The Value Of Lymphocyte/monocyte Ratio In Predicting The Prognosis Of Patients With Small Cell Lung Cancer

BackgroundLung cancer is one of the leading causes of death in cancer patients in the world.Screening for lung cancer through low-dose computed tomography(CT)can improve its mortality,and its treatment depends on the type and stage of lung cancer.Small cell lung cancer is a major type of lung cancer,which has the characteristics of neuroendocrine tumors.Compared with non-small cell lung cancer,small cell lung cancer has a higher degree of malignancy,a rapid doubling time,and a tendency for early metastasis.A number of studies have found that the levels of hematological complex indicators such as neutrophil-lymphocyte ratio(NLR),platelet-lymphocyte ratio(PLR),hemoglobin-red blood cell distribution width ratio(HRR),Which have predictive prognosis for patients with small cell lung cancer.However,there are few studies on the effect of lymphocyte/monocyte ratio(LMR)on the prognosis of patients with small cell lung cancer.AimThis study aims to discuss the general clinical characteristics of patients with small cell lung cancer,analyze the predictive factors that affect the prognosis of patients with small cell lung cancer,and explore whether LMR is an independent predictor of the prognosis of patients with small cell lung cancer,so as to improve clinicians’ understanding of patients with small cell lung cancer.It will help clinicians use the pre-treatment hematology test results as early as possible to predict their prognosis,intervent the treatment methods,improve the quality of life of patients with small cell lung cancer,and prolong the survival time.MethodsThe clinical data of 486 patients who were pathologically diagnosed as small cell lung cancer for the first time from November 2017 to February 2019 were collected,and 146 of them met the inclusion and exclusion criteria.Statistical analysis of 146 patients’ age,gender,smoking history,history of underlying diseases,VALG staging of lung cancer,pre-treatment blood test results(blood routine,coagulation function,liver and kidney function,etc.),treatment methods and the efficacy of two cycles of first-line chemotherapy,and Analyze the influence of the above factors on the prognosis of patients with small cell lung cancer.We used the SPSS 25.0 statistical software to analyze the data.The measurement data conforming to the normal distribution were expressed as mean±standard deviation(x±S),and comparisons between groups were performed by two independent samples t-test;Non-normally distributed measurement data were represented by median(M)and interquartile range(P25,P75),and the non-parametric rank sum test was used for comparison between two groups;the counting data was expressed by frequency(n)and composition ratio(%),and the comparison between groups used chi-square test,continuously adjusted chi-square test or Fisher’s exact test.The receiver operating characteristic(ROC)curve was used to obtain the optimal cut-off value of the inflammatory and nutritional composite index such as LMR and the prognostic nutritional index(PNI).According to the cut-off value,the enrolled patients were divided into high and low levels groups.At the same time,carcinoembryonic antigen(CEA),soluble cytokeratin 19 fragment(CYFRA21-1),neuron-specific enolase(NSE)and D-dimer were divided into high and low levels according to the medical reference value range.The patients were divided into two groups with the age of 60 years old.Single-factor survival analysis was performed on the above indicators,meaningful indicators were included in the multiple collinear model,and the indicators with variance inflation factor(VIF)less than 5 were further included in the COX proportional hazard regression model for COX multivariate analysis to determine the survival time of patients with small cell lung cancer Independent prognostic factors.The Kaplan-Meier method(K-M method)was used to draw the survival curve of SCLC patients in each group,and the log-rank test(Log-Rank test)was used to evaluate whether the difference in survival curve was statistically significant.The level of inspection is set at α=0.05.Results1.The average age of the 146 small cell lung cancer patients was 59.42 years old,and the standard deviation was 9.137 years old(35-81 years old).Most patients(64.4%)were in the extensive phase when they were diagnosed.Follow-up started from the date of diagnosis.It was observed that 119 patients(81.5%)died two years later,and 21 cases(14.4%)survived for more than 2 years.Fifteen cases(71.4%)belonged to the limited-stage disease group,and 6 cases(28.6%)belonged to the extensive-stage disease group.As of the end of the follow-up date,125 cases(85.6%)died.2.The best cut-off value of LMR is 4.3712(AUC=0.782,P=0.001),the sensitivity is 0.872,and the specificity is 0.619.According to the best cut-off value,patients were divided into high-level LMR group and low-level LMR group.The median OS of the high-level LMR group was higher than that of the low-level LMR group,and the difference was statistically significant(P=0.000).There were significant differences in gender,age,smoking history,disease stage,whether combined with pleural effusion,NSE level before treatment,PNI level,fibrinogen level and albumin level(P<0.05).3.Univariate survival analysis found that gender,age,clinical stage,bone metastasis,liver metastasis,response to two cycles of first-line chemotherapy,receiving radiotherapy and targeted therapy,CEA level,CYFRA21-1 level,and NSE level,D-dimer level,fibrinogen level,LMR level,PNI level before treatment were related to the median OS of patients with small cell lung cancer(P<0.05).4.COX multivariate survival analysis showed that targeted therapy(P=0.002)and high LMR level(P=0.012)were independent predictors of the prognosis of patients with small cell lung cancer.The survival curve was drawn by the K-M method and the Log-rank test was performed.The difference between the two curves is statistically significant(P=0.000).Conclusion1.Males,older age,a history of smoking,extensive at the first diagnosis,combined with pleural effusion,patients with high NSE and fibrinogen,low albumin and PNI before treatment,have lower LMR levels.2.We found that the factors such as older,male patients,diagnosed with extensive disease for the first time,with higher CEA level,CYFRA21-1 level,NSE level,D-dimer level,fibrinogen level and lower LMR level,PNI level before treatment indicate that the prognosis of patients with small cell lung cancer is poor.3.The prognosis of SCLC patients with targeted therapy and higher LMR level before treatment is relatively good,and they are the independent predictors of prognosis.The prognosis of patients with small cell lung cancer can be improved by assessing the LMR level of patients before treatment and interventing in treatment as early as possible.