Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer

Abstract

AIMTo identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.METHODSThree-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.RESULTSSixty-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, P < 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, P < 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.CONCLUSIONThe preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.

Does the preoperative platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio predict morbidity after gastrectomy for gastric cancer?

“…Among them, GC is one of the popular foci of these investigations that evaluated cancerrelated inflammation and possible predictors in the preoperative period [6][7][8]. The decrease in lymphocyte count leads to depression of the immune response and cytotoxic destruction, whereas increased platelets and neutrophils induce tumor progression and angiogenesis [3]. Hence, this study was implemented to investigate the predictive power and the relations of the PLR and NLR with morbidity, mainly Clavien-Dindo grade ≥ 3, and mortality in patients with GC.…”

“…Various studies have recommended different cutoff points for the NLR (ranging between 3 and 5) and PLR (ranging between 0.66 and 0.44) [3,7,13]. In the literature, different calculations have been proposed for the PLR, and this study used a relatively less common method (as described in the study by Inaoka et al) [3]. In this study, the cutoff point for the NLR was 3.92 (sensitivity 37.50%, specificity 80.16%), and the cutoff point for the PLR was 0.55 (sensitivity 50.00%, specificity 72.22%).…”

“…Two other meta-analyses investigated the correlations of the PLR with clinicopathologic characteristics, morbidity, and mortality in colorectal cancer patients [19,20]. Growing data and studies about inflammatory markers and prognosis in GC patients indicate the use of these markers as predictors [3,[6][7][8].…”

“…Despite improvements in surgical techniques, gastrectomy still has postoperative complication risks, such as anastomotic leaks, as in all surgical treatment modalities, and these complications lead to increased morbidity and mortality rates. Increased morbidity causes longer hospital stays, increased hospital costs, the postponement of chemotherapy and diminished quality of life [3]. In recent years, it has been shown that wound healing and infection control, especially in the anastomoses line, mainly determine the morbidity rate in surgical patients, and inflammatory, immunological or nutritional indices are used to predict mortality and morbidity [4].…”

Preoperative Controlling Nutritional Status (CONUT) Score Predicts Short-Term Surgical Prognosis in Patients with Gastric Cancer After Laparoscopy-Assisted Radical Gastrectomy

“…As an independent risk factor malnutrition contributes to the occurrence of postoperative complications 4 reduces the body response to antitumor treatment and ultimately impairs long-term survival 5 . Several nutritional assessment scales or systems have been developed to detect the adverse condition of nutrition such as the modi ed Glasgow Prognostic Score (mGPS) 6 Prognostic Nutritional Index (PNI) 3 Naples Prognostic Score (NPS) 7 Platelet-Lymphocyte Ratio (PLR) 8 Skeletal Muscle Index (SMI) 9 or the Malnutrition Universal Screening Tool (MUST) 10 among others.…”