Synergistic value of systemic inflammatory and tumor markers in predicting pretreatment distant metastasis of gastric cancer

Table 1 Comparison of clinical characteristics between the training and validation sets, n (%)

Characteristic	Training set (n = 152)	Validation set (n = 127)	P value
Sex			0.774
Male	103 (67.8)	84 (66.1)
Female	49 (32.2)	43 (33.9)
Age			0.205
< 60 years	71 (46.7)	69 (53.4)
≥ 60 years	81 (53.3)	58 (45.7)
Stage			0.823
I-II	65 (42.8)	56 (44.1)
III-IV	87 (57.2)	71 (55.9)
Hypertension			0.179
No	113 (74.3)	103 (81.1)
Yes	39 (25.7)	24 (18.9)
Diabetes			0.543
No	129 (84.9)	111 (87.4)
Yes	23 (15.1)	16 (12.6)
Tumor location			0.788
Cardia	51 (33.6)	38 (29.9)
Antrum	78 (51.3)	70 (55.1)
Body	23 (15.1)	19 (15.0)
Distant metastasis			0.942
No	94 (61.8)	78 (61.4)
Yes	58 (38.2)	49 (38.6)

Table 2 Comparison of gastric cancer patients between metastatic and non-metastatic groups in the training set, n (%)/median (interquartile range)

Characteristic	Non-metastatic group (n = 94)	Metastatic group (n = 58)	P value
Sex			0.914
Male	64 (68.1)	39 (67.2)
Female	30 (31.9)	19 (32.8)
Age			0.426
< 60 years	44 (46.8)	27 (46.6)
≥ 60 years	50 (53.2)	31 (53.4)
Tumor location			< 0.001
Cardia	22 (23.4)	29 (50.0)
Antrum	59 (62.8)	19 (32.8)
Body	13 (13.8)	10 (17.2)
CEA	2.25 (1.56, 3.98)	7.42 (1.92, 79.93)	< 0.001
CA19-9	11.31 (6.04, 18.19)	57.45 (7.91, 175.68)	< 0.001
NE	2.91 (2.38, 3.79)	4.06 (2.84, 6.83)	< 0.001
LY	1.50 (1.20, 1.90)	1.20 (0.90, 1.50)	< 0.001
MON	0.36 (0.29, 0.44)	0.41 (0.32, 0.50)	0.105
PLT	220.50 (187.50, 270.50)	223.50 (181.25, 300.50)	0.799
NLR	1.95 (1.33, 2.76)	3.57 (2.77, 5.55)	< 0.001
LMR	4.44 (3.07, 6.15)	2.86 (2.30, 3.85)	< 0.001
PLR	150.24 (105.08, 212.00)	186.00 (130.61, 302.65)	0.002
SII	439.54 (298.28, 681.39)	906.07 (505.75, 1785.25)	< 0.001
SIRI	0.76 (0.43, 0.76)	1.48 (0.84, 2.94)	< 0.001

Calculation methods: Neutrophil-to-lymphocyte ratio = neutrophils/Lymphocytes; lymphocyte-to-monocyte ratio = lymphocytes/monocytes; platelet-to-lymphocyte ratio = platelets/Lymphocytes; systemic immune-inflammation index = (neutrophils × platelets)/Lymphocytes; systemic inflammation response index = (neutrophils × monocytes)/Lymphocytes. CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; NE: Neutrophils; LY: Lymphocytes; MON: Monocytes; PLT: Platelets; NLR: Neutrophil-to-lymphocyte ratio; LMR: Lymphocyte-to-monocyte ratio; PLR: Platelet-to-lymphocyte ratio; SII: Systemic immune-inflammation index; SIRI: Systemic inflammation response index.

Table 3 Multivariate logistic regression analysis in the training set

	B	Wald χ2	P value	OR	95% confidence interval
Antrum	-1.015	5.913	0.036	0.362	(0.141-0.935)
CEA	0.003	1.164	0.410	1.003	(0.996-1.009)
CA19-9	0.019	8.140	0.022	1.019	(1.003-1.036)
NE	0.473	5.470	0.005	1.604	(1.151-2.236)
LY	-1.412	4.191	0.017	0.244	(0.077-0.774)
LMR	-0.008	1.635	0.954	0.992	(0.754-1.305)

Calculation methods: Lymphocyte-to-monocyte ratio = lymphocytes/monocytes. CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; NE: Neutrophils; LY: Lymphocytes; LMR: Lymphocyte-to-monocyte ratio.

Table 4 Performance of the combined predictive model and individual indicators for predicting distant metastasis in gastric cancer

	Cut-off	AUC	Sensitivity	Specificity	Youden index
Training set
CA19-9	22.9	0.732	0.638	0.872	0.510
NE	4.75	0.731	0.448	0.947	0.395
LY	1.4	0.687	0.672	0.606	0.278
Antrum	-	0.651	0.672	0.628	0.300
Model	0.337	0.888	0.776	0.819	0.595
Validation set
CA19-9	8.49	0.696	0.714	0.590	0.308
NE	6.09	0.781	0.633	0.872	0.504
LY	1.3	0.721	0.694	0.679	0.627
Antrum	-	0.683	0.674	0.693	0.373
Model	0.311	0.896	0.898	0.718	0.616

CA19-9: Carbohydrate antigen 19-9; NE: Neutrophils; LY: Lymphocytes.