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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer
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
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
Kenta Murotani, Division of Biostatistics, Clinical Research Center, Aichi Medical University Hospital, Nagakute 4801195, Japan
Author contributions: Inaoka K wrote the manuscript; Kanda M and Kodera Y revised the text and contributed to the scientific analysis in the manuscript; Uda H, Tanaka Y, Tanaka C, Kobayashi D, Takami H, Iwata N, Hayashi M, Niwa Y, Yamada S, Fujii T, Sugimoto H, Fujiwara M contributed to data collection; Murotani K conducted the statistical analyses.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Nagoya University.
Informed consent statement: This study conforms to the ethical guidelines of the World Medical Association Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects, and written informed consent for the use of clinical data were obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available for this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mitsuro Kanda, MD, PhD, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan. m-kanda@med.nagoya-u.ac.jp
Telephone: +81-52-7442249 Fax: +81-52-7442252
Received: December 25, 2016
Peer-review started: December 31, 2016
First decision: January 19, 2017
Revised: January 25, 2017
Accepted: March 20, 2017
Article in press: March 20, 2017
Published online: April 14, 2017
AIM
To identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.
METHODS
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.
RESULTS
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, 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.
CONCLUSION
The preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.
Core tip: The prediction of postoperative complications is important for providing appropriate perioperative management. In the present study, the predictive values for postoperative complications after gastrectomy with systemic lymphadenectomy for gastric cancer were compared among candidate preoperative factors to identify a simple and sensitive marker. Our results indicated that the preoperative platelet-lymphocyte ratio is a simple and useful predictor for complications after curative gastrectomy in patients with gastric cancer.
