Correlation Between Multiple Inflammatory Markers And Cervical Lymph Node Metastasis In Patients With Oral Squamous Cell Carcinoma

Objective: To investigate the relationship between the Neutrophil to Lymphocyte ratio(NLR),Platelet to Lymphocyte ratio(PLR),Lymphocyte to monocyte ratio(LMR)and cervical lymph node metastasis in patients with oral cancer,to provide the clinical basis for the relationship between tumor inflammatory reaction and its malignant biological behavior.Methods: From October 2018 to December 2020,the data of patients admitted to the Department of Oral and Maxillofacial Surgery in Hebei Medical University who were diagnosed as oral squamous cell carcinoma by histopathology were collected retrospectively,after inclusion and exclusion criteria screening,a total of 112 patients with oral squamous cell carcinoma were included.51 patients with pathological positive lymphnodes(pN+)were selected as the experimental group,while 61 patients with pathological negative lymphnodes(pN0)were selected as the control group.The values of NLR,PLR and LMR calculated from the results of blood routine examination at admission.SPSS25.0 software was used to compare the differences of inflammatory markers between the two groups.According to Spearman correlation analysis,the degree of correlation between clinical stage of lymph node and inflammatory index in experimental group was obtained.The ROC curve was drawn by MEDCALC software,and the best cut-off value was obtained.Chi-square/Fisher test was used to analyze the relationship between clinical data,inflammatory markers and cervical lymph node metastasis.The independent influencing factors were obtained by Logistic regression analysis.Results:1.There were significant differences in NLR(z =-4.15,P =.000),LMR(z =-2.50,P =.012)and PLR(t = 3.03,P =.003)between pN+group and pN0 group.2.In patients with pathological positive lymphnodes,NLR and PLR were positively correlated with pathological lymph node stage(r =.780,P =.000;r =.537,P =.000),and LMR was negatively correlated with pathological lymph node stage(r =-.429,P =.002).3.The AUC of NLR was 0.734,the best cut-off value was 1.667,the sensitivity was 98.040%,the specificity was 37.700%,the AUC of PLR was 0.674,the best cut-off value was 171.28,the sensitivity was47.060%,the specificity was 83.610%,the AUC of LMRwas 0.638,the best cut-off value was 5.200,the sensitivity was 84.310%,the specificity was 42.620%.There was no significant difference in AUC,sensitivity and specificity among the three groups(P > 0.05).4.Single factor analysis of cervical lymph node metastasis in OSCC showed that the tumor was related to infiltration of neuromuscular tissue,cT staging,NLR,PLR and LMR.Logistic regression analysis showed that peripheral neuromuscular involvement(OR=.152,P=.019),cT4stage(OR=.195,P=.021)and PLR > 171.287(OR=.281,P=.014)were independent risk factors for cervical lymph node metastasis in OSCC.5.Among the ROC curves of independent factors,the AUC of cervical lymph node metastasis was 0.535 when tumor invaded peripheral nerve muscle and 0.672 when it was combined with PLR > 171.287(P=0.0016)The AUC of CT4 stage was 0.546,when it was combined with PLR > 171.287,the AUC was 0.656,the difference was statistically significant(P= 0.0019).Conclusion:1.In patients of OSCC,the level of NLR,PLR and LMR might be related to the pathological stage of lymph node,suggesting that NLR,PLR and LMR might be the auxiliary indexes of pathological stage of OSCC.2.Peripheral neuromuscular invasion,T staging,NLR,PLR and LMR were associated with cervical lymph node metastasis in OSCC.3.Peripheral neuromuscular invasion,clinical T4 stage and PLR >171.287 were independent risk factors for cervical lymph node metastasis in OSCC.The high risk population of cervical lymph node metastasis in OSCC could be assessed.4.Among the independent factors,the accuracy of cT4 staging combined with PLR > 171.287 in predicting cervical lymph node metastasis was improved.