Background
Methods
Patient cohort
Definitions
Follow-up and study endpoints
Statistical analysis
Results
Baseline patient characteristics and inflammatory-related parameters
Parameters | NO. (154) | NLR | P value | PLR | P value | LMR | P value | PNI | P value |
---|---|---|---|---|---|---|---|---|---|
Low (124) /High (30) | Low (84) / High (70) | Low (59) /High (95) | Low (32) /High (122) | ||||||
Age | 0.054 | 0.622 | 0.558 | 0.441 | |||||
≤ 60 years | 54 | 48/6 | 28/26 | 19/35 | 8/46 | ||||
> 60 years | 100 | 76/24 | 56/44 | 40/60 | 24/98 | ||||
Gender | 0.308 | 0.720 | 0.063 | 0.184 | |||||
Male | 90 | 70/20 | 48/42 | 40/50 | 22/68 | ||||
Female | 64 | 54/10 | 36/28 | 19/45 | 10/54 | ||||
Smoking | 0.650 | 0.183 | 0.628 | 0.815 | |||||
Yes | 41 | 34/7 | 26/15 | 17/24 | 8/33 | ||||
No | 113 | 90/23 | 58/55 | 42/71 | 24/89 | ||||
Alcoholism | 0.780 | 0.079 | 0.720 | 0.962 | |||||
Yes | 39 | 32/7 | 26/13 | 14/25 | 8/31 | ||||
No | 115 | 92/23 | 58/57 | 45/70 | 24/91 | ||||
Hypertension | 0.917 | 0.382 | 0.373 | 0.555 | |||||
Yes | 45 | 36/9 | 27/18 | 16/29 | 8/37 | ||||
No | 109 | 88/21 | 57/52 | 43/56 | 24/85 | ||||
Diabetes Mellitus | 1.000 | 0.165 | 0.839 | 0.240 | |||||
Yes | 22 | 18/4 | 15/7 | 8/14 | 2/20 | ||||
No | 132 | 106/26 | 69/63 | 51/81 | 30/102 | ||||
Coronary Artery Disease | 0.153 | 0.247 | 0.056 | 0.216 | |||||
Yes | 21 | 14/7 | 9/12 | 12/9 | 7/14 | ||||
No | 133 | 110/23 | 75/58 | 47/86 | 25/108 | ||||
CEA | 0.415 | 0.593 | 0.023 | 0.261 | |||||
< 5 μg/ml | 126 | 103/23 | 70/56 | 43/83 | 24/102 | ||||
≥ 5 μg/ml | 28 | 21/7 | 14/14 | 16/12 | 8/20 | ||||
CA19–9 | 1.000 | 0.127 | 0.515 | 1.000 | |||||
< 37 U/ml | 147 | 118/29 | 78/69 | 55/92 | 31/116 | ||||
≥ 37 U/ml | 7 | 6/1 | 6/1 | 4/3 | 1/6 | ||||
HGB | 0.063 | 0.012 | 0.854 | 0.013 | |||||
≥ 110 g/L | 143 | 118/25 | 82/61 | 54/89 | 26/117 | ||||
< 110 g/L | 11 | 6/5 | 2/9 | 5/6 | 6/5 | ||||
Occult blood | 0.967 | 0.169 | 0.190 | 0.831 | |||||
Yes | 128 | 103/25 | 73/55 | 52/76 | 27/101 | ||||
No | 26 | 21/5 | 11/15 | 7/19 | 5/21 | ||||
Distance from anal verge | 0.838 | 0.877 | 0.103 | 0.355 | |||||
≤ 50 mm | 54 | 43/11 | 29/25 | 16/38 | 9/45 | ||||
> 50 mm | 100 | 81/19 | 55/45 | 43/57 | 23/77 | ||||
Operation procedure | 0.945 | 0.010 | 0.149 | 0.446 | |||||
TEM | 47 | 38/9 | 33/14 | 14/33 | 8/39 | ||||
Radical resection | 107 | 86/21 | 51/56 | 45/62 | 24/83 | ||||
Time of operation | 0.645 | 0.067 | 0.125 | 0.165 | |||||
< 3 h | 56 | 44/12 | 36/20 | 17/39 | 15/41 | ||||
≥ 3 h | 98 | 80/18 | 48/50 | 42/56 | 17/81 | ||||
Blood transfusion perioperation | 0.024 | 0.626 | 0.973 | 0.191 | |||||
Yes | 4 | 1/3 | 3/1 | 1/3 | 2/2 | ||||
No | 150 | 123/27 | 81/69 | 58/92 | 30/120 | ||||
Differentiation grade | 0.195 | 0.118 | 0.458 | 0.349 | |||||
Well+Moderate | 126 | 99/27 | 65/61 | 50/76 | 28/98 | ||||
Poor+Undifferentiate | 28 | 25/3 | 19/9 | 9/19 | 4/24 | ||||
Tumor size | 0.003 | 0.575 | 0.111 | 0.764 | |||||
< 3 cm | 83 | 66/17 | 47/36 | 27/56 | 18/65 | ||||
≥ 3 cm | 71 | 68/3 | 37/34 | 32/39 | 14/57 | ||||
T stage | 0.389 | 0.952 | 0.052 | 0.255 | |||||
T1 | 62 | 52/10 | 34/28 | 18/44 | 14/48 | ||||
T2 | 92 | 72/20 | 50/42 | 41/51 | 18/74 | ||||
N stage | 0.901 | 0.064 | < 0.001 | 0.096 | |||||
N0 | 132 | 107/25 | 76/56 | 42/90 | 24/108 | ||||
N1/2 | 22 | 17/5 | 8/14 | 17/5 | 8/14 | ||||
TNM stage | 0.901 | 0.064 | < 0.001 | 0.096 | |||||
I | 132 | 107/25 | 76/56 | 42/90 | 24/108 | ||||
III | 22 | 17/5 | 8/14 | 17/5 | 8/14 |
Parameters | Minimum value | Maximum value | Mean value | Standard deviation |
---|---|---|---|---|
Neutrophil count (109/L) | 0.06 | 9.44 | 3.63 | 1.39 |
Lymphocyte count (109/L) | 0.51 | 3.63 | 1.83 | 0.58 |
Platelet count (109/L) | 88.00 | 484.00 | 235.03 | 64.48 |
Monocyte count (109/L) | 0.12 | 0.97 | 0.43 | 0.16 |
Serum albumin (g/L) | 32.10 | 53.40 | 42.90 | 4.32 |
NLR | 0.02 | 12.26 | 2.22 | 1.32 |
PLR | 32.60 | 403.00 | 140.77 | 56.86 |
LMR | 1.06 | 16.69 | 4.76 | 2.27 |
PNI | 37.75 | 65.95 | 52.06 | 5.40 |
Correlations between NLR, PLR, LMR and PNI and clinicopathological variables
Classifi-cation | No. of complications | NLR | P value | PLR | P value | LMR | P value | PNI | P value |
---|---|---|---|---|---|---|---|---|---|
Low (124) /High (30) | Low (84)/ High (70) | Low (59) /High (95) | Low (32) /High (122) | ||||||
Grade I | 2 postop bleed; conservative tx 3 urinary retention; catheterization 2 wound infection; opened at the bedside 2 non-infectious diarrhea; conservative tx | 3/6 | 0.001 | 2/7 | 0.097 | 5/4 | 0.457 | 4/5 | 0.042 |
Grade II | 4 postop bleed; blood transfusion 1 urinary tract infection; antibiotic tx 4 ileus, total parenteral nutrition 2 pneumonia; antibiotic tx 1 diarrhea; antibiotic tx 1 tachyarrhythmia; β-receptor antagonists tx | 3/10 | < 0.001 | 6/7 | 0.525 | 5/8 | 1.000 | 6/7 | 0.046 |
Grade I-II | 22 | 6/16 | < 0.001 | 8/14 | 0.064 | 10/12 | 0.457 | 10/12 | 0.005 |
Grade IIIa | 2 stricture of the anastomosis; endoscopic dilatation | 0/2 | 0.037 | 0/2 | 0.205 | 2/0 | 0.145 | 1/1 | 0.373 |
Grade IIIb | 1 strangulating intestinal obstruction; reintervention | 1/0 | 1.000 | 0/1 | 0.455 | 1/0 | 0.386 | 1/0 | 0.208 |
Grade IVa | 1 anastomotic leak and postop bleed,; reintervention and intensive care unit | 1/0 | 1.000 | 1/0 | 1.000 | 1/0 | 0.386 | 0/1 | 1.000 |
Grade III- IVa | 4 | 2/2 | 0.171 | 1/3 | 0.488 | 4/0 | 0.040 | 2/2 | 0.191 |
Total | 26 | 8/18 | < 0.001 | 9/17 | 0.025 | 14/12 | 0.074 | 12/14 | < 0.001 |
Survival analysis with NLR, PLR, LMR and PNI
Parameters | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
HR | 95% CI | P value | HR | 95% CI | P value | |
Age > 60 years vs. ≤60 years | 1.510 | 0.481–4.744 | 0.480 | |||
Gender Male vs. Female | 2.918 | 0.823–10.341 | 0.097 | |||
Smoking No vs. Yes | 0.420 | 0.095–1.863 | 0.254 | |||
Alcoholism No vs. Yes | 0.734 | 0.207–2.600 | 0.631 | |||
Hypertension Yes vs. No | 2.198 | 0.797–6.063 | 0.128 | |||
Diabetes Mellitus Yes vs. No | 2.159 | 0.687–6.780 | 0.187 | |||
Coronary Artery Disease Yes vs. No | 2.550 | 0.812–8.010 | 0.109 | |||
CEA level ≥ 5 μg/ml vs. < 5 μg/ml | 2.380 | 0.813–6.966 | 0.113 | |||
CA19–9 < 37 U/ml vs. ≥37 U/ml | 0.046 | < 0.001–1702.151 | 0.567 | |||
HGB ≥110 g/L vs. < 110 g/L | 0.172 | 0.055–0.542 | 0.003 | 0.204 | 0.057–0.731 | 0.015 |
NLR ≥2.80 vs. < 2.80 | 5.396 | 1.954–14.896 | 0.001 | 3.149 | 0.933–12.525 | 0.063 |
PLR ≥140.05 vs. < 140.05 | 5.043 | 1.423–17.874 | 0.012 | 1.266 | 0.277–5.783 | 0.761 |
LMR ≥3.88 vs. < 3.88 | 0.208 | 0.066–0.652 | 0.007 | 0.767 | 0.202–2.910 | 0.696 |
PNI ≥47.1 vs. < 47.1 | 0.152 | 0.054–0.427 | 0.295 | 0.462 | 0.127–1.686 | 0.242 |
Occult blood No vs. Yes | 0.560 | 0.178–1.759 | 0.321 | |||
Distance from anal verge ≤50 mm vs. > 50 mm | 2.287 | 0.645–8.104 | 0.200 | |||
Operation procedure Radical resection vs. TEM | 1.823 | 0.514–6.461 | 0.352 | |||
Time of operation ≥3 h vs. < 3 h | 1.600 | 0.510–5.026 | 0.421 | |||
Blood transfusion perioperation Yes vs. No | 3.265 | 0.429–24.840 | 0.253 | |||
Differentiation Poor/Undifferentiate vs. Well/Moderate | 1.293 | 0.729–2.291 | 0.379 | |||
Tumor size ≥3 cm vs. < 3 cm | 1.409 | 0.511–3.886 | 0.508 | |||
T stage T2 vs. T1 | 1.999 | 0.636–6.278 | 0.236 | |||
N stage (N1/2 vs. N0) | 11.888 | 4.215–33.532 | < 0.001 | 9.944 | 3.001–32.954 | < 0.001 |
TNM stage III vs. I | 11.888 | 4.215–33.532 | < 0.001 | 9.944 | 3.001–32.954 | < 0.001 |
Parameters | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
HR | 95% CI | P value | HR | 95% CI | P value | |
Age > 60 years vs. ≤60 years | 1.480 | 0.471–4.649 | 0.502 | |||
Gender Male vs. Female | 2.025 | 0.645–6.362 | 0.227 | |||
Smoking No vs. Yes | 0.431 | 0.097–1.909 | 0.268 | |||
Alcoholism No vs. Yes | 0.463 | 0.105–2.025 | 0.311 | |||
Hypertension Yes vs. No | 2.128 | 0.772–5.870 | 0.144 | |||
Diabetes Mellitus Yes vs. No | 1.513 | 0.427–5.362 | 0.521 | |||
Coronary Artery Disease Yes vs. No | 2.567 | 0.817–8.066 | 0.107 | |||
CEA level ≥ 5 μg/ml vs. < 5 μg/ml | 2.464 | 0.842–7.211 | 0.100 | |||
CA19–9 < 37 U/ml vs. ≥37 U/ml | 0.046 | < 0.001–1734.515 | 0.567 | |||
HGB ≥110 g/L vs. < 110 g/L | 0.178 | 0.057–0.560 | 0.003 | 0.205 | 0.058–0.721 | 0.014 |
NLR ≥2.80 vs. < 2.80 | 6.935 | 2.466–19.499 | < 0.001 | 6.656 | 1.616–27.418 | 0.009 |
PLR ≥140.05 vs. < 140.05 | 8.074 | 1.822–35.790 | 0.006 | 1.689 | 0.313–9.109 | 0.542 |
LMR ≥3.88 vs. < 3.88 | 0.143 | 0.040–0.508 | 0.003 | 0.392 | 0.096–1.597 | 0.191 |
PNI ≥47.1 vs. < 47.1 | 0.206 | 0.075–0.568 | 0.002 | 1.169 | 0.308–4.435 | 0.818 |
Occult blood No vs. Yes | 0.802 | 0.226–2.843 | 0.733 | |||
Distance from anal verge ≤50 mm vs. > 50 mm | 1.595 | 0.508–5.009 | 0.424 | |||
Operation procedure Radical resection vs. TEM | 1.812 | 0.511–6.423 | 0.357 | |||
Time of operation ≥3 h vs. < 3 h | 1.594 | 0.508–5.006 | 0.425 | |||
Blood transfusion perioperation Yes vs. No | 3.312 | 0.435–25.192 | 0.247 | |||
Differentiation Poor/Undifferentiate vs. Well/Moderate | 1.300 | 0.734–2.304 | 0.369 | |||
Tumor size ≥3 cm vs. < 3 cm | 1.869 | 0.665–5.252 | 0.235 | |||
T stage T2 vs. T1 | 2.918 | 0.823–10.341 | 0.097 | |||
N stage (N1/2 vs. N0) | 11.143 | 3.955–31.400 | < 0.001 | 9.193 | 2.665–31.712 | < 0.001 |
TNM stage III vs. I | 11.143 | 3.955–31.400 | < 0.001 | 9.193 | 2.665–31.712 | < 0.001 |