A Prognostic Model Using Inflammation- and Nutrition-Based Scores in Patients With Metastatic Gastric Adenocarcinoma Treated With Chemotherapy

Abstract

The outcomes of patients with metastatic gastric cancer (mGC) are poor. Recent studies have identified the prognostic impact of inflammatory response and nutritional status on survival for patients with gastric cancer. This study aims to create a prognostic model using inflammatory- and nutrition-based scores to predict survival in patients with mGC treated with chemotherapy.After institutional review board approval, patients who had mGC and were treated with chemotherapy from 2007 to 2012 at Kaohsiung Chang Gung Memorial Hospital were retrospectively reviewed. Significantly predictive factors were identified by multivariate Cox regression analyses. Based on these variables, a prognostic model using inflammatory- and nutrition-based scores was constructed to predict survival. Kaplan-Meier curves were plotted to estimate overall survival. The c-statistic values with 95% confidence interval (CI) were also calculated to access their predicting performances.Our study consisted of 256 patients with a median age of 60 years and a median follow-up visit of 18.5 months. Multivariate analyses showed that neutrophil to lymphocyte ratio (NLR), modified Glasgow prognostic score (mGPS), and Patient-Generated Subjective Global Assessment (PG-SGA) were independently related to survival. After computing these scores, patients were classified into favorable-, intermediate-, and poor-risk groups. The median overall survival were 27.6 versus 13.2 versus 8.2 months in favorable, intermediate, and poor-risk groups, respectively. The 2-year survival rate was 52% versus 16% versus 3% in favorable-, intermediate-, and poor-risk groups, respectively. (P < 0.001). The c-statistic value of our model at 2 years is 0.8 (95% CI, 0.75–0.86).NLR, mGPS, and PG-SGA were independently related to survival. Our prognostic model using inflammatory- and nutrition-based scores could provide prognostic information to patients and physicians.

Systemic Inflammatory Reaction in Gastric Cancer: Biology and Practical Implications of Neutrophil to Lymphocyte Ratio, Glasgow Prognostic Score and Related Parameters

“…This finding is in accordance with Cho et al, who also reported significantly higher chemotherapeutic disease control rate in metastatic advanced gastric cancer patients having low NLR, defined as less or equal to 3.0 [50]. Combined scores have been generated to evaluate the prognosis of metastatic gastric cancer as well [26].…”

“…The respective two-year survival rates were 52% vs. 16% vs. 3%. The ROC curve analysis confirmed that the novel score has higher informativity than any of its components [26].…”

“…Thus, complex predictive score regarding survival was elaborated, based on NLR and modified Glasgow prognostic score in patients with metastatic gastric adenocarcinoma treated by chemotherapy, after independent prognostic value of both parameters was justified in a group of 256 patients [26]. The design of studies devoted to GPS in gastric carcinoma is summarised in Table 5.…”

“…Overall survival and chemotherapy response NLR (cut-off 3.0) and fibrinogen (cut-off 400 mg/dL) [103] Prognosis and cancer characteristics NLR (cut-off 2.34) and fibrinogen (cut-off 305 mg/dL) [110] Overall survival Canton score: Overall and cancer-specific survival Platelet count and NLR [29] Overall and cancer-free survival Recurrence Metachronous liver metastases Coagulation score: increased level of fibrinogen and D-dimers [125] Overall survival NLR, mGPS and patient-generated subjective global assessment score [26] Abbreviations: PLR, platelet to lymphocyte ratio; ROC, receiver operating characteristic curve; NLR, neutrophil to lymphocyte ratio; T, local spread of primary gastric cancer by tumour-nodes-metastasis (TNM) classification; CSS, cancer-specific survival; CFS, cancer-free survival; mGPS, modified Glasgow prognostic score. Table 6.…”

“…For patients undergoing chemotherapy because of unresectable and recurrent advanced gastric cancer, NLR also shows independent prognostic significance [24]. NLR is an independent prognostic factor in metastatic gastric cancer [25] and in metastatic gastric cancer treated with chemotherapy [26]. The predictive value is limited in patients receiving palliative treatment for disseminated gastric cancer [21].…”