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Comparative Study
. 2017 Apr 14;23(14):2519-2526.
doi: 10.3748/wjg.v23.i14.2519.

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

Kenichi Inaoka  1 , Mitsuro Kanda  1 , Hiroaki Uda  1 , Yuri Tanaka  1 , Chie Tanaka  1 , Daisuke Kobayashi  1 , Hideki Takami  1 , Naoki Iwata  1 , Masamichi Hayashi  1 , Yukiko Niwa  1 , Suguru Yamada  1 , Tsutomu Fujii  1 , Hiroyuki Sugimoto  1 , Kenta Murotani  1 , Michitaka Fujiwara  1 , Yasuhiro Kodera  1
Affiliations
Comparative Study

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

Kenichi Inaoka et al. World J Gastroenterol. .

Abstract

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.

Keywords: Gastrectomy; Gastric cancer; Platelet-lymphocyte ratio; Postoperative complication; Prediction.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of the predictive value of potential indicators. A: Area under the curve values of potential predictors; B: Predictive values of lymphocyte count, platelet count and PLR for postoperative complications evaluated by receiver operating characteristic curve analysis. PLR: Platelet-lymphocyte ratio.
Figure 2
Figure 2
Comparison of the prevalence of each complication type between the high and low platelet-lymphocyte ratio groups.
Figure 3
Figure 3
Subgroup analyses. The morbidity rates were compared between the high and low PLR groups according to age (A), body mass index (B), operative procedure (C) and clinical disease stage (D). Comparison of predictive value of potential indicators. PLR: Platelet-lymphocyte ratio.
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