Application Value Of Ratio Of Neutrophils To Lymphocytes In Patients With T4 Gastric Cancer

Background and objective Gastric cancer(GC)is the fourth largest cancer in the world,with the second mortality.The early diagnosis rate of GC in C hina is lower than that in Japan,Korea and other countries,and about 80% of GC patients are diagnosed as advanced stage at the first diagnosis.At present,radical gastrectomy plus D2 lymph node dissection is still the only effective treatment for advanced GC,and adjuvant radiotherapy / chemotherapy could further improve the overall survival of GC patients.Higher NLR is associated with poor prognosis of gastric cancer.However,it has not been reported whether the NLR value has the same prognostic value for tumor invading serosa or even invading extra-serosa tissue(T4 stage).Therefore,this study retrospectively analyzed the relationship between N LR value and clinicopathology and overall survival of T4 GC patients,and clarified the application value of N LR in T4 GC.Methods This study retrospectively analyzed the clinicopathological data of 204 patients with stage T4 GC admitted to the first Affiliated Hospital of Anhui Medical University from January 2010 to January 2012.C linicopathological parameters were collected: gender,age,ne utrophil count,lymphocyte count,tumor location,longest tumor diameter,degree of tumor differentiation,number of lymph node metastasis,infiltration depth and extra-serosa infiltration,and postoperative pathological TNM stage.According to recommends of several literature,the cutoff value of NLR was the 2.4,and T4 GC patients were divided into high NLR group(NLR? 2.4)and low NLR group(NLR<2.4).The mean of longest diameter of the tumor was 6.0 cm,so they were divided into the group with the longest diameter <6 cm and the group with the longest diameter 6 cm.According to the degree of differentiation,they were dividedinto: medium-high differentiation group and low-poor differentiation group.All patients received outpatient reexamination or telephone follow-up,and the time of death and cause of death were counted.The end date of follow-up was December 1,2017.Chi-square test or fisher exact probability method were used to analyze the relationship between NLR and clinicopathological factors.Kaplan-meier curve and log rank test were used to analyze the influence of different clinicopathological factors on the overall survival of T4 GC patients.Cox regression model was used to analyze independent risk factors affecting the overall survival of T4 GC patients.Results The chi-square test showed that N LR had no correlation with gender in T4 GC patients(?2=0.648,P=0.421).N LR had no correlation with age of T4 GC patients(?2=1.460,P=0.227).NLR was not related to the degree of tumor differentiation in T4 GC patients(?2=0.261,P=0.609).NLR was not associated with lymph node metastasis in T4 GC patients(?2=0.102,P=0.749).NLR was not related to postoperative pathological TNM stage in T4 GC patients(?2=0.017,P=0.897).N LR was associated with the longest tumor diameter in patients with T4 GC(?2=4.898,P=0.027).Kaplan-Meier survival curve and log-rank test analysis showed that the overall survival of T4 GC patients in the NLR<2.4 group were better than that in the NLR? 2.4 group,and the difference was statistically significant(P=0.002).The overall survival of T4 GC patients with the longest tumor diameter <6 cm was better than that with the longest tumor diameter ? 6 cm,and the difference was statistically significant(P=0.046).The overall survival of T4 GC patients in the medium-high differentiation group of tumor were better than that in the low-poor differentiation group,and the difference was statistically significant(P=0.003).The overall survival of male patients was longer than that of female patients,but the difference was not statistically significant(P=0.153).There was no significant difference in overall survival between those aged 60 years and those aged < 60 years(P=0.516).There was no significantdifference in the overall survival between the negative and positive patients with lymph node metastasis(P=0.686).The overall survival of stage II/III patients was longer than that of stage IV patients,but the difference was not statistically significant(P=0.302).The results of multivariate analysis showed that NLR and tumor differentiation were independent risk factors affecting the overall survival of T4 GC patients(P=0.014 and P=0.008).Conclusion NLR is related to the longest tumor diameter in T4 GC patients,and the overall survival prognosis of patients in low N LR group are better than those in high NLR group.NLR and tumor differentiation were independent risk factors affecting the overall survival of T4 GC patients.