Study on the predictive value of squamous cell carcinoma antigen, peripheral blood lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio before concurrent chemoradiotherapy for recurrence of cervical cancer / 肿瘤研究与临床

ABSTRACT

Objective:To investigate the correlations of squamous cell carcinoma antigen (SCC), peripheral blood lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) before concurrent chemoradiotherapy with recurrence of cervical cancer after concurrent chemoradiotherapy, and to explore the predictive value of the three above indicators for recurrence.Methods:The data of 90 cervical cancer patients who received concurrent chemoradiotherapy in Shanxi Provincial Cancer Hospital from January to December 2018 were retrospectively analyzed, and the patients were divided into recurrence group and non-recurrence group according to whether they relapsed. The patients' basic information and the levels of SCC, LMR and PLR before concurrent chemoradiotherapy were recorded, and the median follow-up was 17 months (5-24 months). Logistic regression was used to analyze the risk factors affecting the recurrence of cervical cancer after concurrent chemoradiotherapy, the obtained risk factors were used to construct a recurrence prediction model, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of different indicators for recurrence.Results:Among 90 patients, 26 patients (28.9%) relapsed and 64 patients (71.1%) did not relapse during follow-up. The proportions of patients with tumor maximum diameter ≥ 4 cm [57.7% (15/26) vs. 34.4% (22/64)], lymph node metastasis [53.8% (14/26) vs. 31.2% (20/64)], Karnofsky score 70-75 points [30.8% (8/26) vs. 21.9% (14/64)], Karnofsky score 76-80 points [42.3% (11/26) vs. 17.2% (11/64)], International Federation of Gynecology and Obstetrics (FIGO) stage Ⅳ [42.3% (11/26) vs. 17.2% (11/64)] in the recurrence group were higher than those in the non-recurrence group, and the differences were statistically significant (all P < 0.05). The SCC and PLR in the recurrence group before concurrent chemoradiotherapy were (4.26±0.53) ng/ml and 144.02±11.16, which were higher than those in the non-recurrence group [(2.91± 0.48) ng/ml and 125.18±12.32], and the LMR in the recurrence group before concurrent chemoradiotherapy was 3.93±0.61, which was lower than that in the non-recurrence group (4.68±0.55), and the differences in SCC, PLR and LMR between the two groups were statistically significant (all P < 0.05). The area under the ROC curve of SCC, LMR and PLR before concurrent chemoradiotherapy alone for predicting the recurrence of cervical cancer after concurrent chemoradiotherapy was 0.819 (95% CI 0.708-0.948), 0.763 (95% CI 0.677-0.860) and 0.735 (95% CI 0.590-0.916), and the best cut-off values were 2.13 ng/ml, 4.08 and 133.65. Multivariate logistic regression analysis showed that the tumor maximum diameter ≥4 cm ( OR = 2.116, 95% CI 1.204-3.718), lymph node metastasis ( OR = 2.669, 95% CI 1.022-6.970), FIGO stage Ⅳ ( OR = 2.699, 95% CI 1.359-5.362) and SCC≥2.13 ng/ml ( OR = 4.256, 95% CI 1.194-15.170), LMR≤4.08 ( OR = 5.216, 95% CI 2.987-9.108) and PLR≥133.65 ( OR = 3.256, 95% CI 1.456-7.281) before concurrent chemoradiotherapy were the risk factors for recurrence of cervical cancer after concurrent chemoradiotherapy (all P < 0.05). The area under the ROC curve of the recurrence prediction model constructed by the above risk factors for cervical cancer after concurrent chemoradiotherapy was 0.857 (95% CI 0.744-0.987), the best cut-off value was 157.24, the sensitivity was 0.873, the specificity was 0.845, and the Youden index was 0.718. Conclusions:The recurrence of cervical cancer after concurrent chemoradiotherapy is associated with many factors. The patients with higher SCC, higher PLR and lower LMR before concurrent radiotherapy have higher risk of recurrence. The combined detection of multiple indicators has high value for predicting recurrence.