Abstract
To explore the value of systemic inflammatory markers as independent prognostic factors and the extent these markers improve prognostic classification for patients with inoperable advanced or metastatic gastric cancer (GC) receiving palliative chemotherapy. We studied the prognostic value of systemic inflammatory factors such as circulating white blood cell count and its components as well as that combined to form inflammation-based prognostic scores (Glasgow Prognostic Score (GPS), Neutrophil-Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Prognostic Index (PI) and Prognostic Nutritional Index (PNI)) in 384 patients with inoperable advanced or metastatic gastric cancer (GC) receiving first-line chemotherapy. Univariate and multivariate analyses were performed to examine the impact of inflammatory markers on overall survival (OS). Univariate analysis revealed that an elevated white blood cell, neutrophil and/or platelet count, a decreased lymphocyte count, a low serum albumin concentration, and high CRP concentration, as well as elevated NLR/PLR , GPS, PI, PNI were significant predictors of shorter OS. Multivariate analysis demonstrated that only elevated neutrophil count (HR 3.696, p=0.003) and higher GPS (HR 1.621, p=0.01) were independent predictors of poor OS. This study demonstrated elevated pretreatment neutrophil count and high GPS to be independent predictors of shorter OS in inoperable advanced or metastatic GC patients treated with first-line chemotherapy. Upon validation of these data in independent studies, stratification of patients using these markers in future clinical trials is recommended.
Highlights
Gastric cancer is the fourth most frequent malignancy and the second leading cause of cancer-related mortality (Herszenyi et al, 2010)
We studied the prognostic value of systemic inflammatory factors such as circulating white blood cell count and its components as well as that combined to form inflammation-based prognostic scores (Glasgow Prognostic Score (GPS), Neutrophil-Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Prognostic Index (PI) and Prognostic Nutritional Index (PNI)) in 384 patients with inoperable advanced or metastatic gastric cancer (GC) receiving first-line chemotherapy
Univariate analysis revealed that an elevated white blood cell, neutrophil and/or platelet count, a decreased lymphocyte count, a low serum albumin concentration, and high C-reactive protein (CRP) concentration, as well as elevated NLR/platelet-lymphocyte ratio (PLR), GPS, PI, PNI were significant predictors of shorter overall survival (OS)
Summary
Gastric cancer is the fourth most frequent malignancy and the second leading cause of cancer-related mortality (Herszenyi et al, 2010). Palliative chemotherapy for advanced or metastatic disease can improve survival and quality of life in patients with gastric cancer (Murad et al, 1993; Pyrhonen et al, 1995; Glimelius et al, 1997). The value of these markers as independent prognostic factors and the extent these markers improve prognostic classification for patients with inoperable advanced or metastatic GC receiving first-line chemotherapy remains uncertain. The laboratory variables were analyzed as categorical variables using standard thresholds Dichotomization of these variables was based on the upper (white blood cells, neutrophils, platelets and CRP) and the lower (albumin and lymphocytes) ranges of normal measurements for these markers. All p-values were two-sided and p
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