| Objective To explore the difference of perioperative systemic inflammatory response and early recovery between Mongolian and Han patients with gastric cancer,and the related factors affecting postoperative hospital stay.Methods Patients with advanced gastric cancer diagnosed by operation and pathology in the Department of Oncology of Chifeng Hospital from January 2017 to January 2021were retrospectively collected and treated with D2 resection of gastric cancer.120patients in the incoming and outgoing group were selected according to the input and output criteria.Observation indicators:(1)sex,age,body mass index(Body Mass Index,BMI),smoking and drinking history;(2)postoperative pathological TNM stage,degree of differentiation(high/medium/low),mode of operation,and postoperative complications;(3)preoperative(Pre),postoperative day 1(POD1),postoperative day 3(POD3)and postoperative day 7(POD7)NLR,PLR,LMR,SII.(4)pain visual analog scale(Visual Analogue Scale,VAS score)and postoperative hospital stay on day 1(POD1),day 2(POD2),and day 3(POD3).Results The main results were as follows:(1)in the comparison of general data,there were significant differences in the history of smoking and drinking between the Mongolian group and the Han group(x~2:4.628;x~2:5.790;0.016),and the Mongolian group had a higher body mass index(BMI)than the Han group(26.14±5.80 vs 23.71±5.25).On the 1st,2nd,and 3rd day after the operation,the visual analog scale(VAS)of pain in Mongolian group was lower than that in Han group(3.74±1.33 vs 4.30±1.24,2.388,2.388,3.33±1.03 vs 3.92,2.950,0.004,2.44,0.86 vs 2.98,1.05,3.046,0.003),and the hospital stay in Mongolian group was shorter than that in Han group(13.64±1.75vs 15.58±5.40,2.732,0.008).There was no significant difference in sex,age,TNM stage,differentiation degree,mode of operation,and total postoperative complications between the two groups.(2)there was no significant difference in the indexes related to inflammatory response between the Mongolian group and the Han group:there was no significant difference in NLR,PLR,LMR,and SII between the two groups before the operation,but there were significant differences in NLR,PLR,LMR,and SII on the 1st and 3rd day after the operation.On the 7th day after the operation,there were significant differences in NLR and SII(9.07±3.01 vs 10.33±2.37).742.76±209.40 vs 816.65±171.77),but there was no significant difference between PLR and LMR.(3)there was a significant difference in the length of stay between the two groups.In order to further verify the relationship between the relevant variables of the difference between the two groups and the length of stay,the general data of all patients included nationality,body mass index(BMI),smoking history,drinking history,VAS score 3 days after the operation and postoperative hospital stay.The results of Logistic multivariate regression analysis showed that nationality and smoking history were the independent risk factors for prolonged postoperative hospital stay on the 3rd day after the operation.The risk of prolonged hospitalization in Mongolian patients was significantly lower than that in Han patients(OR=0.367,95%CI:0.142～0.950),while that in smoking patients was higher than that in non-smoking patients.The risk of prolonged hospitalization was significantly increased(OR=2.500,95%CI:1.003～6.228).For each unit increase in VAS score on the3rd day after the operation,the risk of prolonged hospitalization increased by 1.775 times(OR=1.775,95%CI:1.114～2.827).(4)univariate analysis of hospital stay and postoperative NLR,PLR,LMR,and SII showed that there were significant differences in other variables except for POD1-PLR,POD7-PLR,POD7-LMR,and POD7-SII between the normal discharge group and delayed discharge group.All the inflammatory markers with statistical differences in univariate analysis were included in logistic multivariate regression analysis.The results showed that NLR,LMR,and SII on the 3rd day after operation were statistically significant(OR=1.627,95%CI:1.079～2.454;OR=0.035,95%CI:0.005～0.255).OR=1.009,95%CI:1.003～1.014),in which the risk coefficient of NLR was the highest on the 3rd day after the operation.when POD3-NLR increased by 1 unit,the risk of prolonged hospital stay increased by 1.627 times.Further drawing the ROC curve of POD3-NLR,the best cut-off value corresponding to the most approximate index is 13.52,the area under the curve(Area Under Cure,AUC)is 0.818,95%CI is 0.743～0.892,the sensitivity is 85.4%,and the specificity is 69.6%.The cutoff value was used as the cut-off point to divide the patients into two groups:greater than or equal to 13.52 and less than 13.52.the relationship between POD3-NLR and hospital stay was drawn by the Kaplan-Meier survival curve.The results showed that the patients with NLR greater than or equal to 13.52 had shorter hospital stay on the 3rd day after the operation.Conclusion Compared with Han patients,Mongolian patients with gastric cancer have less fluctuation of postoperative inflammatory reaction,less postoperative pain,faster postoperative recovery,more tolerance to surgical treatment,and shorter hospital stay.Surgical treatment can be given priority to Mongolian patients with advanced gastric cancer.At the same time,postoperative adjuvant radiotherapy and chemotherapy can be carried out as soon as possible,which is helpful to further improve the survival rate of patients. The Mongolian patients with gastric cancer have high adverse factors such as smoking and drinking,so it is necessary to increase the education of smoking and alcohol prohibition in the early stage before the operation,speed up the postoperative recovery,shorten the postoperative hospital stay. Regional analgesia can be appropriately strengthened for Han patients with gastric cancer after operation. For patients with high NLR on the 3rd day after the operation,anti-inflammatory and other treatment schemes can be adjusted to reduce postoperative stress and inflammatory reaction. |
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