| Objectives To investigate the significance of combined detection of pre-treatment derived neutrophil to lymphocyte ratio(d NLR)and lactate dehydrogenase(LDH)on prognosis of patients with advanced HER-2 negative gastric cancer(GC),to establish a clinical predictive model to evaluate the predictive value of combined index for the prognosis of advanced gastric cancer.Methods The clinical data of 141 cases of unresectable advanced HER-2 negative gastric cancer patients who were diagnosed by pathology in Hebei General Hospital from November 2016 to December 2020 were retrospectively analyzed.The optimal cut-off of d NLR was obtained by X-tile software and the upper normal limit value was selected for LDH.The Lung Immune Prognostic Index(LIPI)score was obtained by combining d NLR and LDH.SPSS25.0 software and Graphpad Prism8.0 software were used to analyze and graph.To sdudy the ralationship between the d NLR,LDH and LIPI scores and clinicopathological features and prognosis.A nomogram model was conducted by R4.1.0 software.Results 1 The optimal cut-off values of d NLR,LDH in peripheral blood of ganstric cancer patients before treatment was 2.6 and 250 U/L,and d NLR was positively correlated with LDH level.LIPI score based on LDH and d NLR was conducted,characterizing into 3 groups(LIPI 0,LIPI 1 and LIPI 2).2 The correlation between d NLR,LDH and LIPI scores and clinicopathological features of gastric cancer: The level of d NLR was correlated with TNM stage of gastric cancer(P<0.05),patients in group with high d NLR had late stage.LDH level and LIPI score were correlated with TNM stage and No.of metastatic sites(P<0.05),patients in the group with high LDH and high LIPI score were more likely to have distant metastasis and with late stage.3 The relationship between d NLR,LDH and LIPI scores and curative effect and prognosis: The clinical efficacy and overall survival(OS)in the ganstric cancer were related to d NLR,LDH and LIPI score(P<0.05).Among them patients with d NLR<2.6,LDH<250U/L and low LIPI scores groups had better efficacy.The median survival time(MST)of all gastric cancer patients was 15 months,and the 1-year,2-year and 3-year survival rates were70.20%,13.50% and 4.90%.The MST in low d NLR group was higher than that in the high d NLR group(16 months vs 13 months).The 1-year,2-year and 3-year survival of two groups were 82.30%,21.50%,8.70% vs 54.80%,3.20%,0.00%(P<0.001).The MST in the low LDH group was higher than that in the high LDH group(16 months vs 11months).The 1-year,2-year and 3-year survival of two groups were 82.30%,17.70%,6.40% vs 44.40%,4.40%,2.20%(P<0.001).The MST of patients with LIPI score 0,1 and2 group was 17 months vs 14 months vs 11 months respectively.The 1-year,2-year and3-year survival of three groups were 88.20%,21.10%,9.20% vs 57.10%,14.30%,4.80%vs 45.50%,2.30%,0.00%(P<0.001).suggesting poor prognosis in patients with high levels of d NLR,LDH and high LIPI score.4 Prognostic factors analysis: Univariate analysis showed that OS was associated with patients’ age,ECOG score,TNM stage,No.of metastatic sites,d NLR level,LDH level,and LIPI score(P<0.05).Cox multivariate analysis showed that age,TNM stage,No.of metastatic sites,and LIPI score were independent prognostic factors for unresectable gastric cancer patients(P<0.05).5 The nomogram was constructed to predict the prognosis of gastric cancer based on four combination indexes Age,TNM,No.of metastatic sites,and LIPI score.Conclusions 1 The d NLR and LDH levels before treatment in perpheral blood of patients with advanced HER-2 negative gastric cancer were positively correlated,and d NLR and LDH levels were correlated with prognosis of gastric cancer.2 Lung immune prognostic index(LIPI)was obtained by combining d NLR and LDH.LIPI score was independent risk factor for the prognosis of patients with advanced HER-2 negative gastric cancer.The worse LIPI score was before treatment,the worse treatment efficacy and survival prognosis were.3 The construction of a visual nomogram mad based on LIPI score may be an effective tool for clinical prognosis assessment of ganstric cancer.Figure 7;Table 10;Reference 126... |
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