Development And Validation Of A Novel Nomogram For Predicting Overall Survival In Gastric Cancer Based On Inflammatory Markers

Backgroud: Gastric cancer(GC),which is a common cancer,ranks third in the global cancer death rate and has a high incidence rate and mortality rate,of which nearly 66%of the incidence rate occurs in developing countries.In some cancers,the predictive significance of inflammatory markers has been determined.The ratio of neutrophils to lymphocytes(NLR)is an important indicator that may predict the development of cancer.It can reflect the ratio of neutrophils to lymphocytes.It has special clinical significance because of its accessibility and the ratio easily calculated from the patient’s routine blood cell count.Platelet-lymphocyte ratio(PLR)has been widely used in lung cancer,colorectal cancer and esophageal cancer.It can be easily obtained through blood testing,and the cost is low.NLR and PLR are two additional blood indicators that can be used to predict the survival and prognosis of patients with malignant tumors.In addition,the predictive role of systemic immune inflammation index(SII)has been confirmed in various malignant tumors.NLR and PLR are calculated as the ratio of two different blood cell groups.SII considers three groups by multiplying NLR and platelet count.Aim: To determine other clinical blood indicators that can be used to evaluate the prognosis of patients with gastric cancer and create a reliable scoring system.Methods: Nine hundred and four GC patients treated at the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2013 were recruited.The patient’s age,sex,differentiation grade,tumor size and other characteristics as well as clinicopathological information,neutrophils,lymphocytes and platelets were obtained from the Medical Records Department.The cut-off values of CEA and hemoglobin were obtained according to the normal level,and the cut-off values of NE,LY and PLT were determined using the median.SII is calculated by PLT count,NE count/LY count.utilize χ 2 test or Fisher accurately made statistics on the classification value,and carried out t test for continuous variables.The prognostic risk variables were screened for Cox analysis.The nomogram was evaluated by means of C index,decision curve and subject operator characteristic(ROC)curve.Results: All selected participants were randomly divided into training(n=543)and validation(n=361)cohorts for final analysis of the study.According to the Yoden index,the optimal cutoff values of NLR,PLR and SII were calculated to be 2.0,160.0 and475.6 respectively.Univariate analysis showed that sex,hemoglobin,age,TNM,NLR,tumor size,PLR,SII and CEA were independent risk factors for the prognosis of gastric cancer patients.Through multivariate analysis,it was determined that age,tumor lymph node metastasis stage,carcinoembryonic antigen,and systemic immune inflammation index(SII)were independent prognostic variables of gastric cancer patients.Among them,compared with other inflammatory indexes,the systemic immune inflammatory index value had better prediction ability for the prognosis of gastric cancer patients.ROC showed that the area under the curve of the nomogram was higher than other factors,and it was very reliable to evaluate the c index of the validation group and the training group of gastric cancer patients.In the nomogram,TNM stage,CEA,SII and age occupied an important proportion and value in the scoring system.According to the critical value,the training group was divided into three subgroups(<60=low risk,60-120=medium risk,>120=high risk).The survival curve results showed that the survival prognosis of high-risk patients was the worst.Conlusion:We created a novel nomogram to forecast the prognosis of GC patients following curative gastrectomy based on blood markers and other characteristics.Both surgeons and patients can benefit significantly from this new scoring system.