Analysis Of The Significance Of Neutrophil To Lymphocyte Ratio In The Diagnosis And Prognosis Of Uterine Sarcoma

Objective: The incidence of uterine sarcoma is rare,the diagnosis is difficult,and the prognosis is very poor.This study analyzed the value of neutrophil to lymphocyte ratio(NLR)in preoperative diagnosis of uterine sarcoma and explored the relationship between NLR and prognosis in order to provide reference for clinical diagnosis and treatment of uterine sarcoma.Methods: The clinical data of patients with uterine tumor who were operated and diagnosed in Gansu Provincial Hospital from July 2009 to December 2019 were collected retrospectively.A total of 57 patients with uterine sarcoma and 114 patients with uterine leiomyoma were included.According to case inquiry and telephone follow-up,a total of 27 items of clinical information were collected,such as age,NLR and pathological type.First of all,the preoperative data of patients with uterine sarcoma and uterine leiomyoma were statistically compared.At the same time,the best cut-off point for the diagnosis of uterine sarcoma by NLR was obtained by using the receiver operating characteristic curve,and its diagnostic value was evaluated.Secondly,the relationship between NLR and age,stage,pathological type and maximum diameter of uterine sarcoma was analyzed.Finally,the best cut-off value of NLR for predicting the survival of uterine sarcoma was obtained by the receiver operating characteristic curve of the subjects,and then the uterine sarcoma was divided into high NLR group and low NLR group.The differences of overall survival time(OS)and progression free survival time(PFS)between the two groups were compared.The variables affecting OS and PFS of patients with uterine sarcoma were analyzed by COX univariate and multivariate analysis.Results: 1.Comparison of preoperative data between the uterine sarcoma group and the uterine leiomyoma group: there were significant differences in NLR,age,menopausal state,tumor number,tumor boundary,neutrophil count,cancer antigen125,fibrinogen and asymptomatic clinical manifestations between the two groups(P<0.05).2.The diagnostic value of NLR in uterine sarcoma: NLR in uterine sarcoma group was significantly higher than that in uterine leiomyoma group(P=0.002).The best cut-off value of NLR was 2.937,the area under the curve was 0.648,the sensitivity was 47.4%,and the specificity was 80.7%.3.The relationship between NLR and general clinical characteristics of patients with uterine sarcoma: the NLR in patients with advanced uterine sarcoma(stage III-IV)was significantly higher than that in patients with early uterine sarcoma(stage I-II).There was no significant difference in NLR among different pathological types of uterine sarcoma,and there was no significant correlation between NLR and age and maximum tumor diameter(P>0.05).4.The effect of NLR on the prognosis of patients with uterine sarcoma: the best cut-off value of NLR for predicting the survival of patients with uterine sarcoma was3.390.NLR > 3.390(P=0.001,HR 4.096,95%CI 1.836-9.140)was associated with poor OS in univariate analysis,but not in multivariate analysis.Multivariate analysis showed that NLR > 3.390(P=0.015,HR 3.619,95%CI 1.277-10.253)was the independent predictor of PFS.In patients with stage I uterine sarcoma,the group with NLR ≤ 3.390 also had better OS(P=0.004)and PFS(P=0.001)than the group with NLR > 3.390.Conclusion:1.NLR has a certain value in the diagnosis of uterine sarcoma.Patients with uterine tumor with NLR > 2.937 should be aware of the possibility of uterine sarcoma.2.NLR is related to the clinical stage of patients with uterine sarcoma,and NLR is significantly higher in advanced patients than that in early patients.3.NLR is the influencing factor of OS and the independent influencing factor of PFS in patients with uterine sarcoma.At the same time,it can also predict the prognosis of patients with stage I uterine sarcoma.NLR > 3.390 indicates that the prognosis of patients is poor.