Effects Of D-dimer And Prognostic Nutritional Index(PNI) On 5-year Survival In Patients With Operable Gastric Cancer

Background and purpose: Background and purpose: Gastric cancer(GC)is one of the common malignant tumors of human digestive system.Even with the rapid and vigorous development of the social economy and the general extension of the life expectancy of all human beings,malignant tumors are still one of the important factors causing the death of the global population.Poor nutritional status is common in cancer patients,especially those with gastrointestinal tumors.An index calculated from albumin and blood lymphocyte counts: prognostic nutritional index(PNI),used by clinicians to assess patients’ nutritional status and surgical risk,based on a combination of the body’s nutritional status and immune status Evaluation System.The blood of tumor patients is in a hypercoagulable state,and D-dimer has been proved by many studies to be closely related to the short-term complications and long-term survival prognosis of malignant tumors.Therefore,this study intends to further explore its clinical application value by analyzing the influence of D-dimer and prognostic nutritional index(PNI)on the prognosis of patients with operable gastric cancer.Methods: In this study,the cases and follow-up data of patients undergoing radical gastrectomy for gastric cancer in the Gastrointestinal Surgery Department of Yan’an University Affiliated Hospital from June 2013 to June 2016 were collected and retrospectively analyzed.A total of 316 patients were included according to the inclusion and exclusion criteria.General information includes: patient’s gender,age,family history(tumor-related family history),operation time,and operation plan;tumor pathological data include: tumor maximum diameter,location,degree of differentiation,presence or absence of vascular invasion,and depth of invasion(T staging),regional lymph node metastasis(N staging),TNM staging and Borrmann classification,;clinical data include:preoperative D-dimer level,serum albumin value,peripheral blood lymphocyte count,Tumor marker CEA level,whether 4-6 cycles after surgery standard chemotherapy treatment.The 316 patients included in this study were followed up to see whether the patients were alive and dead(time and cause of death).The study endpoint was 5-year overall survival time(OS),which was defined as the time from the date of surgery to the end of follow-up or patient death.Deadline is June 30,2021.Overall survival time and5-year survival rate were calculated.SPSS 23.0 statistical software was used for statistical analysis of the research data.The optimal cutoff values for D-dimer and PNI were obtained from the receiver operating curves(ROC curves)of the subjects,respectively.Pearson’s chi-square test was used for analysis between groups of different variables.Survival curves were drawn using the Kaplan-Meier method and subjected to univariate analysis and compared by log-rank test.Significant factors in univariate analysis were included for COX multivariate regression analysis.Based on the logistic regression model,a patient survival prognosis prediction model was established,and the predictive ability of each factor was compared by drawing the ROC curve.P<0.05 considered the difference to be statistically significant.Results: 1.In this study,the ROC curve was constructed according to the preoperative D-dimer and PNI values,and the optimal cut-off values of D-dimer and PNI were determined to be 0.49 mg/L and 46.775,respectively.Among them,there were 176 cases in the high D-dimer group(≥0.49mg/L),140 cases in the low D-dimer group(<0.49mg/L).The 5-year survival rate of the patients in the low D-dimer group(67.1%)was higher than that in the hign D-dimer group(12.5%),and the difference was statistically significant(P<0.05).There were 147 cases in the high-level PNI group(≥46.775)and 169 cases in the low-level PNI group(<46.775).The 5-year survival rate of the patients in the high-PNI group(62.6%)was higher than that in the low-PNI group(14.2%),and the difference was statistically significant.(P<0.05).2.Univariate Logistic regression analysis showed that age,tumor differentiation,T stage,N stage,TNM stage,vascular invasion,tumor diameter,Borrmann classification,preoperative D-dimer level,preoperative PNI level,tumor marker CEA level,postoperative Post-chemotherapy was associated with overall survival time and5-year survival rate of patients after radical gastrectomy for gastric cancer(p<0.05).However,gender,tumor location and tissue type did not affect the overall survival time and 5-year survival rate of patients(p>0.05);Multivariate COX regression analysis showed that preoperative D-dimer level,preoperative PNI level,N stage,postoperative chemotherapy or not were independent risk factors for postoperative 5-year survival rate in patients with gastric cancer.3.By drawing the ROC curve to compare the predictive ability of each factor,the area under the curve(AUC)of the D-PNI combination score was 0.851,the AUC of the N stage was 0.765,and the AUC of the postoperative chemotherapy was 0.633.The AUC for D-dimer was 0.818 and the AUC for PNI was 0.798.The combined score has good predictive power.Conclusion:1.D-dimer and PNI are independent risk factors affecting the 5-year survival rate of patients with operable gastric cancer.2.The combined scoring system derived from D-dimer combined with PNI index can better predict the prognosis of patients with operable gastric cancer than other independent risk factors.3.Preoperative PNI<46.775 and D-dimer ≥0.49mg/L indicated poor prognosis of operable gastric cancer patients.