Comparison of multiple inflammatory markers in predicting pathological features of gastric cancer
Authors: Li Yue 
Published: October 2023

Background Gastric cancer is a malignant tumor with a high mortality rate due to the difficulty of timely detection. The tumor-associated systemic inflammatory response is an important indicator of tumor progression, and we can use inflammatory markers to achieve assisted diagnosis, help preoperative staging, and make tumor treatment more accurate and effective.Methods We retrospectively screened and included 110 patients who possessed tumor pathology specimens after radical or palliative surgery for gastric cancer at Shenzhen Hospital of Peking University from January 2020 to June 2022, and collected the results of various blood laboratory tests within one week prior to radical or palliative resection for gastric cancer. First, the diagnostic validity of each inflammatory index was determined by ROC curve, and the optimal diagnostic threshold of each index was further determined; then, the correlation between AJCC stage, T stage, N stage and each inflammatory index was analyzed; then, the variability analysis of each inflammatory index under different clinicopathological factors was performed to evaluate the correlation between the two; and finally, the correlation between the two was determined by multifactorial logistic regression to determine whether each inflammatory index was independent of each pathologic result. indicators were determined by multifactorial logistic regression to determine whether they were independent risk factors for each pathologic outcome.Results The ROC curves suggested that platelet-lymphocyte ratio (PLR) was the best predictor of vascular cancer embolism, advanced T stage, lymph node metastasis, and stage III/IV, with an area under the ROC curve of 0.682, 0.767, 0.642, 0.696, and borderline values of 113.3, 113.3, 113.3, and 130.9, respectively; mean platelet volume- Platelet count ratio (MPV/PC) was the best predictor of nerve infiltration, with an area under the ROC curve of 0.691, while PLR was the second best predictor of nerve infiltration, with an area under the ROC curve of 0.661, and boundary values of 0.05025 and 130.9, respectively; all of the above p-values were less than 0.05. Correlation analysis: correlation between PLR and AJCC staging, T-staging, N staging, with correlation coefficients of 0.416, 0.438, and 0.290, respectively, p < 0.002. Differential analysis of inflammatory indexes in clinicopathological factor subgroups: as more consistent with the appellate analysis is that PLR and MPV/PC had significant differences in more clinicopathological factor subgroups, with PLR in T staging, lymph node metastasis, AJCC staging, vascular infiltration, nerve infiltration were significantly different between groups (P < 0.05), while MPV/PC had significant differences between groups in T stage, AJCC stage, vascular infiltration and nerve infiltration (P < 0.05). Multifactorial logistic regression: high PLR level was the tumor's development of vascular cancer embolism (OR = 5.864), nerve infiltration (OR = 3.423), locally advanced T stage (pT1,T2/pT3,T4) (OR = 8.272), lymph node metastasis (OR = 4.825), and AJCC staging of stage III/IV (OR = 4.126) independent risk factors, and low MPV/PC was an independent risk factor for the development of neural infiltration of the tumor (OR = 5.882), and all of the above p-values were less than 0.05.Conclusions Taken together, PLR had better predictive efficacy in terms of vascular thrombus, nerve infiltration, lymph node metastasis, T-staging, and AJCC staging, and was a more effective indicator of inflammation among those studied in assisting in the preoperative staging of gastric cancers and evaluating their clinicopathologic features. The predictive efficacy of MPV/PC in nerve infiltration was slightly better than that of PLR.