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Diagnostic Utility of NLR, PLR and MLR in Early Diagnosis of Gastric Cancer: an Analytical Cross-Sectional Study

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Abstract

Purpose

Inflammatory markers such as neutrophil–lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) are linked with the pathogenesis of gastric cancer (GC). However, the clinical significance of the combination of these markers is unclear. Hence, this study was carried out to determine the individual and combined diagnostic accuracy of NLR, PLR and MLR among patients with GC.

Methods

In this prospective, cross-sectional study, patients were recruited into three groups, GC, precancerous lesions and age and gender-matched controls. The primary outcome was to determine the diagnostic accuracy of inflammatory markers in the diagnosis of GC. The secondary outcome was to determine the correlation of inflammatory markers with the stage of gastric cancer, nodal involvement and metastasis.

Results

A total of 228 patients, 76 in each group, were enrolled. The cut-off value of NLR, PLR and MLR were 2.23, 146.8 and 0.26, respectively, for the diagnosis of GC. The diagnostic abilities of NLR, PLR and MLR were significantly high at 79, 75 and 68.4, respectively, to predict GC compared to precancerous and control groups. All the models of inflammatory markers showed excellent discrimination between GC and the controls with an AUC > 0.7. The models also showed acceptable discrimination between GC and the precancerous lesion group with AUC between 0.65 and 0.70. No significant difference was found in correlating inflammatory markers with clinicopathological features.

Conclusion

The discrimination capacity of the inflammatory markers could be used as screening biomarkers in diagnosing GC, even in its early stages.

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Data Availability

The datasets of the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the Department of Surgery, Pathology and Biochemistry of Jawaharlal Institute of Postgraduate Medical Education and Research for providing a clinical laboratory to conduct our study. We thank all technical staff from the Department of Biochemistry and Surgery for assisting in the sample processing. We acknowledge the help and expertise provided by Dr Ruben Raj L, Junior Resident, Department of Preventive and Social Medicine, JIPMER, in the analysis. We acknowledge the financial support received from Jawaharlal Institute of Postgraduate Medical Education and Research as intramural grant to conduct this study.

Funding

This work was supported by the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) intramural grant and grant ID: JIP/Res/Intramural/sub com/2020-21_108.

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Authors and Affiliations

  1. Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India

    Sandhya Karra, Mini Rajesh Rajalekshmy, T. P. Elamurugan, Vikram Kate & Gomathi Shankar

  2. Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, India

    Balakrishnan Gurushankari

  3. Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

    T. Mahalakshmy

  4. Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

    Nivedita Nanda

  5. Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

    Nachiappa Ganesh Rajesh

Authors
  1. Sandhya Karra
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Contributions

Vikram Kate contributed to the conception and design of the study. Vikram Kate contributed to the overall supervision and validation of the work; Sandhya Karra, Mahalakshmy T, Mini Rajesh Rajalekshmy and Balakrishnan Gurushankari contributed to the data collection and analysis of the data; Vikram Kate, Elamurugan T.P, Mahalakshmy T and Gomathi Shankar contributed to the interpretation of the data; Sandhya Karra, Mini Rajesh Rajalekshmy and Balakrishnan Gurushankari drafted and edited the manuscript under the supervision of Vikram Kate, Elamurugan T.P and Gomathi Shankar. All authors critically revised the manuscript, agreed to be fully accountable for ensuring the integrity and accuracy of the work and read and approved the final manuscript.

Corresponding author

Correspondence to Vikram Kate.

Ethics declarations

Ethics Approval

This analytical cross-sectional study was conducted prospectively after obtaining approval from the Institute Ethics Committee of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) (JIP/IEC/2018/319).

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Informed consent was obtained from all individual participants included in this study.

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The authors declare no competing interests.

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Karra, S., Gurushankari, B., Rajalekshmy, M.R. et al. Diagnostic Utility of NLR, PLR and MLR in Early Diagnosis of Gastric Cancer: an Analytical Cross-Sectional Study. J Gastrointest Canc 54, 1322–1330 (2023). https://doi.org/10.1007/s12029-023-00937-0

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