| Objective: To investigate the relationship between neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),lymphocyte-to-monocyte ratio(LMR),prognostic nutritional index(PNI),systemic inflammatory response index(SIRI),carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA)and resectable gastric cancer,to establish a clinical predictive model to evaluate the predictive value of single index and combined index for the long-term prognosis of gastric cancer,and to evaluate the predictive ability of the model,so as to provide reference for improving the prognosis of gastric cancer patients in this region.Methods: Descriptive and predictive research methods were used in our study.We collected the clinical data of patients with gastric cancer who underwent radical gastrectomy in the department of general surgery of the second hospital of Lanzhou University from January 2013 to July 2014.The optimal cut-off values of NLR,PLR,LMR,PNI and SIRI were determined and grouped according to the ROC curve.Chi square test,t test and variance analysis were used to explore the correlation between peripheral blood markers,tumor markers and lymph node metastasis and depth of invasion of gastric cancer;Logistic regression analysis was used to analyze the risk factors of lymph node metastasis and depth of invasion of gastric cancer;Kaplan-Meier method was used to calculate the survival rate,log rank test was used to test the significance between groups;Cox proportional hazards regression model was used to analyze the prognostic factors of gastric cancer patients and establish predictive model,the effect of Nomogram was evaluated by consistency index C-index and calibration curve.Results: 1.The best cut-off values of NLR,PLR,LMR,PNI and SIRI were determined according to the ROC curve,and area under ROC curve was used to compare the prognostic value.The area under the curve of CA19-9 was the largest,which was 0.639(95% CI: 0.593-0.683),followed by PNI(AUC=0.631,95% CI:0.585-0.675);Survival analysis after grouping by the best cut-off values showed that the 3-year and 5-year survival rates of gastric cancer patients in the positive group with NLR ≥1.96、PLR ≥126、 LMR ≤4.59、PNI≤48.80、SIRI ≥0.98 were significantly higher than those in the negative group(P<0.05).2.NLR,PLR,LMR,PNI,SIRI,CA19-9,CEA were correlated with tumor size,lymph node metastasis,vascular invasion,neural invasion and TNM stage.CA19-9(OR=2.840,95% CI: 1.567-5.147),CEA(OR=2.707,95% CI: 1.624-4.511)and PLR(OR=1.756,95% CI: 1.167-2.640)were independent risk factors for lymph node metastasis and depth of invasion in gastric cancer patients.3.NLR,PLR,LMR,PNI,SIRI,CA19-9 and CEA were all associated with poor prognosis of gastric cancer patients.PNI(HR=1.351,95% CI: 1.046-1.746),SIRI(HR=1.501,95% CI: 1.172-1.922),CA19-9(HR=1.743,95% CI: 1.329-2.286)and CEA(HR=1.373,95% CI: 1.059-1.780)were independent risk factors for prognosis of gastric cancer patients.4.The two,three and four combination indexes based on PNI,SIRI,CA19-9and CEA were independent risk factors for the prognosis of gastric cancer.The prediction performance of combined index was higher than that of single index.The area under ROC curve of “PNI + SIRI+ CA19-9 + CEA” was the largest(AUC=0.724,95% CI: 0.681-0.764),which was similar to TNM staging.5.The C-index of Nomogram was 0.692(95% CI: 0.675-0.708)of four combination indexes based on PNI,SIRI,CA19-9 and CEA.The calibration curves of3-year survival rate and 5-year survival rate coincided well with the ideal curve(blue dotted line).Conclusions: 1.NLR,PLR,LMR,PNI,SIRI,CA19-9 and CEA in peripheral blood were correlated with the prognosis of gastric cancer.The 3-year and 5-year survival rates of positive group were significantly lower than those of negative group.2.PLR,CA19-9 and CEA were independent predictors of lymph node metastasis and depth of invasion in patients with gastric cancer.Compared with CA19-9 and CEA,PLR has higher ability to predict depth of invasion.3.Age,Vascular invasion,N stage,PNI,SIRI,CA19-9 and CEA were independent risk factors for the prognosis of gastric cancer.The combination of PNI,SIRI,CA19-9 and CEA could significantly improve the prognosis of gastric cancer.4.The visual predictive model based on Nomogram had good consistency and reliability,and could be used as an effective tool for clinical prognosis evaluation of gastric cancer. |
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