Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer

doi:10.4251/wjgo.v12.i10.1146

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World Journal of Gastrointestinal Oncology

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World J Gastrointest Oncol. Oct 15, 2020; 12(10): 1146-1166
Published online Oct 15, 2020. doi: 10.4251/wjgo.v12.i10.1146

Table 1 General characteristics and overall survival among 1038 gastric cancer patients

Characteristic	Patients n (%)	Overall survival months (95%CI)	P value
Sex			0.864
Male	728 (70.2%)	59.6 (56.9-62.2)
Female	309 (29.8%)	59.7 (55.7-63.8)
Age (yr)			< 0.001
< 70	716 (69%)	64.7 (62.2-67.3)
≥ 70	321 (31%)	48.1 (44.1-52.2)
Hospitalization (d)			< 0.001
< 18	494 (47.6%)	68.7 (65.7-71.6)
≥ 18	543 (52.4%)	51.5 (48.4-54.6)
TNM stage			< 0.001
I	251 (24.2%)	87.1 (84.9-89.2)
II	197 (19.0%)	75.5 (71.4-79.5)
III	509 (49.1%)	46.2 (43.1-49.2)
IV	80 (7.7%)	19.1 (14.5-23.8)
Tumor size (cm)			< 0.001
< 4	405 (39.1%)	75.2 (72.3-78.1)
≥ 4	632 (60.9%)	49.7 (46.8-52.6)
Lymph node metastasis (N)			< 0.001
0	393 (37.9%)	80.6 (78.1-83.2)
1-3	644 (62.1%)	46.8 (44.0-49.6)
Distant metastasis (M)			< 0.001
0	957 (92.3%)	62.9 (60.7-65.2)
1	80 (7.7%)	19.1 (14.5-23.8)
Tumor location			< 0.001
Cardia	200 (19.3%)	50.9 (45.9-56.0)
Non-cardia	837 (80.7%)	61.7 (59.2-64.1)
Hematological type			< 0.001
Intestinal type	555 (53.5%)	64.5 (61.6-67.4)
Diffuse type	482 (46.5%)	53.9 (50.6-57.2)
Depth of invasion			< 0.001
1-2	313 (30.2%)	84.4 (82.0-86.8)
3-4	724 (69.8%)	48.9 (46.3-51.6)
Neural invasion			< 0.001
No	822 (74.3%)	63.1 (60.7-65.6)
Yes	215 (25.7%)	45.9 (41.1-50.7)
Vessel invasion			< 0.001
No	771 (74.3%)	65.7 (63.2-68.1)
Yes	266 (25.7%)	42.0 (37.7-46.3)
Esophageal invasion			< 0.001
No	949 (91.5%)	61.6 (59.3-63.9)
Yes	88 (8.5%)	38.7 (31.5-45.8)
NLR			< 0.001
< 2.6	634 (61.1%)	64.5 (61.8-67.3)
≥ 2.6	382 (38.9%)	51.8 (48.2-55.5)
HB (g/L)			< 0.001
< 120	407 (39.2%)	53.2 (49.6-56.8)
≥ 120	630 (60.8%)	63.8 (61.1-66.6)
PLR			< 0.001
< 133	486 (46.9%)	64.9 (61.8-68.0)
≥ 133	551 (53.1%)	54.9 (51.8-58.0)
Albumin			< 0.001
< 35	165 (15.9%)	46.4 (40.8-52.0)
≥ 35	872 (84.1%)	62.1 (59.8-64.5)
Pre-albumin			< 0.001
< 212	354 (34.1%)	45.7 (41.8-49.5)
≥ 212	683 (65.9%)	66.9 (64.3-69.4)
PNI			< 0.001
< 47	387 (37.3%)	48.3 (44.7-52.0)
≥ 47	65 (62.7%)	66.4 (63.7-69.0)

TNM: Tumor–node–metastasis; NLR: Neutrophil-lymphocyte ratio; HB: Hemoglobin; PLR: Platelet lymphocyte ratio; PNI: Prognostic nutritional index.

Table 2 Comparison of clinical characteristics between 716 younger patients (age < 70 yr) and 321 older patients (age > 70 yr) with gastric cancer

Characteristic	Younger group n (%)	Older group n (%)	P value
Sex			0.407
Male	497 (69.4%)	231 (72.0%)
Female	219 (30.6%)	90 (28.0%)
Hospitalization (d)			< 0.001
< 18	369 (51.5%)	125 (38.9%)
≥ 18	347 (48.5%)	196 (61.6%)
TNM stage			0.003
I-II	331 (46.2%)	117 (36.4%)
III-IV	385 (53.8%)	204 (63.6%)
T stage			< 0.001
1-2	240 (33.5%)	73 (22.7%)
3-4	476 (66.5%)	248 (77.3%)
N stage			0.021
0	288 (40.2%)	105 (32.7%)
1-3	428 (59.8%)	216 (67.3%)
M stage			0.343
0	657 (91.8%)	300 (93.5%)
1	59 (8.2%)	21 (6.5%)
Tumor size (cm)			< 0.001
< 4	318 (44.4%)	87 (27.1%)
≥ 4	398 (55.6%)	234 (72.9%)
Tumor location			0.059
Cardia	127 (17.7%)	73 (22.7%)
Non-cardia	589 (82.3%)	248 (77.3%)
Histological type			0.001
Intestinal type	359 (50.1%)	196 (61.1%)
Diffuse type	357 (49.9%)	125 (38.9%)
Neural invasion			0.358
No	562 (78.5%)	260 (81%)
Yes	154 (21.5%)	61 (19%)
Vessel invasion			0.719
No	530 (74%)	241 (75.1%)
Yes	186 (26%)	80 (24.9%)
Esophageal invasion			0.855
No	656 (91.6%)	293 (91.3%)
Yes	60 (8.4%)	28 (8.7%)
NLR			0.003
< 2.6	459 (64.1%)	175 (54.5%)
≥ 2.6	257 (35.9%)	146 (45.5%)
Anemia			< 0.001
No	499 (69.7%)	131 (40.8%)
Yes	217 (30.3%)	190 (59.2%)
PLR			0.003
< 133	358 (50%)	128 (39.9%)
≥ 133	358 (50%)	193 (60.1%)
Low albumin			< 0.001
No	650 (90.8%)	222 (69.2%)
Yes	66 (9.2%)	99 (30.8%)
Low pre-albumin			< 0.001
No	534 (74.6%)	149 (46.4%)
Yes	182 (25.4%)	172 (53.6%)
PNI			< 0.001
< 47	191 (26.7%)	196 (61.1%)
≥ 47	525 (73.3%)	125 (38.9%)

TNM: Tumor–node–metastasis; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet lymphocyte ratio; PNI: Prognostic nutritional index.

Table 3 Univariate and multivariate analyses of overall survival of 716 gastric cancer patients in younger group (age < 70 yr)

Characteristic	Univariate	Analysis	Multivariate	Analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Sex (Male/Female)	0.983 (0.765-1.263)	0.893
Hospitalization (≥ 18/< 18 mo)	2.439 (1.909-3.115)	< 0.001	1.801 (1.394-2.327)	< 0.001
T stage (3 + 4/1 + 2)	9.948 (6.242-15.855)	< 0.001
N stage (1-3/0)	6.841 (4.797-9.756)	< 0.001
M stage (1/0)	5.799 (4.278-7.860)	< 0.001
TNM (III-IV/I-II)	7.791 (5.586-10.867)	< 0.001	5.418 (3.731-7.869)	< 0.001
Location (Cardia/non-cardia)	1.567 (1.190-2.064)	< 0.001	1.042 (0.753-1.441)	0.804
Tumor size (≥ 4/< 4 cm)	2.962 (2.267-3.871)	< 0.001	1.123 (0.831-1.517)	0.452
Histological type (Diffuse/Intestinal)	1.661 (1.311-2.105)	< 0.001	1.249 (0.973-1.604)	0.081
Neural invasion (Y/N)	2.024 (1.573-2.604)	< 0.001	0.987 (0.758-1.286)	0.925
Vessel invasion (Y/N)	2.865 (2.260-3.632)	< 0.001	1.501 (1.163-1.936)	0.002
Esophageal invasion(Y/N)	2.197 (1.566-3.082)	< 0.001	1.214 (0.814-1.810)	0.341
NLR (≥ 2.6/< 2.6)	1.602 (1.267-2.024)	< 0.001	1.151 (0.881-1.505)	0.303
Anemia (Y/N)	1.282 (1.004-1.637)	0.046	0.746 (0.559-0.995)	0.046
PLR (≥ 133/< 133)	1.540 (1.217-1.948)	< 0.001	1.102 (0.835-1.453)	0.493
Low albumin (Y/N)	1.585 (1.117-2.249)	0.010	0.781 (0.515-1.183)	0.243
Low prealbumin (Y/N)	2.149 (1.688-2.735)	< 0.001	1.637 (1.254-2.138)	< 0.001
PNI (< 47/≥ 47)	1.839 (1.444-2.343)	< 0.001	1.226 (0.896-1.679)	0.203

TNM: Tumor–node–metastasis; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet lymphocyte ratio; PNI: Prognostic nutritional index.

Table 4 Univariate and multivariate analyses of overall survival of 321 gastric cancer patients in older group (age > 70 yr)

Characteristic	Univariate	Analysis	Multivariate	Analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Sex (Male/Female)	1.016 (0.742-1.392)	0.920
Hospitalization (≥ 18/< 18 mo)	1.328 (0.991-1.780)	0.058
T stage (3 + 4/1 + 2)	4.356 (2.709-7.003)	< 0.001
N stage (1-3/0)	3.690 (2.544-5.352)	< 0.001
M stage (1/0)	5.142 (3.210-8.237)	< 0.001
TNM (III-IV/I-II)	5.462 (3.723-8.001)	< 0.001	3.873 (2.571-5.836)	< 0.001
Location (Cardia/non-cardia)	1.314 (0.955-1.807)	0.094
Tumor size (≥ 4/< 4 cm)	2.711 (1.854-3.963)	< 0.001	1.468 (0.965-2.232)	0.073
Histological type (Diffuse/Intestinal)	1.675 (1.264-2.220)	< 0.001	1.441 (1.078-1.928)	0.014
Neural invasion (Y/N)	1.928 (1.392-2.671)	< 0.001	1.191 (0.828-1.713)	0.347
Vessel invasion (Y/N)	1.983 (1.464-2.684)	< 0.001	1.299 (0.927-1.822)	0.129
Esophageal invasion (Y/N)	2.602 (1.716-3.944)	< 0.001	2.330 (1.505-3.607)	<0.001
NLR (≥ 2.6/< 2.6)	1.554 (1.174-2.056)	0.002	1.396 (1.038-1.880)	0.028
Anemia (Y/N)	1.336 (0.999-1.785)	0.051
PLR (≥ 133/< 133)	1.221 (0.913-1.633)	0.179
Low albumin (Y/N)	1.420 (1.060-1.904)	0.019	1.121 (0.792-1.587)	0.519
Low prealbumin (Y/N)	1.781 (1.336-2.374)	< 0.001	1.190 (0.857-1.653)	0.299
PNI (< 47/≥ 47)	1.589 (1.179-2.142)	0.002	0.962 (0.659-1.404)	0.840

TNM: Tumor–node–metastasis; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet lymphocyte ratio; PNI: Prognostic nutritional index.

Table 5 Univariate and multivariate analyses of overall survival of 65 gastric cancer patients in younger group (age < 45 yr)

Characteristic	Univariate	Analysis	Multivariate	Analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Sex (Male/Female)		0.555
Hospitalization (≥ 18/< 18 mo)	2.698 (1.153-6.312)	0.022		0.072
T stage (3 + 4/1 + 2)	60.674 (2.194-1677.654)	0.015
N stage (1-3/0)	8.062 (2.361-27.534)	0.01
M stage (1/0)	6.437 (2.599-15.946)	< 0.001
TNM (III-IV/I-II)	10.933 (3.217-37.162)	< 0.001	9.253 (2.644-32.377)	< 0.001
Location (Cardia/non-cardia)	3.684 (1.344-10.092)	0.011		0.301
Tumor size (≥ 4/< 4 cm)	4.293 (1.599-11.527)	0.004		0.271
Histological type (Diffuse/Intestinal)		0.161
Neural invasion (Y/N)		0.63
Vessel invasion (Y/N)	4.518 (1.988-10.266)	< 0.001	2.898 (1.249-6.723)	0.013
Esophageal invasion (Y/N)		0.31
NLR (≥ 2.6/< 2.6)	2.878 (1.257-6.588)	0.012		0.445
Anemia (Y/N)		0.094
PLR (≥ 133/<133)	3.083 (1.148-8.276)	0.025		0.958
Low albumin (Y/N)		0.295
Low prealbumin (Y/N)		0.051
PNI (< 47/≥ 47)	2.760 (1.178-6.466)	0.019		0.244

TNM: Tumor–node–metastasis; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet lymphocyte ratio; PNI: Prognostic nutritional index.

Table 6 Univariate and multivariate analyses of overall survival of 651 gastric cancer patients in middle-age group (45 ≤ age < 70).

Characteristic	Univariate	Analysis	Multivariate	Analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Sex (Male/Female)		0.953
Hospitalization (≥ 18/< 18 mo)	1.546 (1.210-1.976)	0.01		0.127
T stage (3 + 4/1 + 2)	8.995 (5.635-14.358)	< 0.001
N stage (1-3/0)	6.752 (4.659-9.786)	< 0.001
M stage (1/0)	5.792 (4.186-8.013)	< 0.001
TNM (III-IV/I-II)	7.558 (5.348-10.682	< 0.001	5.994 (4.183-8.590)	< 0.001
Histological type (Diffuse/Intestinal)	0.598 (0.468-0.764)	< 0.001		0.104
Location (Cardia/non-cardia)	1.481 (1.111-1.973)	0.007		0.947
Tumor size (≥ 4/< 4 cm)	2.859 (2.165-3.776)	< 0.001		0.302
Neural invasion (Y/N)	2.075 (1.596-2.696)	< 0.001		0.723
Vessel invasion (Y/N)	2.749 (2.146-3.523)	< 0.001	1.603 (1.242-2.069)	< 0.001
Esophageal invasion (Y/N)	2.209 (1.559-3.130)	< 0.001	1.431 (1.285-2.130)	0.046
NLR (≥ 2.6/< 2.6)	1.541 (1.206-1.970)	0.001		0.335
Anemia (Y/N)		0.157
PLR (≥ 133/< 133)	1.486 (1.163-1.898)	0.002		0.436
Low albumin (Y/N)	1.721 (1.216-2.438)	0.002		0.484
Low prealbumin (Y/N)	2.128 (1.656-2.735)	< 0.001	1.654 (1.285-2.130)	< 0.001
PNI (< 47/≥ 47)	1.806 (1.404-2.323)	< 0.001		0.265

TNM: Tumor–node–metastasis; NLR: Neutrophil-lymphocyte ratio; PLR: Platelet lymphocyte ratio; PNI: Prognostic nutritional index.

Table 7 Summary of meta-regression and the subgroup analysis

Subgroup	¹P value	n	HR	95%CI	I²	²P value
Design	0.715
Retrospective		15	1.54	1.39-1.70	14.8	0.287
Prospective		4	1.61	1.31-1.98	9.1	0.345
Sample size	0.879
< 400		12	1.56	1.38-1.76	2	0.424
≥ 400		7	1.54	1.37-1.77	29.8	0.201
Cut-off value	0.223
< 3		10	1.46	1.29-1.66	33.2	0.142
≥ 3		9	1.65	1.45-1.88	0	0.798
Male/all	0.225
< 0.7		14	1.50	1.36-2.66	0	0.469
≥ 0.7		5	1.75	1.43-2.13	25.6	0.251
Treatment	0.162
Surgery		13	1.49	1.34-1.67	25.1	0.190
Chemotherapy		4	1.55	1.29-1.86	0	0.982
Multiple		2	1.95	1.46-2.60	0	0.375

¹P value of meta-regression.

²P value of subgroup analysis.

Citation: Li Q, Huang LY, Xue HP. Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer. World J Gastrointest Oncol 2020; 12(10): 1146-1166
URL: https://www.wjgnet.com/1948-5204/full/v12/i10/1146.htm
DOI: https://dx.doi.org/10.4251/wjgo.v12.i10.1146