Abstract
BackgroundWhether the change of the pre- and postoperative systemic inflammatory response (SIR) levels will affect the prognosis of gastric cancer (GC) is unclear. We aimed to investigate the dynamic changes in the pre- and postoperative SIR and their prognostic value for GC. MethodsThe clinicopathological data from 2257 patients who underwent radical gastrectomy between January 2009 and December 2014 at Fujian Medical University Union Hospital (FMUUH) were analyzed. Perioperative SIR changes were reported as changes in the lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). ResultsThe SIR levels showed different trends from postoperative months 1 to 12. Multivariate analysis showed that preoperative (pre)-LMR was an independent predictor for the prognosis (P = 0.024). The postoperative 12-month (post-12-month) LMR predicted the 5-year overall survival (OS) rate with the highest accuracy (areas under the curve [AUC] 0.717). Patients were divided into four groups according to the optimal cutoff of the preoperative and post-12-month LMR: high pre-LMR to high postoperative (post)-LMR group, high pre-LMR to low post-LMR group, low pre-LMR to high post-LMR group, and low pre-LMR to low post-LMR group. The survival analysis showed 5-year OS rate was significantly higher in patients with high post-12-month LMR than in patients with low post-12-month LMR, regardless of pre-LMR levels (81.6% vs. 44.2%, P < 0.001). The prognostic accuracy was significantly improved by incorporating the post-12-month LMR in the tumor-node-metastasis (TNM) staging system (P = 0.003). ConclusionsThe remeasurement of LMR at post-12-month is helpful in predicting the long-term survival of GC.
Highlights
Gastric cancer (GC) is one of the most common malignancies of the digestive system; it is the 5th most common malignancy and the 3rd leading cause of cancer-related death.[1]
Total gastrectomy was performed in 1180 cases (52.3%), distal gastrectomy was performed in 1027 cases (45.5%), and proximal gastrectomy was performed in 49 cases (2.2%)
The neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in gastric cancer (GC) returned to preoperative levels at post-12month, while post-12-month lymphocyteto-monocyte ratio (LMR) was still significantly higher than preoperative (P = 0.007)
Summary
Gastric cancer (GC) is one of the most common malignancies of the digestive system; it is the 5th most common malignancy and the 3rd leading cause of cancer-related death.[1]. Some studies have explored the relationship between different inflammatory markers and the prognosis of patients with GC.[7,8,9,10] The lymphocyteto-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are the most obtained inflammatory markers and can be obtained from complete blood count (CBC) testing, which is a convenient method for dynamic preoperative and postoperative repeated measurements.[11,12,13,14] As potential markers for predicting the prognosis and guiding the treatment of patients with GC, they reflect the complex interactions between the local immune response and systemic inflammatory response (SIR) in the tumor microenvironment.[15] previous studies have mostly been limited to exploring the relationship between the preoperative (pre)-SIR and the prognosis. We aimed to longitudinally investigate and characterize the SIR from the preoperative period through multiple time points in the postoperative period to examine the dynamic changes in perioperative LMR, NLR, PLR, and SII and to investigate whether changes in the SIR would confer a difference in the overall survival (OS).
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