Combination of CRP and NLR: a better predictor of postoperative survival in patients with gastric cancer

Figures & data

Figure 1 Random forest analysis for the optimal cutoff points.

Abbreviations: NLR, neutrophil to lymphocyte ratio; CRP, C-reactive protein.

Table 1 Relationship between COC-NLR and clinicopathologic characteristics

Variable	Low (n=581)	Medium (n=187)	High (n=290)	p-value
Patient-related factors
Sex				0.228
Male	381	130	206
Female	200	57	84
Age (years)				0.019
<65	421	129	183
≥65	160	58	107
Neutrophils (×10^9/L)				<0.01
<3.61	382	40	60
≥3.61	119	147	230
Lymphocytes (×10^9/L)				0.238
<3.56	581	155	244
≥3.56	0	32	46
Platelets (×10^9/L)				<0.01
<315.5	511	157	206
≥315.5	70	30	84
CRP (mg/L)				<0.01
<4.29	546	183	0
≥4.29	35	4	290
Albumin (g/L)				0.166
<48.45	566	183	288
≥48.45	15	4	2
AGR				0.03
<1.09	6	3	13
≥1.09	575	184	277
NLR				<0.01
<2.5	581	155	244
≥2.5	0	32	46
PLR				<0.01
<125.31	358	45	97
≥125.31	223	142	193
SII				<0.01
<521.56	457	24	82
≥521.56	124	163	208
GPS				<0.01
0	561	176	112
1	20	11	132
2	0	0	46
mGPS				<0.01
0	505	155	6
1	72	32	174
2	4	0	110
HS-mGPS				<0.01
0	476	142	0
1	99	44	232
2	6	1	58
CRP/Alb ratio				<0.01
<0.096	581	187	323
≥0.096	0	0	58
Tumor-related factors
Tumor location				<0.01
Lower third	260	70	87
Middle third	121	35	50
Upper third	200	82	153
Tumor size (cm)				<0.01
<2.9	165	35	27
≥2.9	416	152	263
Histological type				<0.01
Poor-differentiated adenocarcinoma	366	99	196
Other	215	88	94
Metastatic lymph node ratio				<0.01
<0.18	368	105	119
≥0.18	213	82	171
TNM stage				<0.01
IA	82	21	9
IB	52	20	11
IIA	58	20	11
IIB	102	25	43
IIIA	69	16	37
IIIB	109	42	64
IIIC	109	43	115

Notes: Low: NLR ≤2.5, CRP ≤6.1; medium: NLR >2.5, CRP ≤4.6; high: NLR >2.5, CRP >4 or NLR ≤2.5, CRP >6.1. Bold figures represent as statistically significant, p<0.05.

Abbreviations: NLR, neutrophil to lymphocyte ratio; CRP, C-reactive protein; COC-NLR, combination of CRP and NLR; AGR, albumin globulin ratio; GPS, Glasgow Prognostic Score; mGPS, modified Glasgow Prognostic Score; HS-mGPS, high-sensitivity modified Glasgow Prognostic Score; TNM, tumor-node-metastasis; Alb, albumin; PLR, platelet to lymphocyte ratio; SII, systemic immune inflammation index.

Table 2 Hazard ratios of baseline characteristics for all-cause mortality in gastric cancer patients (univariate and multivariate analyses)

	Univariate analysis HR (95% CI)	p-value	Multivariate analysis HR (95% CI)	p-value
Patient-related factors
Sex (male/female)	1.019 (0.825–1.257)	0.863
Age (years) (<65/≥65)	1.514 (1.234–1.857)	<0.01	1.604 (1.289–1.997)	<0.01
COC-NLR (ref: low)		<0.01		<0.01
Medium	1.863 (1.403–2.474)		1.693 (1.195–2.397)	<0.01
High	4.223 (3.382–5.271)		2.698 (1.504–4.841)	<0.01
Neutrophils (×10^9/L)(<3.61/≥3.61)	2.075 (1.684–2.558)	<0.01	1.371 (1.052–1.785)	0.02
Lymphocytes (×10^9/L)(<3.56/≥3.56)	0.927 (0.414–2.077)	0.855
Platelet (×10^9/L)(<315.5/≥315.50)	1.422 (1.117–1.810)	0.004	1.105 (0.822–1.485)	0.51
CRP (mg/L) (<4.29/≥4.29)	3.265 (2.676–3.983)	<0.01	1.149 (0.607–2.176)	<0.01
Albumin (g/L) (<48.45/≥48.45)	1.459 (0.821–2.592)	0.198
AGR (<2.5/≥2.5)	0.210 (0.169–0.262)	<0.01	2.847 (1.331–6.091)	<0.01
NLR (<2.5/≥2.5)	0.210 (0.169–0.262)	<0.01	1.345 (0.965–1.875)	0.08
PLR (<125.31/≥125.31)	1.443 (1.181–1.763)	<0.01	1.105 (0.822–1.485)	0.51
SII (<521.56/≥521.56)	1.762 (1.444–2.151)	<0.01	0.795 (0.573–1.103)	0.17
GPS (ref: 0)		<0.01		0.21
1	2.297 (1.808–2.919)	<0.01	0.868 (0.618–1.219)	0.42
2	3.689 (2.551–5.336)	<0.01	0.443 (0.179–1.097)	0.08
mGPS (ref: 0)		<0.01		0.14
1	0.312 (0.235–0.414)	<0.01	1.052 (0.709–1.559)	0.80
2	0.762 (0.569–1.020)	0.068	0.689 (0.386–1.229)	0.21
HS-mGPS (ref: 0)		<0.01		0.02
1	2.579 (2.091–3.181)	<0.01	0.987 (0.668–1.459)	0.74
2	4.124 (2.944–5.775)	<0.01	2.764 (1.242–6.150)	0.06
CRP/Alb ratio (<0.096/≥0.096)	2.945 (2.076–4.179)	<0.01	1.501 (0.910–2.477)	0.11
Tumor-related factors
Tumor location (ref: lower)		<0.01		<0.01
Middle	1.412 (1.051–1.895)	0.022	1.312 (0.970–1.776)	0.08
Upper	2.453 (1.946–3.092)	<0.01	1.813 (1.417–2.319)	<0.01
Tumor size (cm) (<2.9/≥2.9)	3.051 (2.207–4.217)	<0.01	0.933 (0.651–1.338)	0.71
Histological type (ref: poor-differentiated adenocarcinoma)	1.365 (1.104–1.687)	<0.01	0.718 (0.575–0.897)	<0.01
Metastatic lymph node ratio (<0.18/≥0.18)	4.753 (3.817–5.919)	<0.01	2.099 (1.526–2.888)	<0.01
TNM stage (ref: IA)		<0.01		<0.01
IB	0.037 (0.015–0.091)	<0.01	1.625 (0.513–5.147)	0.41
IIA	0.072 (0.034–0.153)	<0.01	3.153 (1.094–9.089)	0.03
IIB	0.129 (0.072–0.231)	<0.01	4.765 (1.833–12.389)	0.01
IIIA	0.235 (0.167–0.331)	<0.01	5.992 (2.286–15.710)	<0.01
IIIB	0.377 (0.269–0.527)	<0.01	7.352 (2.807–19.254)	<0.01
IIIC	0.631 (0.497–0.802)	<0.01	9.639 (3.620–25.669)	<0.01

Note: Bold figures represent as statistically significant, p<0.05.

Abbreviations: NLR, neutrophil to lymphocyte ratio; CRP, C-reactive protein; COC-NLR, combination of CRP and NLR; AGR, albumin globulin ratio; GPS, Glasgow Prognostic Score; mGPS, modified Glasgow Prognostic Score; HS-mGPS, high-sensitivity modified Glasgow Prognostic Score; TNM, tumor-node-metastasis; Alb, albumin; PLR, platelet to lymphocyte ratio; SII, systemic immune inflammation index; HR, hazard ratio; Ref, reference.

Table 3 Comparison of the AUCs for the five inflammatory markers

	AUC	95% Cl	p-value
1 year
AGR	0.512	0.458–0.565	0.671
Neutrophils	0.597	0.545–0.648	<0.01
HS-mGPS	0.660	0.609–0.711	<0.01
CRP	0.641	0.587–0.695	<0.01
COC-NLR	0.662	0.609–0.715	<0.01
3 years
AGR	0.504	0.470–0.539	0.807
Neutrophils	0.586	0.552–0.620	<0.01
HS-mGPS	0.611	0.577–0.645	<0.01
CRP	0.618	0.584–0.651	<0.01
COC-NLR	0.644	0.611–0.677	<0.01
5 years
AGR	0.502	0.454–0.549	0.946
Neutrophils	0.586	0.540–0.633	<0.01
HS-mGPS	0.609	0.565–0.652	<0.01
CRP	0.608	0.506–0.651	<0.01
COC-NLR	0.655	0.614–0.696	<0.01

Abbreviations: NLR, neutrophil to lymphocyte ratio; CRP, C-reactive protein; COC-NLR, combination of CRP and NLR; AGR, albumin globulin ratio; HS-mGPS, high-sensitivity modified Glasgow Prognostic Score; AUC, area under the curve.

Figure 2 (A–C) The predictive abilities of the inflammatory markers were compared by receiver operating characteristic curves for 1, 3, and 5 years.

Abbreviations: NLR, neutrophil to lymphocyte ratio; CRP, C-reactive protein; COC-NLR, combination of CRP and NLR; AGR, albumin globulin ratio; HS-mGPS, high-sensitivity modified Glasgow Prognostic Score.

Figure 3 (A) The optimal survival curves of all patients according to the different levels of COC-NLR. (B) The optimal survival curves of stage II patients according to the different levels of COC-NLR. (C) The optimal survival curves of stage III patients according to the different levels of COC-NLR.

Abbreviations: NLR, neutrophil to lymphocyte ratio; CRP, C-reactive protein; COC-NLR, combination of CRP and NLR.