*3.2.2. Metastases in regional lymph nodes: N*

In patients diagnosed with resectable gastric cancer, high PLR correlated with higher number of lymph node metastases [16]. The association between high PLR and presence of lymph node metastasis was re-confirmed by a meta-analysis of 8 studies comprising 4513 patients with gastric cancer. Elevated PLR showed association with lymph node metastasis with the relevant odds ratio of 1.50 (OR 1.24–1.82) as reported by Xu et al. [85]. In another meta-analysis comprising 14 cohorts and 6280 cases, elevated PLR also was significantly associated with lymph node metastases [86]. However, in a multicentre study of 245 gastric cancer patients, PLR was not associated with N [61].

PLR has been investigated as predictive factor for lymph node metastases in a cohort of surgically treatable gastric cancer comprising 492 patients. PLR was identified as an independent predictive factor for lymph node metastasis and along with other independent prognostic factors that can be determined preoperatively was included in scoring system. This complex



**Study group** **Characteristics**

Patients with confirmed

103

170

GC diagnosis

Patients with confirmed

245

160

Ref. [87]

OS

Kaplan-Meier

PLR correlated

[61]

with T and stage

but not survival

analysis

Multicentre study

GC diagnosis

**Surgically treated GC**

GC patients subjected

873

117

ROC analysis

OS

Kaplan-Meier

Higher PLR is

[30]

associated with

worse OS

analysis

to curative resection

Operable GC patients

Operable patients with

312

106

ROC analysis

N

Multivariate

PLR was an

[72]

independent factor

predicting N+ and

was incorporated

in complex score

early GC

Surgically treated GC

GC patients undergoing

632

140

ROC analysis

OS

Multivariate

PLR was associated

[45]

with OS by

univariate but

not multivariate

analysis

gastrectomy

207

3-tiered complex

ND

OS

Multivariate

PLR was associated

[63]

with OS and CFS

by univariate but

not multivariate

analysis

CFS

scoring

492

155.67

ROC analysis

N

Multivariate

PLR was an

[55]

independent factor

predicting N+ and

was incorporated

in complex score

**Size**

**Value**

**Approach**

Median

OS

Kaplan-Meier

PLR is associated

[56]

with worse OS in

advanced but not

local GC

analysis

**Cut-off**

**Study target**

**Level of** 

**Main conclusions**

**References**

168 Gastric Cancer

**justification**

of metastases in regional lymph nodes; ND, no data available; CFS, cancer-free survival; CSS, cancer-specific survival.

**Table 3.** Cut-offs of PLR in gastric cancer studies. score consisted of NLR (cut-off 1.59), PLR (cut-off 155.67), T/depth of invasion, macroscopic type according to Bormann and tumour size [55].

As previously outlined, lymph node status is crucial to select the most appropriate treatment in early gastric cancer. PLR has been analysed in this context. In a retrospective assessment of 312 early gastric cancer cases subjected to surgical treatment, high PLR along with high NLR was significantly associated with lymph node metastases. Although both PLR and NLR showed this association by univariate analysis, only PLR was identified as an independent risk factor by multivariate analysis. Thus PLR, but not NLR was included in a complex score. The scoring system was based on the identified independent risk factors: PLR (cut-off 106, based on ROC analysis), age, tumour size, grade and depth of invasion and successfully validated in a prospective training set [72].
