The Effect of Platelets to Lymphocyte Ratio on Overall Survival in Gastrointestinal Cancer Patients Undergoing Surgery

Abstract

Abstract cancer, and inflammatory indicators derived from complete blood cells are more economical and efficient. Patients with gastrointestinal cancer undergoing surgery are prone to metabolic disorders and malnutrition owing to gastrointestinal anatomical changes. Therefore, we aimed to select the best prognostic inflammatory index and explore the relationship between systemic inflammation and the prognosis of patients with gastrointestinal cancer undergoing surgery. Methods: This prospective multicenter cohort study included 1165 participants from 4040clinical medical centers. The median age of participants was 61.0 (52.0, 68.0) years, and 775 were men. Five inflammation indices were used, and their cutoff values were calculated using maximally selected log-rank statistics. The concordance index (c-index) and receiver operating characteristic (ROC) curve were used to compare the accuracies of the different models. Cox regression analysis was used to examine the association between the platelet–lymphocyte ratio (PLR) and the overall survival (OS) of patients. Subgroup analysis was then conducted to examine the OS in different populations, and interaction analysis was performed. We also investigated the relationship between PLR and intensive care unit (ICU) admission. Results: The c-index and prognostic ROC curve showed that PLR was superior to the neutrophil–lymphocyte ratio, prognostic nutritional index, advanced lung cancer inflammation index, and systemic immune-inflammatory index. After adjustment for potential confounders, a high PLR (hazards ratio 1.61, 95% confidence interval=1.24–2.09, p<0.001) was associated with an increased OS. Shorter OS was observed with a high inflammatory status in most subgroups, but enteral nutrition showed an interaction with systemic inflammation (p=0.050). Additionally, individuals with high levels of inflammation are more likely to be admitted to the ICU. Conclusion: PLR may be a better prognostic indicator for gastrointestinal cancer patients undergoing surgery. Patients with a high PLR had a worse prognosis.