Background
Methods
Statistical analysis
Results
Predictive ability and cut-off values of inflammation-based and/or nutritional markers
Patient demographics
Variables | 5-year OS (%) | No. of patients | Univariate | ||
---|---|---|---|---|---|
n | % | HR (95% CI) | p value | ||
Total | 48.7 | 225 | 100 | ||
Age (years) | |||||
≤ 68 | 54.0 | 117 | 52.0 | 1 | |
> 68 | 42.8 | 108 | 48.0 | 1.643 (1.164–2.319) | 0.005 |
Sex | |||||
Male | 47.3 | 147 | 65.3 | 1 | |
Female | 51.2 | 78 | 34.7 | 1.188 (0.823–1.715) | 0.357 |
BMI (kg/m2) | |||||
Low (≤ 21.9) | 46.7 | 114 | 50.7 | 1 | |
High (> 21.9) | 50.6 | 111 | 49.3 | 0.950 (0.674–1.339) | 0.771 |
Performance status | |||||
0 | 52.1 | 167 | 74.2 | 1 | |
1–3 | 39.1 | 58 | 25.8 | 1.606 (1.109–2.325) | 0.012 |
Location | |||||
Upper/Middle/Lower | 50.7 | 209 | 92.9 | 1 | |
Whole | 20.6 | 16 | 7.1 | 1.334 (1.092–1.630) | 0.005 |
Macroscopic type | |||||
Type 0/1/2 | 56.9 | 61 | 27.1 | 1 | |
Type 3/4/5 | 45.6 | 164 | 72.9 | 1.145 (0.774–1.693) | 0.497 |
Operative procedure | |||||
Distal gastrectomy | 59.7 | 117 | 52.0 | 1 | |
Total gastrectomy | 36.9 | 108 | 48.0 | 1.835 (1.295–2.600) | 0.001 |
Lymph node dissection | |||||
D1 | 49.8 | 32 | 14.2 | 1 | |
D2 | 48.6 | 193 | 85.8 | 0.911 (0.553–1.500) | 0.713 |
Histology | |||||
Differentiated | 54.0 | 97 | 43.1 | 1 | |
Undifferentiated | 44.4 | 128 | 56.9 | 1.198 (0.846–1.697) | 0.308 |
Lymphatic invasion | |||||
Absent | 57.9 | 19 | 8.4 | 1 | |
Present | 47.8 | 206 | 91.6 | 1.174 (0.633–2.177) | 0.611 |
Venous invasion | |||||
Absent | 50.3 | 156 | 69.3 | 1 | |
Present | 44.8 | 69 | 30.7 | 1.193 (0.830–1.716) | 0.340 |
TNM sub-stage | |||||
IIIA | 62.2 | 80 | 35.6 | 1 | 0.011 |
IIIB | 45.4 | 72 | 32.0 | 1.579 (1.030–2.420) | 0.036 |
IIIC | 36.2 | 73 | 32.4 | 1.908 (1.242–2.931) | 0.003 |
Tumor size (mm) | |||||
≤ 60 | 55.9 | 115 | 51.1 | 1 | |
> 60 | 40.9 | 110 | 48.9 | 1.534 (1.086–2.166) | 0.015 |
Adjuvant chemotherapy | |||||
Absent | 40.1 | 41 | 18.2 | 1 | |
Present | 50.6 | 184 | 81.8 | 0.575 (0.382–0.865) | 0.008 |
CAR | |||||
Low (≤ 0.47) | 50.6 | 211 | 93.8 | 1 | |
High (> 0.47) | 21.4 | 14 | 6.2 | 2.844 (1.561–5.181) | 0.001 |
NLR | |||||
Low (≤ 1.90) | 58.0 | 99 | 44.0 | 1 | |
High (> 1.90) | 41.2 | 126 | 56.0 | 1.400 (0.986–1.988) | 0.060 |
PLR | |||||
Low (≤ 172) | 53.2 | 141 | 62.7 | 1 | |
High (> 172) | 40.9 | 84 | 37.3 | 1.376 (0.970–1.953) | 0.074 |
PNI | |||||
Low (≤ 45.6) | 39.0 | 90 | 40.0 | 1 | |
High (> 45.6) | 54.9 | 135 | 60.0 | 0.730 (0.517–1.031) | 0.074 |
GPS | |||||
0 | 51.1 | 171 | 76.0 | 1 | |
1/2 | 41.1 | 54 | 24.0 | 1.463 (0.992–2.156) | 0.055 |
PI | |||||
0 | 50.1 | 205 | 91.1 | 1 | |
1/2 | 35.0 | 20 | 8.9 | 1.592 (0.914–2.773) | 0.101 |
Survival
Prognostic factors for OS
Variables | Analysis with CAR | Analysis with NLR | Analysis with PLR | Analysis with PNI | Analysis with GPS | |||||
---|---|---|---|---|---|---|---|---|---|---|
HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | |
Age (years) | ||||||||||
≤ 68 | 1 | 1 | 1 | 1 | 1 | |||||
> 68 | 1.245 (0.832–1.862) | 0.287 | 1.303 (0.878–1.935) | 0.189 | 1.354 (0.910–2.014) | 0.135 | 1.284 (0.851–1.937) | 0.234 | 1.298 (0.871–1.934) | 0.200 |
Performance status | ||||||||||
0 | 1 | 1 | 1 | 1 | 1 | |||||
1–3 | 1.246 (0.793–1.957) | 0.340 | 1.311 (0.843–2.039) | 0.229 | 1.320 (0.852–2.046) | 0.214 | 1.333 (0.857–2.073) | 0.202 | 1.318 (0.847–2.051) | 0.221 |
Location | ||||||||||
Upper/Middle/Lower | 1 | 1 | 1 | 1 | 1 | |||||
Whole | 1.097 (0.882–1.364) | 0.406 | 1.079 (0.866–1.345) | 0.497 | 1.079 (0.867–1.343) | 0.496 | 1.095 (0.880–1.362) | 0.417 | 1.090 (0.876–1.358) | 0.439 |
Operative procedure | ||||||||||
Distal gastrectomy | 1 | 1 | 1 | 1 | 1 | |||||
Total gastrectomy | 1.765 (1.201–2.595) | 0.004 | 1.657 (1.138–2.413) | 0.008 | 1.753 (1.195–2.573) | 0.004 | 1.654 (1.132–2.417) | 0.009 | 1.660 (1.136–2.425) | 0.009 |
TNM sub-stage | ||||||||||
IIIA | 1 | 0.060 | 1 | 0.048 | 1 | 0.034 | 1 | 0.066 | 1 | 0.063 |
IIIB | 1.511 (0.972–2.348) | 0.067 | 1.481 (0.953–2.300) | 0.081 | 1.531 (0.983–2.382) | 0.059 | 1.487 (0.953–2.321) | 0.081 | 1.495 (0.962–2.323) | 0.074 |
IIIC | 1.694 (1.074–2.671) | 0.023 | 1.754 (1.111–2.768) | 0.016 | 1.812 (1.146–2.865) | 0.011 | 1.707 (1.074–2.714) | 0.024 | 1.702 (1.074–2.697) | 0.024 |
Tumor size (mm) | ||||||||||
≤ 60 | 1 | 1 | 1 | 1 | 1 | |||||
> 60 | 1.017 (0.689–1.501) | 0.933 | 1.065 (0.726–1.561) | 0.749 | 0.983 (0.663–1.457) | 0.931 | 1.058 (0.717–1.561) | 0.776 | 1.054 (0.715–1.554) | 0.791 |
Adjuvant chemotherapy | ||||||||||
Absent | 1 | 1 | 1 | 1 | 1 | |||||
Present | 0.807 (0.507–1.284) | 0.366 | 0.810 (0.509–1.288) | 0.373 | 0.772 (0.486–1.227) | 0.274 | 0.797 (0.501–1.267) | 0.337 | 0.806 (0.508–1.281) | 0.361 |
CAR | ||||||||||
Low (≤0.47) | 1 | |||||||||
High (> 0.47) | 2.257 (1.180–4.319) | 0.014 | ||||||||
NLR | ||||||||||
Low (≤1.90) | 1 | |||||||||
High (> 1.90) | 1.322 (0.926–1.887) | 0.124 | ||||||||
PLR | ||||||||||
Low (≤172) | 1 | |||||||||
High (> 172) | 1.478 (1.025–2.133) | 0.037 | ||||||||
PNI | ||||||||||
Low (≤45.6) | 1 | |||||||||
High (> 45.6) | 0.922 (0.631–1.348) | 0.676 | ||||||||
GPS | ||||||||||
0 | 1 | |||||||||
1/2 | 1.141 (0.754–1.727) | 0.533 |
Relationship between CAR, PLR and clinicopathological variables, and CSS
Variables | CAR | p value | PLR | p value | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Low | High | Low | High | |||||||
n | % | n | % | n | % | n | % | |||
Age (years) | ||||||||||
≤ 68 | 115 | 54.5 | 2 | 14.3 | 74 | 52.5 | 43 | 51.2 | ||
> 68 | 96 | 45.5 | 12 | 85.7 | 0.004 | 67 | 47.5 | 41 | 48.8 | 0.851 |
Sex | ||||||||||
Male | 136 | 64.5 | 11 | 78.6 | 99 | 70.2 | 48 | 57.1 | ||
Female | 75 | 35.5 | 3 | 21.4 | 0.389 | 42 | 29.8 | 36 | 42.9 | 0.046 |
BMI (kg/m2) | ||||||||||
Low (≤21.9) | 105 | 49.8 | 9 | 64.3 | 61 | 43.3 | 53 | 63.1 | ||
High (> 21.9) | 106 | 50.2 | 5 | 35.7 | 0.293 | 80 | 56.7 | 31 | 36.9 | 0.004 |
Performance status | ||||||||||
0 | 161 | 76.3 | 6 | 42.9 | 107 | 75.9 | 60 | 71.4 | ||
1–3 | 50 | 23.7 | 8 | 57.1 | 0.006 | 34 | 24.1 | 24 | 28.6 | 0.460 |
Location | ||||||||||
U/M/L | 197 | 93.4 | 12 | 85.7 | 132 | 93.6 | 77 | 91.7 | ||
Whole | 14 | 6.6 | 2 | 14.3 | 0.261 | 9 | 6.4 | 7 | 8.3 | 0.582 |
Macroscopic type | ||||||||||
Type 0/1/2 | 59 | 28.0 | 2 | 14.3 | 41 | 29.1 | 20 | 23.8 | ||
Type 3/4/5 | 152 | 72.0 | 12 | 85.7 | 0.361 | 100 | 70.9 | 64 | 76.2 | 0.390 |
Operative procedure | ||||||||||
Distal gastrectomy | 110 | 52.1 | 7 | 50.0 | 72 | 51.1 | 45 | 53.6 | ||
Total gastrectomy | 101 | 47.9 | 7 | 50.0 | 0.877 | 69 | 48.9 | 39 | 46.4 | 0.716 |
Lymph node dissection | ||||||||||
D1 | 30 | 14.2 | 2 | 14.3 | 19 | 13.5 | 13 | 15.5 | ||
D2 | 181 | 85.8 | 12 | 85.7 | 1.000 | 122 | 86.5 | 71 | 84.5 | 0.678 |
Histology | ||||||||||
Differentiated | 91 | 43.1 | 6 | 42.9 | 58 | 41.1 | 39 | 46.4 | ||
Undifferentiated | 120 | 56.9 | 8 | 57.1 | 0.984 | 83 | 58.9 | 45 | 53.6 | 0.438 |
Lymphatic invasion | ||||||||||
Absent | 18 | 8.5 | 1 | 7.1 | 13 | 9.2 | 6 | 7.1 | ||
Present | 193 | 91.5 | 13 | 92.9 | 1.000 | 128 | 90.8 | 78 | 92.9 | 0.588 |
Venous invasion | ||||||||||
Absent | 150 | 71.1 | 6 | 42.9 | 102 | 72.3 | 54 | 64.3 | ||
Present | 61 | 28.9 | 8 | 57.1 | 0.027 | 39 | 27.7 | 30 | 35.7 | 0.205 |
TNM sub-stage | ||||||||||
IIIA | 77 | 36.5 | 3 | 21.4 | 54 | 38.3 | 26 | 31.0 | ||
IIIB | 69 | 32.7 | 3 | 21.4 | 41 | 29.1 | 31 | 36.9 | ||
IIIC | 55 | 26.1 | 8 | 57.1 | 0.125 | 46 | 32.6 | 27 | 32.1 | 0.404 |
Tumor size (mm) | ||||||||||
≤ 60 | 112 | 53.1 | 3 | 21.4 | 84 | 59.6 | 31 | 36.9 | ||
> 60 | 99 | 46.9 | 11 | 78.6 | 0.027 | 57 | 40.4 | 53 | 63.1 | 0.001 |
Adjuvant chemotherapy | ||||||||||
Absent | 37 | 17.5 | 4 | 28.6 | 29 | 20.6 | 12 | 14.3 | ||
Present | 174 | 82.5 | 10 | 71.4 | 0.292 | 112 | 79.4 | 72 | 85.7 | 0.238 |
CAR | ||||||||||
Low (≤0.47) | 139 | 98.6 | 72 | 85.7 | ||||||
High (> 0.47) | 2 | 1.4 | 12 | 14.3 | < 0.001 | |||||
NLR | ||||||||||
Low (≤1.90) | 98 | 46.4 | 1 | 7.1 | 85 | 60.3 | 14 | 16.7 | ||
High (> 1.90) | 113 | 53.6 | 13 | 92.9 | 0.004 | 56 | 39.7 | 70 | 83.3 | < 0.001 |
PLR | ||||||||||
Low (≤172) | 139 | 65.9 | 2 | 85.7 | ||||||
High (> 172) | 72 | 34.1 | 12 | 85.7 | < 0.001 | |||||
PNI | ||||||||||
Low (≤45.6) | 78 | 37.0 | 12 | 85.7 | 37 | 26.2 | 53 | 63.1 | ||
High (> 45.6) | 133 | 63.0 | 2 | 14.3 | < 0.001 | 104 | 73.8 | 31 | 36.9 | < 0.001 |
GPS | ||||||||||
0 | 171 | 81.0 | 0 | 0 | 115 | 81.6 | 56 | 66.7 | ||
1/2 | 40 | 19.0 | 14 | 100 | < 0.001 | 26 | 18.4 | 28 | 33.3 | 0.011 |
PI | ||||||||||
0 | 205 | 97.2 | 0 | 0 | 135 | 95.7 | 70 | 83.3 | ||
1/2 | 6 | 2.8 | 14 | 100 | < 0.001 | 6 | 4.3 | 14 | 16.7 | 0.002 |
Recurrence | ||||||||||
Absent | 113 | 53.6 | 4 | 28.6 | 80 | 56.7 | 37 | 44.0 | ||
Present | 98 | 46.4 | 10 | 71.4 | 0.097 | 61 | 43.3 | 47 | 56.0 | 0.065 |
Variables | Analysis with CAR | Analysis with PLR | ||
---|---|---|---|---|
HR (95% CI) | p value | HR (95% CI) | p value | |
Location | ||||
Upper/Middle/Lower | 1 | 1 | ||
Whole | 1.099 (0865–1.395) | 0.439 | 1.083 (0.852–1.376) | 0.516 |
Operative procedure | ||||
Distal gastrectomy | 1 | 1 | ||
Total gastrectomy | 1.723 (1.110–2.676) | 0.015 | 1.705 (1.100–2.643) | 0.017 |
TNM sub-stage | ||||
IIIA | 1 | 0.002 | 1 | 0.001 |
IIIB | 2.019 (1.187–3.435) | 0.010 | 2.015 (1.184–3.432) | 0.010 |
IIIC | 2.617 (1.534–4.467) | < 0.001 | 2.799 (1.635–4.792) | < 0.001 |
Tumor size (mm) | ||||
≤ 60 | 1 | 1 | ||
> 60 | 0.978 (0.630–1.519) | 0.921 | 0.946 (0.605–1.481) | 0.809 |
CAR | ||||
Low (≤0.47) | 1 | |||
High (> 0.47) | 2.771 (1.398–5.493) | 0.004 | ||
PLR | ||||
Low (≤172) | 1 | |||
High (> 172) | 1.552 (1.029–2.341) | 0.036 |