The Role of Baseline Inflammatory Response Biomarkers in Predictingthe Prognosis in No Metastatic Gastric Cancer Patients Treated with Preoperative Chemoradiation

Abstract

Purpose: To evaluate the prognostic potential of inflammatory response biomarkers neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) in predicting the outcome of gastric cancer patients undergoing neoadjuvant chemoradiation prior to surgical resection. Methods: Patients with localized, gastric adenocarcinoma received two cycles of induction chemotherapy of fluorouracil, docetaxel, and cisplatin (TPF) followed by 45 Gy of radiation and concurrent fluorouracil plus docetaxel then surgery for non-metastatic patients. Baseline NLR, dNLR, PLR and LMR calculated from peripheral blood cell count taken at pre-operation were compared with clinicopathological parameters. The prognostic value of baseline NLR, dNLR, PLR and LMR for disease free survival (DFS) and overall survival (OS) were assessed using Log rank and Cox regression. Results: The final analysis included 80 patient who had resection after neoadjuvant chemoradiation. The receiver operating curve (ROC) cut off values of baseline NLR, dNLR, LMR and PLR in predicting outcome were 2.4, 1.7, 5.1 and 130 respectively. Elevated NLR, dNLR, PLR, LMR, age of patients (≥ 50 years), stage III, grade 3 tumors, R1 resection and partial response to preoperative chemoradiation course with >10% residual tumor were significantly associated with decreased OS, and DFS. Multivariate analysis revealed that elevated NLR and dNLR were independent factors for worse OS and DFS hazard ratio (HR) 2.04 (95% CI=2.41-8.24), 6.63 (95% CI, 1.61- 10.32) and DSF with (HR) 1.84 (95% CI=3.27-7.36), 4.63 (95% CI=3.61-12.12) respectively. Conclusion: The baseline NLR, dNLR, LMR and PLR showed a significant association with different clinicopathological prognostic factors in gastric cancer patients receiving preoperative chemoradiation. Additionally, NLR, dNLR may be considered as potential independent prognostic indicators of clinical outcomes in this group of patients.