Prognostic Value Of Preoperative Systemic Inflammatory Response Indexes In Patients With StageⅠ-Ⅲ Esophageal Squamous Cell Carcinoma

Background and Objective Esophageal cancer is an aggressive and rapidly progressing malignant tumor,and the prognosis of patients with esophageal cancer is usually poor.Histological types of esophageal cancer mainly include squamous cell carcinoma and adenocarcinoma,among which esophageal squamous cell carcinoma is the most common,especially in some high incidence areas such as China and Iran.However,in Europe and America,where the incidence of esophageal cancer is low,the histological type of esophageal cancer is mainly adenocarcinoma.In addition,although the perioperative mortality and overall survival of esophageal cancer patients have been significantly improved with the progress of thoracic surgery technology and the application of individualized and multimodality treatment,it is still one of the most difficult malignant tumors to be cured.The final outcome of most esophageal cancer patients is local or distant tumor metastasis or recurrence,which has a great impact on the general survival status of patients.In recent years,it has been well known that the important factors affecting the prognosis of esophageal cancer patients include lesion location,degree of differentiation,TNM stage,lymph node metastasis,etc.However,some studies conducted subgroup analysis and found that even for esophageal cancer patients with the same degree of differentiation,TNM stage,lymph node status and other factors,their prognosis was quite different,and the specific cause of this phenomenon has not been clearly revealed.With the study of treatment and prognostic factors gradually entering the bottleneck period,people once again pay attention to the interaction between inflammation and cancer.As research has progressed since the 19 th century,it has become generally accepted,based on the evidence that has been found,that there is a definite link between inflammation and cancer.Inflammation plays a decisive role in different stages of tumor occurrence,development,malignant transformation,invasion and metastasis,and inflammation can also affect immune surveillance and treatment response.Therefore,this research from esophageal cancer patients with preoperative peripheral inflammation cell count and related inflammatory cells counting the ratio of the perspective,to explore different inflammatory cells and peripheral blood neutrophils and lymphocytes ratio(NLR),lymphocytes and monocytes ratio(LMR)and platelet and lymphocyte ratio(PLR)patients with esophageal squamous cell carcinoma(ESCC)relationship of clinical pathology and prognosis.Materials and Methods The clinicopathological data of 180 ESCC patients who were treated with concurrent surgery in the first affiliated hospital of zhengzhou university from December 2012 to December 2013 were retrospectively analyzed.The truncation values of NLR,PLR and LMR were determined by calculating the Youden’s Index according to the ROC curve,and the above three indexes were divided into two groups according to the selected truncation values.Overall survival and clinicopathological characteristics were compared between the groups,and univariate and multivariate analyses were performed.At the same time,140 cases of esophageal leiomyoma and 200 cases of normal physical examination patients who visited the hospital in the same period were selected as the control group.Similarly,the gender,age and the number of inflammatory cells in blood routine were recorded,and NLR,PLR and LMR were calculated.Results(1)The results of the comparison of inflammatory response indexes in peripheral blood of the three groups The counts of neutrophils,monocytes and NLR in peripheral blood of patients in the ESCC group were all higher than those in the esophageal leiomyoma group and the normal control group,with statistically significant differences.The level of peripheral blood LMR in the ESCC group was lower than that in the two control groups,and the difference was statistically significant.There was no statistically significant difference in lymphocyte counts between the ESCC group and the esophageal leiomyoma group(p=0.196),but both were lower than those in the normal control group.(2)The correlations of NLR,PLR,LMR in patients with ESCC According to the ROC curve,the critical value of NLR was 1.87 based on the maximum value of Youden’s Index,and it’s sensitivity was 66.7%,and the specificity was 66.7%.There were 99 cases in the high NLR group(≥1.87)and 81 cases in the low NLR group(<1.87),and the difference in T staging and TNM staging between the two groups was statistically significant.Similarly,the critical value of PLR was 120,and it’s sensitivity was 50.9%,and the specificity was 74.2%.There were 77 cases in the high PLR group(≥120)and 103 cases in the low PLR group(<120),and the difference in T staging and TNM staging between the two groups was statistically significant.There was no significant difference between the two groups in gender,age,tumor’s location,differentiation degree,T stage,N stage,TNM stage(p>0.05).The critical value of LMR was 3.66,and it’s sensitivity was 62.3%,and the specificity was 78.8%.There were 95 cases in the high LMR group(≥3.66)and 85 cases in the low LMR group(<1.87),and the difference in T staging and TNM staging between the two groups was statistically significant.(3)The prognostic value of NLR,PLR,LMR in patients with ESCC The results of univariate analysis showed that overall survival had obvious correlations with the tumor location,the degree of differentiation,T stage,N stage,TNM stage,NLR PLR and LMR(p<0.05).The 3-year and 5-year survival rates in the high NLR group were 44.4% and 22.3%,respectively,and they were 69.1% and 53.1% in the low NLR group respectively.The 3-year and 5-year survival rates in the high PLR group were 44.2% and 23.4%,respectively,and they were 64.1% and 47.6%in the low PLR group respectively.The 3-year and 5-year survival rates in the high LMR group were 69.5% and 52.6%,respectively,and they were 40.0% and 15.5% in the low LMR group respectively.In multivariate analysis,the degree of differentiation,N stage,TNM stage,PLR and LMR were independent predictors of ESCC(p<0.05).Conclusion(1)The increase of preoperative peripheral blood neutrophils,monocytes and NLR levels,as well as the decrease of lymphocytes and LMR levels have certain implications for the diagnosis of esophageal malignancy;(2)Preoperative peripheral blood LMR is an important prognostic factor for ESCC patients.