Abstract
Various blood cell ratios exist which seem to have an impact on prognosis for resected gastric cancer patients. The aim of this systematic review was to investigate the prognostic role of blood cell ratios in patients with gastric cancer undergoing surgery in a curative attempt. A systematic literature search in MEDLINE (via PubMed), CENTRAL, and Web of Science was performed. Information on survival and cut-off values from all studies investigating any blood cell ratio in resected gastric cancer patients were extracted. Prognostic significance and optimal cut-off values were calculated by meta-analyses and a summary of the receiver operating characteristic. From 2831 articles, 65 studies investigated six different blood cell ratios (prognostic nutritional index (PNI), lymphocyte to monocyte ratio (LMR), systemic immune-inflammation index (SII), monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR)). There was a significant association for the PNI and NLR with overall survival and disease-free survival and for LMR and NLR with 5-year survival. The used cut-off values had high heterogeneity. The available literature is flawed by the use of different cut-off values hampering evidence-based patient treatment and counselling. This article provides optimal cut-off values recommendations for future research.
Highlights
Gastric cancer (GC) is the fifth most common malignancy, and the third most common cause of cancer-related death worldwide
The aim of this systematic review was to investigate the prognostic role of blood cell ratios in patients with gastric cancer undergoing surgery in a curative attempt
While for Prognostic nutritional index (PNI) a validated cut-off value exists of 45 [87], which is recommended for future use, only a minority of the included studies used this validated cut-off value
Summary
Gastric cancer (GC) is the fifth most common malignancy, and the third most common cause of cancer-related death worldwide. GC caused 783,000 deaths worldwide in 2018 [1]. Radical surgery in combination with multimodal therapy remains the only curative treatment option, depending on the tumor stage. Apart from the tumor cells with defined genetic alterations, which can be targeted in modern treatment regimens [2,3], the tumor communicates/interacts with surrounding cells in the microenvironment. The tumor microenvironment is a very complex process and not completely yet understood. One part of the microenvironment includes inflammatory cells. Understanding the influence of cancer cells on immune reactions may help to find new approaches in cancer treatment
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