Correlation Explaration Between Peripheral Blood Neutrophil To Lymphocyte Ratio,CA199 And Intrahepatic Cholangiocarcinoma Lymph Node Metastasis

Background and object:Lymph node metastasis is the main metastatic pathway of intrahepatic cholangiocarcinoma(ICC),and lymph node metastasis is an important factor affecting the prognosis of patients with ICC.ICC morbidity and mortality are rapidly increasing worldwide,and ICC is one of the most deadly cancers,and surgical resection remains the primary means of ICC curative treatment.Unfortunately,the prognosis of ICC patients after partial hepatectomy is unsatisfactory.The 5-year survival rate after hepatectomy is 30%to 40%,and the median survival of unresectable ICC patients is only 12-15 months.Lymph node metastasis is a surgical contraindication,so improving the accuracy of lymph node metastasis diagnosis in ICC patients is critical to the selection of treatment options for patients with ICC.Peripheral blood neutrophil-to-lymphocyte ratio(NLR)and CA199 all can be used as predictors in some tumors to determine whether there is lymph node metastasis before surgery and affect prognosis.By detecting NLR and CA199 in peripheral blood of patients with ICC,we explored the correlation between the two and lymph node metastasis of intrahepatic cholangiocarcinoma,and then explored the factors affecting lymph node metastasis of intrahepatic cholangiocarcinoma and provided a new Idea treatment for tumor treatment.Methods:Collect the clinical data,whose pathological results indicat intrahepatic cholangiocarcinoma after surgery,from the Hepatobiliary and Pancreatic Surgery of Henan Provincial People's Hospital,the time is from December 2016 to December2018.The clinical data were selected and the patients with the following conditions were screened out:1.Patients consolidating with other malignancies.2.Patients with missing medical history data.3.Patients with immunological disease and long-term application of glucocorticoids or immunosuppressive agents preoperative.4.Combine other infectious diseases before surgery.There are 130 cases of ICC from the pathological diagnosis,including 45 cases with lymph node metastasis,it is LNM group,and those with negative lymph node metastasis are defined as NLNM group.We get the first time blood test results of all130 patients to calculate the NLR.We get the first time blood test of the tumor markers to obtain the CA199,when the 130 patients were admitted into the hospital.At the same time,the age,gender,hepatitis background,tumor size,location,quantity of the imaging,ALT,AST,GGT,TBIL,ALP,albumin,AFP,CEA,CRP and other factors were collected and analyzed.All the the first time test indicators were admitted when the patients get into the hospital.Assess the impact of various factors on ICC lymph node metastasis.Statistical analysis was performed using SPSS 22.0 statistical software.The quantitative data obeying to normal distribution was analyzed by independent sample t test,the quantitative data obeying to skew distribution was analyzed by rank sum test,and the qualitative data was analyzed by x~2 test.Univariate analysis was used to analyze the correlation between each factor and the results.Multivariate analysis was used to analyze the independence of each variable and the results.P<0.05 indicated that the difference was statistically significant.Results:1.The incidence of lymph node metastasis in 130 patients with ICC was34.6%(45/130).2.Univariate analysis showed that NLR,CA199,ALT,AST were related factors of lymph node metastasis in intrahepatic cholangiocarcinoma.3.By establishing the ROC curve of NLR and CA199,the best cutoff value of NLR is 3,and the best cutoff value of CA199 is 36U/ml.4.The incidence of high NLR was 75.6%(34/45)in the lymph node metastasis group,80.8%(36/45)in the high CA199,80.0%(36/45)in the ALT,and57.8%in the AST(26/45),each of the above items is higher than the non-lymph node metastasis group(P<0.05).5.Multivariate analysis showed that NLR,CA199 is an independent risk factor for lymph node metastasis of intrahepatic cholangiocarcinoma.Conclusion:1.NLR,CA199,ALT,AST are related factors of lymph node metastasis in intrahepatic cholangiocarcinoma2.The NLR value of ICC LNM group is higher than that of NLNM group.High NLR was an independent risk factor for ICC lymph node metastasis.3.The CA199 value of ICC LNM group is higher than that of NLNM group.High CA199 was an independent risk factor for ICC lymph node metastasis.