Study On The Ratio Of Lymphocytes To Neutrophils And The Prognosis Of Nasopharyngeal Carcinoma

ObjectiveTo discuss the prognostic correlation between lymphocyte-to-neutrophil ratio（LNR）and nasopharyngeal carcinoma（NPC）among nasopharyngeal carcinoma patients before treatment.Meanwhile,to give comments on its function of predicting the overall survival time for nasopharyngeal carcinoma and risks of disease development.MethodsHaving retrospectively collected the data of the patient who received first treatment（radiotherapy or chemotherapy）,from Jan 1^st,2013 to Dec 31^st,2018 in The First Affiliated Hospital of Guangzhou Medical University.Besides,all patients are diagnosed as nasopharyngeal carcinoma through biopsy（World Health Organization（WHO）type II or III）.The number of those who have met the standard are altogether119,91 males and 28 females.Based on the blood routine results before treatment,I have figured out the LNR,taking the following factors as the reference index of the study:ages,performance status score,clinical stages,white blood cell（WBC）,neutrophile granulocyte（Neur）,lymphocyte（LN）,monocyte（Mono）,hemoglobin（Hb）,blood platelet（PLT）,serum albumin（ALB）,lymphocyte-to-monocytes ratio（LMR）,platelet-to-lymphocyte ratio（PLR）,platelet-to-albumin ratio（PAR）,fibrinogen（FIB）,D-dimer,fibrinogen-to-D dimer ratio（FDR）,Epstein-Barr virus DNA（EBV-DNA）and pathological type.To examine the computing and compare the survival results,methods like Independent T test,chi-square test,analysis of Spearman and Kaplan-Meier have been used.Moreover,COX regression analyses is used to proceed single and multiple regression analyses,so as to review the prognostic correlation between NPC and it.Results（1）According to the literature,the cutoff value of LNR is 0.2,divided into two groups,LNR<0.2,LNR≥0.2.After the Independent T test,it is apparent that the P values of WBC,Neur,LN,LMR,PLR and FIB are respectively 0.028,0.004,0.000,0.000,0.010 and 0.024,all with statistical discrepancy.（2）Comparing LNR with other parameter correlation test（analysis of Spearman）,it is obvious that there is correlation between LNR and WBC,Neur,LN,PLT,LMR,PLR,PAR,FIB（P<0.05）.To be specific,WBC,Neur,PLT,PLR,PAR,FIB are negatively correlated,and the corresponding correlation coefficients are-0.380,-0.695,-0.219,-0.712,-0.240,-0.395.On the contrary,LN and LMR are positively correlated,and the corresponding correlation coefficients are 0.668和0.718.（3）Under the packet ratio of LNR,comparison of NPC TNM stage has been done.The figure of Group LNR<0.2,Period IV 63.6%and Group LNR≥0.2,Period IV 33.3%.P=0.008,which means the percentage of patients in Group LNR<0.2 is higher than the other group,and the difference is of statistical significance.（4）After comparing the overall survival curve of the LNR groups,it can be found out that the median survival time of Group LNR<0.2 is 43.727±5.323（month）while the figure of Group LNR≥0.2 is 67.034±1.879（month）,P=0.244.But when proceeding univariate and multivariate analyses on the overall survival time of tumor patients,in univariate analysis,age,radiotherapy,chemotherapy,D dimer,hemoglobin are the risk factors affecting the overall survival time of tumor patients,In multivariate analysis,Radiotherapy,D dimer and hemoglobin are independent risk factors affecting the overall survival time of tumor patients,However,age and chemotherapy are not independent risk factors affecting the overall survival time of tumor patients.（5）After comparing the progression-free survival curve of the LNR groups,the median survival time of LNR<0.2 is 15.000±5.081（month）,and Group LNR≥0.267.034±1.879（month）,P=0.844.But when proceeding univariate and multivariate analyses on the progression-free survival time of tumor patients,in univariate analysis,it can be seen that the number of leukocytes is the risk factor affecting the survival time of tumor patients without progression,and the risk of tumor progression was2.282 times higher in patients with elevated leukocyte count,P=0.021,95%CL:1.132-4.600.But because the risk factors P values of the age,hemoglobin for tumor patients without progression of survival time are close to the statistical significance,which are respectively 0.058 and 0.050,in the multivariate analysis,these two factors are still included in the statistical analysis.It is obvious that age,white blood cell count and hemoglobin were the independent risk factors for progression-free survival time in tumor patients.Conclusions（1）There was a correlation between LNR and WBC,Neur,LN,PLT,LMR,PLR,PAR,FIB（P<0.05）,which is negatively correlated with WBC,Neur,PLT,PLR,PAR,FIB and positively correlated with LN,LMR.（2）LNR was associated with the stage of nasopharyngeal carcinoma,and the lower LNR value indicates that the later the stage is,it may be an index of indicating prognosis.（3）The LNR value was not related to the total survival and progression-free survival of NPC patients.（4）Multivariate analysis showed that radiotherapy,D-dimer and hemoglobin were independent risk factors affecting the overall survival time of NPC patients.（5）Multivariate analysis showed that age,leukocyte count and hemoglobin were independent risk factors for progression-free survival in NPC patients.