Objective: To investigate the impact of preoperative lymphocyte to monocyte ratio on the prognosis of elderly patients with stage II(-III( gastric cancer.
Methods: Clinicopathological data of 188 patients with stage II(-III( gastric cancer aged≥75 years undergoing radical gastrectomy in our department from January 2007 to December 2011 were analyzed retrospectively. The optimal critical value of preoperative peripheral blood LMR in prediction of overall survival was determined through the receiver-operating characteristic (ROC) curve analysis. According to the critical value, patients were divided into the low LMR group and high LMR group. Clinicopathological features and prognosis were compared between the two groups. Univariate and multivariate analyses were performed to evaluate the clinical factors affecting prognosis with Cox proportional hazard model.
Results: ROC curve revealed the optimal critical value of preoperative peripheral blood LMR in prediction of overall survival was 4.34, then 71 cases were divided into the low LMR group (<4.34) and 117 cases into high LMR group (≥4.34). The low LMR group had greater tumor size (P=0.015) and higher level of carcinoembryonic antigen (CEA) (P=0.018) as compared to the high LMR group, and other clinicopathological parameters were not significantly different (all P>0.05). Median follow-up time of all the 188 patients was 21.8 (1.3 to 92.9) months. The 3-year survival rate of the low and high LMR groups was 36.8% and 45.1% respectively with significant difference (P=0.001). Univariate analysis revealed that the postoperative overall survival was associated with the preoperative LMR (P<0.001), absolute count of lymphocyte (P=0.002), absolute count of monocyte (P=0.016), CEA level (P=0.011), CA199 level (P=0.003), lymph node metastasis (P<0.001), tumor maximal size (P<0.001), TNM stage (P<0.001), postoperative adjuvant chemotherapy (P=0.004). Multivariate analysis revealed that the TNM stage III( (HR:2.708, 95%CI:1.356 to 5.411, P=0.005), tumor maximal size≥50 mm (HR: 1.737, 95%CI: 1.114 to 2.709, P=0.015), without postoperative adjuvant chemotherapy (HR: 0.651, 95%CI: 0.440 to 0.961, P=0.031), and preoperative peripheral blood LMR<4.34 (HR: 0.600, 95%CI: 0.376 to 0.958, P=0.032) were independent risk factors of prognosis.
Conclusions: Preoperative peripheral blood LMR level possesses good predictive value of prognosis for the elderly patients with stage II(-III( gastric cancer. Low LMR is associated with poor outcomes.