Evaluation of systemic inflammatory and nutritional indexes in locally advanced gastric cancer treated with adjuvant chemoradiotherapy after D2 dissection

Abstract

BackgroundMany studies have shown that the peripheral blood inflammatory index and nutritional index, such as the platelet lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), lymphocyte monocyte ratio (LMR), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), systemic immune-inflammation index (SII), and prognostic nutrition index (PNI), are independent prognostic factors for tumors. The present study aimed to investigate the prognostic role of these peripheral blood indexes before treatment in locally advanced gastric cancer (LAGC) treated with adjuvant chemoradiotherapy after D2 dissection.MethodsA total of 89 patients with LAGC who underwent D2 gastrectomy and adjuvant chemoradiotherapy at our hospital from 2010–2018 were eligible. Systemic inflammatory indicators before treatment were evaluated. Receiver operating characteristic curve (ROC), Kaplan–Meier analysis, and Cox regression were utilized for prognosis evaluation.ResultsThe median follow-up time was 29.1 (4.1–115.8) months. The overall survival at 3 years (OS) and the disease-free survival (DFS) were 78.9% and 59.1%, respectively. According to the ROC curve for 3-year DFS, the best cut-off values of pre-treatment NLR, PLR, LMR, SII, SIRI, PIV and PNI were 1.7, 109.3, 2.9, 369.2, 0.58, 218.7, and 48, respectively. Multivariate Cox regression analysis showed that NLR was an independent prognostic factor for DFS (HR 2.991, 95%CI 1.085–8.248, P = 0.034). Kaplan-Meier analysis showed that a higher NLR (>1.70) was significantly associated with a poorer OS (3-year OS: 68.8% vs 92.9%, P = 0.045) and DFS (3-year DFS: 47.5% vs 80.9%, P = 0.005). In terms of the free locoregional recurrence rate (LRR), the prognosis of patients with high NLR was also significantly worse than those with low NLR (70.2% vs 96.0%, P = 0.017). Paraaortic lymph nodes were the most common site of LRR (7/14 patients). The seven cases of paraaortic lymph node metastasis occurred in patients with high NLR.ConclusionsIn our retrospective analysis, we found that pretreatment NLR could serve as a prognostic factor for survival in LAGC treated with adjuvant chemoradiotherapy after D2 dissection, especially for the prediction of LRR and paraaortic lymph node metastasis. Prospective studies are needed to confirm our findings.

Prognostic value of neutrophil to lymphocyte ratio in gastric cancer patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis

“…Wang et al. demonstrated that pretreatment NLR could be a prognostic factor for survival in locally advanced gastric cancer receiving adjuvant chemotherapy after D2 resection ( 40 ).…”

Development and validation of an inflammatory biomarkers model to predict gastric cancer prognosis: a multi-center cohort study in China

“…As a result, there has been an increased focus on systemic inflammatory parameters, especially those measured by simple laboratory tests (e.g., platelet, leukocyte, neutrophil, lymphocyte, and albumin analyses). Recent studies have confirmed that many inflammatory factors, such as peripheral blood neutrophil-to-lymphocyte ratio (NLR) [ 13 ], platelet-to-lymphocyte ratio (PLR) [ 14 ], lymphocyte-to-monocyte ratio (LMR) [ 15 ] and systemic immune-inflammatory index (SII) [ 16 ], are closely associated with the prognosis of patients with gastric cancer. However, most current studies focus on the prognosis value of GC with a single inflammatory factor, and few studies have considered to establish a prognosis model by different combinations of inflammatory factors for gastric cancer.…”