Published online Apr 14, 2017. doi: 10.3748/wjg.v23.i14.2519
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
Processing time: 110 Days and 5.3 Hours
To identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.
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.
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.
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.