The Study On The Relationship Between Preoperative Peripheral Blood Markers And Prognosis Of Patients With Small Cell Lung Cancer

Background and purposeNCCN guidelines recommend preoperative TNM staging for small cell lung cancer(SCLC),and surgical treatment is recommended for patients with TNM staging T1-2N0M0.Recent epidemiological and SEER databases have shown that surgical treatment of stage T1-2N0M0 SCLC significantly improves survival compared with radiotherapy or concurrent chemoradiotherapy.However,clinically,we found that patients with similar tumor size,clinical stage and tumor tissue grade often had significantly different clinical prognosis after surgical treatment,and TNM stage alone was not enough to determine the prognosis of patients.Therefore,we attempted to determine the prognosis of patients by preoperative peripheral blood molecular markers.Studies have reported that the number of human peripheral blood cells and the ratio can reflect the tumor microenvironment inflammatory response,and the microenvironment of inflammation can affect tumor cell proliferation and survival,so as to promote angiogenesis and tumor metastasis,reduce tumor cell’s response to anticancer drugs,in malignant tumor play a key role in the occurrence and development.Therefore,this study analyzed the number and ratio of preoperative peripheral blood cells to explore the correlation with the prognosis of patients with early resectable SCLC,so as to provide a theoretical basis for predicting the prognosis of patients and taking effective treatment.MethodsA total of 110 patients with SCLC who received radical surgical treatment in the Department of Surgery of the Affiliated Cancer,Harbin Medical University Cancer Hospital from January 2013 to December 2018 were selected,and their preoperative TNM staging was T1-2N0M0.The primary end point was overall survival(OS),and the end of follow-up was December 1,2019.Through access to electronic medical records and telephone follow-up of patients with clinical data collection and preoperative hematology indexes,receiver operating characteristic curve(ROC)drawing according to the results of preoperative patients with hematology test calculation neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),albumin to globin ratio(AGR)values of the cut-off,Log-rank test to compare survival between groups,Kaplan Meier-survival curve drawing method,using the single factor analysis and multi-factor analysis of peripheral blood markers relationship with the prognosis of patients.Results(1)The optimal cut-off point values of NLR,PLR and AGR for predicting disease prognosis were obtained by ROC curve,respectively.The optimal cut-off point values of NLR,PLR and AGR were 3.08,140 and 1.33.(2)Combined with clinical data and follow-up data of 110 patients with SCLC after surgical treatment,the median age of the patients was 58.5 years old and the median follow-up time was 28.5 months.Follow-up results showed that 44 patients died and 66 patients survived.The overall 1-year,3-year and 5-year survival rates of the patients were 89.1%,58.5% and 50.6%,respectively,and there was statistically significant difference in survival rates among PLT,NLR,PLR and AGR groups(P <0.05).(3)Univariate results showed that PLT(HR=0.286,95%CI: 0.147-0.559,P <0.001),NLR(HR=5.474,95%CI: 2.885-10.388,P < 0.001),PLR(HR=0.18,95%CI:0.096-0.336,P < 0.001),and AGR(HR=0.377,95%CI: 0.204-0.698,P=0.002)were associated with OS in SCLC patients.Multivariate results showed that PLT(HR=0.322,95%CI:0.113-0.539,P=0.004),NLR(HR=0.294,95%CI:0.132-0.655,P<0.001)and AGR(HR=2.856,95%CI:1.187-4.331,P=0.013)were independent risk factors affecting the prognosis of SCLC,and the differences were statistically significant.ConclusionsPreoperative high PLT(≥300×109/L),high NLR(≥3.08),high PLR(≥140)and low AGR(< 1.33)indicate poor survival prognosis in SCLC patients,and preoperative PLT,NLR and AGR can be used as biomarkers to predict the prognosis of SCLC patients.