Abstract
Background: Chemotherapy is a cornerstone of treatment in advanced gastric cancer (GC) with a proven impact on overall survival, however, reliable predictive markers are missing. The role of various inflammatory markers has been tested in gastric cancer patients, but there is still no general consensus on their true clinical applicability. High neutrophil-to-lymphocyte (NLR) and low (medium)-platelets-volume-to-platelet ratio (PVPR) are known markers of unspecific immune system activation, correlating significantly with outcomes in advanced GC patients. Methods: Metastatic GC patients (N:155) treated with chemotherapy +/− trastuzumab were enrolled in this retrospective study. Pre-treatment NLR and PVPR, as well as other inflammatory markers were measured in peripheral blood. Univariate Cox regression was conducted to find markers with a significant impact on overall survival (OS) and progression-free survival (PFS). Spearman correlation and Cohen’s kappa was used to analyze multicollinearity. Multiple multivariable Cox regression models were built to study the combined impact of NLR and PVPR, as well as other known prognostic factors on OS. Results: Elevated NLR was significantly associated with increased risk of death (HR = 1.95; 95% CI: 1.17–3.24), and lower PVPR was significantly associated with improved outcomes (HR = 0.53; 95% CI: 0.32–0.90). A novel inflammatory marker, based on a combination of NLR and PVPR, allows for the classification of GC patients into three prognostic groups, characterized by median OS of 8.4 months (95% CI 5.8–11.1), 10.5 months (95% CI 8.8–12.1), and 15.9 months (95% CI 13.5–18.3). Conclusion: The NLR and PVPR score (elevated NLR and decreased PVPR) is a marker of detrimental outcome of advanced GC patients treated with chemotherapy.
Highlights
Data on 155 gastric cancer (GC) patients treated in the Department of Clinical Oncology, University
The choice of chemotherapy regimen was left to the discretion of the leading physician; the decision was based on the patient’s general condition, HER2 expression, and current therapeutic guidelines at a given time
The allocation of patients to chemotherapy could have been biased by the evolution of guidelines, which occurred over time, promoting the switch from 3-drug to 2-drug regimens in asymptomatic or mildly symptomatic patients or patients with suboptimal performance status
Summary
Interactions between the immune system and cancer are attracting considerable interest because of growing evidence of underlying correlations that are sometimes too elusive to be appropriately described. Many years of intensive evolution of the immuno-oncology field, which led to the introduction of checkpoint inhibitors, allowed us to predict, if not fully comprehend, the interplay between the immune system and malignancy in a way that is consistent and beneficial. Despite significant progress in systemic treatment, metastatic gastric cancer (GC). In this palliative setting, systemic chemotherapy still represents the 4.0/). Treatment of choice worldwide, with the potential to improve patients’ outcomes (overall survival and quality of life) [1]. Platinum-based chemotherapy is a cornerstone of the first-line treatment for stage IV gastric cancer [2]. In combination with capecitabine [4], 5-fluorouracil [5]
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