Abstract:
Objective:To investigate the predictive value of preoperative peripheral blood neutrophil-to-lymphocyte ratio(NLR) for the prognosis of elderly gastric cancer after radical operation.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 216 elderly patients with gastric cancer who underwent radical operation in the Second Hospital of Lanzhou University from January 2012 to January 2015 were collected. There were 166 males and 50 females, aged (71±13)years, with a range from 65 to 81 years. Among the 216 patients, 89 patients with NLR>2.86 were allocated into high NLR group, and 127 patients with NLR≤2.86 were allocated into low NLR group. Observation indicators: (1) clinicopathological characteristics of patients; (2) analysis of risk factors for the prognosis of patients; (3) follow-up. Follow-up was carried out by outpatient examination or telephone interview to detect postoperative tumor recurrence or distant metastasis and patient′s survival up to March 2019. The overall survival time was from the operation date to the end event date (date of death or the last effective follow-up date). Measurement data with normal distribution were represented as Mean±SD, and t test was used for comparison between groups. Measurement data with skewed distribution were represented as M (range). Count data were expressed as percentages, and chi-square test or Fisher exact probability method was used for comparison between groups. The Kaplan-Meier method was used to calculate survival rates, Graphpad prism 7 was used to draw survival curve, and Log-rank test was used for survival analysis. The COX proportional hazards model was used for univariate and multivariate analyses.
Results:(1) Clinico-pathological characteristics of patients: among the 216 patients, the lymphocyte count, cases carcinoembryonic antigen (CEA)<5.0 μg/L or ≥5.0 μg/mL, cases with CA19-9<37.0 kU/L or ≥37.0 kU/L, cases negative or positive for Helicobacter pylori, cases with or without lymph node metastasis, cases with or without postoperative recurrence or metastasis of the high NLR group were (1.6±1.2)×109/L, 54, 35, 51, 38, 33, 56, 43, 46, 18, 71; the above indicators of the low NLR group were (1.7±1.1)×109/L, 98, 29, 92, 35, 66, 61, 42, 85, 12, 115, respectively. There were significant differences in the above indicators between the two groups (t=4.923, x
2=6.825, 5.359, 4.673, 5.095, 5.081, P<0.05). (2) Analysis of risk factors for the prognosis of patients. Results of univariate analysis showed that age, lymphocyte count, NLR, CEA, CA19-9, Helicobacter pylori, tumor maximum diameter, TNM staging, postoperative recurrence and metastasis were the related factors affecting the postoperative 5-year overall survival rates of elderly gastric cancer patients after radical operation ［hazard ratio (HR)=1.400, 0.432, 1.901, 1.129, 1.726, 2.357, 2.149, 1.964, 5.032; 95% confidence interval (CI) as 1.285-1.525, 0.246-0.758, 1.006-1.832, 1.385-7.031, 1.107-2.699, 1.828-6.165, 0.872-7.414, 0.907-3.163, 1.726-8.457, P<0.05). Results of multivariate analysis showed that the lymphocyte count ≥1.20×109/L was an independent protective factor for the postoperative 5-year overall survival rates of elderly gastric cancer patients after radical operation (HR=0.285, 95%CI as 0.103-0.792, P<0.05), while NLR>2.86, Helicobacter pylori infection, tumor maximum diameter≥50 mm, stage Ⅲ of TNM staging, postoperative recurrence and metastasis were independent risk factors affecting the overall 5-year survival rates of elderly gastric cancer patients after radical operation (HR=2.221, 2.196, 1.972, 2.415, 4.582; 95%CI as 1.285-3.532, 1.359-6.873, 1.033-3.767, 1.296-3.545, 1.747-9.857, P<0.05). (3) Follow-up: all the 216 patients were followed up for 57 months (range, 3-84 months). Of the 216 patients, 21 had postoperative metastasis and 9 had recurrence. The median survival time of 216 patients was (29±14)months. The median postoperative survival time of the high NLR group and the low NLR group were (19±10)months and (38±12)months, respectively. The 5-year overall survival rates of patients in the high NLR group and the low NLR group were 18.0% and 35.7%, respectively, showing a significant difference between the two groups (x
2=19.330, P<0.05). Further analysis showed that among the 117 Helicobacter pylori-positive patients, the 5-year overall survival rates of patients in the high NLR group and the low NLR group were 13.5% and 24.3%, respectively, showing a significant difference (x
2=5.470, P<0.05). Among the 99 Helicobacter pylori-negative patients, the 5-year overall survival rates of patients in the high NLR group and the low NLR group were 25.4% and 37.1%, respectively, showing a significant difference (x
2=5.850, P<0.05).
Conclusion:Preoperative peripheral blood NLR has a good predictive value for the prognosis of elderly gastric cancer after radical resection, and high NLR indicates a worse prognosis.
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