Prognostic Value Of Preoperative Ratio Of Neutrophil, Platelet, Monocyte Count To Different Types Of Lymphocyte Count In Patients With Gastric Cancer

Objective: Gastric cancer(GC)is one of the major causes of cancer-related death worldwide,but it lacks accurate,convenient and sensitive predictive indicators to evaluate the prognosis of GC patients.This study aimed to explore the predictive value of the ratio of preoperative neutrophils,platelets,and monocytes to different types of lymphocytes in GC patients without distant metastasis.Methods: From March 2012 to March 2016,the clinical and pathological data of GC patients who underwent surgery in Liaoning Cancer Hospital were collected and the ratios of neutrophil count,platelet count,monocyte count to different types of lymphocyte count were calculated.Chi-square test was used to compare the differences between each group and clinicopathological features.The survival curve was drawn using Kaplan-Meier method and the difference was analyzed by log-rank test.Cox proportional hazard model was used to analyze the single and multiple factors to identify independent prognostic factors.Nomogram was used to construct a scoring model for indicators with independent prognostic factors,and AUC method was used to evaluate the stability of the model.Results: The average age of 1145 patients with GC was 63(29-82)years old,827 males and 319 females.Univariate analysis showed: NTLR high level group(vs low group)(HR = 1.85;P < 0.05;HR = 1.85;P < 0.05),NCTLR high level group(vs low group)(HR = 1.98;P < 0.05),NBLR high level group(vs low group)(HR = 0.56;P < 0.05);PTLR high level group(vs low group)(HR = 1.77;P < 0.05);the group with high PCTLR level(vs low group)(HR = 1.51;P < 0.05),the group with high PBLR level(vs low group)(HR = 0.51;P < 0.05);the group with high MTLR level(vs low group)(HR = 1.79;P < 0.05),the group with high MCTLR level(vs low group)(HR = 1.94;P < 0.05),the group with high MBLR level(vs low group)(HR = 0.58;P < 0.05);the earlier T and N stages and high BMI,the better prognosis(P < 0.05).In subsequent multivariate analysis,N stage,NTLR,NBLR,NCTLR and PBLR were found to be independent prognostic factors(P < 0.05).BMI,T,N stages and NTLR were used to construct the prediction model,and nomogram was drawn,and the AUC was 0.81,which was a reliable prediction model.Conclusion: The higher ratio of neutrophil count,platelet count,monocyte count to T lymphocyte and toxic T lymphocyte showed the worse the prognosis,while the higher ratio of B lymphocyte had the better the prognosis.