Prognostic Value Of Peripheral Inflammatory Index In Advanced Or Metastatic Gastric Cancer

Purposes:Gastric cancer(GC)is consider as high morbidity,high mortality,low early diagnosis rate and poor prognoses.Predicting the survival outcome is quite difficult nowadays.The aim of this study is to explore the potential prognostic value of peripheral inflammatory index: combined neutrophil–lymphocyte ratio(NLR)and platelets-lymphocytes ratio(PLR)in patients with recurrent or metastatic stage IV GC.Methods:The study included patients with recurrent or metastatic stage IV GC who received first-line chemotherapy for the first time on the Department of Medical Oncology of the First Affiliated Hospital of Zhejiang University from 2010.1 to 2017.12.NLR and PLR were calculated for peripheral blood inflammatory indicators detected in one week before treatment.According to the median value of NLR and PLR as cut-off value,The NLR-PLR score was obtained as a new predictive marker while combined with NLR and PLR,and the patients were divided into three groups through the NLR-PLR score: 0;1;2.The relationship of the peripheral inflammatory index and survival outcomes was compared by Kaplan-Meier method,log-rank test,univariate and multivariate analysis,and subgroup analysis.Results:A total of 466 patients with advanced GC were included in this study.Through the analysis of all included patients,the median overall survival(OS)and progression-free survival(PFS)were 15.5 months(0.7-96.8 months)and 6.7 months(0.5-30.4 months).Meanwhile,the history of GC operation(radical prostatectomy or palliative operation),tumor differentiation,NLR,PLR and combined NLR-PLR score were identified as independent prognostic factors according to the univariate and multivariate model for OS(all P <0.001).The Kaplan-Meier survival curves indicated that The median OS for patients with NLR-PLR scores of 0,1 and 2 were 22.5,15.7 and 11.2 months;the 5-year OS rates were 26.5%,12.5% and 6.2%(P <0.001);the median PFS time for patients with NLR-PLR scores of 0,1 and 2 were 7.8,7.1 and 5.2 months;the 1-year PFS were25.7%,20.0%,8.5%,respectively(P <0.001).In addition,subgroup analyses based on age,Carcinoembryonic Antigen(CEA),Carbohydrate Antigen 199(CA199),body mass index(BMI)and differentiation degree showed that an elevated NLR-PLR score was significantly associated with worse OS in GC patients with stage IV(all P <0.05).Patients receiving first-line chemotherapy with SOX in advanced GC showed significant correlation between NLR,PLR and NLR-PLR scores and OS,but no significant correlation with PFS.For patients receiving SPA first-line chemotherapy,only low NLR level showed significantly prolonged OS,while PLR,NLR-PLR score showed no significant difference with OS.But there were significant differences between NLR,PLR and NLR-PLR scores and PFS.However,there was no statistically significant difference in prognosis between different chemotherapy regimens at different NLR or PLR levels.Conclusions:The history of GC operation,tumor differentiation,NLR,PLR and combined NLR-PLR score were identified as independent prognostic factors according to the univariate and multivariate model for OS.High NLR,PLR and NLR-PLR score were associated with low survival outcome.Our study demonstrated that NLR,PLR and NLR-PLR score may be included on the list of pre-treatment factors that independentlypredicted survival outcome.However,it need to be confirmed by further prospective studies.