Service of General Surgery, University Hospital Mútua Terrassa, Terrassa, Barcelona, Spain.
Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain.
Langenbecks Arch Surg. 2022 May;407(3):1017-1026. doi: 10.1007/s00423-022-02432-9. Epub 2022 Jan 8.
The aim of this study was to determine if the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) could be modified by the presence of postoperative complications (POC) and their severity in patients with gastric adenocarcinoma resected with curative intent.
A retrospective study based on a prospective database of patients with resectable gastric adenocarcinoma treated with radical intention (R0) between January 1998 and February 2012. The primary endpoint was overall survival according to preoperative peripheral blood NLR and postoperative complications. Clinicopathological variables, preoperative blood tests, POC and its severity (Clavien-Dindo classification), type of POC (infectious or not infectious) and mortality were registered. A univariate and multivariate analysis (step forward Cox regression) was performed. The Kaplan-Meier method was used to assess overall survival.
The 147 patients with gastric cancer who had undergone radical resection were included from an initial cohort of 209 patients. Univariant analysis: type of surgery, pT, pN, postoperative complications (Clavien-Dindo ≥ 3) and preoperative NLR ≥ 2.4 were significantly associated with survival (p < 0.05). Patients with POC showed worse long-term survival (p = 0.000), with no difference (p = 0.867) between infectious or non-infectious POC. NLR ≥ 2.4 was associated with infectious POC (p < 0.001). Patients with preoperative NLR ≥ 2.4 (p = 0.02) had a worse prognosis. Multivariate analysis: pN (p < 0.001), postoperative complications (p < 0.001) (HR 3.04; 95% CI: 1.97-4.70) and NLR ≥ 2.4 (p = 0.04) (HR = 1.55; 95% CI: 1.02-2.3) were independent prognostic factors.
The preoperative inflammatory state of patients with gastric cancer measured by NLR behaves as an independent prognostic factor, even in patients with POC.
本研究旨在确定术前中性粒细胞与淋巴细胞比值（NLR）的预后价值是否可以通过术后并发症（POC）及其严重程度来改变，这些患者接受了根治性手术切除的胃腺癌。
这是一项基于前瞻性数据库的回顾性研究，纳入了 1998 年 1 月至 2012 年 2 月接受根治性手术（R0）切除的可切除胃腺癌患者。主要终点是根据术前外周血 NLR 和术后并发症评估的总生存。记录了临床病理变量、术前血液检查、POC 及其严重程度（Clavien-Dindo 分类）、POC 类型（感染性或非感染性）和死亡率。进行了单变量和多变量分析（逐步向前 Cox 回归）。采用 Kaplan-Meier 法评估总生存。
从最初的 209 例患者中，纳入了 147 例接受根治性切除术的胃癌患者。单变量分析：手术类型、pT、pN、术后并发症（Clavien-Dindo≥3）和术前 NLR≥2.4 与生存显著相关（p<0.05）。发生 POC 的患者长期生存较差（p=0.000），感染性或非感染性 POC 之间无差异（p=0.867）。NLR≥2.4 与感染性 POC 相关（p<0.001）。术前 NLR≥2.4 的患者预后较差（p=0.02）。多变量分析：pN（p<0.001）、术后并发症（p<0.001）（HR 3.04；95%CI：1.97-4.70）和 NLR≥2.4（p=0.04）（HR=1.55；95%CI：1.02-2.3）是独立的预后因素。
术前 NLR 测定的胃癌患者炎症状态表现为独立的预后因素，即使在发生 POC 的患者中也是如此。
