Changes Of Serum NLR And PLR Before And After The First ¹³¹I Treatment For Thyroid Papillary Carcinoma And Its Clinical Significance

Objective:The purpose of this study was to explore the changes of serum neutrophil-lymphocyte ratio(neutrophiltolymphocyteratio,NLR)and platelet-lymphocyte ratio(platelet tolymphocyteratio,PLR)before and after treatment and their correlation with the clinicopathological features of patients with papillary thyroid carcinoma(papillary thyroidcancer,PTC),andthe relationship between them and the clinical efficacy and prognosis of PTC,so as to provide new ideas for improving the prognosis of patients with PTC.Methods:1、Collected PTC patients who received the first 131I treatment in the Department of Nuclear Medicine,affiliated Hospital of North Sichuan Medical College from January 2014 to December 2018.All patients underwent total thyroidectomy or subtotal thyroidectomy plus cervical lymph node dissection.After operation,131I nail dissection was performed according to the 2015 version of ATA guidelines.The clinical data of patients with PTC were collected,including sex,age,pathological type,risk stratification of recurrence,invasion of capsule,cervical lymph node metastasis,distant metastasis,1-3 days before the first 131I nail dissection.Blood routine,serum thyrotropin(TSH),thyroglobulin(Tg),thyroglobulin antibody(TgAb),neck ultrasound and chest CT were measured 40 days after the first treatment and 6 months after treatment.2、According to the 2015 version of ATA guidelines,the efficacy was evaluated at the 6th month after 131I treatment:(1)stimulatingTg(sTg)<1ug/L or unstimulatedTg(uTg)<0.2ug Tg/L;(2)TgAb<115;(3)negative cervical color ultrasound;(4)Chest CT was negative;(5)DX-WBS or whole body bone scan was negative.If all the above criteria are met,the reaction is judged to be complete(ER);otherwise,the reaction is incomplete(NER).Taking total thyroidectomy or subtotal thyroidectomy plus cervical lymph node dissection as the observation point,the discharged patients were followed up every half a year by outpatient revisit and telephone,and the last follow-up time was December 31,2021.Relapse-free survival(RFS)was from the date of operation to the date of recurrence or the end of follow-up.3、①Analysis of the changes of NLR and PLR levels before and after 131I treatment:Mann-whitney U test was compared between groups,Kruskal-Walis H test was used for pairwise comparison;②Correlation analysis of clinicopathological features of NLR,PLR and PTC:Mann-whitney U test and χ2 test were used to compare between groups;③Predictive value of NLR and PLR in curative effect and prognosis before and after 131I treatment:univariate and multivariate Logisitc regression analysis;④Pairwise comparison using Bonferroni method to adjust P value,P<0.05.The difference was statistically significant.Results:1、A total of 422 patients with PTC were included,including 323 females and 99 males,with an average age of 44±12.2 years,ranging from 16 to 78 years old.There were 182 cases of NER,240 cases of ER,75 cases of poor RFS and 347cases of RFS.2、the level of NLR in 422 PTC patients was the highest 40 days after the first 131I treatment,which was significantly higher than that before treatment and 6 months after treatment(H=26.495,P=0.000).There was no significant difference between the levels of NLR before and 6 months after 131I treatment.The level of PLR was the highest 40 days after the first 131I treatment,followed by PLR level 6 months after treatment,and the lowest PLR level was found before treatment(H=97.523,P=0.000).There was no significant difference in the levels of NLR and PLR between the NER group and the ER group before the first 131I treatment,40 days after the first treatment and 6 months after the treatment,that is,there was no correlation between the efficacy of 131I and the levels of NLR and PLR at different time points.Before the first 131I treatment,40 days after the first treatment and 6 months after the first 131I treatment,the level of PLR in the poor RFS group was higher than that in the RFS group in the same period,but there was no correlation between RFS and NLR at different time points.3、ROC curve showed that the best cutoff value of PLR for predicting prognosis 6 months after 131I treatment was 102.2(area under ROC curve(AUC)=0.61355 95%CI15 0.541-0.685),that is,when PLR≥102.2 6 months after 131I treatment,it was more likely to predict poor curative effect.There was no correlation between NLR and PLR before 131I treatment,40 days after 131I treatment and 6 months after 131I treatment.NLR and PLR before 131I treatment,NLR and PLR 40 days after 131I treatment,NLR 6 months after 131I treatment had no correlation with prognosis(P>0.05).4、Kaplan-Meier survival curve showed that the median recurrence-free survival time of low NLR group before 131I treatment was longer than that of high NLR group(33.3 months and 25.1 months respectively,P=0.046).Before 131I treatment,the median recurrence-free survival time of low PLR group was longer than that of high PLR group(25.4months and 21.7months respectively,P=0.014).The median relapse-free survival time in the low PLR group was longer than that in the high PLR group 40 days after 131I treatment(42.3months and 22.7months respectively,P=0.002).Six months after 131I treatment,the median relapse-free survival time in the low PLR group was longer than that in the high PLR group(24.0months and 21.9months respectively,P=0.021).40 days and 6 months after 131I treatment,the level of NLR was not related to RFS in patients with PTC(P>0.05).5、Correlation between NLR,PLR and clinicopathology of PTC:NLR level before 131I treatment(<2.28 VS≥2.28)was related to thyroid invasion in vitro.NLR level at 40 days after 131I treatment(<115.86 VS≥115.86),PLR level before 131I treatment(<115.86 VS≥ 115.86),PLR level at 40 days after treatment(<139.0 VS≥ 139.0),PLR level at 6 months after treatment(<102.2 VS≥ 102.2)were correlated with gender constituent ratio(P<0.05).Other indexes were not correlated with the clinicopathology of PTC.6、Univariate analysis showed that the efficacy was correlated with cervical lymph node metastasis(χ2=6.661,P=0.010),risk stratification of recurrence(χ2=7.163,P=0.028).The prognosis was correlated with sex(χ2=29.937,P=0.000),curative effect after the first 131I treatment(χ2=20.604,P=0.000),and PLR level 6 months after treatment(χ2=7.742,P=0.005).Multivariate analysis showed that cervical lymph node metastasis(OR:6.252,P=0.000),high risk stratification of recurrence(OR:1.213,P=0.000)were independent factors affecting the efficacy of NER,while male(OR:2.761,P=0.006)、curative effect after the first 131I treatment was NER(OR:6.200,P=0.019)and high PLR 6 months after treatment(OR:4.660,P=0.041)were independent influencing factors of poor RFS.Conclusion:1、The PLR level was the highest 40 days after the first 131I treatment,followed by the PLR level 6 months after treatment,and the lowest PLR level before the first 131I treatment.The higher PLR level before the first 131I treatment,40 days after the first treatment and 6 months after treatment predicted a poor prognosis.There was no correlation between the change trend of NLR before and after 131I treatment and the prognosis of patients.2、The level of NLR before 131I treatment was related to the invasion of thyroid gland in vitro.The level of NLR 40 days after 131I treatment and the level of PLR before 131I treatment,40 days and 6 months after 131I treatment were only related to gender.3、NER can be predicted in PTC patients with cervical lymph node metastasis,high risk stratification of recurrence,while poor RFS can be predicted in male patients、curative effect after the first 131I treatment was NER with PLR>102.2 6 months after the first 131I treatment.