| Objective:1.A cross-sectional study to understand the occurrence of complications after radical gastric cancer surgery in elderly patients with gastric cancer;2.To explore the factors influencing the occurrence of complications postoperative elderly patients with gastric cancer,through case-control studies;3.To further analyze the predictive value of PNI combined with NLR on post-radical gastric cancer complications in elderly patients and the effect of the interaction between the two indices on post-operative complications in elderly gastric cancer,so as to provide a basis for the prevention of post-operative complications.Methods:1.In this study,elderly patients with gastric cancer who underwent standard surgical treatments in the Department of Gastrointestinal Surgery of the First Hospital of Shanxi Medical University were used as the study subjects according to the inclusion and exclusion criteria,and the relevant medical records were reviewed to understand the baseline data,clinicopathological data and laboratory tests of elderly patients with gastric cancer in cross-sectional studies.The baseline data includes patient’s age,gender,history of smoking,history of alcohol consumption,history of underlying diseases such as hypertension and diabetes,and patient’s BMI;the clinicopathological data mainly includes tumour T-stage,tumour N-stage,cholangiocarcinoma embolism,nerve invasion,degree of differentiation,with or without post-operative complications and surgical anastomosis;the laboratory test indexes mainly include patients’ concentration of preoperative serum albumin and the count of platelet,lymphocyte and neutrophil within a week before surgery.The preoperative NLR,PNI,PLR and SII are calculated according to the laboratory indexes.2.On the basis of the cross-sectional study,a case-control study was conducted between the complication group and the uncomplicated group divided according to the incidence of postoperative complications.The factors influencing the occurrence of postoperative complications in elderly gastric cancer patients were advanced explored.Factors with P<0.05 in the univariate analysis and variables that might be significant were included in the multi-factor logistic regression analysis to find independent risk factors for the occurrence of postoperative complications in elderly gastric cancer patients,and P<0.05 is considered a statistically significant difference.ROC curves were plotted to compare the predictive value of NLR,PNI and the combination of the two indicators for postoperative complications by area under the curve(AUC),respectively.Analyzing the effects of the interaction between NLR and PNI on postoperative complications in elderly gastric cancer.3.Data collation was performed via EPidata 3.1 real-time dual entry and logical error correction and calibration were performing at the same time.SPSS 25.0 was used for statistical description and analysis of the data.Quantitative data that conformed to a normal distribution were expressed as (?)± s and statistically analyzed using the independent samples t-test.Those that did not conform to a normal distribution were expressed as median and interquartile range(IQR)and statistically analysed using the Mann-Whiney U test.The qualitative data were expressed in the form of rates(composition ratio,%)and statistically analyzed by chi-square test and unconditional logistic regression.Multi-factor analysis was conducted using an unconditional logistic regression model,yielding OR and 95% CI,and differences considered statistically significant when P < 0.05.ROC curves were used to analyse the study indicators to get the best cut-off values and compare the predictive value of different indicators and the combination of indicators on postoperative complications by area under the curve(AUC).The logistic regression model was used for the multiplicative interaction analysis and the Excel software was used for the summative interaction analysis.Evaluation indexes include RERI,QAP and the synergy index.Results:1.General information about the patients included1.1 Baseline informationA total of 431 patients with gastric cancer were included in this study,345(80.0%)were male and 86(20.0%)were female,with a male to female ratio of 4:1.The mean age was 69.38 ± 6.59 years(age range 60-91 years).There were 166 patients(38.5%)who smoked,100 patients(23.2%)who drank alcohol,134 patients(31.1%)with previous hypertension,52 patients(12.1%)with previous diabetes,35 patients(8.1%)with previous coronary artery disease,68 patients(15.8%)with previous respiratory disease,among which most patients have a normal BMI(57.8%,249/431)1.2 Clinicopathological data and laboratory tests of the patientPostoperative pathology indicated that there were vascular thrombosis in 154(35.7%)patients and nerve invasion in 254(58.9%)patients.The stage of T1(46.6%,201/431)takes most part in the stage of T,and the stage of N0(38.5%,166/431)takes most part in the stage of N..According to the degree of tumour differentiation,162patients(37.6%,162/431)had hypodifferentiated gastric cancer,,which indicated that patients were generally with low differentiation and high tumour malignancy.The main anastomotic mode is conventional Roux-en-Y anastomosis(62.4%,269/431).There were122 patients(28.3%)with combined preoperative low ALB haemoglobin(ALB <35 g/L)and more patients in the low NLR group(NLR <2.99,323/431).The number of patients in the high PNI group(PNI ≥44.07)is a bit larger than in the low PNI group(58.5%,252/431).There were 343 patients(79.6%)in the low PLR group(PLR <210.66)and292 patients(67.7%,292/431)in the low SII group(SII < 579.34)and 139 patients(32.3%)1.3 Early post-operative complications in patientsPostoperative complications occurred in 206 of 431 patients(47.7%),with 87 cases of peritoneal effusion(20.2%),85 cases of pleural effusion(19.7%),63 cases of pneumonia(14.6%),47 cases of anaemia(10.9%),27 cases of electrolyte disturbances(6.3%),24 cases of intestinal obstruction(5.6%),22 cases of anastomotic fistula(5.1%)hepatic insufficiency in 16 cases(3.7%),pelvic effusion in 16 cases(3.7%),residual gastritis in 13 cases(3.0%),anastomitis in 10 cases(2.3%),renal insufficiency in 9 cases(2.1%),coagulation dysfunction in 7 cases(1.6%),cholecystitis in 3 cases(0.7%)and duodenal stump fistula in 3 cases(0.7%).2.Analysis of influencing factors of postoperative complications in elderly patients with gastric cancer2.1 Univariate analysis of factors influencing postoperative complications in elderly patients with gastric cancerUnivariate analysis of whether patients had early postoperative complications(no complications = 0,with complications = 1)as the dependent variables by t-test,chi-square test or Z-test showed that hypo-ALBemia(OR=0.440,P<0.001),NLR(OR=2.980,P<0.001),PNI(OR=0.402,P<0.001),PLR(OR=2.713,P<0.001),and SII(OR=2.326,P<0.001)were statistically significant,but the rest were not statistically significantly different.2.2 Multifactorial analysis of factors influencing postoperative complications in elderly patients with gastric cancerAfter including univariate analysis of significant variables and relevant variables reported as potentially significant in the literature,unconditional logistic regression analysis showed that elderly patients with PNI ≥ 44.07 had a reduced risk of postoperative gastric cancer complications(OR=0.518,95% CI: 0.339-0.790,P=0.002);and elderly gastric cancer patients with NLR ≥ 2.99 were 2.283 times more likely to have complications than patients with NLR <2.99(OR=2.283,95% CI: 1.396-3.732,P=0.001).3.Predictive value of PNI and NLR for postoperative complications in elderly patients with gastric cancerAnalysis of the ROC curve showed that the AUC for PNI is 0.609(95% CI:0.556-0.662,p < 0.001)and the AUC for NLR is 0.599(95% CI: 0.546-0.653,p < 0.001).Combining PNI and NLR by binary logistic regression analysis,we could get a joint prediction probability value regression model,whose AUC is 0.642(95% CI:0.590-0.694,p < 0.001),indicating that PNI combined with NLR significantly improved predictive efficacy compared to individual indicators alone.4.Effect of interaction of PNI and NLR on postoperative complications in elderly gastric cancerThe results above show that both low PNI and high NLR are risk factors for postoperative complications in elderly patients with gastric cancer.And since PNI is an indicator of nutrition and NLR is an indicator of inflammation,the hypothesis arose that whether there is an interaction between the factors(synergistic or antagonistic effect)that increases or decreases the risk of deregulation? So an advanced analysis of the interaction between the two factors was then carried out.The results of the analysis showed that the three evaluation indicators in the summation model were: relative excess risk RERI = 1.066,interaction attribution ratio AP = 0.243,and interaction index S =1.462.None of them were statistically significant(p > 0.05).Conclusion:1.The incidence of postoperative complications in elderly patients with gastric cancer in this study was 47.7%.Patients often have underlying diseases and late pathological stages,so tumour screening should be improved and the health management of elderly patients should be enhanced.2.Unconditional logistic regression results indicates that PNI(PNI < 44.07)and NLR(NLR≥2.99)may be risk factors for postoperative complications in elderly patients with gastric cancer.3.PNI combined with NLR significantly improves the predictive efficacy of postoperative complications in elderly gastric cancer patients compared to using only a single indicator,but there is no interaction between the two factors.4.The results of this study suggest that PNI and NLR can be used as a simple and effective predictor of postoperative complications in elderly patients with gastric cancer.we can implement individualized treatment and preventive measures in the perioperative period of patients to reduce the occurrence of postoperative adverse events in elderly patients,according to the predictive results. |
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