The Prognostic Value Of NLR,LMR,PLR And Their Dynamic Changes In Esophageal Squamous Cell Carcinoma

Background and ObjectiveAmong all cancers in the world,esophageal cancer ranks 7th and 6th in morbidity and mortality,respectively.In China,the incidence of esophageal squamous cell carcinoma accounts for 90%of all esophageal cancer tissue types.Radical resection of esophageal carcinoma and complete lymph node dissection are the most effective treatment for esophageal squamous cell carcinoma.It has been reported that the immune state and inflammatory response of the human body are related to the occurrence and development of a variety of tumors,and the elevated systemic inflammatory response is often a sign of poor prognosis.In this study,based on peripheral blood cell count before and after surgery,an inflammation scoring system was established and discussed from the following two aspects.Study 1 mainly analyzed the relationship between preoperative inflammatory markers such as neutrophil to lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR),platelet to lymphocyte ratio(PLR)and other clinical features and their effects on prognosis.Study 2 mainly included the change of neutrophil to lymphocyte ratio(NLRc=preoperative NLR-postoperative NLR),the change of lymphocyte to monocyte ratio(LMRc=preoperative LMR-postoperative LMR),the change of platelet to lymphocyte ratio(PLRc=preoperative PLR-postoperative PLR),and other clinical data and overall survival.MethodsA total of 290 thoracic surgery patients from the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2015 were selected,all of whom had undergone radical resection of esophageal cancer.Meanwhile,clinical data including blood routine report before and after surgery were collected.Preoperative NLR,LMR,PLR,and NLRc,LMRc,and PLRc were compared with other clinical features for univariate and multivariate survival analyses,respectively.Data were analyzed and charts were plotted using X-tile,SPSS,and GraphPad Prism 9.Results1.The critical values of NLR,LMR,PLR,NLRc,LMRc and PLRc were determined by X-tile software.Taking 2.25 as the optimal cut-off point of NLR,it was divided into two groups:low NLR(NLR≤2.25)and high NLR(NLR>2.25).Taking 2.88 as the optimal cut-off point of LMR,it was divided into two groups:low LMR(LMR≤2.88)and high LMR(LMR>2.88).Taking 143.85 as the optimal cut-off point of PLR,it was divided into two groups:low PLR(PLR≤143.85)and high PLR(PLR>143.85).Taking-13.36 as the optimal cut-off point for NLRc,the NLRc was divided into two groups:low NLRc(NLRc ≤-13.36)and high NLRc(NLRc>-13.36).Taking 2.24 as the optimal cut-off point for LMRc,the group was divided into two groups:low LMRc(LMRc≤2.24)and high LMRc(LMRc>2.24).Taking-415.9 as the optimal cut-off point of PLRC,it was divided into two groups:low PLRc(PLRc≤-415.9)and high PLRc(PLRc-415.9).2.The first study showed that the level of NLR was closely related to gender(P=0.025),tumor length(P=0.004)and T stage(P=0.000).The level of LMR was closely related to gender(P=0.001)and tumor length(P=0.000).PLR level was closely related to tumor location(P=0.007)and T stage(P=0.028).Kaplan-Meier analysis and log-rank test showed that the preoperative increase in NLR,decrease in LMR and increase in PLR were associated with decreased overall survival.Multivariate Cox regression analysis showed that age,T stage,N stage,NLR and LMR were independent risk factors for prognosis,while PLR was excluded.3.In study 2,gender(P=0.010),smoking history(P=0.001)and N stage(P=0.000)were closely correlated with NLRc level.The level of LMRc was closely related to age(P=0.026)and tumor length(P=0.000).PLRc level was closely correlated with T stage(P=0.020)and N stage(P=0.005).Kaplan-Meier analysis and log-rank test showed that lower LMRc and higher PLRc were associated with shorter overall survival.Multivariate Cox regression analysis showed that T stage,N stage and LMRc were one of the prognostic indicators for patients with esophageal squamous cell carcinoma after radical surgery,and the survival time of patients with LMRc≤2.24 was shorter.ConclusionBoth studies showed that patients with higher T and N stages had poorer outcomes.In addition,age,NLR,LMR,and LMRc were independent prognostic factors affecting overall survival.Routine assessment of NLR,LMR or LMRc,as well as T stage and N stage,timely identification of patients with poor prognosis and formulation of effective treatment plan can improve the overall survival of patients.