br Influence of the ANLR on OS br

Influence of the ANLR on OS
The relationship between the ANLR and clinicopathological data was compared (Table 3). The high ANLR group was dominated by patients with higher ASA scores, larger tumor sizes, and more advanced staging, and patients who were prone to lymphovascular invasion (all P < 0.05, Table 3).
Kaplan-Meier curves showed significant differences in the 5-year OS among the three ANLR groups (the 5-year OS: low ANLR group: 75.2%, intermediate ANLR group: 67.9%, high ANLR group: 55.6%, P < 0.001, Fig. 1B). Multivariate Cox regression analysis showed that the ANLR was an independent prognostic factor for 5-year OS. Other independent risk factors included tumor size and TNM staging (all P < 0.001, Table 4).
We further compared the predictive accuracy of the model combining the ANLR and pTNM staging with that containing pTNM staging only for prediction of OS by establishing the time-ROC curves (Fig. 2A). The results showed that the prognostic model incorporating the ANLR and pTNM was superior to the model with simple pTNM staging during the follow-up period. The C-index of the model combining the ANLR with pTNM was 0.744 (95% CI: 0.728e0.760), which was significantly higher than the model with only the pTNM stage (0.717, 95% CI: 0.702e0.731; P < 0.001). The clinical performance of the combination of the ANLR and pTNM exceeded that of pTNM staging alone (Fig. 2B, likelihood ratio P < 0.001).
Discussion
In recent years, the proportion of elderly patients with gastric cancer has been increasing due to the extension of human life ex-pectancy [25]. Age has been identified as an independent prog-nostic factor for the survival of many malignant diseases [26e29]. The functional reserve of the human body tends to decline with age. Furthermore, elderly patients are prone to have more comorbid-ities, leading to decreased quality of life and increased risk of death [4]. Inflammation has been implicated in the pathogenesis of several of the major age-related diseases, including cardiovascular disease, type 2 diabetes, and dementia, and this ZVAD FMK condition is asso-ciated with increased mortality [30]. Cancer-related inflammation
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
4 J.-X. Lin et al. / European Journal of Surgical Oncology xxx (xxxx) xxx
Table 2
The relationship between systemic inflammation and other clinicopathological parameters.
Clinicopathological features Odds Ratio for Systemic Inflammation (95%CI)
Univariate analysis
P value Multivariate analysis P value
Gender
Female
BMI
ACCI
ALB
ASA
Tumor Location
Upper
Tumor Size(mm)
pTNM stage
I
Histologic type
Undifferentiated
Lymphovascular invasion
Negative
Fig. 1. KaplaneMeier analysis for OS of GC patients according to preoperative NLR and ACCIeMeier analysis for OS according to (A) combination of preoperative NLR and ACCI, and (B) ANLR.
has been recognized as one of the hallmarks of cancer [31] with a crucial role in regulating the tumor microenvironment. Therefore, there may be a strong correlation between age, comorbidity and systemic inflammation. However, no relevant studies have been reported so far.
In this study with a large cohort, we found that both the ACCI and the marker of systemic inflammation, NLR, were independent risk factors for the prognosis of GC. The NLR, a measure of the proportion of systemic neutrophils and lymphocytes, has been
proposed as an indicator of cancer-related inflammation and has been shown to have prognostic relevance across a large variety of tumor types [32e34]. Lymphocytes are basic components of the innate and adaptive immune system and are the cellular basis of immunosurveillance and immunoediting [35]. Previous studies have found that the presence of tumor-infiltrating lymphocytes was associated with improved outcomes in a variety of cancers, which may be due to tumor infiltration, lymphocyte induction, antitumor activity and the inhibition of angiogenesis [36]. Kazuo
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
J.-X. Lin et al. / European Journal of Surgical Oncology xxx (xxxx) xxx