Correlation Between Preoperative Inflammatory Markers NLR,PLR And Prognosis In Patients With Gastric Neuroendocrine Neoplasms

Objective: To study the correlation between preoperative inflammatory indicators:Neutrophil count/Lymphocyte count Ratio（NLR）and Platelet count/Lymphocyte count Ratio（PLR）and prognosis of patients with gastric neuroendocrine neoplasms（g-NENs）.Methods: A retrospective analysis method was used.The clinicopathological data of patients who received surgical treatment in the First Affiliated Hospital of Anhui Medical University and were diagnosed as gastric neuroendocrine neoplasm by postoperative pathology from January 2009 to August 2018 were collected and sorted.According to the set inclusion criteria,A total of 103 patient data were included.The cut-off time for follow-up was December 2020 or the occurrence of the end-point event（death）.The distribution characteristics of the clinicopathological data of all patients were counted,and then,according to the blood routine examination results of each patient before surgery,the corresponding NLR and PLR values ??were obtained according to the calculation formula.Using Receiver Operator Characteristic Curve（ROC）to calculate the optimum cut-off values ??of NLR and PLR respectively.The cohorts were sequentially grouped according to the optimum cut-off values ??of NLR and PLR,and the discrepancies in clinicopathological data of patients between groups were compared.The cohorts were then divided into groups according to various factors that may affect the prognosis of patients,and the survival differences of patients among the groups were compared by K-M（Kaplan-Meier）survival curve method and Log-Rank test.NLR,PLR and other interfering factors were included in multivariate Cox regression survival analysis.To identify the independent risk factors affecting the prognosis of patients with gastric neuroendocrine neoplasm.Results: The optimum cut-off value of NLR on the ROC curve was 2.08.There were 35 patients in the NLR<2.08 group and 68 patients in the NLR≥2.08 group.The optimum cut-off value of PLR on the ROC curve was 147.51.There were 58 patients in the PLR<147.51 group and 45 patients in the PLR≥147.51 group.Compared with the patients in the low NLR group and the high NLR group,the following clinicopathological indicators were significantly different: the number of preoperative symptoms（P value 0.044）;the number of patients with abnormal CEA（P value 0.042）;maximum tumor diameter（P value 0.023）;the number of vascular invasion cases（P value 0.028）;intraoperative bleeding（P value 0.009）;the number of intraoperative blood transfusion cases（P value 0.048）;the number of cases with postoperative complications（P value 0.008）;postoperative hospital stay（P value 0.026）.Between high and low PLR groups,the discrepancies between age distribution（P value 0.024）;the number of patients with abnormal CEA（P value 0.031）;the number of vascular invasion cases（P value 0.011）and intraoperative bleeding（P value 0.008）is significant.The comparison of survival time between groups with different prognostic factors showed that there was a statistically significant difference in survival between groups of NLR（P value 0.023）,PLR（P value 0.012）,maximum tumor diameter（P value 0.013）,tumor clinical stage（P value 0.021）and postoperative complications（P value 0.032）,which were risk factors affecting the survival of patients.Multivariate Cox regression analysis showed that high NLR value [HR=1.682,95%CI:（1.079-2.621）;P=0.022] and tumor pathological stage（Ⅲ/Ⅳ）[HR=1.828,95%CI:（1.098-3.044）;P = 0.020)]were strong predictor of patient survival,so they could be considered as independent prognostic factor affecting Overall Survival（OS）in patients with gastric neuroendocrine neoplasm.Conclusion: Preoperative inflammatory indicators NLR and PLR are not only correlated to various clinicopathological indicators in patients with gastric neuroendocrine neoplasm,but also correlated to the long-term prognosis of patients.In addition,NLR is an independent risk factor affecting the prognosis of patients with gastric neuroendocrine neoplasm.It is recommended that preoperative NLR and PLR could be regarded as potential markers for evaluating the perioperative risk and prognosis of patients with gastric neuroendocrine neoplasm.