Table Ⅰ :Comparison of various factors between groups
Factor
|
NLR
|
P value
|
PLR
|
P value
|
LMR
|
P value
|
low-NLR Group
|
high-NLR Group
|
low-PLR Group
|
high-PLR Group
|
low-LMR Group
|
high-LMR Group
|
(n=35)
|
(n=68)
|
(n=58)
|
(n=45)
|
(n=54)
|
(n=49)
|
Patient Characteristics
|
Age
|
66(60-70)
|
63(59-71.75)
|
0.464
|
67(61.5-71.0)
|
62(58.0-69.0)
|
0.024*
|
66(59.75-71.25)
|
63(59.0-70.50)
|
0.385
|
Sex ratio(male:female)
|
27:8
|
57:11
|
0.408
|
48:10
|
36:9
|
0.720
|
47:7
|
37:12
|
0.132
|
BMI(kg/m2)
|
21.57±2.572
|
21.65±3.157
|
0.910
|
21.65±2.845
|
21.59±3.171
|
0.926
|
21.52±2.733
|
21.74±3.272
|
0.746
|
ASA score(1-4)
|
2(2-3)
|
2(2-2)
|
0.136
|
2(2-2.25)
|
2(2-2)
|
0.533
|
2(2-2)
|
2(2-3)
|
0.184
|
Preoperative symptoms amount
|
3(2-4)
|
4(3-5)
|
0.003*
|
3(2-5)
|
4(3-5)
|
0.004*
|
4(3-5)
|
3(2-5)
|
0.160
|
Loss of weight (kg)
|
1.0(0-3)
|
2.0(0.25-5.0)
|
0.157
|
1.0(0-3.25)
|
2.0(1-5.0)
|
0.128
|
2.0(1-5)
|
1.0(0-5)
|
0.191
|
CEA(ng/ml)
|
2.91(1.80-5.65)
|
2.75(1.57-6.13)
|
0.981
|
2.59(1.59-5.46)
|
3.20(1.95-6.60)
|
0.395
|
3.13(1.60-5.86)
|
2.6(1.80-5.40)
|
0.548
|
CA199(U/ml) (normal:abnormal)
|
33:2
|
61:7
|
0.681
|
52:6
|
42:3
|
0.761
|
49:5
|
45:4
|
0.844
|
CA72-4(U/ml incomplete)
(normal:abnormal)
|
19:1
|
35:11
|
0.138
|
34:3
|
20:9
|
0.017*
|
26:9
|
28:3
|
0.092
|
AFP(ng/ml)
(normal:abnormal)
|
31:4
|
57:11
|
0.725
|
52:6
|
36:9
|
0.168
|
45:9
|
43:6
|
0.525
|
CA125(U/ml incomplete)
(normal:abnormal)
|
31:1
|
53:7
|
0.319
|
48:4
|
36:4
|
0.697
|
45:4
|
39:4
|
0.847
|
CA153(U/ml,incomplete)
|
6.75(5.26-8.16)
|
6.13(3.48-6.83)
|
0.074
|
6.4(4.8-7.86)
|
5.9(3.76-7.0)
|
0.208
|
6.4(5.1-8.2)
|
5.9(4.2-6.9)
|
0.187
|
Tumor-related characteristics
|
|
|
|
|
|
|
|
|
|
Tumor location (cardia:others)
|
29:6
|
51:17
|
0.364
|
48:10
|
32:13
|
0.159
|
38:16
|
42:7
|
0.062
|
Tumot size(cm)
|
4.0(3.0-6.0)
|
5.75(4.13-7.15)
|
0.004*
|
5.0(3.87-7)
|
6.0(4.0-7.5)
|
0.115
|
5.75(4-7.2)
|
5.0(3.5-6.5)
|
0.081
|
T staging (T2+T3:T4a+T4b)
|
3:32
|
4:64
|
0.920
|
2:56
|
5:40
|
0.255
|
3:51
|
4:45
|
0.599
|
N staging
(N0=0,N1=1,N2=2,N3=3)
|
2(1-2)
|
1(0-3)
|
0.644
|
2(0-3)
|
1(0-3)
|
0.639
|
2(1-3)
|
1(0-2)
|
0.070
|
M staging (M0:M1)
|
32:3
|
61:7
|
0.780
|
52:6
|
41:4
|
0.804
|
47:7
|
46:3
|
0.242
|
Pathology Stage (UICC,7th edition)
ⅠA=1ⅠB=2
ⅡA=3ⅡB=4
ⅢA=5ⅢB=6ⅢC=7
Ⅳ=8
|
6(5-7)
|
6(4-7)
|
0.788
|
6(4-7)
|
6(5-7)
|
0.352
|
6(5-7)
|
6(4-7)
|
0.096
|
NET classification
(NEC: MNEC)
|
22:13
|
47:21
|
0.522
|
39:19
|
30:15
|
0.951
|
37:17
|
32:17
|
0.729
|
NET cell classification
(Large :Small)
|
32:3
|
60:8
|
0.873
|
49:9
|
43:2
|
0.138
|
48:6
|
44:5
|
0.882
|
Nerve invasion
|
7(20%)
|
8(11.8%)
|
0.262
|
7(12.1%)
|
8(17.8%)
|
0.415
|
10(18.5%)
|
5(10.2%)
|
0.232
|
Vascular invasion
|
9(25.7%)
|
25(36.8%)
|
0.259
|
13(22.4%)
|
21(46.7%)
|
0.009*
|
19(35.2%)
|
15(30.6%)
|
0.622
|
Ki-67 index(incomplete)
|
60%(50%-65%)
|
60%(50%-71.25%)
|
0.772
|
60%(45%-65%)
|
60%(50%-70%)
|
0.706
|
60%(47.5%-67.5%)
|
60%(50%-70%)
|
0.287
|
Number of lymph nodes metastases
|
3(1-6)
|
2.5(0-9)
|
0.748
|
3(0-7)
|
2(0-9.5)
|
0.814
|
4(1-9)
|
1(0-5)
|
0.044*
|
Number of lymph nodes dissected
|
16.51±7.233
|
16.13±6.994
|
0.796
|
16.1±6.431
|
16.5±7.832
|
0.797
|
16.72±7.288
|
15.76±6.802
|
0.489
|
Lymph node metastasis rate
|
26.67%(5%-36.84%)
|
14.64%(0-43.03%)
|
0.686
|
24.26%(0-41.25%)
|
14.28%(0-41.42%)
|
0.859
|
31.41%(7.14%-45%)
|
12.5%(0-33.3%)
|
0.059
|
Surgical characteristics
|
|
|
|
|
|
|
|
|
|
Operative route
|
|
|
0.827
|
|
|
0.708
|
|
|
0.886
|
Laparotomy
|
32
|
63
|
54
|
41
|
50
|
45
|
Laparoscopic surgery
|
3
|
5
|
4
|
4
|
4
|
4
|
Excision extentsion
|
|
|
0.571
|
|
|
0.874
|
|
|
0.111
|
Total gastrectomy
|
28
|
51
|
46
|
32
|
38
|
41
|
Distal gastrectomy
|
2
|
7
|
4
|
5
|
6
|
3
|
Proximal gastrectomy
|
1
|
1
|
1
|
1
|
0
|
2
|
Palliative surgery
|
4
|
9
|
7
|
6
|
10
|
3
|
Reconstruction way
|
|
|
0.708
|
|
|
0.639
|
|
|
0.858
|
Roux-en-Y
|
32
|
59
|
52
|
39
|
48
|
43
|
Others
|
3
|
9
|
6
|
6
|
6
|
6
|
Operating time(minutes)
|
184.29±73.895
|
187.79±62.762
|
0.811
|
190.52±75.705
|
181.56
|
0.501
|
186.39±66.591
|
186.84±66.901
|
0.973
|
Combined with other organ excison
|
8(22.9%)
|
12(17.6%)
|
0.527
|
13(22.4%)
|
7(15.6%)
|
0.383
|
11(20.4%)
|
9(18.4%)
|
0.797
|
Intraoperative blood loss(ml)
|
30(20-50)
|
50(30-150)
|
0.009*
|
30(20-50)
|
50(50-150)
|
0.001*
|
50(20-150)
|
50(20-50)
|
0.222
|
Intraoperative blood transfusion
|
2(5.7%)
|
14(20.56%)
|
0.048*
|
6(10.3%)
|
10(22.2%)
|
0.099
|
11(20.4%)
|
5(10.2%)
|
0.155
|
Postoperative characteristics
|
|
|
|
|
|
|
|
|
|
Postoperative complications
|
3(8.6%)
|
22(32.4%)
|
0.008*
|
11(19.0%)
|
14(31.1%)
|
0.154
|
17(31.5%)
|
8(16.3%)
|
0.073
|
Length of postoperative hospital
stay(days)
|
10(8-12)
|
11(10-13)
|
0.006*
|
11(9-13)
|
10(10-12)
|
0.734
|
11(10-13)
|
10(9-12)
|
0.411
|
Postoperative anal exhaust time
(days)
|
4.06±0.814
|
4.10±1.394
|
0.865
|
4.11±0.838
|
4.07±1.601
|
0.876
|
4.19±1.480
|
3.98±0.863
|
0.387
|
Postoperative time of getting out of
bed(days)
|
2.68±0.806
|
3.03±1.728
|
0.303
|
2.67±0.852
|
3.18±2.003
|
0.085
|
3.07±1.882
|
2.69±0.829
|
0.192
|
Postoperative recurrence
|
23(65.7%)
|
55(80.9%)
|
0.089
|
42(72.4%)
|
36(80%)
|
0.373
|
43(79.6%)
|
35(71.4%)
|
0.332
|
Postoperative chemotherapy
|
17(48.6%)
|
28(41.2%)
|
0.474
|
26(44.8%)
|
19(42.2%)
|
0.791
|
27(50%)
|
18(36.7%)
|
0.175
|
Footnotes:NLR,neutrophil -to-lymphocyte ratio ;PLR,platelet -to lymphocyte ratio ;LMR,lympho-
cyte -to- monocyte ratio ;BMI ,body mass index ;ASA,American society of Anesthesiologist;
CEA,carcinoembryonic antigen ;CA19-9, carbohydrate antigen 19-9;CA72-4, carbohydrate antigen
72-4;AFP, α-fetoprotein ;CA 125, carbohydrate antigen 125,CA153, carbohydrate antigen153
UICC, Union for International Cancer Control,;Cardia,the opening into the stomach and that
part of the stomach connected to the esophagus ;NEC,neuroendocrine carcinoma ;MNEC,mixed
neuroendocrine carcinoma; Ki-67,Proliferating cell related antigen
*:P<0.05
Table2 Survival analysis of prognostic factors at different index
Parameter
|
Cut-off value
|
No.of Patient
|
MST(month)
|
P value
|
Systemic inflammatory response markers
NLR
High
Low
LMR
High
Low
Lymphocyte count
High
Low
PLR
High
low
|
2.08
3.94
1.64
147.5
|
0.023*
68 13
35 30
0.006*
49 28
54 13
0.117
40 27
63 13
0.012*
47 13
56 28
|
Cancer-related prognostic factors
|
CEA(ng/ml)
High
Low
AFP(ng/ml)
High
Low
CA199( U/ml)
High
Low
CA72-4(incomplete, U/ml)
High
Low
CA125(incomplete, U/ml)
High
Low
CA153(incomplete, U/ml)
High
Low
Tumor size(cm)
Large
Small
Tumor location
Cardia
Others
NET classification
NEC
MNEC
NET cell classification
Large
Small
Lymphnode metastasis
Yes
no
Vascular invasion
Yes
No
Nerve invasion
Yes
No
Stage(UICC 7th.Edition)
Ⅰ/Ⅱ
Ⅲ/Ⅳ
|
4.75
5.0
8.01
5.85
9.74
6.2
5
|
31
72
28
75
50
53
33
33
46
46
35
37
48
55
80
23
69
34
92
11
74
29
34
69
15
88
25
78
|
22
19
20
18
20
19
20
32
16
28
20
28
12
28
20
17
19
20
20
12
18
27
15
22
27
19
32
17
|
0.592
0.441
0.175
0.171
0.317
0.049*
0.011*
0.453
0.500
0.228
0.096
0.441
0.810
0.021*
|
Host-related prognostic factors
|
Age
High
Low
Sex ratio
Male
Female
BMI(kg/m2)
High
Low
ASA score(1-4)
High
Low
Loss of weight (kg)
High
low
Preoperative symptoms amount
High
Low
Postoperative chemotherapy
Yes
No
|
65
21.3
3
2
5
|
54
49
84
19
39
44
20
83
37
66
34
69
45
58
|
19
20
19
30
20
20
27
18
22
19
20
19
20
19
|
0.853
0.164
0.800
0.119
0.285
0.367
0.698
|
Surgery-related prognostic factors
|
Operating time (minutes)
High
Low
Intraoperative blood loss (ml)
High
Low
Intraoperative blood Transfusion
Yes
No
Excision extentsion
Total gastrectomy
Others
Length of postoperative hospital stay
High
Low
Postoperative complications (Score≧Clavien-Dindo grade III)
high
low
|
180
50
10
|
42
61
32
71
16
87
79
24
51
52
9
94
|
22
16
18
20
28
19
22
11
12
28
10
20
|
0.914
0.705
0.255
0.059
0.035*
<0.001*
|
Footnotes:NLR,neutrophil -to-lymphocyte ratio ;PLR,platelet -to lymphocyte ratio ;LMR,lympho-
cyte -to- monocyte ratio ;BMI ,body mass index ;ASA,American society of Anesthesiologist;
CEA,carcinoembryonic antigen ;CA19-9, carbohydrate antigen 19-9;CA72-4, carbohydrate antigen
72-4;AFP, α-fetoprotein ;CA 125, carbohydrate antigen 125,CA153, carbohydrate antigen153
UICC, Union for International Cancer Control,;Cardia,the opening into the stomach and that
part of the stomach connected to the esophagus ;NEC,neuroendocrine carcinoma ;MNEC,mixed
neuroendocrine carcinoma; Clavien-Dindo grade, assesses the grade of postoperative
complications; MST,median survival time (month)
*:P<0.05.
Table Ⅲ Univariate & Multivariate regression analyses of prognostic factors
Parameters
|
Univariate analyses
|
|
Multivariate analyses
|
Uncorrected HR & 95% CI
|
P value
|
|
Corrected HR & 95% CI
|
P value
|
Age
|
0.994 (0.972~1.016)
|
0.585
|
|
/
|
/
|
Sex
|
|
|
|
|
|
male
|
1.470 (0.843~2.564)
|
0.174
|
|
/
|
/
|
female
|
1
|
|
|
|
|
Excision extentsion
|
|
|
|
|
|
others
|
1.571 (0.970~2.545)
|
0.066
|
|
1.314 (0.676~2.555)
|
0.421
|
Total gastrectomy
|
1
|
|
|
|
|
Postoperative complications
(Score ≥Clavien-Dindo grade III)
|
|
|
|
|
|
yes
|
2.651 (1.310~5.363)
|
0.007*
|
|
2.847 (1.129~7.480)
|
0.027*
|
no
|
1
|
|
|
|
|
PTM stage
|
|
|
|
|
|
ⅡB
|
1.228 (0.284~5.317)
|
0.784
|
|
1.480 (0.307~7.141)
|
0.626
|
ⅢA
|
2.233 (0.493~10.110)
|
0.297
|
|
2.082 (0.380~11.405)
|
0.398
|
ⅢB
|
2.009 (0.474~8.521)
|
0.344
|
|
2.207 (0.428~11.384)
|
0.344
|
ⅢC
|
1.919 (0.456~8.072)
|
0.374
|
|
1.258 (0.191~8.306)
|
0.811
|
Ⅳ
|
5.115 (1.092~23.961)
|
0.038*
|
|
2.645 (0.379~18.477)
|
0.327
|
ⅠB
|
1
|
|
|
|
|
High Loss weight(kg)
|
0.946 (0.870~1.030)
|
0.200
|
|
/
|
/
|
Large Tumor size(cm)
|
1.118 (1.045~1.198)
|
0.001*
|
|
1.130 (1.032~1.239)
|
0.009*
|
High CA199(U/ml)
|
1.002 (1.000~1.003)
|
0.015*
|
|
1.001 (0.999~1.002)
|
0.336
|
High CA125(U/ml)
|
1.009 (1.002~1.016)
|
0.013*
|
|
1.005 (0.996~1.014)
|
0.260
|
Intraoperative blood transfusion
|
|
|
|
|
|
yes
|
0.716 (0.397~1.291)
|
0.266
|
|
/
|
/
|
no
|
1
|
|
|
|
|
High Lymphnode metastasis rate
|
2.497 (1.100~5.669)
|
0.029*
|
|
4.170 (0.669~25.987)
|
0.126
|
High NLR
|
1.185 (1.023~1.373)
|
0.024*
|
|
0.948 (0.734~1.225)
|
0.682
|
High PLR
|
1.002 (0.999~1.005)
|
0.161
|
|
1.002 (0.997~1.007)
|
0.385
|
High LMR
|
0.898 (0.825~0.977)
|
0.013*
|
|
0.923 (0.860~0.991)
|
0.027*
|
Long postoperative hospital stay
|
1.042 (0.992~1.095)
|
0.104
|
|
1.027 (0.967~1.091)
|
0.383
|
Footnotes: CI, confidence interval; NLR,neutrophil -to-lymphocyte ratio ;PLR,platelet -to lymphocyte ratio ;LMR,lympho-cyte -to- monocyte ratio ; CA19-9, carbohydrate antigen 19-9; CA 125, carbohydrate antigen 125, Clavien-Dindo grade, assesses the grade of postoperative complications;
*: p < 0.05.