Significance Of NLR Combined With Serum Tumor Markers In Early Diagnosis Of Gallbladder Carcinoma

Introduction:Carcinoma of the gallbladder(GBC)is considered to be a rare tumor with a high mortality rate and is the most common tumor of the biliary tract worldwide.The symptoms of gallbladder cancer may be unclear at first,and many people do not have particularly obvious symptoms,making early detection more difficult.Moreover,the symptoms of GBC are similar to those of cholelithiasis and cholecystitis,so it can be difficult to distinguish benign gallbladder lesions without a family history.When a patient’s clinical symptoms are obvious,it usually means that the disease may be in the advanced stage.Surgery is the only radical treatment at present,but the recurrence rate of tumors after surgery is high,the mortality rate is high,the 5-year overall survival rate is less than 5%,and due to a variety of factors,it is usually impossible to carry out radical surgery.However,most of the incidental GBCs are found in the early stage,especially in those who need surgery due to gallbladder polyp(GBP).Most of the GBCs can be radically excised and achieve a satisfactory prognosis,even reaching the clinical cure standard.It has been found that the neutrophil-to-lymphocyte ratio(NLR)is significantly abnormal in many kinds of tumors,and is significantly correlated with malignant tumors,and is an important indicator for predicting their prognosis.However,there is no clinical report on its role in the early diagnosis and monitoring of malignant tumors(including GBC).Therefore,this study aims to analyze the serum indicators of GBC and the significance of NLR in the early diagnosis of GBC.Objective: The purpose of this study is to analyze and discuss the correlation of blood neutrophils,lymphocytes,and tumor markers(CA19-9,CA125,CEA)in GBC,to provide some reference for the early diagnosis and screening of GBC.Methods: The cases of GBC and GBP in Shenzhen Second People’s Hospital from January 2010 to December 2019 were collected and summarized,including 60 cases of GBC and 60 cases of GBP.The general conditions,imaging data,serum markers,hematological tests,treatment methods,clinical and pathological stages of patients in the two groups were compared and analyzed.Among them,the chi-square test is used for counting data,and the t-test is used for measuring data.P < 0.05 was considered significant difference.Result:1.A total of 60 GBC patients were classified as GBC group,including 19 males and 41 females with a sex ratio of 1:2.16,aged 39-85 years,with an average age of(65.45±10.8)years.TNM clinical staging was conducted according to the eighth edition of AJCC,and the staging was preliminary evaluated according to imaging examination,including 4 patients in stage I,6 patients in Ⅱ stage,20 patients in the cancer stage,and 30 patients in the cancer stage.Among them,34 patients underwent surgery and 26 patients received conservative treatment.60 cases of GBP were classified as GBP group.There were 29 males and 31 females with a sex ratio of 1:1.07 and an average age of(62.71±8.9)years.There was no significant difference in gender,age,BMI and other general data between the two groups.2.The values of serum tumor markers(CA19-9,CA125,and CEA)in the GBC group were 872.97±1725.34,175.61±348.84 and 64.37±235.79,respectively,while those in the GBP group were 15.45±11.53,16.12±50.44,and 1.02±0.81,respectively.GBC group was significantly higher than the GBP group(all P < 0.05);There was no significant difference in AFP between the two groups.The sensitivity of tumor markers(CA19-9,CA125,and CEA)was 51.7%,38.3%,and 28.3%,respectively,and the specificity was 95%,98.3%,and 98.3%,among which CA19-9 had the highest sensitivity.The positive likelihood ratios of CA19-9,CA125,and CEA were 10.34,22.53,and 16.65,respectively.The sensitivity of CA19-9+CEA,CA19-9+CA125,CA125+CEA,CA19-9+CA125+CEA were 56.7%,60%,48.3%,68.3%,and the specificity were 93.3%,93.3%,96.7%,91.7%,respectively.The positive likelihood ratios were 8.46,8.95,14.64,and 8.23,respectively.The results showed that the sensitivity of CA19-9,CEA,or CA125 to the diagnosis of GBC was low,but the combined detection of CA19-9,CEA,or CA125 could improve the sensitivity of the diagnosis.3.The mean NLR value of the GBC group was 5.18±8.27,and the mean NLR value of the GBP group was 1.95±1.14,with a significant difference between the two groups(P=0.004).The ROC curve of NLR was calculated by SPSS to determine the critical value of NLR in the diagnosis of GBC.The critical value was determined by the cuff-off of the sum of specificity and sensitivity.The results showed that NLR diagnostic GBC threshold value was 2.1,sensitivity was 0.783,specificity was 0.767,Youden index was 0.53,and area under curve(AUC)was 0.793.The NLR of the GBC group was divided into low NLR group and high NLR group based on 2.1.There were significant differences in serum albumin,white blood cells,CA125,CEA,and CA19-9between the two groups(all P < 0.05).There were no significant differences in gender,age,BMI,hemoglobin,total bilirubin,aspartate aminotransferase,alanine aminotransferase,platelet count,AFP,and TNM stage(all P values were > 0.05).Conclusions:1.The combination of CA199,CA125,and CEA can significantly improve the detection rate of GBC,and the combined detection of tumor markers can improve the sensitivity of diagnosis.2.NLR can be used as a reference tool for the early diagnosis and screening of GBC,and patients with high-risk factors for GBC can be helpful for the early diagnosis and screening of GBC through regular monitoring of changes in NLR.According to our study,when NLR≥2.1,it may be related to the occurrence of GBC.