Clinical Value Of Preoperative Peripheral Blood Lymphocytes/monocytes Ratio In Prognosis Of Cervical Cancer

Objective:To explore the clinical value of preoperative peripheral blood lymphocytes/monocytes ratio(LMR)in the prognosis of cervical cancer,and to explore the LMR cut-off value for reference.Methods: 134 patients with stage Ⅰ A2 ~ Ⅱ A undergoing radical hysterectomy in the First Affiliated Hospital of Wannan Medical College were enrolled from January2013 to December 2014.The preoperative peripheral blood LMR was used as the observation index,and the clinicopathological and follow-up data of the patients were included in the study.The cut-off values of LMR predicted PFS and OS obtained by ROC curve were 3.45 and 2.54,respectively.According to the cut-off value,the subjects were divided into high value group and low value group.The differences between the two groups were compared and tested by χ2 test and Fisher exact probability method.Log-rank analysis was selected to make the Kaplan-Merier survival curve between each influencing factor and PFS or OS.Univariate and multivariate COX analysis were then performed.Results:1.When LMR was used to predict PFS before operation,LMR=3.45 was the cut-off value.There were significant differences in FIGO stage(P=0.001)and lymph node metastasis(P=0.023)between high LMR group(LMR>3.45)and low LMR group(LMR≤3.45).While there were no significant differences in age(P=0.956),SCC-Ag(P=0.116),tumor diameter(P=0.068),vascular tumor thrombus(P=0.826),interstitial invasion depth(P=0.100)and pathological type of tumor(P=0.494).Univariate analysis showed that SCC-Ag(P=0.009),FIGO stage(P=0.000),LMR(P=0.000),tumor diameter(P=0.021),lymph node metastasis(P=0.000)and interstitial invasion depth(P=0.000)were risk factors for PFS.Age(P=0.275),vascular tumor thrombus(P=0.259)and pathological type of tumor(P=0.693)were not associated with PFS.Multivariate analysis showed that preoperative LMR≤3.45(HR: 7.675,95%CI:2.151-27.378)and late stage(HR: 3.771,95%CI: 1.441-9.868)were independent risk factors for postoperative PFS.2.When LMR was used to predict OS before operation,LMR=2.54 was the cut-off value.There were significant differences in FIGO stage(P=0.000),tumor diameter(P=0.003),interstitial invasion depth(P=0.001)and lymph node metastasis(P=0.009)between high LMR group(LMR>2.54)and low value group(LMR≤2.54).While there was no significant difference in age(P=0.213),SCC-Ag(P=0.465),vascular tumor thrombus(P=0.199)and pathological type of tumor(P=0.460).Univariate analysis showed that SCC-Ag(P=0.009),FIGO stage(P=0.000),LMR level(P=0.000),tumor diameter(P=0.001),lymph node metastasis(P=0.012)and interstitial invasion depth(P=0.000)were the influencing factors of OS.Age(P=0.137),vascular tumor thrombus(P=0.113)and pathological type of tumor(P=0.255)were not associated with OS.Multivariate analysis showed that preoperative LMR≤2.54(HR: 4.633,95%CI:1.317-16.3)was an independent risk factor for postoperative OS.Conclusion:1.Patients with low LMR level often have large tumor diameter,higher SCC level,later FIGO stage,more severe lymph node metastasis and deeper interstitial invasion.2.FIGO stage,SCC-Ag,preoperative LMR,lesion size,lymph node metastasis and interstitial invasion depth were the influencing factors of PFS and OS in patients with early cervical cancer.3.FIGO stage can be used as an independent predictive factor of recurrence in patients with early cervical cancer.4.Preoperative LMR level is an independent prognostic factor for predicting PFS and OS in patients with early cervical cancer.