Correlation Between The Level Of Inflammatory Complex Indicators And The Prognosis And Efficacy Of Chemotherapy In Patients With Advanced Non-small Cell Lung Cancer

Objective: The aim of this study was to investigate the correlation between the levels and changes of mean platelet volume(MPV),lymphocyte to monocyte ratio(LMR)and albumin/fibrinogen ratio(AFR)in peripheral blood before chemotherapy and the prognosis and efficacy of chemotherapy in patients with advanced non-small cell lung cancer(NSCLC),and to provide theoretical basis for the prognosis evaluation and individualized comprehensive treatment of NSCLC patients.Methods: Patients with advanced NSCLC who were admitted to the Second Affiliated Hospital of Hainan Medical College from January 2012 to December 2017 were selected and selected according to the inclusion and exclusion criteria.Collect general clinical data,blood routine,liver function and coagulation indicators of patients,calculate MPV,LMR and AFR based on the collected blood cell parameters.The receiver operating characteristic curve(ROC)was drawn,and the optimal cut-off values for predicting the survival status of patients with MPV,LMR,and AFR before chemotherapy were determined.The patients were divided into low-level and high-level groups according to the cut-off.Objective evaluation results and overall survival time(OS)of patients after 2 cycles of chemotherapy were recorded.Kaplan-Meier method was used to draw the survival curve,and Log-rank test was used to compare the differences in survival rates between groups.Cox multivariate regression analysis of independent risk factors for prognosis in advanced NSCLC.Results:(1)147 patients with advanced NSCLC were included in this study,including 43 females and 104 males.The average age was 59.39±9.39 years.64 cases in stage Ⅲb and 83 cases in stage IV.There were 75 smokers and 72 non-smokers.Pathological types were more common in adenocarcinoma,a total of 95,44 squamous cell carcinoma,the other 8 cases.(2)The ROC curve determined the best cut-off values for predicting the survival of patients with MPV,LMR and AFR were 8.550 fl,3.539,and 12.349,respectively.The patients were grouped according to the cut-off values,and the results showed that 20 patients in the low MPV group and 127 patients in the high MPV group;72 patients in the low LMR group and 75 patients in the high LMR group;98 patients in the low AFR group and 49 patients in the high AFR group.(3)Comparing the differences between the short-term chemotherapy effects of different groups,the results showed that the ORR of patients in the phase IIIb group was higher than that in patients in the phase IV group(P <0.05).The ORR in the high-level AFR group was higher than low level AFR group(P <0.05).There was no significant difference in ORR between gender,age,smoking history,pathological type,primary lesion,MPV and LMR in different groups(P> 0.05).(4)Univariate analysis showed that the OS of stage IIIb group was significantly higher than that of stage IV group(18 months vs 6 months,P = 0.000).The OS in the high-level MPV group was significantly lower than that in the low-level MPV group(7Month vs 15 months,P = 0.008).The OS in high-level LMR group before treatment was higher than low-level LMR group(9 months vs 7 months,P = 0.002).The OS in high-level AFR group before treatment was higher than low Level AFR group(13months vs 6 months,P = 0.001).There was no significant difference in OS between different gender,age,smoking history,pathological type and primary lesions(P>0.05).Multivariate analysis showed that different stages(HR = 2.498 95% CI:1.575-3.962,P <0.05)and MPV(HR = 2.103 95% CI: 1.055-4.194,P <0.05)were independent risk factors affecting the prognosis of patients with advanced NSCLC.(5)After 2 cycles of first-line platinum-containing medication,there was no statistically significant difference between the OS of the MPV-increased group and the MPV-reduced group(P> 0.05).No statistically significant difference is found between the OS of the LMR-increased group and LMR-reduced group(P> 0.05).No statistically significant difference is found between the OS in the AFR-increased group and the AFR-reduced group(P> 0.05).Conclusion:(1)Stage Ⅲb,high levels of AFR before chemotherapy suggest that patients with advanced NSCLC have may be more sensitive to first-line platinum-containing standard chemotherapy and have greater benefit from chemotherapy.(2)Staging,MPV,LMR and AFR are all related to the prognosis of patients with advanced NSCLC.Staging and MPV may be independent risk factors that affect the prognosis of patients.