Preoperative Neutrophil-to-lymphocyte Ratio(NLR) And Serum CA199 Serve As Survival Predictors In Advanced Gallbladder Carcinoma Patients With Radical Resection

Background:The neutrophil-lymphocyte ratio(NLR)has been reported as a significant survival predictor in various solid tumors.The carbohydrate antigen199(CA199)is a tumor marker and is also associated with prognosis of various cancers.The aim of this study was to explore the prognostic significance of preoperative NLR and CA199 in advanced gallbladder carcinoma(GBC)patients with radical resection.Methods:From June 2011 to December 2017,ninety-seven GBC patients classified as stage III and IV who received radical resection were included.Cutoff values of NLR and CA199 were obtained through operating characteristic curves(ROC).The clinical and histopathological data were analyzed by univariate analysis.The prognostic factors on overall survival(OS)were evaluated by the COX proportional hazard regression model.Results:The cutoff values of NLR and CA199 were 2.40 and 108.87 U/ml,respectively.Univariate analyses indicated that lymph node metastasis,platelet count(PLT),NLR,PLR(platelet-to-lymphocyte ratio),PNI(prognostic nutritional index= Albumin+5× Total lymphocyte count(×10^9/L)),TP(total albumin),CEA(carcinoembryonic antigen),CA199 were significantly correlated with OS(p<0.05).In multivariable analysis,lymph node metastasis(HR=0.369,95%CI: 0.222-0.611,P=0.0001),NLR(HR=0.547,95%CI: 0.337-0.886,P=0.014),CEA(HR=0.445,95%CI: 0.274-0.721,P=0.001),CA199(HR=0.613,95%CI: 0.385-0.977,P=0.04)were independent prognostic factors for OS.The OS was better in low NLR and CA199 group than those with high NLR and/or CA199 groups.Conclusion:Preoperative NLR,CA199,CEA and positive lymph node metastasis are independent risk factors for the prognosis of in advanced GBC patients with radical resection.Preoperative NLR and serum CA199 were correlated with OS in advanced GBC patients who underwent radical resection.Low NLR and CA199 suggested better OS.High NLR and CA199 suggested that radical resection has no survival benefit compared with palliative resection.