Analysis Of The Relationship Between Preoperative Peripheral Blood NLR,PLR,LMR And Prognosis After Radical Resection Of Hilar Cholangiocarcinoma

Background: Hilar cholangiocarcinoma(HCCA)is the most common type of biliary malignant tumor,accounting for about 60%.Since most of them are found in the late stage and lack of effective therapeutic drugs,hence the overall prognosis is poor.Radical surgery is the only possible cure,but the postoperative 5-year survival rate is only about 30%,and less than 10% in patients with lymph node metastasis.Therefore,it is crucial to find effective prognostic markers after radical resection.Tumor-associated inflammation is one of the characteristics of malignant tumors.Inflammatory cells and related inflammatory factors are important components of tumor microenvironment,which play a key role in the occurrence and development of tumors.It has been found that neutrophil / lymphocyte ratio(NLR),platelet / lymphocyte ratio(PLR)and lymphocyte / monocyte ratio(LMR)may be reliable indicators of tumor-related inflammation and are considered to be independent prognostic factors for the survival of many kinds of malignant tumors.However,there are few studies on NLR,PLR and LMR in HCCA.Objective: The purpose of this study was to analyze the correlation between preoperative peripheral blood NLR,PLR,LMR and clinicopathological features and prognosis in patients with HCCA carcinoma,so as to provide theoretical basis for judging the prognosis of HCCA.Method:A retrospective case-control study was used.All patients with HCCA who underwent radical resection from January 2010 to January 2018 were collected and screened according to the relevant criteria established in this study.76 patients with HCCA who met the criteria were finally enrolled in the group.Observation indicators:(1)results of preoperative auxiliary examination;(2)results of surgical treatment and pathological examination;(3)follow-up information and survival status;(4)correlation analysis of prognostic factors.The best cut-off values of NLR,PLR,LMR,CA199 and CEA were determined by ROC curve,and then the patients were divided into high and low level groups.Chi-square test was used to explore the correlation between different levels of NLR,PLR,LMR and clinicopathological features of patients.The survival rate of patients was determined by Kaplan-Meier method,and the survival curve of related indexes was drawn.Survival analysis and predictive univariate analysis were performed using Log-rank test.After univariate analysis,valuable parameters were included in COX proportional hazard model analysis,and the risk factors that independently affected the survival and prognosis of patients with R0 resection of HCCA were obtained.Result: According to the ROC curve drawn,the best cut-off values of NLR,PLR,LMR,CA199 and CEA were 2.08,2.07,2.07,268.5 and 2.99 respectively.Taking NLR=2.08 as the best cut-off value,the patients were divided into two groups: low NLR group(<2.08)and high NLR group(2.08).NLR was correlated with age,T stage,Bismuth-Coretre classification and preoperative bilirubin level in patients with HCCA.Taking PLR=117.58 as the best cut-off value,the patients were divided into two groups:low PLR group(< 117.58)and high PLR group(117.58).PLR was correlated with the longest diameter of tumor parenchyma and tumor differentiation in patients with HCCA.Taking LMR=2.07 as the best cut-off value,the patients were divided into two groups:low LMR level group(< 2.07)and high NLR level group(P < 2.07).There was a significant correlation between LMR and vascular invasion in patients with HCCA.The results of survival analysis showed that the high level of NLR suggested a poor prognosis in patients with HCCA.However,there was no correlation between PLR,LMR and the prognosis of patients with HCCA.The patients with double positive of CA199+NLR,CA199+PLR and CEA+NLR were worse than those with double negative and single positive.CA199+LMR,CEA+PLR and CEA+LMR were not related to the prognosis of patients with HCCA.Univariate analysis had shown that gender,T stage,lymph node metastasis,nerve invasion,vascular invasion,tumor maximum diameter,tumor differentiation,preoperative highest total bilirubin level,CA199,NLR,CA199+NLR combined positive,CA199+PLR combined positive and CEA+NLR combined positive were associated with survival and prognosis of HCCA patients after radical resection.Multivariate COX proportional hazard model analysis showed that gender(HR:0.396,P=0.031),preoperative highest total bilirubin level(HR:17.197,P=0.003),lymph node metastasis(HR:2.473,P=0.041),tumor differentiation(HR:0.233,P=0.001)and CA199+PLR(HR:6.380,P=0.001)were independent factors affecting the poor prognosis of HCCA patients undergoing radical resection.Conclusion:The prognosis after radical resection of hilar cholangiocarcinoma was affected by many factors.The overall prognosis was poor amongst male in which their preoperative highest bilirubin 342umol/L,lymph node metastasis,low tumor differentiation and positive parallel CA199+PLR were independent risk factors.Preoperative NLR could be used to predict the survival and prognosis of patients with HCCA after radical resection,but it was not an independent factor affecting the prognosis.The combination of tumor markers and peripheral blood inflammatory markers might be more helpful to evaluate the prognosis of patients with hilar cholangiocarcinoma.