Fibrinogen-to-Lymphocyte Ratio Was an Independent Predictor of Lymph Node Metastasis in Patients with Clinically Node-Negative Advanced-Stage Gastric Cancer

Figures & data

Figure 1 Screening flowchart.

Table 1 Clinicopathological Variables of Patients with cN0 Advanced Gastric Cancer

Variables	Discovery Cohort			P	Validation Cohort			P
	Total	Positive (n = 360)	Negative (n = 211)		Total	Positive (n = 152)	Negative (n = 55)
Sex				0.226				0.513
Male	450	278	172		150	112	38
Female	121	82	39		57	40	17
Age (years)  Median (IQR)	66 (57–72)	66 (57–72)	66 (58–72)	0.971	67 (60–72)	67 (61–72)	67 (57–71)	0.381
Hypertension				0.916				0.677
No	418	263	155		146	106	40
Yes	153	97	56		61	46	15
Diabetes mellitus				0.756				0.281
No	539	339	200		193	140	53
Yes	32	21	11		14	12	2
Tumor size (cm)				0.002				0.041
<5	380	223	157		115	78	37
≥5	191	137	54		92	74	18
Tumor site				0.265				0.177
Upper	124	79	45		57	41	16
Middle	182	114	68		55	35	20
Lower	201	120	81		78	62	16
Overlap	64	47	17		17	14	3
T stage				<0.001				0.008
T2	136	37	99		41	23	18
T3	325	237	88		119	89	30
T4	110	86	24		47	40	7
Grade				<0.001				<0.001
Low	413	290	123		161	131	30
High/Moderate	158	70	88		46	21	25
Lauren type			1	0.112				0.113
Intestinal type	409	247	162		123	84	39
Diffuse type	65	45	20		26	22	4
Mixed type	97	68	29		58	46	12
Number of dissected nodes  Median (IQR)	28 (22–35)	29 (23–36)	26 (22–33)	0.010	26 (21–32)	26 (21–32)	26 (21–33)	0.995
CA199 (u/mL)				0.012				0.733
<37	474	288	186		170	124	46
≥37	97	72	25		37	28	9
FLR				<0.001				<0.001
Low	221	119	102		38	18	20
High	350	241	109		169	134	35

Abbreviations: FLR, fibrinogen-to-lymphocyte ratio; CA19-9, carbohydrate associated antigen 19–9; IQR, interquartile range.

Figure 2 (A) The ROC curve of FLR for predicting LNM in patients with cN0 AGC. (B) Receiver operating curves of the FLR and the CA199 for prediction of LNM in patients with cN0 AGC.

Abbreviations: FLR, fibrinogen-to-lymphocyte ratio; ROC, receiver operating characteristic; LNM, lymph node metastasis; AGC, advanced-stage gastric cancer.

Table 2 Logistic Analyses the Predictors of Lymph Node Metastasis in Patients with cN0 Advanced Gastric Cancer

Variables	Discovery Cohort				Validation Cohort
	Univariate Analysis		Multivariate Analysis		Multivariate Analysis
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Sex
Female	Ref
Male	0.77 (0.50–1.17)	0.226
Age (years)  Median (IQR)	1.00 (0.98–1.02)	0.933
Hypertension
No	Ref
Yes	1.02 (0.70–1.50)	0.916
Diabetes mellitus
No	Ref
Yes	1.13 (0.54–2.47)	0.756
Tumor size (cm)
< 5	Ref		Ref		Ref
≥ 5	1.79 (1.23–2.61)	0.002	1.01 (0.66–1.56)	0.958	1.33 (0.61–2.93)	0.478
Tumor site
Upper	Ref
Middle	0.95 (0.59–1.53)	0.849
Lower	0.84 (0.53–1.34)	0.471
Overlap	1.57 (0.82–3.12)	0.180
T stage
T2	Ref		Ref		Ref
T3	7.21 (4.63–11.41)	<0.001	6.70 (4.19–10.91)	<0.001	1.63 (0.66–4.01)	0.284
T4	9.59 (5.40–17.59)	<0.001	7.08 (3.84–13.44)	<0.001	2.40 (0.74–8.26)	0.151
Grade
High/Moderate	Ref		Ref		Ref
Low	2.96 (2.03–4.34)	<0.001	2.65 (1.73–4.06)	<0.001	4.91 (2.28–10.80)	<0.001
Lauren type		0.114
Intestinal type	Ref
Diffuse type	1.48 (0.85–2.64)	0.175
Mixed type	1.54 (0.96–2.51)	0.077
Number of dissected nodes  Median (IQR)	1.02 (1.01–1.04)	0.010	1.02 (1.00–1.04)	0.056	0.99 (0.95–1.03)	0.651
CA199 (u/mL)
< 37	Ref		Ref		Ref
≥ 37	1.86 (1.15–3.09)	0.013	1.40 (0.82–2.45)	0.233	0.72 (0.29–1.88)	0.483
FLR
Low	Ref		Ref		Ref
High	1.90 (1.34–2.69)	<0.001	1.70 (1.14–2.53)	0.009	4.54 (1.99–10.60)	<0.001

Abbreviations: CA19-9, carbohydrate associated antigen 19–9; FLR, fibrinogen-to-lymphocyte ratio; OR, odds ratio; CI, confidence interval.

Figure 3 Distribution of FLR in terms of different clinicopathological variables. (A) T stage. (B) Tumor site. (C) Lauren type. (D) Tumor size. (E) Sex. (F) Grade. (G) CA199.

Abbreviation: FLR, fibrinogen-to-lymphocyte ratio.

Figure 4 Development and evaluation of the nomogram for predicting LNM in patients with cN0 AGC. (A) Nomogram. (B) Calibration curves. (C) ROC curves. (D) Decision curve analysis.