| Background At present,gastric cancer is one of the most common cancers harmful to human health in the world.In China,the new number of gastric cancer and the number of deaths are in the forefront of malignant tumors.Because early screening of gastric cancer cannot be effectively popularized,most patients have reached the advanced stage when diagnosed,and the prognosis is poor.Therefore,it is urgent to make an effective and easy-to-use tumor-related marker effectively predict the prognosis of stomach cancer.In recent years,peripheral blood-related inflammation index with its unique advantages in the prognosis of stomach cancer has been paid more and more attention.Objective The purpose of this study was to investigate the neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)of peripheral blood markers before surgery.The prognosis of patients with stage III gastric cancer undergoing radical gastrectomy and postoperative adjuvant chemotherapy Predictive value and relationship with clinically relevant pathological features.Method In this study,through the method of retrospective analysis,the clinicopathological data of patients with III stage gastric cancer who underwent D2 radical resection of gastric cancer and received SOX(oxaliplatin + S-1)chemotherapy from January 2013 to December 2016 in the Department of Gastrointestinal surgery of the first affiliated Hospital of Zhengzhou University were collected from the electronic medical record system and followed up.Those who had received neoadjuvant radiotherapy and chemotherapy before operation,increased peripheral blood indexes caused by infection,suffered from hematological diseases and antiplatelet therapy,and died of other malignant tumors or other diseases after operation were excluded and A total of 68 patients with gastric cancer were included in this retrospective study.There were 56 males and 12 females.The minimum age is 36 years old,the maximum age is 73 years old,and the median age is 65 years old.The tumor was located in the upper stomach in 32 cases,the body of the stomach in 11 cases and the lower part of the stomach in 25 cases.The maximum diameter of the median tumor was 3cm,61 cases were greater than or equal to 3cm and 7 cases were less than 3cm.There were 28 cases of poorly differentiated tumors and 40 cases of moderately differentiated or moderately poorly differentiated tumors.In T staging,there were 6 cases in T2,16 cases in T3 and 46 cases in T4.In N staging,there were 15 cases of N0/N1,21 cases of N2 and 32 cases of N3.In TNM staging,there were 52 cases of IIIA/IIIB and 16 cases of IIIC.57 cases had no family history and 11 cases had family history.The median course of postoperative chemotherapy with SOX regimen was 6(1-8),of which 35 cases were more than or equal to 6 courses and 33 cases were less than 6 courses.The ratio of neutrophils to lymphocytes((NLR),),the ratio of platelets to lymphocytes((PLR))was calculated according to the results of the first blood routine before operation.Drawing the(ROC)curve of subjects’ working characteristics by SPSS software and According to the best Youden index,the best cut-off value is found.According to the best cut-off value,NLR and PLR are divided into low NLR group and high NLR group,low PLR group and high PLR group.Chi-square test was used to analyze and compare the relationship between NLR and PLR groups and clinicopathological features.KaplanMeier method was used to draw the survival curve of III stage gastric cancer associated with NLR and PLR,and the total survival of each group was compared.Cox regression model was used to analyze univariate and multivariate prognosis.When P <0.05,it was considered that the difference was statistically significant.Results According to the preoperative peripheral blood NLR,PLR and the survival status of the patients 3 years after operation,the ROC curve was constructed,and the area under the curve was 0.680 and 0.652,respectively.According to the best Youden index,the best cut-off values of NLR and PLR were 2.1 and 137.8,respectively.NLR and PLR were divided into high NLR group(n = 43),low NLR group(n = 25),high PLR group(n = 31)and low PLR group(n = 37).The chi-square test was used to compare the clinicopathological data among the groups.The results showed that NLR was correlated with tumor T stage,tumor N stage and tumor TNM stage(P<0.05.);PLR was correlated with tumor T stage and tumor N stage(P<0.05).Using Kaplan-Meier survival curve analysis,the 1-,2-and 3-year survival rates of patients with III stage gastric cancer in low NLR group and high NLR group were 97.3%,78.4%,67.6%and90.3%,64.5%,48.4%,respectively.The 1-,2-and 3-year survival rates of gastric cancer with low PLR and high PLR were95.3%,76.7%,67.8%and92.0%,64.0%,52.0%.The survival rate of high NLR and PLR group was lower than that of low NLR and PLR group,and the difference was statistically significant(P<0.05).Through univariate analysis of clinicopathological factors related to the prognosis of gastric cancer,the results showed that the overall survival time of patients with gastric cancer was related to tumor T stage,tumor N stage,tumor TNM stage,NLR,PLR and the course of chemotherapy.The difference was statistically significant(P<0.05).It was not related to sex,age,tumor location,maximum tumor diameter,tumor differentiation and family history,the difference was not statistically significant(P>0.05).Through COX regression multivariate analysis of the indexes related to the overall survival of patients with gastric cancer,the results showed that,NLR(HR=3.369 95%CI:1.243-9.136,P=0.017)were independent risk factors for the overall survival of gastric cancer.Conclusions The level of NLR in peripheral blood before operation can be used as an independent factor to predict the prognosis of patients with stage III gastric cancer who received SOX regimen chemotherapy after D2 radical resection of gastric cancer.The prognosis of patients with high NLR before operation was worse than that of patients with low NLR.Preoperative peripheral blood PLR can be used as a prognostic factor to evaluate the prognosis of stage III gastric cancer,but it is not an independent prognostic factor. |
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