Correlations Of Preoperative Neutrophil To Lymphocyte Ratio With Clinical Pathology And Prognosis In Non-small Cell Lung Cancer

Background and Objective Primary lung cancer is the most common malignant neoplastic disease and one of multiple etiology diseases,caused by genetic and environmental factors.At present,statistics show that the number of lung cancer in our country has reached 730,000 every year and the number of deaths has reached 610,000,which keep increasing.Although the lifetime of lung cancer has improved by strengthening physical examinations in the high-risk populations,carrying out early detection and treatment and performing positive therapies(mainly including operation,chemotherapy,radiotherapy,molecular-targeted therapy,interventional therapy,immunotherapy,and so on),the prognosis and outcome still remain unsatisfactory that five-year survival rate of lung cancer in the world is still low.Now it is necessary for us to design a rational and effective evaluation system of prognosis and find more significant molecular markers beneficial to early diagnosis,which can provide accurate evidences for closely monitoring and assessing prognosis of lung cancer treated by individualized therapy.A large number of epidemiological data has revealed that inflammation is one of specific carcinogenic stimuli.Owing to the ongoing chronic inflammation,tissues and surroundings are infiltrated with plenty of inflammatory cells,which contribute to inflammatory cytokines and active substances gathering in micro-environment of body and finally cause the changes of internal environment,which may be responsible for mutation of genetic materials and reduction of genome stability.As we all know,neutrophile and leukomonocyte counts are cardinal indicators in blood test,furthermore,it is universally acknowledged that neutrophil to lymphocyte ratio(NLR)has become an indicator reflecting systemic inflammatory.In addition,some researches has presented that NLR may have close correlations with anti-tumor effect and prognosis of cancers.As a result,our study aims at exploring the potential correlations of preoperative NLR with clinical pathology and prognosis in non-small cell lung cancer(NSCLC),in order to look for simple and convenient prognostic biomarkers of lung cancer and offer clinical references to evaluate efficacy and supervise prognosis.Materials and Methods(1)We retrospectively analyzed clinical data of one hundred and forty-seven patients with non-small cell lung cancer treated by operation in our hospital from January 2010 to December 2012.The clinical data mainly included gender,age,results of blood routine within one week before operation(containing leukocyte,neutrophil and lymphocyte counts),post-operative pathological characteristics(containing histological types,TNM stage and degree of tumor differentiation)and postoperative recurrence and overall survival(defined as interval time from the day of surgery to the day of death induced by various factors or as the time of final follow-up)observed by telephone follow-up.(2)After establishing receiver operating characteristic(ROC)curves to determine critical point of each indicator,we transformed continuous variables to categorical variables.Numerical variables were compared between two groups by Mann-Whitney U test or by Kruskal-Wallis H test,and categorical variables were compared between groups by chi-squared test or by Fisher exact probabilities.We used Kaplan-Meier method to execute univariate analysis,portrayed survival curves and compared survival rate by log-rank test.Then Cox regression model was applied to multiple-factor analysis.(3)Statistical analyses were calculated by using SPSS 21.0 software.We defined ? = 0.05 for the test level.Results(1)The correlations of WBC,NEU,LYM counts and NLR with clinical pathology and prognosis The critical point of WBC count was set as 6.56×109/L based on ROC curve,with the sensitivity of 61% and the specificity of 79.2%.Compared high-WBC group with low-WBC group,there were significant differences in gender,histological types and T stage(all P<0.05).The critical point of NEU count was considered as 4.31×109/L according to ROC curve,with the sensitivity of 61% and the specificity of 87.5%.Gender,histological types,T stage,N stage,TNM stage and the degree of tissue differentiation revealed statistical differences between high-NEU group and low-NEU group(all P<0.05).The critical point of LYM count was regarded as 1.79×109/L according to ROC curve,with the sensitivity of 60.2% and the specificity of 66.7%.Statistical difference was found in terms of TNM stage between high-LYM group and low-LYM group(P<0.05).The critical point of NLR was defined as 2.66 according to ROC curve,with the sensitivity of 57.7% and the specificity of 95.8%.Compared high-NLR group with low-NLR group,there were significant differences in histological types,T stage,N stage,M stage and TNM stage(all P<0.05).(2)Analysis on influencing factors for overall survival In univariate analysis,overall survival had obvious correlations with TNM stage,the degree of tissue differentiation,WBC,NEU and LYM counts and NLR(all P<0.05).In multi-factor analysis,TNM stage and NLR were the independent prognostic factors influencing overall survival(all P<0.05).With the higher TNM stage,patients had lower overall survival(P < 0.05).What's more,high-NLR group showed lower overall survival than low-NLR group(P<0.05).Conclusion NLR can serve as one factor to evaluate the prognosis in NSCLC patients.