| Background and purpose:Gastric malignancy is one of the most common malignancy in the world.Despite the continuous progress of modern human civilization and the emergence of various anti-cancer methods,malignant tumors still pose a serious threat to the survival time and quality of human beings.Malignant tumors are one of the important factors that cause human death worldwide.Malnutrition and cachexia are widely seen in patients with malignant tumors,especially those of digestive system.A biological index based on albumin and lymphocytes of hospitalized patients:Prognostic nutritional index,has been widely used to measure initial nutritional situation of hospitalized patients and the whole perioperative risk,the index comprehensive assessment of the patient’s current nutrition related risk and the body’s immune condition.At present,relevant studies have confirmed that the process of tumor progression is closely related to tumor-related inflammation,and many inflammatory cells and immune cells are components of tumor microenvironment.Neutrophils,monocytes,platelets and lymphocytes in peripheral blood are related to tumor metastasis and invasion,The ratio of Neutrophil to lymphocyte,an inflammatory index based on neutrophils and lymphocytes,has been widely used to predict the survival and prognosis of malignant tumors,and has been verified in liver cancer and pancreatic cancer.Therefore,the purpose of this study is to explore the specific effects of NLR and PNI on the 5-year survival rate of patients with gastric cancer after surgery,so as to further explore their potential significance for medical work,better predict the prognosis of patients with gastric cancer,and guide clinical treatment.Method:According to the inclusion and exclusion criteria,a total of 146 patients who underwent radical gastrectomy in the Department of Gastrointestinal Surgery,Affiliated Hospital of Southwest Medical University from December 2014 to December 2017 were retrospectively included in this study.All patients were followed up for at least 5 years or lost to follow-up due to death or other reasons.The end time of follow-up was December 2022.General data collected include:patient’s gender,age,BMI value and underlying disease;The results of tumor pathology included maximum tumor diameter,primary site,differentiation,tissue type,vascular invasion,presence of cancer nodules,depth of invasion(T stage),lymph node metastasis(N stage),TNM stage and Borrmann classification.Clinical data included:preoperative peripheral blood lymphocyte count,neutrophil count,CEA value of tumor markers,CA199 value,serum albumin value,and postoperative chemotherapy or not.The 146patients included in the study were regularly followed up to investigate whether the patients survived or died(the specific date and reason of death,etc.).The final outcome of the study was 5 years overall survival time,defined as the period from the day of surgery to the time of termination of follow-up or the date of the patient’s death.Overall survival time and 5-year survival rate were calculated.Based on blood samples collected before surgery,NLR and PNI were calculated,where NLR=neutrophil count÷lymphocyte count,PNI=5×lymphocyte(×10~9/L)+serum albumin(g/L).In this study,SPSS20.0(IBM)medical statistical processing software was used to comprehensively analyze the collected clinical data,draw the receiver operating characteristic curve of preoperative NLR and PNI,and obtain the optimal cut-off value by calculating the maximum Youden index.According to the optimal cut-off value,the above indicators were divided into high level group and low level group,Pearson Chi-square test was used to analyze the different groups of all the included observational factors.Univariate analysis was performed on the observational factors,and COX multivariate regression analysis was performed on statistically significant observational factors.Statistically significant factors in multivariate analysis were treated by Kaplan-Meier method and relevant survival curves were obtained,and ROC curve was used to measure the ability of observation indicators to evaluate survival prognosis.P<0.05 was considered statistically significant.Result:1.In this study,the ROC curve was made based on the calculated values of NLR and PNI,and the optimal cut-off values of NLR and PNI were 5.115 and 49.145.There were 45 cases in the high level NLR group(>5.115)and 101 cases in the low level NLR group(≤5.115).The 5-year overall survival rate in the low level NLR group(44.6%)was higher than that in the high level NLR group(11.1%).The difference was statistically significant(P<0.05).There were 57 cases in the high level PNI group(>49.145)and 89 cases in the low level PNI group(≤49.145).The 5-year survival rate in the high level PNI group(61.4%)was higher than that in the low level PNI group(16.9%),the difference was statistically significant(P<0.05).2.Univariate Logistic regression analysis showed that age,depth of tumor invasion(T stage),N stage,TNM stage,Borrmann classification,postoperative chemotherapy,preoperative NLR level,preoperative PNI level were correlated with the overall survival time and 5-year survival rate of patients after radical gastrectomy(p<0.05).The overall survival time and 5-year survival rate of patients were not affected by patient gender,tumor location,tumor differentiation degree,tumor tissue type,vascular invasion,tumor diameter,CEA level of tumor markers,CA199 level,and presence of cancer nodules(p>0.05).Multivariate COX regression analysis determined that patient age,preoperative NLR value and preoperative PNI value were independent risk factors affecting the 5-year survival rate of patients with gastric cancer after radical gastrectomy.3.ROC curve was used to evaluate the ability of observation indicators to evaluate the prognosis of patients with gastric cancer.The Area under the curve(AUC)of N-PNI was 0.789,that of NLR was0.658,and that of PNI was 0.762.The AUC for age was 0.714.N-PNI combination score has good predictive value.Conclusion:1.Preoperative NLR and PNI values are independent risk factors affecting the 5-year survival rate of patients with gastric cancer after surgery.2.The combination score of preoperative NLR value and PNI value can evaluate the survival prognosis of postoperative patients with gastric cancer more accurately and effectively than other indicators.3.Preoperative NLR level>5.115 and PNI level≤49.145 suggest poor prognosis in patients with gastric cancer. |
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