br Table br The relationship between the ANLR
The relationship between the ANLR and clinicopathological characteristics in patients undergoing potentially curative resection for gastric cancer.
Clinicopathological features ANLR
Low Intermediate High
Tumor size (mm)
Multivariate analysis of clinicopathologic variables in relation to OS in patients undergoing potentially curative resection for gastric cancer.
Clinicopathological features Multivariate analysisa
Tumor size (cm)
a Adjusted for the following variables: ASA score, tumor location, tumor size, Lymphovascular invasion, BMI, Adjuvant chemotherapy, pTNM stage, NLR, PLR, ALb and postoperative complication.
et al. found that the number of peripheral blood circulating lymphocyte is closely related to the state of tumor infiltrating lymphocytes . Peripheral lymphocyte count reduction could herald a tumor infiltrating Z VAD FMK decreased, thus affecting the prognosis of patients with tumor. Studies have shown that the potential role of the NLR in carcinogenesis and tumor aggressive-ness may be due to an increased number of neutrophils, which were shown to interact with other cell populations to produce cytokines and effector molecules . Neutrophils are high motility cells with antitumor or protumor phenotypes depending on microenvironmental factors .
Aging is accompanied by the development of low-grade sys-temic inflammation, termed ‘inflammaging’, which is characterized by raised serum C-reactive protein (CRP) and pro-inflammatory cytokines . Studies have shown that the increase of CRP is closely related to the rise of peripheral neutrophils . However, CRP in patients won't be preoperatively monitored until elevated
Please cite this article as: Lin J-X et al., Association of the age-adjusted Charlson Comorbidity Index and systemic inflammation with survival in gastric cancer patients after radical gastrectomy, European Journal of Surgical Oncology, https://doi.org/10.1016/j.ejso.2019.07.010
6 J.-X. Lin et al. / European Journal of Surgical Oncology xxx (xxxx) xxx
Fig. 2. Predictive accuracy of the model combining the ANLR and pTNM staging with that containing pTNM staging only for prediction of OS: A.Time-dependent ROC curves of pTNM and new model (pTNMN þ ANLR) for the prediction of OS. B.Clinical performance of independent prognostic factors parameters. (The predictive accuracy for 5-year overall survival based on the iAUC with 1000 bootstrap resampling for each parameter is shown in a box plot. Median values of 1000 bootstrap resampling are shown with thick lines).
neutrophils were observed obviously, which makes preoperative CRP difficult to be obtained. What's more, the test price of CRP is relatively higher. Therefore, we use NLR, an inexpensive, widely available, and reproducible index, combining ACCI to predict the prognosis of patients with gastric cancer. And further analysis found that the ACCI is significantly correlated with the marker of systemic inflammation, NLR, which is an independent risk factor for increasing the preoperative NLR. This result is consistent with a previous hypothesis on “inflammation” in aging. Therefore, this study established a new prognostic scoring system, the ANLR, by combining the ACCI with the preoperative NLR. This study showed that the ANLR was an independent prognostic factor in patients with GC. As a combination of the ACCI and preoperative NLR, the ANLR can better reflect the coeffect of the ACCI and systemic inflammation on tumor progression.
According to previous studies, most patients with gastric cancer die of cancer. Therefore, we further analyzed the impact of ACCI, NLR and ANLR on cancer-specific death and death from other
causes, respectively. During the follow-up period of 112 months, a total of 756 patients died, of whom 688/2257(30.5%) died of cancer, and only 68/2257(3.0%) died of other causes. Among the patients with high ACCI, 245 cancer-specific deaths (10.9%) and 43 non-cancer-specific deaths (1.9%) were observed. We found that tak-ing the low ACCI group as the reference group, the high ACCI group had a 0.7 fold increased risk of death due to cancer and a 6.8 fold increased risk of death due to other diseases after considering competitive event (all P < 0.01, Supplemental Fig. 1). However, high NLR only had a significant effect on cancer-specific death (Supplemental Fig. 2). ANLR had a similar effect with ACCI on cancer-specific death and other causes of death (Supplemental Fig. 3). Nevertheless, the overall impact of ANLR on the survival of GC patients is remarkable.