The Prognostic Values Of DNLR,LMR And AGR In EGFR-mutant Advanced Non-small Cell Lung Cancer

Objectives The purpose of this study was to investigate the predictive power of derived neutrophil to lymphocyte ratio(dNLR),lymphocyte to monocyte ratio(LMR)and albumin to globin ratio(AGR)on the clinical outcomes in epidermal growth factor receptor(EGFR)-mutant patients with advanced non-small cell lung cancer(NSCLC).Methods Clinical and follow-up data of 126 advanced NSCLC patients diagnosed as EGFR mutation positive in our hospital from January 2016 to December 2019 were collected.In addition,the blood routine and biochemical indexes were collected from 50 healthy physical examinees.SPSS22.0 software was used for statistical analysis to study the relationship between the levels of dNLR,LMR and AGR and the clinicopathological characteristics,short-term efficacy and long-term prognosis of patients.Results 1 Relationship between dNLR,LMR,AGR and clinicopathological characteristics:The dNLR level in peripheral blood of EGFR-mutant group was higher than that of healthy control group(P<0.05),while the LMR and AGR levels in peripheral blood of EGFR-mutant group were lower than that of healthy control group(P<0.05).The level of dNLR was correlated with brain metastasis,and the patients with brain metastases had higher dNLR level(P<0.05).The level of LMR was correlated with gender,bone metastasis,and clinical stage.In the higher LMR group,no bone metastases,clinical Ⅲb-Ⅲc stage and female patients occur more(P<0.05).The level of AGR was related to eastern cooperative oncology group(ECOG)score,and the patients with ECOG score 0-1 had higher AGR level(P<0.05).2Relationship between dNLR,LMR,AGR and short-term efficacy as well as long-term prognosis of patients: The objective response rate(ORR)of 126 EGFR-mutant advanced NSCLC patients was 28.57%.Among them,patients with dNLR≤2.21,LMR>3.10 and AGR>1.41 had better short-term efficacy.The median progression-free survival(PFS)and overall survival(OS)of all patients was 14 months and 24 months,respectively.The median PFS and OS of the dNLR≤2.21 group were 17 months and 28 months,respectively.The median PFS and OS of the dNLR>2.21 group were 11 months and 22 months,respectively.Patients with higher dNLR have shorter median PFS and OS,earlier recurrence and worse prognosis(P<0.05).The median PFS and OS of the LMR≤3.10 group were 10 months and 19 months,respectively.The median PFS and OS of the LMR>3.10 group were 17 months and28 months,respectively.Patients with lower LMR have shorter median PFS and OS,earlier recurrence and worse prognosis(P<0.05).The median PFS and OS of the AGR≤1.41 group were 9 months and 20 months,respectively.The median PFS and OS of the AGR>1.41 group were 17 months and 29 months,respectively.Patients with lower AGR have shorter median PFS and OS,earlier recurrence and worse prognosis(P<0.05).Univariate analysis showed that PFS was associated with clinical stage,dNLR,LMR and AGR(P<0.05).OS was correlated with age,ECOG score,clinical stage,dNLR,LMR,and AGR(P<0.05).Cox multivariate analysis showed that dNLR,LMR and AGR levels were independent prognostic factors for PFS(P<0.05).ECOG score,dNLR,LMR and AGR were independent prognostic factors for OS(P<0.05).Subgroup survival analysis showed that the lower dNLR and higher LMR and higher AGR group had longer PFS,OS and better prognosis.Conclusions 1 The dNLR level in peripheral blood of EGFR-mutant group was higher than that of healthy control group;the LMR and AGR levels in peripheral blood of EGFR-mutant group were lower than that of healthy control group.2 The level of dNLR was correlated with brain metastasis.The level of LMR was related to gender,bone metastasis and clinical stage.The level of AGR was correlated with ECOG score.3 Patients with higher dNLR,lower LMR,and lower AGR before treatment tend to have worse efficacy and prognosis.Figure[13];Table[13];Reference[92]...