P-231 Systemic inflammatory biomarkers and their association with survival in gastroesophageal cancer patients: A retrospective single-center analysis

Abstract

Gastroesophageal cancer is a devastating disease with poor prognosis and limited treatment options. Recent large immunotherapy trials suggested that a subgroup of patients with advanced gastroesophageal cancer might benefit from addition of immunotherapy to chemotherapy. Even for patients with resectable tumors with high risk of recurrence, immunotherapy might extend disease-free survival. Despite these advances, immunotherapy still can only be recommended for a subset of patients and reliable prognostic and predictive biomarkers to identify this cohort are desirable. Potential interaction between inflammatory mechanisms and immunotherapy has been postulated for several oncological diseases. However, for understanding of the involvement of this mechanism in gastroesophageal cancers, further research is needed. We analyzed systemic inflammatory biomarkers at the time of first cancer diagnosis including leucocyte levels (WBC), C-reactive protein levels (CRP), neutrophil-to-lymphocyte ratio (NLR), leucocyte-to-lymphocyte ratio (LLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and CRP/Albumin ratio (CRP/Alb) as well as their association with the overall survival (OS) in patients with gastroesophageal cancer treated at the Medical University of Vienna between 1990 and 2020. Systemic inflammatory parameters were evaluated in 1086 patients (gender: 69% male; tumor localization: 32% gastroesophageal junction, 39% stomach, 29% esophagus; histology: 79% adenocarcinoma, 21% squamous cell carcinoma; 34% metastatic disease at first diagnosis; 73% dead at the time of analysis). WBC levels were elevated in 17% and CRP levels in 65% of patients. Elevated WBC (1051 patients; within the normal limit, n: 846, median OS: 19.6 months; below the normal limit, n: 32, median OS: 22.0 months; above the normal limit, n: 187, median OS: 12.8 months; p=0.019, HR: 1.133, CI: 1.035-1.240), as well as elevated CRP levels (994 patients; within the normal limit, n:300, median OS: 22.8 months; above the normal limit, n: 694, median OS: 16.0 months; p≤0.001, HR:1.187, CI: 1.090-1.293) were associated with a poorer OS. Differential blood count was available in 860 patients and CRP/Albumin ratio in 910 patients. NLR (median 3.3; SD 3.0; p≤0.001, HR=1.114, CI: 1.086-1.142), LLR (median 4.8; SD 3.2; p≤0.001, HR=1.108, CI: 1.082-1.134), PLR (median 173.6, SD 121.4; p≤0.001, HR=1.002, CI: 1.001-1.002), LMR (median 2.8; SD 2.3; p≤0.001, HR=0.886, CI: 0.844-0.931), and CRP/Albumin ratio (median 0.02; SD 0.14; p≤0.001, HR=5.030, CI: 3.291-7.688) were significantly associated with the OS. The results of this analysis from a large European cohort of gastroesophageal cancer patients suggest that systemic inflammatory biomarkers, which are routinely investigated as part of the diagnostic work-up, are associated with OS and, thus, might be feasible prognostic markers. This study could be an impulse for further prospective investigation of systemic inflammatory parameters and their prognostic as well as potential predictive value, especially in conjunction with novel immunotherapy treatment strategies.