Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer

Abstract

BACKGROUND Gastric cancer (GC) is one of the most common malignant tumors in the world. Although in recent years tremendous progress has been made in its early detection, the postoperative overall survival (OS) of GC patients remains extremely low. A number of studies have shown that age, to varying degrees, affects the prognosis of patients with GC. Therefore, this study retrospectively analyzed the clinical and pathologic data of patients with GC to explore the differences in the clinical characteristics and prognostic factors in different age groups. AIM To explore the difference in clinicopathological characteristics and prognostic factors in GC patients in different age groups. METHODS In this retrospective study, we analyzed 1037 GC patients admitted to Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2010 to January 2013. The patients were divided into two groups based on age: Younger group (less than 70 years old) and older group (no less than 70 years old). In the younger group, we subdivided the patients in two subgroups by a cut-off value of 45 years. The clinical features and prognostic factors were analyzed in both groups. Subsequently, we retrieved studies that evaluated the predictive role of neutrophil-lymphocyte ratio (NLR) by searching two medical databases, PubMed and EMBASE, to conduct a meta-analysis. Random-effects model was used to pool the data. RESULTS In the retrospective study, the mean OS time of the younger group (64.7 mo) was significantly longer than that of the older group (48.1 mo) ( P < 0.001). Among patients under 70 years of age, hospitalization time, tumor–node–metastasis (TNM) stage, vascular invasion, and preoperative low pre-albumin were independently associated with OS ( P < 0.005). In patients aged 70 years and above, TNM stage, esophageal invasion, histological type, and preoperative NLR were independent factors for OS ( P < 0.05). The OS of these older patients was also significantly shorter ( P < 0.05). In the meta-analysis, 19 retrieved studies included a total of 8312 patients, among whom 3558 had elevated NLR values. The results showed that high NLR value was a risk factor for the prognosis of GC ( P < 0.01). CONCLUSION The OS of elderly patients is significantly worse than that of younger patients. There are significant differences in clinicopathological characteristics and prognostic factors between younger and older patients. NLR is a convenient, inexpensive, and reproducible marker that can be used as an important predictor of the prognosis of GC.

Prognostic significance of preoperative osteopenia on outcomes after gastrectomy for gastric cancer

“… 3 Higher PLR and NLR have been associated with poor survival in GC. 4 , 5 However, only a few studies have compared the effectiveness of multiple inflammatory response markers for predicting survival outcomes. In the current study, we identified the most suitable predictor and demonstrated that preoperative osteopenia was an independent risk factor for poor OS and DFS.…”

“…Wang et al reported that in 324 patients with GC, an elevated preoperative GPS was associated with a shorter OS and DFS 3 . Higher PLR and NLR have been associated with poor survival in GC 4,5 . However, only a few studies have compared the effectiveness of multiple inflammatory response markers for predicting survival outcomes.…”

“…Systemic inflammatory response markers based on preoperative laboratory tests, such as GPS, 3 PNI, 13 NLR, 4 and PLR, 14 were examined in this study. GPS scores were defined as a combination of C‐reactive protein (CRP) and albumin levels.…”

“…Increasing evidence shows that systemic inflammatory responses like Glasgow prognostic score (GPS), prognostic nutritional index (PNI), neutrophil‐lymphocyte ratio (NLR), and platelet‐lymphocyte ratio (PLR) are important in the prognosis of GC. 2 , 3 , 4 , 5 …”

“…Therefore, early identification of high‐risk patients with GC and provision of more active, comprehensive treatment will have a significant impact on the effectiveness of treatment. Increasing evidence shows that systemic inflammatory responses like Glasgow prognostic score (GPS), prognostic nutritional index (PNI), neutrophil‐lymphocyte ratio (NLR), and platelet‐lymphocyte ratio (PLR) are important in the prognosis of GC 2–5 …”