Exploration Of The Value Of PNI,NLR,PLR And LMR In Predicting The Efficacy And Prognosis During Concurrent Chemoradiotherapy In Patients With Cervical Cancer

Objective: Discuss the efficacy and prognosis of prognostic nutrition index(PNI),neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),lymphocyte to monocyte ratio(LMR)in patients with cervical cancer who underwent Concurrent Chemoradiotherapy Methods: From January 2013 to December 2016,a total of 394 patients with who were diagnosed with cervical cancer and completed simultaneous radiotherapy and chemotherapy in Sichuan Cancer Hospital were enrolled in this study.the clinical data,follow-up information were collected.Using the receiver working curve(ROC)and Jordan value to determine the best cut-off value of the relevant inflammatory indicators to predict the curative effect and prognosis of the patients,compare the predictive ability of each index,and divide the patients into groups according to the curative effect,and compare the differences of clinical characteristics between the groups.Kaplan-Meier and log-rank test univariate analysis were used to compare the objective remission rates of(ORR)overall survival(OS),distant metastasis-free survival(DMFS)and disease progression-free survival(PFS).COX regression multivariate analysis was used to determine the independent prognostic factors of curativeeffect and prognosis of imaging cervical cancer.According to the general terminology standard of adverse events(CTCAE)and Radiation Therapy Oncology Group(RTOG),the treatment-related side effects of patients were also counted.Results: In the analysis of curative effect,there were 367 patients in effective group and 27 patients in ineffective group.The objective remission rate was93.14%.The average PNI and average LMR values of the effective group(51.49 ±4.13)and LMR(5.18 ±2.06)were significantly higher than patients of the ineffective group(49.21 ±5.00)and 4.05 ±1.52(P < 0.05).The best cut-off value of PNI was 48.65,AUC =0.689(P=0.002);The best cut-off value of LMR was 4.07,AUC= 0.670(P= 0.001).PNI and LMR were correlated with age,stage,tumor diameter and anemia.Univariate analysis showed that small tumor diameter > 4cm,staging III-IVA stage,PNI ? 48.65,LMR ?4.07 and lymph node metastasis were risk factors for curative effect.Multivariate analysis showed that PNI > 48.65(OR=4.219,P=0.005)was an independent prognostic factor for curative effect,and an independent poor prognostic factor for LMR(OR=0.187,P=0.002).In the analysis of prognostic,A total of 100patients(25.38%)developed disease progression,including 48 patients with simple recurrence(12.18%),44 patients with distant metastasis(11.17%),and 8patients with recurrence and metastasis(2.03%).The 0S of patients in 1 year,3years and 5 years were 97.2%,91.6% and 85.7%,respectively.The 1-year,3-year and 5-year DFS of the patients were 97.7%,91.1% and 85.8%.TheDMFS of 1 year,3 years and 5 years were 97.2%,92.3% and 90.2%.the best cut-off value of PNI was 49.5 AUC=0.671(P < 0.0001).);he best cut-off value of NLR was 2.86,AUC=0.582;he best cut-off value of PLR was159.91,AUC=0.600.The values of NLR and PLR were related to the age of the patients,the diameter of the tumor and whether they were anemic or not.Univariate analysis showed that anemia,tumor diameter > 4cm,III-IVA stage,lymph node metastasis,PNI ? 49.5,NLR > 2.86,PLR > 159.91,LMR ?4.07 were all important risk factors for OS and PFS,while multivariate analysis showed that PNI ? 49.5,lymph node metastasis and tumor diameter > 4cm were independent poor prognostic factors for OS,PFS and DMFS.Conclusion: PNI,NLR,PLR and LMR have certain predictive value for the curative effect and prognosis of locally advanced cervical cancer patients who have completed radical concurrent chemoradiotherapy.PNI,lymph node metastasis and tumor diameter are effective independent prognostic indicators.