Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2020, Vol. 16 ›› Issue (05): 558 -566. doi: 10.3877/cma.j.issn.1673-5250.2020.05.009

Special Issue:

Original Article

Predictive values of neutrophil-to-lymphocyte ratio for neoadjuvant chemotherapy effects in patients with locally advanced cervical cancer

Xiaoxia Zheng1,(), Dapeng Li2   

  1. 1. Department of Gynecology, Binzhou Central Hospital, Binzhou 251700, Shandong Province, China
    2. Shandong Institute of Cancer Prevention and Control, Jinan 250000, Shandong Province, China
  • Received:2020-04-10 Revised:2020-09-11 Published:2020-10-01
  • Corresponding author: Xiaoxia Zheng
  • Supported by:
    Key Research and Development Plan in Public Welfare Related Science and Technology of Shandong Province in 2018(2015-421)
Objective

To explore predictive values of neutrophil-to-lymphocyte ratio (NLR) for neoadjuvant chemotherapy (NACT) effects in patients with locally advanced cervical cancer (LACC).

Methods

From January 2018 to June 2019, a total of 273 patients who received NACT in Binzhou Central Hospital and definitely diagnosed as LACC by pathological examination were selected as research subjects. After NACT, complete response (CR) and partial response (PR) were 74 and 147 cases respectively, while stable disease (SD) and disease progression (PD) were 48 and 9 cases respectively, and they were divided into effective group (n=221) and ineffective group (n=52), respectively. The age, clinical stage of International Federation of Gynecology and Obstetrics (FIGO), pathological grade, pathological type, serum squamous cell carcinoma antigen (SCCA), cancer antigen 125 (CA125), CA199, cytokeratin-19-fragment antigen (CY)21-1, carcino-embryonic antigen (CEA) and NLR were compared between two groups by independent-samples t test or chi-square test. Multivariate unconditional logistic regression analysis was used to analyze influencing factors of NACT effect and NLR in LACC patients. Receiver operating characteristic curve (ROC) was used to analyze the value of NLR in predicting NACT effect of LACC patients.There were no significant differences between two groups of ages and the largest diameter of tumors (P>0.05). This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

Results

①The proportion of FIGO stage ⅠB2, pathological grade G1 and pathological type squamous-celled carcinoma in effective group were significantly higher than those in ineffective group, while serum SCCA, CA125, CA199, CY21-1, CEA and NLR were significantly lower than those in ineffective group, and all differences were significant (all P<0.05). Multivariate logistic regression analysis showed that serum SCCA, CA125, CA199, CY21-1, CEA levels, NLR and FIGO stage were all independent influencing factors to curative effects of NACT in LACC patients with LACC (OR=0.851, 0.931, 0.856, 0.614, 0.841, 0.521, 33.577; 95%CI: 0.767-0.945, 0.880-0.985, 0.780-0.938, 0.448-0.841, 0.749-0.944, 0.344-0.790, 5.509-204.660, P=0.002, 0.013, 0.001, 0.002, 0.003, 0.002, <0.001). ②ROC analysis showed that area under curve of ROC (ROC-AUC) of NLR in predicting curative effects of NACT in patients with LACC was 0.707 (95%CI: 0.649-0.760, P<0.001), and optimal critical value was 3.92%. ③NLR>3.92% of patients whose proportions of FIGO stage ⅡA, pathological grade of G2 and G3, and non-squamous cell carcinoma all were significantly higher than those NLR≤3.92% of patients, and differences were statistically significant (χ2=16.652, 19.721, 17.332, all P<0.001). Multivariate unconditional logistic regression analysis showed that FIGO stage, pathological grade and pathological type were all independent influencing factors of NLR in LACC patients (OR=4.908, 0.067, 12.293, 95%CI: 1.688-14.269, 0.005-0.871, 1.087-187.983, P=0.003, 0.039, 0.043).

Conclusions

NLR can effectively predict curative effects of NACT in patients with LACC, and its optimal critical value is 3.92%. NLR of patient with LACC is related to its clinical stage of FIGO, pathological grade and pathological type. Since this is just a single-center retrospective study with a relatively small sample size, NLR for clinical evaluation curative effects of NACT in patients with LACC still needs to further studied and confirmed by large-sample, multi-center, randomized controlled trials.

表1 LACC患者NACT疗效影响因素的单因素分析结果
表2 LACC患者NACT疗效影响因素的多因素非条件logistic回归分析变量含义及赋值情况
表3 LACC患者NACT疗效影响因素的多因素非条件logistic回归分析结果
图1 NLR预测LACC患者NACT疗效的ROC
表4 LACC患者NLR影响因素的单因素分析结果
表5 LACC患者NLR影响因素的多因素非条件logistic回归分析变量含义及赋值情况
表6 LACC患者NLR影响因素的多因素非条件logistic回归分析结果
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