Novel immunological and nutritional-based prognostic index for gastric cancer

Table 1 The list of multiple immunological and nutritional-based prognostic indices for gastric cancer

Combined marker	Score
Prognostic Nutritional Index
≥ 48.2	1
< 48.2	2
Neutrophil-lymphocyte ratio
≤ 1.83	1
> 1.83	2
Platelet-lymphocyte ratio
≤ 140	1
> 140	2
Canton score
PNI ≥ 48, NLR ≤ 1.83 and PLT ≤ 3 × 1011/L	0
PNI ≥ 48, NLR ≤ 1.83 and PLT > 3 × 1011/L	1
PNI ≥ 48, NLR > 1.83 and PLT ≤ 3 × 1011/L	1
PNI < 48, NLR ≤ 1.83 and PLT ≤ 3 × 1011/L	1
PNI ≥ 48, NLR > 1.83 and PLT > 3 × 1011/L	2
PNI < 48, NLR ≤ 1.83 and PLT > 3 × 1011/L	2
PNI < 48, NLR > 1.83 and PLT ≤ 3 × 1011/L	2
PNI < 48, NLR > 1.83 and PLT > 3 × 1011/L	3

PNI: Prognostic Nutritional Index; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet-lymphocyte ratio.

Table 2 Relationship between clinicopathological factors, postoperative complications, and prognostic nutritional index

Variable	n (%)	PNI-H	PNI-L	P value
Age (yr)				0.407
≤ 65	445 (70.4)	235	210
> 65	187 (29.6)	92	95
Sex				0.958
Male	413 (65.3)	214	199
Female	219 (34.7)	113	106
Resectability				< 0.001
0	509 (80.5)	285	224
1, 2	123 (19.5)	42	81
Tumor depth				0.006
T1, T2	126 (19.9)	79	47
T3, T4	506 (80.1)	248	258
Lymph node				0.015
N0	193 (30.5)	114	79
N1-3	439 (69.5)	213	226
Distant metastasis				< 0.001
M0	474 (75.0)	266	208
M1	158 (25.0)	61	97
Pathological stage				0.002
I, II	207 (32.8)	125	82
III, IV	425 (67.2)	202	223
WBC				0.279
≤ 11 × 109/L	597 (94.5)	312	285
> 11 × 109/L	35 (5.5)	15	20
ALB				< 0.001
≥ 35 g/L	507 (80.2)	325	182
< 35 g/L	125 (19.8)	2	123
PLT				0.072
≤ 300 × 109/L	484 (76.6)	260	224
> 300 × 109/L	148 (23.4)	67	81
CEA				0.353
≤ 5 ng/mL	547 (86.6)	287	260
> 5 ng/mL	85 (13.4)	40	45
Histological type				0.958
Well	190 (30.1)	98	92
Poor	442 (69.9)	229	213
Blood loss				0.034
≤ 400 mL	423 (66.9)	233	190
> 400 mL	209 (33.1)	94	115
Operative time				0.883
≤ 4 h	253 (40.0)	130	123
> 4 h	379 (60.0)	197	182
Postoperative chemotherapy				0.666
Absent	237 (37.5)	120	117
Present	395 (62.5)	207	188
Postoperative complications				0.488
Absent	551 (87.2)	288	263
Present	81 (12.8)	39	42
Severe complication				0.045
Absent	580 (91.8)	307	273
Present	52 (8.2)	20	32

WBC: White blood cell; ALB: Albumin; PLT: Platelet; CEA: Carcinoembryonic antigen.

Table 3 Univariate and multivariate analyses of prognostic factors in gastric cancer patients

Variable	UnivariateP value	Multivariate
		HR	95%CI	P value
Age (yr)	0.041			0.004
≤ 65		1
> 65		2.323	1.299-4.156
Sex	0.299
Male
Female
Resectability	< 0.001			0.018
R0		1
R1, R2		2.062	1.133-3.759
Tumor depth	< 0.001
T1, T2
T3, T4
Lymph node	< 0.001
N0
N1-3
Distant metastasis	< 0.001			< 0.001
M0		1
M1		10.505	6.540-16.874
Pathological stage
I		1
II	< 0.001	2.552	1.591-4.095	< 0.001
III	< 0.001	4.695	3.053-7.220	< 0.001
IV	< 0.001	10.505	6.540-16.874	< 0.001
WBC	0.002
≤ 11 × 109/L
> 11 × 109/L
ALB	< 0.001
≥ 35 g/L
< 35 g/L
PLT	< 0.001
≤ 300 × 109/L
> 300 × 109/L
CEA	< 0.001			0.004
≤ 5 ng/mL		1
> 5 ng/mL		1.457	1.126-1.883
Histological type	< 0.001
Well
Poor
Blood loss	< 0.001
≤ 400 mL
> 400 mL
Operative time	0.067
≤ 4 h
> 4 h
Postoperative chemotherapy	0.479
Absent
Present
Postoperative complications	< 0.001			0.002
Absent		1
Present		1.516	1.164-1.974
PNI	< 0.001			< 0.001
1		1
2		1.668	1.368-2.035
NLR	< 0.001			0.656
1		1
2		1.056	0.830-1.343
PLR	< 0.001			0.113
1		1
2		1.190	0.960-1.475
Propensity score				0.398

WBC: White blood cell; ALB: Albumin; PLT: Platelet; CEA: Carcino-embryonic antigen; PNI: Prognostic nutritional index; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet-lymphocyte ratio; HR: Hazard ratio.

Table 4 Areas under the receiver operating characteristic curve for survival of gastric patients based on all the derived prognostic scores at the end of follow-up, or after 12, 36, or 60 mo

Item	All survival		12 mo		36 mo		60 mo
	AUC	P value	AUC	P value	AUC	P value	AUC	P value
PNI	0.630	< 0.001	0.602	< 0.001	0.621	< 0.001	0.614	< 0.001
NLR	0.613	< 0.001	0.593	< 0.001	0.587	< 0.001	0.588	< 0.001
PLR	0.611	< 0.001	0.580	0.002	0.592	< 0.001	0.593	< 0.001
PLT	0.573	0.004	0.564	0.013	0.562	0.007	0.566	0.005
PNI + NLR	0.535	0.493	0.502	0.968	0.476	0.570	0.487	0.776
PNI + PLR	0.477	0.656	0.480	0.644	0.435	0.123	0.455	0.309
PNI + PLT	0.498	0.970	0.493	0.867	0.469	0.468	0.449	0.251
NLR + PLR	0.477	0.647	0.447	0.229	0.459	0.329	0.472	0.522
NLR + PLT	0.487	0.796	0.466	0.437	0.488	0.772	0.461	0.382
PLR + PLT	0.440	0.240	0.448	0.237	0.448	0.219	0.442	0.190
PNI + NLR + PLR	0.679	< 0.001	0.638	< 0.001	0.651	< 0.001	0.647	< 0.001
PNI + NLR + PLT	0.684	< 0.001	0.655	< 0.001	0.657	< 0.001	0.654	< 0.001
PNI + PLR + PLT	0.668	< 0.001	0.634	< 0.001	0.647	< 0.001	0.646	< 0.001
NLR + PLR + PLT	0.660	< 0.001	0.627	< 0.001	0.629	< 0.001	0.632	< 0.001
PNI + NLR + PLR + PLT	0.685	< 0.001	0.647	< 0.001	0.657	< 0.001	0.655	< 0.001

AUC: Area under the curve; PNI: Prognostic nutritional index; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet-lymphocyte ratio.

Table 5 Univariate and multivariate analyses of prognostic factors including Canton score

Variable	Univariate P value	Multivariate
		HR	95%CI	P value
Age (yr)	0.041			0.051
≤ 65		1
> 65		1.238	0.999-1.536
Sex	0.299
Male
Female
Resectability	< 0.001			0.002
R0		1
R1, R2		1.567	1.204-2.040
Tumor depth	< 0.001
T1, T2
T3, T4
Lymph node	< 0.001
N0
N1-3
Distant metastasis	< 0.001
M0
M1
Pathological stage				0.234
I, II
III, IV	< 0.001
WBC	0.002
≤ 11× 109/L
> 11× 109/L
ALB	< 0.001
≥ 35 g/L
< 35 g/L
PLT	< 0.001			0.795
≤ 300 × 109/L
> 300 × 109/L
CEA	< 0.001
≤ 5 ng/mL
> 5 ng/mL
Histological type	< 0.001
Well
Poor
Blood loss	< 0.001			0.407
≤ 400 mL
> 400 mL
Operative time	0.067
≤ 4 h
> 4 h
Postoperative chemotherapy	0.479
Absent
Present
Postoperative complications	< 0.001
Absent
Present
PLR	< 0.001			0.524
PLR-L
PLR-H
Canton score
0		1
1	0.021	1.076	0.796-1.454	0.633
2	< 0.001	1.554	1.151-2.097	0.004
3	< 0.001	1.643	1.142-2.364	0.007

WBC: White blood cell; ALB: Albumin; PLT: Platelet; CEA: Carcino-embryonic antigen; PLR: Platelet-lymphocyte ratio.

Table 6 Univariate and multivariate analyses of prognostic factors including Canton score

Variable	UnivariateP value	Multivariate
		HR	95%CI	P value
Resectability	< 0.001			0.002
R0		1
R1, R2		1.567	1.204-2.040
Canton score
0		1
1	0.021	1.076	0.796-1.454	0.633
2	< 0.001	1.554	1.151-2.097	0.004
3	< 0.001	1.643	1.142-2.364	0.007

HR: Hazard ratio.