| ObjectiveTo explore the predictive value of inflammatory indexes such as platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR)and systemic immune inflammatory index(SII)for postoperative survival of gastric cancer with different Lauren classification.MethodsRetrospective collection of clinical and pathological data from 330 gastric cancer patients at Lanzhou University Second Hospital,overall comparison of postoperative survival in patients with different Lauren subtypes of gastric cancer.The patients were divided into intestinal gastric cancer(IGC)group and diffuse gastric cancer(DGC)group,and the optimal cutoff values of inflammatory indicators PLR,NLR,MLR,and SII were calculated using X-tile.The patients were grouped according to their optimal cutoff values.The overall survival rates of patients at 1,3,and 5 years after surgery were compared,Cox regression analysis was used to identify independent risk factors affecting postoperative survival in gastric cancer patients with different Lauren subtypes.Kaplan Meier method was used for survival analysis,R software was used to draw Nomogram prediction models,and C-index,ROC curve analysis,and calibration curves were used to evaluate the predictive efficacy of the models.Results1.The average postoperative survival time of patients in the IGC group was 52 months,and the 1-year,3-year,and 5-year survival rates were 90.5%,72.2%,and67.4%,respectively,which was superior to the postoperative survival of patients in the DGC group(48 months,86.3%,62.7%,and 54.5%).2.The optimal cutoff values for inflammatory indicators PLR,NLR,MLR,and SII in IGC group were 175.3,2.0,0.3,and 625.7,respectively.Patients in PLR<175.3,NLR<2.0,and SII<625.7 groups had higher 1-year,3-year,and 5-year survival rates after surgery(P<0.05),and MLR had no significant impact on the survival of IGC patients(P>0.05);The optimal cutoff values for inflammatory markers PLR,NLR,MLR,and SII in the DGC group were 148.1,2.3,0.3,and 446.6,respectively.Patients in the PLR<148.1,MLR<0.3,and SII<175.3 groups had higher 1-year,3-year,and5-year survival rates(P<0.05).NLR had no significant impact on postoperative survival of DGC patients(P>0.05).3.According to Cox regression analysis,PLR,TNM stage,and presence or absence of vascular infiltration are independent risk factors affecting postoperative survival in patients with IGC;MLR,N-stage,and presence or absence of vascular infiltration are independent risk factors for postoperative survival in patients with DGC.4.Construction of Nomogram predictive models for different Lauren typing based on independent risk factors affecting postoperative survival in patients with IGC and DGC.The C-index of the prediction model was calculated to be 0.825 and0.757,respectively.The area under the ROC curve of the prediction model was larger than other influencing factors,and the 1-year,3-year,and 5-year calibration curves were well fitted,indicating that the constructed IGC and DGC prediction models had good predictive efficacy.Conclusions1.Inflammatory markers have different effects on the prognosis of gastric cancer with different Lauren’s classification.The inflammatory index that significantly affects the postoperative survival of IGC patients is PLR.The postoperative survival of IGC patients with PLR ≥ 175.3 is significantly worse than that of patients with PLR<175.3;The inflammatory index that has a significant impact on postoperative survival of DGC patients is MLR.The survival of DGC patients in the MLR≥0.3group is significantly worse than that in the MLR<0.3 group.2.Clinical prediction models for different Lauren subtypes of gastric cancer based on various inflammatory indicators were constructed.C-index,ROC curve analysis,and calibration curve evaluation showed that both models had good predictive performance and could be used as a tool for clinical prediction of postoperative survival in gastric cancer patients. |
