tumor differentiation,the 5-year DFS of the NLR≥1.785 group was lower(47.5%vs 70.7%,P<0.001).5.In univariate analysis:smoking history,preoperative NLR,CEA,tumor differentiation,pleural invasion,N stage,TNM stage were related to the OS of the patients with lung adenocarcinoma;preoperative NLR,CEA,pleural violations,N stage,TNM stage were related to the DFS of the patients with lung adenocarcinoma.6.In multivariate analysis:tumor differentiation,TNM stage and preoperative NLR is an independent predictor of OS in the patients with lung adenocarcinoma;pleural invasion,TNM stage and preoperative NLR is an independent predictor of DFS in the patients with lung adenocarcinoma.Summary:1.The prognosis of the preoperative NLR≥1.785 in the patients with adenocarcinoma is worse than the preoperative NLR<1.785’s.2.The preoperative NLR was correlated with gender,smoking history,tumor differentiation,and platelet count in patients with lung adenocarcinoma.3.The preoperative NLR can become an independent predictor of DFS and OS in patients with lung adenocarcinoma. |
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