Absolute monocyte and lymphocyte count prognostic score for patients with gastric cancer

Table 1 Demographics and tumor-related factors in patients with gastric cancer n (%)

Variable
Median age (range, yr)	59 (25-92)
Male: female	195:104 (65.2:34.8)
Lauren’s classification
Intestinal	148 (49.5)
Diffuse	79 (26.4)
Mixed	58 (19.4)
Unknown	14 (4.7)
Median tumor size (range), cm	3.0 (0.2-20.0)
Location
Upper1/3	28 (9.4)
Mid1/3	90 (30.1)
Lower1/3	176 (58.9)
Diffuse	5 (1.7)
Lymphatic invasion
Negative	203 (67.9)
Positive	96 (32.1)
Vascular invasion
Negative	287 (96.0)
Positive	12 (4.0)
T category
T1	168 (56.2)
T2	29 (9.7)
T3	73 (24.4)
T4	29 (9.7)
N category
N0	199 (66.6)
N1	39 (13.0)
N2	25 (8.4)
N3	36 (12.0)
TNM stage
I	179 (59.9)
II	60 (20.1)
III	60 (20.1)

TNM: Tumor node metastasis.

Table 2 Host-related factors in patients with gastric cancer

Variable	Mean ± SD	Median (range)
WBC (/μL)	6857.5 ± 2358.8	6500.0 (1900.0-19500.0)
ANC (/μL)	4180.8 ± 2054.4	3718.4 (1064.0-17100.0)
AMC (/μL)	480.6 ± 180.1	458.2 (31.0-1618.5)
ALC (/μL)	1980.8 ± 633.9	1879.2 (341.0-5271.7)
Hemoglobin (g/dL)	12.8 ± 2.2	13.1 (5.7-17.9)
MCV (fL)	91.6 ± 7.5	92.8 (56.7-109.4)
Platelet (× 103/μL)	245.4 ± 71.8	235 (54.0-577.0)
MPV (fL)	7.9 ± 0.8	7.8 (5.9-10.9)
NLR	2.4 ± 1.9	2.0 (0.4-25.6)
PLR	138.0 ± 85.8	122.5 (34.3-1190.6)
Albumin (g/dL)	4.1 ± 0.4	4.1 (2.4-5.1)

SD: Standard deviation; ANC: Absolute neutrophil count; AMC: Absolute monocyte count; ALC: Absolute lymphocyte count; MCV: Mean corpuscular volume; MPV: Mean platelet volume; NLR: Neutrophil/lymphocyte count ratio; PLR: Platelet/lymphocyte count ratio.

Table 3 Clinical characteristics according to the absolute monocyte count/absolute lymphocyte count prognostic score in patients with gastric cancer

Variable	Low risk (n = 158)4		Intermediate risk (n = 128)4		High risk (n = 13)4		P value
	n (%)	Mean ± SD	n (%)	Mean ± SD	n (%)	Mean ± SD
Age (yr)		56.4 ± 10.71		61.2 ± 12.22		64.0 ± 10.11,2	0.0006
Gender							0.2602
Male	99 (62.7)		85 (66.4)		11 (84.6)
Female	59 (37.3)		43 (33.6)		2 (15.4)
Tumor size (cm)		3.7 ± 2.91		4.3 ± 3.21		7.1 ± 5.12	0.0005
T category							0.0008
T1-2	117 (74.1)		76 (59.4)		4 (30.8)
T3-4	41 (25.9)		52 (40.6)		9 (69.2)
N category							0.0565
N0	111 (70.3)		83 (64.8)		5 (38.5)
N1-3	47 (29.7)		45 (35.2)		8 (61.5)
TNM stage							0.0200
I-II	133 (84.2)		99 (77.3)		7 (53.8)
III	25 (15.8)		29 (22.7)		6 (46.2)
Lymphatic invasion							0.0102
Negative	117 (74.1)		81 (63.3)		5 (38.5)
Positive	41 (25.9)		47 (36.7)		8 (61.5)
Vascular invasion							0.0105
Negative	156 (98.7)		120 (93.8)		11 (84.6)
Positive	2 (1.3)		8 (6.3)		2 (15.4)
Albumin (g/dL)		4.2 ± 0.31		4.0 ± 0.42		3.7 ± 0.53	< 0.0001
AMC (/μL)		459.1 ± 110.01		478.3 ± 226.91		765.5 ± 93.92	< 0.0001
ALC (/μL)		2283.8 ± 423.11		1661.2 ± 685.92		1444.9 ± 219.52	< 0.0001
Hemoglobin (g/dL)		13.4 ± 1.91		12.4 ± 2.32		10.2 ± 2.53	< 0.0001
Platelet (× 103/μL)		248.8 ± 66.61		238.7 ± 78.01		270.1 ± 67.01	0.2219
MPV (fL)		8.0 ± 0.91		7.9 ± 0.81		7.6 ± 0.91	0.2373
NLR		1.7 ± 0.71		2.9 ± 2.62		4.2 ± 2.62	< 0.0001
PLR		111.8 ± 35.31		165.0 ± 116.32		191.6 ± 58.32	< 0.0001

^1,2,3Means with the same letter are not significantly different;

⁴AMLPS (AMC/ALC prognostic score) was defined as low-risk (both AMC ≤ 672.4/μL and ALC > 1734/μL), intermediate-risk (either AMC > 672.4/μL or ALC ≤ 1734/μL) and high-risk (both AMC > 672.4/μL and ALC ≤ 1734/μL). P values for comparison of mean difference for continuous variables were obtained by analysis of variance with post-hoc test of Scheffe; P values for independent test for categorical variables were obtained by χ² test. TNM: Tumor node metastasis; SD: Standard deviation; ANC: Absolute neutrophil count; AMC: Absolute monocyte count; ALC: Absolute lymphocyte count; MCV: Mean corpuscular volume; MPV: Mean platelet volume; NLR: Neutrophil/lymphocyte count ratio; PLR: Platelet/lymphocyte count ratio.

Table 4 Relationship between clinicopathologic characteristics, the systemic inflammatory or immunologic response, and disease-free survival in gastric cancer

Variable	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Age (yr)	3.32 (1.50-7.35)	0.0032	3.33 (1.50-7.40)	0.0032
Tumor size (cm)	4.92 (2.79-8.69)	< 0.0001
T category (T1-2 vs T3-4)	7.26 (3.82-13.81)	< 0.0001
N category (N0 vs N1-3)	5.16 (2.87-9.27)	< 0.0001
TNM Stage (I-II vs III)	8.93 (5.08-15.69)	< 0.0001	4.69 (2.15-10.24)	0.0001
Lymphatic invasion	3.63 (2.08-6.32)	< 0.0001
Vascular invasion	2.96 (1.17-7.47)	0.0214
Albumin (g/dL)	0.29 (0.16-0.51)	< 0.0001
AMC (/μL)	2.06 (1.08-3.92)	0.0285
ALC (/μL)	0.37 (0.21-0.64)	0.0004
Hemoglobin (g/dL)	0.32 (0.19-0.56)	< 0.0001
Platelet (× 103/μL)	2.45 (1.41-4.26)	0.0015
MPV (fL)	0.38 (0.18-0.77)	0.0080
NLR	2.18 (1.22-3.88)	0.0085
PLR	2.94 (1.68-5.13)	0.0002
AMLPS1
High- vs intermediate-risk2	0.11 (0.05-0.26)	< 0.0001	0.23 (0.10-0.56)	0.0011
High- vs low-risk3	0.24 (0.11-0.52)	0.0004	0.40 (0.18-0.90)	0.0274

¹AMLPS (AMC/ALC prognostic score) was defined as low-risk (both AMC ≤ 672.4/μL and ALC > 1734/μL), intermediate-risk (either AMC > 672.4/μL or ALC ≤ 1734/μL) and high-risk (both AMC > 672.4/μL and ALC ≤ 1734/μL);

²Statistically significant after adjusting for age, tumor size, T category, N category, TNM stage, lymphatic invasion, vascular invasion, serum albumin concentration, hemoglobin concentration, platelet count, MPV, NLR, PLR, and low-risk AMLPS;

³Statistically significant after adjusting for age, tumor size, T category, N category, TNM stage, lymphatic invasion, vascular invasion, serum albumin concentration, hemoglobin concentration, platelet count, MPV, NLR, PLR, and intermediate-risk AMLPS. Hazard ratio (HR) was obtained by Cox’s proportional hazard model. TNM: Tumor node metastasis; AMC: Absolute monocyte count; ALC: Absolute lymphocyte count; MPV: Mean platelet volume; NLR: Neutrophil/lymphocyte count ratio; PLR: Platelet/lymphocyte count ratio.

Table 5 Relationship between clinicopathologic characteristics, the systemic inflammatory or immunologic response, and overall survival in gastric cancer

Variable	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Age (yr)	2.68 (1.46-4.92)	0.0016	2.34 (1.25-4.37)	0.0083
Tumor size (cm)	4.47 (2.38-8.37)	< 0.0001
T category (T1-2 vs T3-4)	5.12 (2.63-9.98)	< 0.0001
N category (N0 vs N1-3)	3.57 (1.92-6.64)	0.0001
TNM Stage (I-II vs III)	6.28 (3.41-11.55)	< 0.0001	5.53 (2.96-10.34)	< 0.0001
Lymphatic invasion	2.88 (1.56-5.28)	0.0007
Vascular invasion	2.71 (0.97-7.63)	0.0583
Albumin (g/dL)	0.27 (0.14-0.52)	0.0001
AMC (/μL)	2.41 (1.21-4.79)	0.0125
ALC (/μL)	0.31 (0.16-0.58)	0.0003	.	.
Hemoglobin (g/dL)	0.40 (0.22-0.73)	0.0030
Platelet (× 103/μL)	2.11 (1.14-3.93)	0.0188
MPV (fL)	0.52 (0.28-0.97)	0.0415
NLR	2.21 (1.17-4.19)	0.0155
PLR	3.18 (1.70-5.97)	0.0003
AMLPS1
High- vs intermediate-risk2	0.08 (0.03-0.21)	< 0.0001	0.17 (0.06-0.45)	0.0004
High- vs low-risk3	0.20 (0.09-0.44)	< 0.0001	0.30 (0.13-0.71)	0.0057

¹AMLPS (AMC/ALC prognostic score) was defined as low-risk (both AMC ≤ 672.4/μL and ALC > 1734/μL), intermediate-risk (either AMC > 672.4/μL or ALC ≤ 1734/μL) and high-risk (both AMC > 672.4/μL and ALC ≤ 1734/μL);

²Statistically significant after adjusting for age, tumor size, T category, N category, TNM stage, lymphatic invasion, vascular invasion, serum albumin concentration, hemoglobin concentration, platelet count, MPV, NLR, PLR, and low-risk AMLPS;

³Statistically significant after adjusting for age, tumor size, T category, N category, TNM stage, lymphatic invasion, vascular invasion, serum albumin concentration, hemoglobin concentration, platelet count, MPV, NLR, PLR, and intermediate-risk AMLPS. Hazard ratio (HR) was obtained by Cox’s proportional hazard model. TNM: Tumor node metastasis; AMC: Absolute monocyte count; ALC: Absolute lymphocyte count; MPV: Mean platelet volume; NLR: Neutrophil/lymphocyte count ratio; PLR: Platelet/lymphocyte count ratio.