Prognostic Significance Of Peripheral Blood Neutrophils/lymphocytes In Staging And Grading Of Bladder Cancer

Objective:Bladder cancer is the most common cancer in the urinary system,which is a serious threat to people's life and health.Neutrophil-lymphocyte ratio(NLR)is a marker of tumor-related inflammation,which has been proved to be associated with the prognosis of various types of tumors,but the correlation with pathology after operation is not clear.In this study,we used descriptive statistical methods to summarize the clinical and pathological features of bladder cancer patients,and to evaluate the correlation between preoperative neutrophil/lymphocyte ratio and whether the tumor invaded the muscular layer,pathological stage and histological grade.Methods:The clinical data of 277 patients with urothelial carcinoma diagnosed from January 2014 to January 2018 were retrospectively analyzed,including gender,age,preoperative peripheral blood neutrophils,lymphocyte count,neutrophil/lymphocyte ratio(NLR),pathological stage,histological grade,tumor size,tumor number,etc.SPSS20.0 statistical software was used for statistical analysis.The measurement data were statistically described by mean standard deviation,and independent sample t test was used for comparison between groups.Percentage was used to describe the counting data,and chi-square test was used for comparison between groups.Spearman correlation was used to analyze the correlation between gender,age,leukocyte,neutrophil,lymphocyte and NLR and tumor muscle infiltration,tumor pathological stage and histological grade.The determination of the boundary value of related parameters was determined by drawing ROC curve.P<0.05 was considered statistically significant.Results:1.A total of 277 cases of bladder cancer were included in the study.(1)233cases were male(84.1%)and 44 cases were female(15.9%);174 cases were male(85.3%)and 30 cases were female(14.7%)in NMIBC group;59 cases were male(80.0%)and 14 cases were female(19.2%)in MIBC group.There was no significant difference in gender between NMIBC group and MIBC group.(2)The onset age of bladder cancer is 46~89 years old.There are 15 cases(5.4%)of patients under 50 years old,63 cases(22.7%)of patients aged 50~59 years old,92 cases(33.2%)of patients aged 60~69 years old and 107 cases(38.6%)of patients over 70 years old.It can be seen that the incidence of bladder cancer increases with age.The average age of NMIBC group was 64.32±9.46(range 46-89 years),and that of MIBC group was71.32±8.35(range 51~88 years).There was significant difference between the two groups(p < 0.05).(3)The average number of neutrophils in NMIBC group was 5.82±1.68 and that in MIBC group was 6.63 ±2.14.There was significant difference between the two groups(p < 0.05).(4)The average number of lymphocyte in NMIBC group was 1.93±0.63)and that in MIBC group was 1.75±0.54.There was significant difference between the two groups(p < 0.05).(5)The average NLR of NMIBC group was 3.14 ±1.64 and MIBC group was 3.67±2.03.There was significant difference between the two groups(p < 0.05).(6)In NMIBC group,122 cases were high-level(59.8%)and 82 cases were low-level(40.2%).In MIBC group,65 cases were high-level(89%)and 8 cases were low-level(11%).There was significant difference between the two groups(p < 0.05).(7)In the NMIBC group,42 patients(20.6%)had tumors larger than 3 cm in diameter and 162 patients(79.4%)had tumors smaller than3 cm in diameter.In the MIBC group,35 patients(42.2%)had tumors larger than 3cm in diameter and 48 patients(57.8%)had tumors smaller than 3 cm in diameter.The average diameter of tumors in NMIBC group was 2.25±1.21 cm and that in MIBC group was 3.52±1.45 cm.There was significant difference between the two groups(p < 0.05).(8)In the NMIBC group,111 patients(54.4%)had single tumors and 93 patients(45.6%)had multiple tumors.In the MIBC group,23 patients(31.5%)had single tumors and 50 patients(68.5%)had multiple tumors.There was a significant difference between the two groups(p < 0.05).(9)Postoperative pathological stages: 204 patients with NMIBC(73.6%)and 73 patients with MIBC(26.4%);of them,stage Ta(9 cases,3.2%),stage T1(195 cases,70.4%),stage T2(46cases,16.6%),stage T3(21 cases,7.6%),stage T4(6 cases,2.2%);stage NO(227cases,81.9%)Nx(8 cases,2.9%),N1(33 cases,11.9%),N2(3 cases,l.1%)and N3(0cases),respectively.M0(273 cases,98.5%)and M1(4 cases,1.5%).2.SPSS20.0 statistical software was used for statistical analysis.Spearman correlation analysis showed that the muscle invasion of tumors was not correlated with age and sex,but positively correlated with the level of central granulocyte(r=0.515 P < 0.05),NLR(r=0.699 P < 0.05),and negatively correlated with the level of lymphocyte(r=-0.572 P < 0.05).T staging was not correlated with age and sex,but positively correlated with central granulocyte level(r=0.527 P < 0.05),NLR(r=0.577 P < 0.05),and negatively correlated with lymphocyte level(r=-0.443 P < 0.05).Histological grade was not correlated with age and sex,but positively correlated with central granulocyte level(r=0.252 P < 0.05),NLR(r=0.277 P < 0.05),and negatively correlated with lymphocyte level(r=-0.164 P < 0.05).3.The cutoff value of NLR is 2.61 from ROC curve.When the NLR is more than2.61 before operation,the possibility of tumor cells infiltrating muscular layer is greater.Conclusion:1.Preoperative NLR greater than 2.61 may indicate that bladder cancer patients are more likely to invade the muscular layer.