Neutrophil Count and the Inflammation-based Glasgow Prognostic Score Predict Survival in Patients with Advanced Gastric Cancer Receiving First-line Chemotherapy

Abstract

Purpose: To explore the value of systemic inflammatory markers as independent prognostic factors and the extent these markers improve prognostic classification for patients with inoperable advanced or metastatic gastric cancer (GC) receiving palliative chemotherapy. Methods: We studied the prognostic value of systemic inflammatory factors such as circulating white blood cell count and its components as well as that combined to form inflammation-based prognostic scores (Glasgow Prognostic Score (GPS), Neutrophil-Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Prognostic Index (PI) and Prognostic Nutritional Index (PNI)) in 384 patients with inoperable advanced or metastatic gastric cancer (GC) receiving first-line chemotherapy. Univariate and multivariate analyses were performed to examine the impact of inflammatory markers on overall survival (OS). Results: Univariate analysis revealed that an elevated white blood cell, neutrophil and/or platelet count, a decreased lymphocyte count, a low serum albumin concentration, and high CRP concentration, as well as elevated NLR/PLR , GPS, PI, PNI were significant predictors of shorter OS. Multivariate analysis demonstrated that only elevated neutrophil count (HR 3.696, p=0.003) and higher GPS (HR 1.621, p=0.01) were independent predictors of poor OS. Conclusion: This study demonstrated elevated pretreatment neutrophil count and high GPS to be independent predictors of shorter OS in inoperable advanced or metastatic GC patients treated with first-line chemotherapy. Upon validation of these data in independent studies, stratification of patients using these markers in future clinical trials is recommended.

Relationship Between Prognosis and Neutrophil: Lymphocyte and Platelet:Lymphocyte Ratios in Patients with Malignant Pleural Mesotheliomas

“…Preliminary studies showed that inflammation could be an important marker for cancer development. It was reported that chronic inflammation is involved in gastric, hepatic, intestinal, pulmonary, pancreatic, esophageal cancers and in the cancers of bladder and biliary tract (Klinger and Welkmann 2002;Cedres et al, 2012;Li et al, 2014). Although etiology and underlying mechanisms are unknown, it is suggested that toxic granules in the cytoplasm of neutrophils accounts from inflammation in neoplastic tissues by activating monocytes (Prete et al, 2011).…”

“…Thrombocytosis occurs as a result of megakaryocyte stimulation by pro-inflammatory mediators such as IL-1, IL-2 and IL-6. The level of platelets is a parameter that indicates severity of inflammation (Klinger and Welkmann 2002;Alexandrakis et al, 2003;Prete et al, 2011;Li et al, 2014). It was reported that survival was shorter in cases with neutrophilia and thrombocytosis (Edwards et al, 2000;Alexandrakis et al, 2003;Kwon et al, 2012).…”

“…In the literature, relationship between inflammation and neutrophil has been widely investigated in cancer. It is shown that white blood cell and subtypes have predictive and prognostic value in many cancer types (Klinger and Welkmann 2002;Prete et al, 2011;Li et al, 2014).…”

Novel immunological and nutritional-based prognostic index for gastric cancer

“…The optimal cut-off value is that which allows the prediction of 5-year OS with the best sensitivity and specificity [20] . According to the defined cut-off values for these three indices, patients were stratified into a PNI low or high group, a NLR low or high group, and a PLR low or high group (Table 1) [10,21] . Events occurring within 30 d after surgery were classified as postoperative complications or mortality.…”

“…However, its prognostic significance in gastric cancer has not been fully studied, and the mechanisms that link PNI to outcome remain unclear [7][8][9] . In addition to PNI, markers of systematic inflammation, such as the number of white blood cells, neutrophils, platelets, and lymphocytes, and the indices derived from these, including the neutrophil-lymphocyte ratio (NLR) [10,11] and platelet-lymphocyte ratio (PLR), have also been used as prognostic markers. NLR was found to be associated with survival in lung and ovarian cancers, while PLR was found to be associated with prognosis in pancreatic cancer [12][13][14][15] .…”