Relationship Between Inflammatory Index And Prognosis Of Patients With Neoadjuvant Chemotherapy For Gastric Cancer

Introduction:Increased neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),and monocyte to lymphocyte ratio(MLR)have been reported to be associated with poor prognosis in many types of tumor.but,These inflammatory indicators have been less studied in patients with gastric cancer after neoadjuvant chemotherapy(NAC)+ D2 lymph node dissection.Objective:The purpose of this study was to investigate the relationship between baseline NLR,MLR,PLR,and dynamic changes of NLR,MLR,and PLR before and after neoadjuvant chemotherapy with the prognosis of gastric cancer patients who underwent NAC+D2 lymph node dissection.Whether the effect of neoadjuvant chemotherapy can be understood by the inflammatory indicators and their fluctuations before and after neoadjuvant chemotherapy?Methods: A retrospective analysis of 212 patients with locally advanced gastric cancer who underwent NAC combined with D2 lymph node dissection at the Fourth Hospital of Hebei Medical University from January 2016 to June 2017.The NLR,MLR,and PLR before and after NAC were divided into groups for exploratory analysis with different cutoff values,and the correlation of clinical pathological data was analyzed.Univariate and multivariate analyses of factors associated with overall survival(OS)disease progression(PFS)were performed by Cox hazard ratio model.The kaplan-meier method was used for the survival curve.Results:1.After NAC,NLR,PLR decreased in 212 patients,while MLR increased(all P < 0.05).2.Univariate analysis showed longer OS,PFS in patients with baseline PLR <197 or baseline NLR <3.1.Multivariate Cox regression showed that high baseline NLR was independently associated with poor OS and PFS.3.Changes in the inflammatory markers NLR,MLR,and PLR before and after NAC are negatively correlated with patient survival.Patients with low NLR or MLR or PLR before and after NAC had the best prognosis.4.Multivariate analysis showed that baseline PLR is independently related to tumor regression score,which can reflect the efficacy of NAC.5.Normalizing MLR(below cut-off value)after NAC improves patient survival.Conclusions: The baseline NLR is expected to be a prognostic factor for patients with gastric cancer after neoadjuvant chemotherapy with D2 lymph node dissection.And the baseline PLR may be an inflammatory indicator of NAC clinical efficacy judgment.