The Study On The Correlation Between Preoperative Peripheral Blood Inflammatory Index And EGFR Gene Mutation In Patients With Lung Adenocarcinoma

Background and ObjectiveThe incidence rate and mortality rate of lung cancer are high in the world.The incidence rate and mortality of lung cancer in China are increasing.According to the statistical data of China cancer survey released in 2019,the incidence of lung cancer in China has reached 20.03%,and the mortality rate has reached 26.99%,ranking the first among malignant tumors.Lung adenocarcinoma is a common pathological type of lung cancer.Early patients can be treated by radical operation,but most of them are still faced with recurrence and metastasis.Chemotherapy and radiotherapy can be used for patients who have lost the opportunity of operation,but the overall treatment effect is limited,and the effect of radiotherapy and chemotherapy has entered the bottleneck period.Molecular targeted therapy is a new therapy to drive gene mutation patients.Targeted drugs can induce tumor cell apoptosis by combining with specific tumor molecular sites.Epidermal growth factor receptor(EGFR)is a targeted therapeutic site for lung adenocarcinoma patients.EGFR tyrosine kinase inhibitor(EGFR-TKIs)has been used to target the patients with sensitive mutations.It has less side effects and obvious therapeutic effect.It has become the first-line treatment drug for patients with EGFR sensitive mutation lung cancer.Egfr19 exon deletion mutation and L858R mutation of egfr21 exon are the most common EGFR mutations.However,EGFR-TKIs also has some disadvantages and is expensive.Some basic hospitals don't have expensive testing equipment,some patients can't afford the cost of testing because of economic problems,which leads to some patients lose the opportunity of the best treatment.Some studies have shown that the NLR of patients with L858R mutation in egfr21 exon of lung cancer is lower than that of patients with wild type.If there is a simple index that can preliminarily screen the EGFR mutation state of patients,it will be helpful for these lung cancer patients to choose treatment drugs.The purpose of this study is to explore its value by observing the correlation between preoperative peripheral blood inflammatory index and EGFR gene mutation of lung adenocarcinoma patients.MethodsFrom January 2018 to November 2019,72 patients with lung adenocarcinoma were selected from the Second Affiliated Hospital of Zhengzhou University for surgical treatment and EGFR gene detection.The clinical data of the patients were collected,including the sex,age,smoking history and clinical stage of the patients;the blood routine examination results within 1 week before operation,including neutrophil count,monocyte count,lymphocyte count and platelet count,and PLR(ratio of platelet count to lymphocyte count),NLR(ratio of neutrophil count to lymphocyte count),LMR(ratio of lymphocyte count to monocyte count);the results of EGFR gene detection in patients' surgical specimens.In the measurement data,for the data that do not conform to the normal distribution,Wilcoxon rank sum test is used for the inter group comparison,which is expressed by the median and interquartile spacing,and t test is used for the inter group comparison of the data that conform to the normal distribution,which is expressed by the mean±standard deviation.The counting data is expressed by rate.The comparison between groups uses variance test or Fisher exact test to draw ROC curve.When the maximum value of Youden's index(sensitivity+specificity-1)is used,the best screening value is selected.The sensitivity and specificity at this time are calculated,and the area under the surface is calculated.P<0.05 means there is statistical significance in the difference.Results(1)There were 18 males and 24 females in the EGFR mutant,20 males and 10 females in the EGFR wild type,and the EGFR mutation was common in females(P=0.046);there were 8 smokers and 34 nonsmokers in the EGFR mutant,14 smokers and 16 nonsmokers in the EGFR wild type,and the EGFR mutation was common in the nonsmokers(P=0.002);the EGFR mutation was common in the nonsmokers(P=0.002)The median of neutrophil count(×109/L)was 3.42,which was less than 4.37(P=0.008)in the wild-type patients;the median of NLR in the EGFR mutant patients was 1.80,which was less than 2.41(P=0.030)in the EGFR wild-type patients;stage,lymphocyte,monocyte,platelet,PLR,LMR had no significance(P>0.05).(2)The average age of patients with EGFR 19 exon deletion mutation was 54.20 years old which was less than 59.91 years of EGFR21 exon L858R mutation patients(P=0.0024);platelet counts of patients with EGFR 19 exon deletion mutation(x 109/L)The average value is 265.73,which is greater than 219.45 in patients with EGFR21 exon L858R mutation(P=0.0025);neutrophils,lymphocytes,monocytes,NLR,PLR,LMR,gender,stage,and smoking history are not significant(P>0.05).(3)Neutrophils,NLR and smoking history were independent predictors of EGFR gene mutation(P<0.05);when the Youden's index of neutrophils was 0.305,cut off value was 4.215(×109/L),the sensitivity was 73.8%,the specificity was 56.7%,the Youden's index of NLR was 0.300,cut off value was 2.6783,the sensitivity was 83.3%,and the specificity was 46.7%.There was no statistical significance in lymphocyte,monocyte,platelet,PLR,LMR and gender(P>0.05).Conclusions1.The mutation of EGFR gene was correlated with the number of neutrophils and NLR.2.There was a difference in platelet count between different mutations of EGFR gene(exon 19 deletion mutation and exon 21 L858R mutation).3.Peripheral blood neutrophils and NLR can predict the mutation of EGFR gene in patients with lung adenocarcinoma.