| BackgroundLung cancer is the world's highest incidence and mortality of malignant tumors,serious harm to human life and health.Although with the continuous progress of medical level,more and more new therapies have been widely used in the treatment of tumors and achieved better therapeutic effects.the survival rate of most malignant tumors has been improved to varying degrees,but the survival rate of lung cancer is not significantly improved.If we can find a simple and fast indicator to predict the prognosis of lung cancer and help clinicians identify high-risk patients early,it may provide new ideas for the treatment of lung cancer.ObjectivesIn recent years,the incidence and mortality of tumors have been increasing year by year,and more and more studies have been conducted on factors related to tumor incidence.Most of the studies have found that the occurrence and development of tumors are related to inflammatory factors in vivo.Studies have found that the prognosis of various tumors,including lung cancer,breast cancer,stomach cancer,and liver cancer,is related to neutrophil-lymphocyte ratio(NLR).Among lung cancer patients,increased NLR before chemotherapy often indicates a poor prognosis.The purpose of this study was to analyze the relationship between the change of NLR level before and after first-line chemotherapy and the prognosis of patients with advanced non-small cell lung cancer,and to explore its application value to guide clinical work.MethodsThrough the electronic medical record query system to gather in November 2010 to July 2015 in qilu hospital of shandong university and oncology and respiratory medicine gives a line of the clinical data of 266 cases of patients with advanced NSCLC chemotherapy,including age,sex,smoking history,pathological data,first-line chemotherapy,chemotherapy before neutrophil count.lymphocyte count,neutrophil count after 2 cycles of chemotherapy,lymphocyte count,after 2 cycles of chemotherapy curative effect evaluation,progression-free survival(PFS)and overall survival(OS),and excluded those who were lost to follow-up and information is not complete.A total of 178 patients were enrolled in the final study.According to the neutrophil count and lymphocyte count,calculate the ratio of the two to get the neutrophil-lymphocyte ratio,namely NLR.PFS and OS of Patients were obtained by electronic medical records and telephone follow-up.By drawing ROC(Receiver Operating Characteristic)curves determine the optimal cut-off point of the study,patients with chemotherapy NLR before 2.99 as cut points are divided into high NLR group and low NLR,NLR after chemotherapy for 2.6 cutoff Point was divided into high NLR group and low NLR,NLR change values before and after chemotherapy(?NLR)to 0.6 for the cut point is divided into high ?NLR group and the low ?NLR group,NLR rate before and after chemotherapy(ANLR%)to 0.54 for the cut point is divided into high ANLR%group and low ?NLR%group.We analyzed the final data in SPSS 25.0 software,two groups and two sets of the above analysis of the numerical variable data the Mann-WhitneyU inspection or Kruskal-Wallis,for categorical data analysis of the differences between groups by chi-square test,analysis level variable data between groups using Wilcoxon rank and inspection,the single factor survival analysis using Kaplan-Meier curve method,and statistically significant factors(P<0.05)were further included in multivariate COX analysis to determine independent risk factors affecting the prognosis of patients with first-line chemotherapy with NSCLC.ResultsNLR level before chemotherapy was correlated with gender(P=0.024).and the high NLR group was mainly male.The optimal cut-off value of NLR before chemotherapy was 2.99.the median survival time of patients with NLR>2.99 before chemotherapy was 493 days,and the median survival time of patients with NLR?2.99 before chemotherapy was 650 days,showing a significant statistical difference(P=0.001).The median progression-free survival time(PFS)of the high NLR group before chemotherapy and the low NLR group before chemotherapy were 198 and 246 days,respectively,and the difference between the two groups was statistically significant(P=0.022).Univariate analysis was performed on all patients.and the results showed that:NLR before chemotherapy(P=0.001),the change value of NLR before and after chemotherapy(P=0.006)and the change rate of NLR before and after chemotherapy(P=0.031)were closely related to the overall survival(OS)of patients.Pathologic type(P=0.02),NLR value before chemotherapy(P=0.022),and efficacy evaluation after 2 cycles of chemotherapy(P<0.0001)were correlated with progression-free survival time(PFS).Factors with P<0.05 in univariate analysis were included in multivariate COX analysis,and the results showed that only NLR>2.99 before chemotherapy was an independent risk factor for poor prognosis(P<0.05).ConclusionsThe overall survival time of patients with high NLR before chemotherapy was shorter than that of those with low NLR before chemotherapy.Patients with high NLR before chemotherpPy had a shorter progression-free survival time than those with low NLR before chemotherapy.Increased NLR before chemotherapy is an independent predictor of poor prognosis in advanced NSCLC patients treated with first-line chemotherapy.The change value of NLR before and after chemotherapy and the change rate of NLR before and after chemotherapy were within a certain range to evaluate the total survival time of advanced NSCLC patients treated with first-line chemotherapy.Monitoring the NLR level before and after chemotherapy and its change was beneficial to evaluate the prognosis of advanced NSCLC patients treated with first-line chemotherapy. |
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