Preoperative NLR,PLR And LMR In Evaluating Prognosis Of Patients Undergoing Radical Gastrectomy

Background:Gastric cancer is a common malignant tumor of digestive tract in China.Every year,679,100 new cases are reported.It is the fifth most common cancer in the world,and ranks third in cancer-related fatal diseases.In Japan,early screening of gastric cancer by gastroscopy is effective.Most of the patients with confirmed gastric cancer belong to early gastric cancer,and the prognosis is usually good.But in our country,the incidence of gastric cancer is high,and most of the patients are locally advanced gastric cancer.The prognosis is often poor and it is difficult to achieve R0 resection.Therefore,it is extremely necessary and urgent to find a simple,easy to obtain and economical tumor biological detection index related to the clinicopathological characteristics and prognosis of gastric cancerObjective:Peripheral blood NLR,PLR and LMR are important biological indicators reflecting systemic inflammation and immune status.This study explored the relationship between preoperative peripheral blood neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),lymphocyte/monocyte ratio(LMR)and clinicopathological characteristics of patients undergoing radical gastrectomy,and analyzed the influence on stomach.The clinical and pathological factors of total survival time(OS)and disease-free survival(DFS)of cancer patients after operation were studied to explore the prognostic effects of inflammatory markers NLR,PLR and LMR in peripheral blood.Method:From January 2011 to January 2013,216 patients with gastric cancer were diagnosed by gastrointestinal surgery of the First Affiliated Hospital of Dalian Medical University and underwent radical gastrectomy.Among them,156 were males(72.2%)and 60 were females(27.8%).SPSS22.0 was used for statistical analysis.Frequency and percentage were used to describe different clinicopathological features.The critical values of NLR,PLR and LMR are determined by ROC curve analysis,and grouped by the maximum bounds of Yoden index.The single factor analysis of NLR,PLR,LMR and other clinicopathological factors was performed by X2 test.The exact probability method of Fisher was used.The binary stepwise logistic regression was used for multivariate analysis.The probability of variables entering the equation was set to 0.05,and the probability of elimination was set to 0.10.Prognosis and clinicopathological factors(age,sex,location of tumors,degree of differentiation,maximum diameter of tumors,presence or absence of vascular invasion,presence or absence of cancer nodules,CEA,proportion of positive lymph nodes,depth of invasion of tumors(T stage),number of positive lymph nodes(N stage),TNM stage,Borrmann classification,lymphocyte value,platelet value,neutrophil value,monocyte value,CA199)Univariate analysis of NLR,PLR,LMR and whether or not chemotherapy was used to draw survival curve by Kaplan-Meier method,and log-rank was used for statistical test.Stepwise COX regression was used in multivariate analysis.The probability of variables entering the equation was set to 0.05,and the probability of elimination was set to 0.10.The test level alpha was set to 0.05,when P was less than 0.05,the difference was statistically significant.Result:A total of 216 patients who underwent radical gastrectomy(R0 resection)in gastrointestinal surgery of the First Affiliated Hospital of Dalian Medical University were collected.ROC curves were constructed according to preoperative NLR,PLR and LMR values of peripheral blood and 5-year survival status of patients.The highest critical values of Yoden index were selected as the grouping criteria of NLR,PLR and LMR.NLR,PLR and LMR were divided into two groups,high and low,and compared between the two groups.The results showed that the NLR corresponding to the maximum diameter of tumors,depth of invasion(T),TNM stage,early or advanced gastric cancer,platelet value and monocyte value had significant differences between the two groups,and the PLR corresponding to the maximum diameter of tumors,depth of invasion of tumors,TNM stage,early or advanced gastric cancer and platelet value had significant differences between the two groups.There were significant differences in LMR between the two groups in age,maximum diameter of tumors,presence or absence of cancer nodules,depth of invasion(T stage),lymphocyte value,platelet value and monocyte value.Logistic regression was used to analyze the preoperative NLR,PLR and LMR.The results showed that age,Borrmann typing,platelet value and monocyte value were independent factors affecting NLR;platelet value was independent factor affecting PLR;age,cancer nodules and monocyte value were independent factors affecting LMR.Survival analysis showed that high NLR(>1.745),PLR(>102.5)and low LMR(<3.290)in peripheral blood of patients with gastric cancer before operation were the adverse factors affecting the prognosis of gastric cancer.Conversely,high LMR(>3.290),low NLR(<1.745)and PLR(<102.5)were the positive factors affecting the prognosis of patients with gastric cancer.NLR,PLR and LMR can be used to evaluate the prognosis of patients with gastric cancer,but they are not independent risk factors affecting prognosis.By combining CEA,CA199 with NLR,PLR and LMR,we re-included survival analysis.We found that NLR+CA199 parallel positive was an independent risk factor affecting prognosis of patients.Tumor markers combined with peripheral blood inflammatory markers may be a better prognostic indicator for patients with gastric cancer.Conclusion:1.Preoperative NLR,PLR and LMR can be used to evaluate the prognosis of gastric cancer patients,but they are not independent risk factors affecting the prognosis of gastric cancer.2.The proportion of positive lymph nodes,depth of invasion(T stage)and NLR+CA199 parallel positive were independent risk factors affecting the prognosis of gastric cancer patients.3.When evaluating the prognosis of gastric cancer patients,the combination of peripheral blood inflammatory markers and tumor markers may achieve better results.