The pre-operative neutrophil–lymphocyte ratio predicts overall and disease-free survival following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with pseudomxyoma peritonei of appendiceal origin

Figures & data

Table 1. NLR and tumour markers.

	NL ratio group
Elevated TMs	A	B	C	D	Total
None	175	12	6	8	201
Any one	10	120	18	7	155
Any two	6	15	157	11	189
All three	9	13	3	129	154
Total	200	160	184	155	699

Figure 1. The Kaplan–Meier plot shows the disease free interval of the NLR groups and numbers at risk.

Figure 2. The Kaplan–Meier plot shows the overall survival of the NLR groups and numbers at risk.

Table 2. Overall survival of grouped NLR and TMs.

Overall survival	3-year	5-year	Median in months (95% CI)
NL ratio
Group A	91.3%	86.9%	141.1 (125.6–156.7)
Group B	82.5%	70.9%	117.6 (104.3–131.0)
Group C	70.1%	62.0%	88.7 (75.4–102.1)
Group D	60.5%	50.2%	52.2 (43.4–60.1)
TM elevated
None	93.4%	87.6%	142.1 (136.2–161.4)
Any one	90.2%	79.1%	126.2 (115.3–138.5)
Any two	72.3%	62.2%	90.5 (80.7–100.0)
All three	66.4%	56.1%	66.3 (49.7–70.6)

Table 3. Univariate and multivariate Cox regression analysis for overall survival (OS).

	Univariate		Multivariate
Variable	Hazard ratio (95% CI)	p Value	Hazard ratio (95% CI)	p Value
Gender (male)	1.70 (1.22–2.27)	0.001	1.66 (1.12–2.98)	0.031
Age (<56 years)	2.01 (0.67–4.30)	0.280
CEA-elevated	2.00 (1.40–2.63)	0.001	2.10 (1.70–3.00)	0.008
CA 125-elevated	2.00 (1.46–2.71)	0.001	1.70 (1.12–2.90)	0.009
CA 19-9 elevated	2.20 (1.56–3.05)	0.001	1.09 (0.34–3.00)	0.064
Tumour grade (high)	4.00 (2.80–5.12)	0.001	3.10 (2.60–6.40)	0.001
Neutrophil–lymphocyte ratio
Group B (NLR = 2.10–2.78)	1.10 (0.78–2.15)	0.583	1.09 (0.34–3.00)	0.809
Group C (NLR = 2.79–4.31)	2.20 (1.40–3.50)	0.001	1.98 (1.09–2.88)	0.030
Group D (NLR ≥ 4.32)	3.10 (2.00–5.00)	0.001	2.10 (1.10–3.00)	0.011

Table 4. Univariate and multivariate Cox regression analysis for disease free survival (DFS).

	Univariate		Multivariate
Variable	Hazard ratio (95% CI)	p Value	Hazard ratio (95% CI)	p Value
Gender (male)	1.01 (0.78–2.02)	0.444
Age (<56 years)	1.49 (1.14–2.32)	0.021	2.12 (1.51–3.14)	0.016
CEA-elevated	2.60 (2.00–3.55)	0.001	2.20 (1.27–3.82)	0.005
CA 125-elevated	3.34 (1.75–3.11)	0.001	2.25 (1.23–4.11)	0.049
CA 19-9 elevated	2.83 (2.10–3.91)	0.001	2.48 (1.42–4.35)	0.001
Tumour grade (high)	2.10 (1.52–2.84)	0.001	2.19 (1.59–3.01)	0.001
Neutrophil–lymphocyte ratio
Group B (NLR = 2.10–2.78)	1.60 (1.12–2.27)	0.005	1.01 (0.31–3.86)	0.081
Group C (NLR = 2.79–4.31)	2.70 (1.80–4.10)	0.002	1.42 (1.10–2.21)	0.042
Group D (NLR ≥ 4.32)	4.64 (3.00–7.20)	0.001	1.75 (1.23–3.33)	0.010