Correlation Between Preoperative Peripheral Blood NLR And PLR And Prognosis Of Esophageal Squamous Cell Carcinoma

Background and Objective:Esophageal cancer is one of the common malignant tumors of the digestive tract caused by genetic factors,environmental factors,and individual dietary habits.There are about 300,000 people die of esophageal cancer every year in the world.At present,China is one of the countries with the highest mortality rate of esophageal cancer in the world.The average annual mortality rate is 15.59/100,000,of which the lowest in Yunnan Province(1.05/100,000),the highest in Henan Province(32.22/100,000),showing a distinct regionality and a trend of increasing year by year.At present,with the advancement of medical standards,the popularity of electronic fiber endoscopy and extensive publicity and education,the early and mid-term diagnosis and treatment of esophageal cancer and the survival of patients have improved significantly,but the prognosis of patients is still not ideal,5-year survival Still unsightly.Therefore,we still lack reasonable and effective prognostic indicators to provide a reasonable assessment of the prognostic effects of personalized treatment for esophageal cancer patients.A large number of epidemiological evidence suggests that chronic uncontrollable inflammation is one of the causative factors of tumors.Sustained chronic inflammation results in the infiltration of a large number of inflammatory cells in and around the tissue,enriching the inflammatory cells in the microenvironment within the collective.Inflammatory factors and their active substances can cause changes in the human environment,induce mutations in genetic material,and reduce the stability of the genome,thereby inducing the occurrence of malignant tumors.Therefore,Neutrophil to lymphocyte ratio(NLR)and platelet/lymphocyte ratio(NLR)are recognized as common indicators of systemic inflammatory response.Some studies have shown that it is resistant to the body.Tumor effects are closely related to cancer prognosis.Therefore,this study aims to further study esophageal squamous cell carcinoma by studying the ratio of neutrophil to lymphocyte and the ratio of platelet to lymphocyte to the prognosis of esophageal squamous cell carcinoma(ESCC).A simple prognostic marker provides a reference and provides clinical evidence for assessing the efficacy and prognosis of esophageal squamous cell carcinoma treatment regimens.Methods:(1)To retrospectively analyze the clinical data of 153 patients with esophageal squamous cell carcinoma who underwent concurrent surgery on thoracic surgery in the Second Affiliated Hospital of Zhengzhou University from June 2010 to December 2013.It mainly includes the gender and age of the patient;and the routine blood test results within 1 week before surgery,including the absolute values of white blood cells,platelets,neutrophils and lymphocytes;the postoperative pathological features of the patients: tumor TNM staging,tumor differentiation Through telephone follow-up,to understand the patient’s recurrence and overall survival after surgery.(2)Calculate the Yoden index(Youden index,sensitivity + specificity-1)and the area under the curve by plotting the receiver operating characteristic curves(ROC)of the patient’s preoperative NLR and PLR levels(area under the Curve,AUC).Determine the optimal threshold for preoperative NLR and PLR,and convert the continuity variable into a categorical variable based on this.The measurement data were expressed as mean ± standard deviation,and the comparison between measurement data was performed by independent sample T test,and the comparison of count data was performed by chi-square test.Univariate analysis and multivariate analysis were performed using a semiparametric analytical Cox regression model.Survival curves were plotted against the relevant risk factors using the Kaplan-Meier method.(3)Statistical analysis using SPSS21.0 data analysis software.Take α=0.05 for the test level.Results:(1)Using NLR as the test variable,draw the receiver operating characteristic curve(ROC curve),the area under the curve is 0.789.When NLR=2.01,the Yoden index(sensitivity + specificity-1)is the largest,0.524.The sensitivity was 72.9% and the specificity was 79.4%.According to the NLR counting threshold we obtained,the patients were divided into two groups: low NLR group(<2.01)and high NLR group(≥2.01).The difference of TNM staging between the high NLR group and the low NLR group was statistically significant.P values < 0.001;that is,patients with high NLR groups had a later TNM stage than the low NLR group.There was no significant difference in gender,age,and tumor tissue differentiation between the high NLR group and the low NLR group.PLR was used as the test variable to plot the receiver operating characteristic curve(ROC curve).The area under the curve was 0.852.When PLR=123.47,the Yoden index(sensitivity + specificity-1)was the largest at 0.668.80.0%,specificity was 86.8%.According to the NLR counting threshold we obtained,the patients were divided into low PLR group(<123.47)and high NLR group(≥123.47).The difference of TNM staging between the high NLR group and the low NLR group was statistically significant.P value < 0.001;that is,patients with high PLR group had a later TNM stage than the low PLR group.There was no significant difference in gender,age,and tumor tissue differentiation between the high NLR group and the low NLR group.(2)Analysis of factors affecting overall survival: In the univariate analysis,patients’ TNM stage,NEU count,LYM count,PLT count,NLR value and PLR value were significantly correlated with the overall survival of the patients(P<0.05).In multivariate analysis,TNM stage,PLT count,and PLR were independent prognostic factors that affected overall patient survival(P < 0.05).With the increase of TNM staging,the overall survival of patients was significantly reduced(P<0.05).The survival time of patients with low NLR group was significantly higher than that of high NLR group(P<0.05).The survival of patients with the same low PLR group was significantly higher than that of the high PLR group(P<0.05).Conclusions:The ratio of neutrophil to lymphocyte(NLR)and platelet to lymphocyte(PLR)in peripheral blood can be used as one of the important parameters for evaluating the prognosis of esophageal squamous cell carcinoma.