Combined Neutrophil-to-Lymphocyte and Platelet-Volume-to-Platelet Ratio (NLR and PVPR Score) Represents a Novel Prognostic Factor in Advanced Gastric Cancer Patients

Abstract

Background: Chemotherapy is a cornerstone of treatment in advanced gastric cancer (GC) with a proven impact on overall survival, however, reliable predictive markers are missing. The role of various inflammatory markers has been tested in gastric cancer patients, but there is still no general consensus on their true clinical applicability. High neutrophil-to-lymphocyte (NLR) and low (medium)-platelets-volume-to-platelet ratio (PVPR) are known markers of unspecific immune system activation, correlating significantly with outcomes in advanced GC patients. Methods: Metastatic GC patients (N:155) treated with chemotherapy +/− trastuzumab were enrolled in this retrospective study. Pre-treatment NLR and PVPR, as well as other inflammatory markers were measured in peripheral blood. Univariate Cox regression was conducted to find markers with a significant impact on overall survival (OS) and progression-free survival (PFS). Spearman correlation and Cohen’s kappa was used to analyze multicollinearity. Multiple multivariable Cox regression models were built to study the combined impact of NLR and PVPR, as well as other known prognostic factors on OS. Results: Elevated NLR was significantly associated with increased risk of death (HR = 1.95; 95% CI: 1.17–3.24), and lower PVPR was significantly associated with improved outcomes (HR = 0.53; 95% CI: 0.32–0.90). A novel inflammatory marker, based on a combination of NLR and PVPR, allows for the classification of GC patients into three prognostic groups, characterized by median OS of 8.4 months (95% CI 5.8–11.1), 10.5 months (95% CI 8.8–12.1), and 15.9 months (95% CI 13.5–18.3). Conclusion: The NLR and PVPR score (elevated NLR and decreased PVPR) is a marker of detrimental outcome of advanced GC patients treated with chemotherapy.

Albumin/fibrinogen ratio, a predictor of chemotherapy resistance and prognostic factor for advanced gastric cancer patients following radical gastrectomy

“…Platelet to lymphocyte ratio (PLR), another peripheral blood-derived inflammation marker, has also been reported to be a prognostic factor in advanced GC patients after radical resection [ 20 , 21 ]. In addition, the combination of NLR and PLR was also recognized as a promising predictor for tumor response and prognosis in advanced GC patients [ 22 , 23 ]. Dysregulated noncoding RNAs are also involved in the mechanisms of chemotherapy resistance and have the potential to serve as novel therapeutic targets and prognostic biomarkers for GC [ 24 , 25 ].…”

Changes in Neutrophil to Lymphocyte Ratio, Lymphocyte to Monocyte Ratio, and Platelet to Lymphocyte Ratio During Palliative Radiotherapy May Predict Efficacy of Immune Checkpoint Inhibitor as Re-Challenge Treatment in Advanced Gastric Cancer: A Case Report

“…In recent years, systematic inflammation markers including NLR, LMR, and PLR have been reported as indicators of systematic response for cancer treatment strategies. High NLR and PLR and low LMR are supposed as markers of unspecific immune system activation, correlating significant poor clinical outcomes in various cancers including advanced gastric cancer patients ( 15 ), small cell lung cancer ( 16 ), colorectal cancers ( 17 , 18 ), pancreatic cancer ( 19 ), and non-small cell lung cancers ( 8 ). However, in previous literatures, only internal factors including NLR, LMR, and PLR, which were evaluated before systematic treatment, had been adequately investigated.…”

Model based on preoperative clinical characteristics to predict lymph node metastasis in patients with gastric cancer

“…we found that preoperative CEA level and CA19-9 level were independent risk factors for LNM in GC. NLR and PLR are common serum markers, they can reflect the state of inflammation, and they are related to the prognosis of GC patients (24). Few studies were comparing the risk factor of LNM with NLR (PLR).…”