Clinical study of CTC combined with NLR to predict the efficacy and prognosis of postoperative adjuvant chemotherapy in senile patients with resectable primary gastric cancer
Objective To investigate the predictive effect of circulating tumor cell(CTC)combined with neutrophil to lymphocyte count ratio(NLR)in postoperative adjuvant chemotherapy in senile patients with resectable primary gastric cancer.Methods Ninety-three elderly patients with resectable primary gastric cancer from December 2017 to December 2020 were selected as the observation group.Serum samples from 51 healthy volunteers were selected as control group.Observation group was divided into chemotherapy insensitive group and chemotherapy sensitive group according to chemotherapy efficacy.CTC and NLR levels of the two groups were compared and their diagnostic efficacy in adjuvant chemotherapy efficacy was analyzed.Overall survival(OS)and progression-free survival(PFS)curves of patients with different CTC and NLR expression were plotted by Kaplan-meier method,and survival differences were tested by Log-rank.Results The NLR of observation group was higher than that of control group[2.90(2.15,4.20)vs.1.89(1.50,2.42),Z=-6.382,P<0.05].Of the 93 patients,32 were insensitive group and 61 were sensitive group after adjuvant chemotherapy.The levels of NLR and CTC in chemotherapy insensitive group were higher than those in chemotherapy sensitive group(P<0.05).Receiver operating characteristic curve(ROC)analysis showed that the area under the curve(AUC)of NLR was 0.714(95%CI:0.612-0.815).When the cut-off value was 2.24,the sensitivity was up to 100%and the specificity was 41.0%.When NLR combined with CTC,AUC = 0.806(95%CI:0.709-0.903),sensitivity 78.14%,specificity 75.43%.Only NLR was associated with patient age(P<0.05).The median OS and PFS in patients with high CTC expression were 22.0 months and 15.0 months,both lower than 27.0 months and 20.0 months in patients with low CTC expression,and the differences were statistically significant(P<0.05).The median OS and PFS in patients with high NLR expression were 22.0 months and 14.0 months,both lower than those in patients with low NLR expression(30.0 months and 19.0 months),and the differences were statistically significant(P<0.05).Conclusion NLR combined with CTC can predict the efficacy and prognosis of adjuvant chemotherapy,and can be used as a potential indicator to judge the therapeutic effect and prognosis of patients.
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