| Background:Radiotherapy is an important treatment for advanced non-small cell lung cancer(NSCLC).But the efficacy of radiotherapy is not ideal and the prognosis is not satisfactory.Currently,the method of evaluating efficacy is to rely on a chest CT scan within 4-12 weeks after the completion of radiotherapy,which is a long waiting period and may miss the opportunity to adjust the treatment.Therefore,it is necessary to find a marker to provide earlier and more accurate information for evaluating the efficacy of radiotherapy.More and more evidence shows that systemic inflammatory response plays an indispensable role in the occurrence and development of various cancers.Peripheral blood cells(such as neutrophils,lymphocytes,platelets and monocytes)representing inflammatory markers and their ratios are associated with the prognosis of a variety of malignant tumors.Most studies focus on the predictive effect of peripheral blood cell parameters on survival before and after radiotherapy,but few reports have reported the correlation between peripheral blood cell parameters after radiotherapy and the efficacy and prognosis of radiotherapy.Therefore,in this study,we collected patients with advanced non-small cell lung cancer treated by radiotherapy alone for a retrospective study.We analyzed the relationship between the parameters and changes of peripheral blood cells before and after radiotherapy and the short-term and long-term effects of radiotherapy,in order to explore the value of parameters and changes of peripheral blood cells before and after radiotherapy in predicting the radiation of advanced non-small cell lung cancer.Objectives:By analyzing the clinical data of advanced NSCLC before and after radiotherapy,To investigate the relationship of the parameters of peripheral blood cells such as white blood cell(WBC),neutrophil(NEUT),lymphocyte(LYM),monocyte(MONO),platelet(PLT),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR)and their change values(ΔN,ΔL,ΔM,ΔP,ΔNLR,ΔPLR,ΔNMR,ΔMLR)with radiotherapy efficacy in patients with advanced non-small cell lung cancer(NSCLC).in order to obtain indicators that can predict the radiotherapy efficacy of advanced NSCLC.Methods:The clinical data of patients with advanced NSCLC who received radiotherapy alone in our hospital from March 2011 to June 2016 with complete follow-up data were retrospectively analyzed.The patients were divided into two groups based on the short-term efficacy: the radiotherapy sensitivity(PR+CR)group and non-sensitivity(SD+PD)group.They were divided into two groups based on the long-term efficacy with median PFS as the critical value.The blood routine before and after radiotherapy of the two groups was compared respectively.ROC curve demonstrated the critical value was the best cut-off values of Peripheral blood Cell Parameter for radiation response,The patients were divided into two groups according to the critical value.Differences in short-term efficacy were compared between the group with lower group and higher group.Differences in short-term efficacy were compared between the group with lower changes of Peripheral blood Cell Parameter before and after radiotherapy.and that with higher changes.Results:1.According to inclusion criteria and exclusion criteria,70 cases received simple radiotherapy with complete follow-up data were screened.According to international regulations,people over 65 years old were identified as elderly,25 of them were elderly(>65 years old),45 were non-elderly.CR 0 cases,PR 37 cases,SD 22 cases,PD 11 cases,the objective response rate(ORR)was 52.86%,the median PFS(mPFS)was 5 months.2.There were no significant differences in WBC,NEUT,LYM,MONO,PLT and NMR between sensitive group and non-sensitive group after radiotherapy(P > 0.05),but there were significant differences in NLR,PLR and MLR between the two groups(P < 0.05).3.The correlation analysis showed that PLR and MLR after radiotherapy were well correlated with NLR after radiotherapy,and the difference between pre-radiotherapy and post-radiotherapy such as ΔNLR,ΔPLR,ΔMLR was also well correlated with ΔNLR.4.The ROC curve demonstrated the optimal critical value of NLR after radiotherapy was 5.77(sensitivity and specificity were 0.78 and 0.67 respectively),and the ORR between lower group and higher group was significantly different(26.7% vs 72.5%)when the patients were divided into two groups according to the cut-off point(5.77).The optimal critical value of ΔNLR was 6.78(sensitivity and specificity were 0.95 and 0.52 respectively).There was significant difference(10.5% vs 68.6%)in ORR between lower group and higher group when the patients were divided into two groups according to the cut-off point 6.78.5.After radiotherapy,the optimal critical value of PLR was 253.50(sensitivity and specificity were 0.73 and 0.61 respectively),and the ORR between lower group and higher group was significantly different(33.3% vs 65.7%).,when the patients were divided into two groups according to the cut-off point(253.50).the optimal critical value of ΔPLR was 179.64(sensitivity and specificity were 0.81 and 0.52 respectively),and the ORR between lower group and higher group than the cut-off point(179.64)was significantly different(29.2% vs 65.2%),when the patients were divided into two groups according to the cut-off point(179.64).6.After radiotherapy,the optimal critical value of MLR was 42.52(sensitivity and specificity were 0.46 and 0.82 respectively),and the ORR between lower group and higher group was significantly different(43.5% vs 70.8%),when the patients were divided into two groups according to the cut-off point(42.52).the optimal critical value of ΔMLR was 0.08(sensitivity and specificity were 0.41 and 0.85 respectively),and the ORR between lower group and higher group than the cut-off point(0.08)was significantly different(44.9% vs 71.4%),when the patients were divided into two groups according to the cut-off point(0.08).7.After radiotherapy,the best value of function value(P)o that combined prediction of therapeutic effect by blood cell parameters was 0.61(sensitivity and specificity were 0.57 and 0.82 respectively),and the ORR between higher group and lower group than the cut-off point(0.61)was significantly different(77.8% vs 37.2%).8.There was a significant difference(4.2 months vs 6.1 months,P < 0.05)in mPFS between lower group and higher group,when the patients were divided into two groups according to the cut-off point(5.77)of NLR.9.There was no significant difference between NLR,PLR,ΔPLR,MLR,ΔMLR and mPFS before and after radiotherapy.Conclusions:1.NLR,PLR and MLR after radiotherapy are correlated with the short-term efficacy of radiotherapy.The higher the ratio,the lower the ORR.2.The changes of NLR,PLR and MLR before and after radiotherapy are correlated with the short-term curative effect of radiotherapy.The more significant the increase,the worse the curative effect of radiotherapy.3.Both NLR after radiotherapy and ΔNLR are relatively valuable in predicting the short-term efficacy of NSCLC radiotherapy.4.The higher the ratio of NLR to PFS,the shorter the PFS.5.Peripheral blood cell parameters before and after radiotherapy have important predictive value for radiotherapy alone in NSCLC. |
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