Department of General Surgery & Institute of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
Medical School of Chinese PLA, Beijing, 100853, China.
World J Surg Oncol. 2022 Nov 9;20(1):356. doi: 10.1186/s12957-022-02822-9.
Gastric neuroendocrine neoplasm (g-NEN) is a rare but heterogeneous neoplasm, with an increasing incidence yearly. Conventional prognostic markers of g-NEN remain limited which could only be detected after surgery. There is an urgent need to explore new prognostic markers for g-NEN patients. This study aimed to investigate the prognostic value of platelet-to-lymphocyte, ratio (PLR) and the association between PLR and body mass index (BMI) in patients with gastric neuroendocrine neoplasms (g-NEN).
A retrospective cohort of patients with g-NEN from January 2001 through June 2016 was examined. The prognostic significance of PLR was determined by multiple regression analysis in different models. Stratified analysis was performed to examine the prognostic value of PLR at different BMI levels.
In total, 238 patients were enrolled. Those with higher PLRs tended to undergo open surgery, had larger tumor sizes, were diagnosed more frequently with neuroendocrine carcinoma, and had higher tumor grades. PLR was significantly associated with the survival of patients with g-NEN. With PLR increased per standard deviation, the all-cause mortality risk of patients with g-NEN increased by 67%, 63%, and 54% in the crude (HR = 1.67, 95% CI 1.32-2.12, P < 0.001), minimally adjusted (HR = 1.63, 95% CI 1.28-2.08, P < 0.001), and fully adjusted (HR = 1.54, 95% CI 1.202-1.98, P = 0.001) models, respectively. Patients with higher PLR (quartile 4, ≥ 187) had a 1.8-fold increase in all-cause mortality risk compared with those with lower PLR (quartile 1-3, < 187). Furthermore, there was a significant interaction effect between BMI subgroups and PLR in predicting the survival of patients with g-NEN (PLR regarded as a continuous variable: all P for interaction < 0.05 in the crude, minimally adjusted, and fully adjusted models; PLR regarded as a categorical variable: P for interaction < 0.05 in the fully adjusted model). Patients with g-NEN with the characteristics of higher PLR (quartile 4, ≥ 187) and non-obesity (BMI < 25 kg/m) had worse survival than others (P < 0.05).
The inflammation marker PLR has an independent prognostic value for patients with g-NENs, and high PLR combined with non-obesity increases the mortality risk of these patients.
胃神经内分泌肿瘤（g-NEN）是一种罕见但具有异质性的肿瘤，其发病率逐年增加。g-NEN 的传统预后标志物仍然有限，只能在手术后检测到。因此，迫切需要探索 g-NEN 患者的新预后标志物。本研究旨在探讨血小板与淋巴细胞比值（PLR）在胃神经内分泌肿瘤（g-NEN）患者中的预后价值及与体质量指数（BMI）的相关性。
回顾性分析 2001 年 1 月至 2016 年 6 月间收治的 g-NEN 患者。采用多元回归分析不同模型中 PLR 的预后意义。进行分层分析，以探讨不同 BMI 水平下 PLR 的预后价值。
共纳入 238 例患者。PLR 较高的患者倾向于接受开放性手术，肿瘤较大，神经内分泌癌的诊断更为常见，肿瘤分级较高。PLR 与 g-NEN 患者的生存显著相关。PLR 每增加一个标准差，g-NEN 患者的全因死亡率风险分别增加 67%、63%和 54%（粗模型 HR = 1.67，95%CI 1.32-2.12，P < 0.001；最小调整模型 HR = 1.63，95%CI 1.28-2.08，P < 0.001；完全调整模型 HR = 1.54，95%CI 1.202-1.98，P = 0.001）。与 PLR 较低（四分位数 1-3，< 187）的患者相比，PLR 较高（四分位数 4，≥ 187）的患者全因死亡率风险增加 1.8 倍。此外，在预测 g-NEN 患者生存方面，BMI 亚组与 PLR 之间存在显著的交互作用效应（PLR 视为连续变量：粗模型、最小调整模型和完全调整模型中所有交互 P 值均<0.05；PLR 视为分类变量：完全调整模型中交互 P 值<0.05）。具有较高 PLR（四分位数 4，≥ 187）和非肥胖（BMI < 25 kg/m）特征的 g-NEN 患者的生存情况较其他患者差（P < 0.05）。
炎症标志物 PLR 对 g-NEN 患者具有独立的预后价值，高 PLR 结合非肥胖会增加这些患者的死亡风险。
