Neutrophil-Lymphocyte Ratio Predicts The Efficacy Of First-Line Treatment For Stage ?-? Lung Adenocarcinoma

Objective: To study the value of neutrophil to lymphocyte ratio(NLR)as a predictor of first-line therapeutic efficacy in patients with stage ?-? lung adenocarcinoma,and to provide a new biomarker for predicting the firstline therapeutic efficacy of lung adenocarcinoma.Methods: We screened 167 patients with primary stage ?-? lung adenocarcinoma admitted to the Fourth Hospital of Hebei Medical University from 2013 to 2018,and conducted a retrospective cohort study of patients receiving first-line chemotherapy/targeted therapy according to NCCN guidelines.According to the survival situation,the NLR value was drawn to obtain the best critical value of ROC.The patients were divided into two groups: high NLR group and low NLR group.The data were analyzed by IBM SPSS statistical software v.21.0(SPSS Inc.,Chicago,Illinois,USA).Results:1.Analysis of the correlation between clinical factors and NLR value and NLR level before first-line treatmentBefore treatment,NLR value in TNM stage was lower in N0 group than in N1 group,the difference was statistically significant(P=0.042).There were no significant differences in NLR before treatment in sex,age,location of primary tumors,T stage,M stage and EGFR mutation status,P value was greater than 0.05.The critical value of NLR before treatment was 2.96 by drawing ROC according to the survival condition.The patients before treatment were divided into high NLR group(NLR > 2.96)and low NLR group(NLR < 2.96).There was no significant difference in sex,age,smoking history,tumor location,clinical stage and EGFR status between the high NLR group and the low NLR group before treatment,P value was greater than 0.05..2.Trends of NLR values in treatment cyclesThe NLR value decreased first and then increased.The NLR value decreased to the lowest level in the 2nd to 3rd cycles,then began to increase gradually.After 6 cycles of treatment,the NLR value in the target group did not exceed the initial value,while the NLR value in the chemotherapy group did exceed the initial value after 6 cycles of treatment.The NLR value of target group was higher than that of chemotherapy group in 6 cycles.NLR0 and NLR1,NLR2,NLR3,NLR4,NLR5 have statistical differences,NLR6 and NLR1,NLR2,NLR3,NLR4,NLR5 have statistical differences,NLR3 and NLR4 have statistical differences,P values are less than 0.05.There was no statistical difference between the other groups.3.The relationship between high and low NLR group and 2-cycle,4-cycle and 6-cycle curative effect of PDAccording to the survival status,the ROC curve was drawn to obtain the boundaries,which were divided into high NLR group and low NLR group.After 2,4 and 6 cycles of treatment,the proportion of PD in high NLR group was higher than that in low NLR group,while the incidence of PD in low NLR group was lower.The best critical values of NLR after treatment in the second,fourth and sixth cycles were obtained by drawing ROC curves according to the condition of PD in the current cycle.They were divided into high NLR and low NLR groups in the current cycle.After 2,4 and 6 cycles of treatment,the proportion of PD in the high NLR group was higher than that in the low NLR group,and the incidence of PD in the low NLR group was lower.Compared with the threshold value based on survival condition,the threshold value determined according to the curative effect could more accurately increase the proportion of PD in the high NLR group and reduce the incidence of PD in the low NLR group,thus improving the accuracy of clinical effect prediction.Conclusion:1.NLR are different in the treatment cycles,and the overall trend is to decrease first and then increase.2.NLR can be used as a predictor of curative effect in patients with advanced lung adenocarcinoma.High NLR is less effective after treatment,while low NLR is better.3.When using NLR evaluate the curative effect,it is more advantageous to select the boundary value according to the curative effect.