Inaoka Kenichi, Kanda Mitsuro, Uda Hiroaki, Tanaka Yuri, Tanaka Chie, Kobayashi Daisuke, Takami Hideki, Iwata Naoki, Hayashi Masamichi, Niwa Yukiko, Yamada Suguru, Fujii Tsutomu, Sugimoto Hiroyuki, Murotani Kenta, Fujiwara Michitaka, Kodera Yasuhiro
Kenichi Inaoka, Mitsuro Kanda, Hiroaki Uda, Yuri Tanaka, Chie Tanaka, Daisuke Kobayashi, Hideki Takami, Naoki Iwata, Masamichi Hayashi, Yukiko Niwa, Suguru Yamada, Tsutomu Fujii, Hiroyuki Sugimoto, Kenta Murotani, Michitaka Fujiwara, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan.
World J Gastroenterol. 2017 Apr 14;23(14):2519-2526. doi: 10.3748/wjg.v23.i14.2519.
To identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.
Three-hundred and twelve patients with previously untreated clinical T2-4 gastric cancer who underwent a D2 standard gastrectomy (distal gastrectomy or total gastrectomy) were included in the analysis. Correlations between 21 parameters that can be determined by preoperative routine blood tests and clinically relevant postoperative complications (grade II or higher according to the Clavien-Dindo classification) were evaluated. The optimal cutoff values and clinical significance of the selected markers were further evaluated by subgroup analyses according to age, body mass index, operative procedure and clinical disease stage.
Sixty-six patients (21.1%) experienced grade II or higher postoperative complications. The platelet-lymphocyte ratio (PLR, total lymphocyte count/platelet count × 100) exhibited the highest area under the curve value (0.639) for predicting postoperative complications among the 21 parameters, and the optimal cutoff value was determined to be 0.71 (sensitivity = 70%, specificity = 56%). In the univariate analysis, the odds ratio of a low PLR for the occurrence of postoperative complications was 2.94 (95%CI: 1.66-5.35, < 0.001), and a multivariate binomial logistic analysis involving other potential risk factors identified a low PLR as an independent risk factor for postoperative complications (OR = 3.32, 95%CI: 1.82-6.25, < 0.001). In subgroups classified according to age, body mass index, operative procedure and clinical disease stage, the low PLR group exhibited an increased incidence of postoperative complications.
The preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.
为了确定胃癌切除术后并发症的简单且敏感的标志物，对候选术前因素的预测价值进行比较。
纳入312例未经治疗的临床T2-4期胃癌患者，这些患者接受了D2标准胃切除术（远端胃切除术或全胃切除术）并纳入分析。评估了21项可通过术前常规血液检查确定的参数与临床相关术后并发症（根据Clavien-Dindo分类为II级或更高）之间的相关性。根据年龄、体重指数、手术方式和临床疾病分期，通过亚组分析进一步评估所选标志物的最佳临界值和临床意义。
66例患者（21.1%）发生了II级或更高的术后并发症。在21项参数中，血小板-淋巴细胞比率（PLR，总淋巴细胞计数/血小板计数×100）在预测术后并发症方面表现出最高的曲线下面积值（0.639），最佳临界值确定为0.71（敏感性=70%，特异性=56%）。在单因素分析中，低PLR发生术后并发症的比值比为2.94（95%CI：1.66-5.35，P<0.001），在涉及其他潜在危险因素的多因素二项逻辑分析中，低PLR被确定为术后并发症的独立危险因素（OR=3.32，95%CI：1.82-6.25，P<0.001）。在根据年龄、体重指数、手术方式和临床疾病分期分类的亚组中，低PLR组术后并发症的发生率增加。
术前PLR是临床T2-4期胃癌患者根治性胃切除术后并发症的简单且有用的预测指标。
