Analysis Of The Relationship Between SII,MLR And The Progression And Prognosis Of Advanced Non-small Cell Lung Cancer After Short-term Chemotherapy

Objective: The Systemic Immune-inflammation Index(SII)and the ratio of Monocyte to Lymphocyte(MLR)were measured before the first chemotherapy in patients with advanced non-small cell lung cancer,and other clinical related indexes were collected to analyze the effect of SII and MLR on the short-term chemotherapy efficacy of patients with advanced NSCLC,and to explore their value in predicting the long-term prognosis of patients with advanced NSCLC.Methods: According to the inclusion and exclusion criteria set by the program,patients with stage III/IV NSCLC who received chemotherapy in the Department of Respiratory and critical Care Medicine of the second affiliated Hospital of Nan Hua University from January 2016 to November 2020 were selected as the study object.All patients received at least 2 cycles of chemotherapy.The relevant laboratory indexes,pathological features and other clinical data were collected within one week before the first chemotherapy,and the baseline SII,MLR and baseline clinical data were obtained.The curative effect after chemotherapy was evaluated by reviewing the inpatient and outpatient examination data of the patients,and the survival condition and other medical information of the patients were obtained by telephone follow-up.According to the progression of lesions after two cycles of chemotherapy,all patients with NSCLC were divided into control group and progressive group,and the differences of SII,MLR and clinicopathological parameters between the two groups were compared.Binary logistic regression analysis was used to evaluate the possible risk factors affecting the progression of patients with advanced NSCLC after short-term chemotherapy.Progressive Free Survival(PFS)was used as an index to evaluate the prognosis.Draw the ROC curve and obtain the predicted cutoff point values of SII and MLR.The Kaplan-Meier survival curve of each factor was drawn,and log-rank test was used to compare the difference of progression-free survival rate among the factor groups.COX regression model was used to analyze the possible factors affecting PFS in patients with advanced NSCLC.Results:1.This study included 115 patients with lung cancer,including95 males and 20 females,aged from 35 to 74 years old,with a median age of 59 years,90 patients with smoking history,25 patients without smoking history,73 patients with central lung cancer,42 patients with peripheral lung cancer,64 patients with adenocarcinoma,51 patients with squamous cell carcinoma,44 patients with III stage and71 patients with IV stage.33 patients progressed after 2 cycles of chemotherapy.The median PFS of all NSCLC patients was 4.3months.2.Comparison of laboratory indexes,general clinical data and pathological features between control group and progressive group:there were significant differences in the levels of SII,MLR and lactate dehydrogenase between the control group and the progressive group(P < 0.05).The proportion of patients with distant metastasis such as pleura,bone,adrenal gland,brain,liver and stage IV lung cancer in the progressive group was higher than that in the control group,and the difference between the two groups was statistically significant(P < 0.05).3.Draw the ROC curve of SII、MLR,when the Youden index is maximum,the corresponding values of SII、MLR are 722.88 and 0.45,respectively.4.The relationship between different levels of SII,MLR and post-chemotherapy progression: the proportion of post-chemotherapy progression in high-level SII and MLR groups was higher than that in low-level SII and MLR groups,and the difference between groups was statistically significant(P < 0.05).5.Binary logistic regression analysis showed that SII,lactate dehydrogenase and adrenal metastasis were independent risk factors affecting the progression of middle and advanced NSCLC patients after short-term chemotherapy,and their OR values were 1.003,1.012 and 5.394,respectively.6.The relationship between SII,MLR and general clinical data and pathological features of middle and late NSCLC patients: sex,pathological type,clinical stage and the distribution proportion of contralateral lung,pleura,bone,brain,adrenal gland and pericardium distant metastasis between high SII group and low SII group(P <0.05),there was significant difference in the distribution proportion of pleural metastasis,bone metastasis and clinical stage between high MLR group and low MLR group(P < 0.05).7.Kaplan-Meier analysis of prognosis in patients with advanced NSCLC: the survival curve of various factors was drawn.Log-rank test showed that there were significant differences in SII,MLR,pathological type,clinical stage and progression-free survival rate among patients with distant metastasis such as liver,brain,bone,adrenal gland,contralateral lung and pleura(P < 0.05).8.COX regression analysis: univariate analysis showed that SII,MLR,pathological type,clinical stage and distant metastasis of liver,brain,bone,adrenal gland,contralateral lung and pleura were related to PFS in patients with NSCLC in this study.COX multivariate analysis showed that SII,MLR,liver metastasis,brain metastasis,adrenal metastasis and contralateral lung metastasis were independent prognostic factors of PFS in NSCLC patients in this study.Conclusion:1.SII may play a role in predicting the efficacy of short-term chemotherapy in patients with advanced NSCLC.2.SII and MLR have certain clinical value in evaluating the prognosis of advanced NSCLC patients who received first-line chemotherapy.