Bao Lin, Shijie Sun, Hongjian Zhang, Changqing Lin, Yuanlong Chi
PLR exhibits distinct dynamic change trajectories from surgery to chemotherapy in rectal cancer patients. The persistently decreasing PLR pattern identified by GBTM is associated with lower complication rates and superior long-term survival, suggesting its potential utility in postoperative risk stratification.
PURPOSE: To investigate the association of dynamic platelet-to-lymphocyte ratio (PLR) change trajectories, grouped via Group-Based Trajectory Modeling (GBTM), with short-term outcomes and survival prognosis in patients undergoing laparoscopic radical resection for rectal cancer.
METHODS: Clinical data of patients who underwent laparoscopic radical resection for rectal cancer at Sanming First Hospital Affiliated to Fujian Medical University between February 2016 and January 2020 were retrospectively analyzed. GBTM was applied to PLR values measured at five time points: preoperatively (T0) to before the fourth postoperative adjuvant chemotherapy session (T4), to identify distinct PLR trajectories. Clinicopathological characteristics, perioperative indicators, complications, and survival were compared among trajectory groups.
RESULTS: GBTM identified three distinct PLR trajectories: Increasing Group (IG, n=67, 27.2%), Increasing-Decreasing Group (IDG, n=90, 36.6%), and Decreasing Group (DG, n=89, 36.2%). The incidence of grade II or higher postoperative complications was significantly lower in the DG group (7.9%) compared to the IG (20.9%) and IDG groups (11.1%) (P = 0.046). The 5-year overall survival (OS) rate for the entire cohort was 68.3%. Survival analysis showed that the 5-year OS rates of patients in the DG and IDG groups were significantly higher than that in the IG group (P < 0.05).Multivariate Cox analysis identified age ≥65 years (HR = 1.803, P = 0.017), N2 stage (HR = 1.724, P = 0.041), and poor differentiation (HR = 2.009, P = 0.003) as independent risk factors. Compared to the IG group, the IDG (HR = 0.497, P = 0.012) and DG groups (HR = 0.365, P = 0.001) remained protective factors in the multivariable-adjusted Cox model.
CONCLUSION: PLR exhibits distinct dynamic change trajectories from surgery to chemotherapy in rectal cancer patients. The persistently decreasing PLR pattern identified by GBTM is associated with lower complication rates and superior long-term survival, suggesting its potential utility in postoperative risk stratification.