| BackgroundGastric cancer,despite its declining incidence rate,is still the second cause of cancer-related death worldwide.About 750,000 people died every year because of it.The best examples of inflammation associated cancer in human beings may be gastric cancer.Studying the molecular mechanism of the inflammation in carcinogenesis can help developing new strategies against gastric cancer.ObjectivesPeripheral blood neutrophils-to-lymphocytes ration(NLR)reaction is the important serum marker of inflammation.A large number of researches show that the elevation of NLR is associated with the poor survival of patients with gastric cancer.Previous study only focused on NLR levels in gastric cancer patients before treatment,and the postoperative NLR and the correlation between the prognosis of patients with gastric cancer are rarely reported.NLR is a dynamic process.The changes of postoperative NLR reflect the changes of immune function in body from the side.At the same time,the current clinical studies did not reach an agreement about NLR level threshold.The present study was designed to evaluate the predictive value of dynamic change of NLR in patients who undergo curative resection for gastric cancer from a retrospective analysis of 275 patients with gastric cancer and these pathological characteristics.MethodsA retrospective study was performed to analyze 275 patients with gastric cancer who underwent curative resection in Qilu Hospital between May 2010 and December 2011.The statistical analyses were performed using the IBM SPSS Statistics software(version 22.0;SPSS,Inc.,Chicago,IL,USA)statistical analysis.Categorical variables were compared using the x 2-test.Continuous variables were compared using the independent sample t-test.The overall and recurrence free survivals were calculated using Kaplan-Meier method and compared by log-rank test.The prognostic factors independently associated with overall and recurrence free survival were identified by multivariate Cox proportional hazards regression analysis.All statistical tests were two-sided,and a significant difference was considered when P<0.05.ResultsTwo hundred seventy-five patients who received curative resection were enrolled.Among them,there were 202 males and 73 females.According to patients with preoperative and postoperative NLR ratio change,they were divided into two groups:increased NLR group,decreased NLR group.There was no statistically significant difference between the clinical pathologic data including age,sex,tumor location,the degree of differentiation,tumor diameter,the proportion of positive lymph node number,depth of tumor invasion,lymph node metastasis,tumor emboli or not,whether preoperative CEA,preoperative CA19-9,postoperative chemotherapy.According to the postoperative NLR change,the 1、3、5 years RFS for patients with decreased NLR was 73.9%,49.9%,and 47.0%respectively,and 64.2%.23.2%,and 15.8%respectively for patients with increased NLR.The RFS of patients with increased NLR was significantly poorer than that of patients with decreased NLR(log-rank test,P<0.001).According to the postoperative NLR change,the 1、3、5 years OS for patients with decreased NLR was 88.3%,57.8%,and 47.I%respectively,and 81.1%,34.7%,and 15.8%respectively for patients with increased NLR.The OS of patients with increased NLR was significantly poorer than that of patients with decreased NLR(log-rank test,P<0.001).Univariate analysis revealed that RFS was influenced by tumor size,lymph node ratio,N stage,tumor thrombus,pre-CEA,pre-CA 19-9,pre-NLR,NLR change and postoperative chemotherapy.Multivariate analysis showed that,NLR change,pre-NLR,lymph node ratio and postoperative chemotherapy were significant prognostic factors for RFS.ConclusionsPostoperative NLR change is the independent factors affecting the prognosis of patients with gastric cancer.Whether preoperative NLR level is high or low,for patients with increased postoperative NLR,their prognosis is worse than patients whose postoperative NLR reduces. |
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