title: The Granulocyte-to-Lymphocyte Ratio as a Marker of Surgical Stress and a Predictor of Postoperative Infectious Complications After Gastric Cancer Surgery: An Analysis of Patients Enrolled in a Prospective Randomized Trial.
abstract: BACKGROUND
  The granulocyte-to-lymphocyte ratio (GLR) in the blood may be a useful marker of surgical stress (SS) following surgery for cancer. The aim of the present study was to compare the SS by measuring the GLR, and further study the value of the GLR in predicting postoperative infectious complications (ICs).
  
  
  METHODS
  Data from 201 gastric cancer patients at Fujian Medical University Union Hospital who were enrolled in our prospective randomized controlled trial were extracted for this study. Blood samples to perioperatively measure the GLR were routinely taken. Additional external validation was performed using the dataset (n = 135) from Nanfang Hospital who were enrolled in the same trial.
  
  
  RESULTS
  Patients undergoing either laparoscopic or open resection showed a similar preoperative GLR, as well as similar GLRs, on postoperative days (PODs) 1 and 3. The GLR on POD 5 was lower in the laparoscopic group compared with the open group (p = 0.014), and the optimal predictive GLR thresholds of postoperative ICs in both the laparoscopic and open groups were the same on POD 5, i.e. 6.5 and 7.4, respectively. The GLR on POD 5 was identified as an independent factor for postoperative ICs in both the laparoscopic and open groups. Similar results were found in the validation dataset.
  
  
  CONCLUSIONS
  The GLR status not only correlates with SS but may also be a reliable predictor of ICs for gastric cancer patients after gastrectomy. The ideal GLR thresholds on POD 5 for ICs following laparoscopic and open gastrectomy are 6.5 and 7.4, respectively.
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Long-Long
authors.initials: LL
authors.lastname: Cao
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Chao-Hui
authors.initials: CH
authors.lastname: Zheng
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Xie
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Jia-Bin
authors.initials: JB
authors.lastname: Wang
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Jian-Xian
authors.initials: JX
authors.lastname: Lin
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Qi-Yue
authors.initials: QY
authors.lastname: Chen
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Mi
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Ru-Hong
authors.initials: RH
authors.lastname: Tu
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China. gzliguoxin@163.com.
authors.forename: Guo-Xin
authors.initials: GX
authors.lastname: Li
authors.affiliation: Department of Gastric Surgery, Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. hcmlr2002@163.com.
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Huang
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006098:Granulocytes; D006801:Humans; D007239:Infections / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000097:blood* / Q000601:surgery*; D013312:Stress, Physiological / Q000276:immunology
chemical_list: D014408:Biomarkers, Tumor