| Objective:To discuss Peripheral blood inflammatory factors such as Pretreatment neutrophil-lymphocyte with platelet-lymphocyte ratio(NLR 、PLR)and squamous cell carcinoma associated antigen(SCCA)predict Lymph node metastasis and prognosis for stage ⅡB cervical Cancer.Method:Based on the clinical diagnosis and treatment cases of the Department of gynecology and oncology in the Cancer Hospital of Guangxi Medical University,173 patients with stage ⅡB(FIGO stage in 2009)cervical cancer who met the inclusion criteria,including 89 patients with comprehensive surgical treatment and 84 patients with concurrent chemoradiotherapy,were included in the study from January 2011 to December 2017.The best cut-off values of NLR,PLR and SCCA before treatment were determined by drawing ROC curves,and were divided into high NLR,PLR and SCCA groups and low NLR,PLR and SCCA groups according to the cut-off values.The intra-group differences were compared with the clinical information,pathological characteristics and total survival time of patients in each group respectively,and the high-risk factors of lymph node metastasis were predicted and the factors affecting the prognosis of patients were analyzed.Result:By establishing ROC curves of NLR,PLR and SCCA before treatment,the optimal cutoff values of NLR,PLR and SCCA were 2.23,168.57 and 6.44 ng/L respectively.Pearson correlation analysis showed that there was a linear correlation between NLR and PLR in peripheral blood before treatment,the correlation coefficient was 0.596,P=0.000.NLR is related to lymph node metastasis(P=0.016),but not to age,pathological type,histological grade and tumor size(P=0.586,P=0.304,P=0.388,P = 0.153);PLR has nothing to do with pathological type,histological grade,tumor size,lymph node metastasis and age(P=0.223,P=0.179(P=0.223,P=0.179,P=0.113,P = 0.136,P=0.151);SCCA is related to pathological type,histological grade and lymph node metastasis(P=0.003,P=0.002,P=0.041),but not related to tumor size and age(P=0.061,P=0.903).The total survival time of pretreatment high NLR(median OS=68 months),high PLR(median OS=65 months),high SCCA(median OS=63 months)group were shorter than that of low NLR(median OS=101 months),low PLR(median OS = 90 months),and low SCCA group(median OS=101 months),with statistically significant differences(P=0.004,P=0.011,P=0.009).Univariate COx analysis showed that NLR,PLR,SCCA,lymph node metastasis and pathological types were related to the overall survival time of patients(P=0.006,P=0.012,P=0.010,P=0.000,P=0.008).Multivariate COX analysis showed that NLR(HR=1.740,P=0.047),SCCA(HR=2.275,P=0.003),lymph node metastasis(HR=2.665,P=0.000)and pathological type(HR=3.140,P=0.000)were independent risk factors affecting the overall survival of patients.The metastatic rate of pelvic and abdominal lymph nodes in patients with stage ⅡB cervical cancer was 36.4%(63/173),and the metastatic rate of pathologically confirmed lymph nodes was 37.1%(33/89).There was no difference in lymph node metastasis between the high PLR group and the low PLR group.The lymph node metastasis rate in the high NLR group was higher than that the low NLR group(OR: 2.660,95%CI: 1.054-6.746,P=0.036),and the lymph node metastasis rate in the high SCCA group was higher than that the low SCCA group(OR: 2.702,95%CI: 1.055-6.918,P=0.035).When NLR and SCCA were combined,the lymph node metastasis detection rate was higher(OR:4.691,95%CI: 1.449-15.189,P=0.006).The ROC curve areas of NLR,PLR and SCCA were 0.626,0.595 and 0.609,the sensitivity were 0.739,0.522 and0.500,and the specificity were 0.505,0.692 and 0.768 respectively.The total survival time of the patients in the low NLR group treated with concurrent radiotherapy and chemotherapy(median OS: 91 months)was significantly longer than that of the patients in the combined operation group(median OS: 71.9 months),the difference was statistically significant(P =0.029);the total survival time of patients in the low NLR group treated with concurrent radiotherapy and chemotherapy(median OS: 91 months)was longer than that in the high NLR group(median OS: 75 months),the difference was statistically significant(P = 0.002);There was no difference(P = 0.671)in the total survival time between combined operation group(median OS: 58 months)and CCRT group(median OS: 75 months)of high NLR;The total survival time of patients with different PLR and SCCA levels was not related to the treatment(P > 0.05).Conclusion:There was a linear correlation between NLR and PLR in peripheral blood,but the correlation coefficient was not significant.The level of PLR was related to the prognosis of patients,but not an independent risk factor.NLR,SCCA,lymph node metastasis and pathological type were independent risk factors for the prognosis of stage ⅡB cervical cancer patients.NLR and SCCA can be used as indicators to predict the lymph node metastasis of patients.When they were combined,the sensitivity and specificity were higher.The patients in low NLR group choose concurrent radiotherapy and chemotherapy for better prognosis than surgery. |
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