Neutrophil–Lymphocyte Ratio Predicts Overall Survival in Elderly Patients With Unresectable or Recurrent Gastric Cancer

Abstract

BackgroundThe relationship between various systemic inflammatory biomarkers and outcomes in patients with a variety of solid cancers has been reported. However, the relevance of these markers is unclear in elderly patients with unresectable or recurrent gastric cancer (GC). This retrospective study was conducted to identify specific factors associated with the survival of elderly patients with GC.Methods Patients with GC undergoing chemotherapy at our institution from April 2014 to April 2020 were included in the study. The patients were categorized into either the young group (Y group; aged <70 years) or the elderly group (E group; aged ≥70 years). The association between overall survival (OS) and pre-treatment values of systemic biomarkers, including the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio, and Glasgow prognostic score, was evaluated using the Kaplan–Meier method and log-rank test in each group. Univariate and multivariate analyses using Cox proportional hazards regression were used to investigate the prognostic factors associated with OS in each group.ResultsA total of 112 patients were eligible for inclusion in the analysis. The patients were categorized into the Y and E groups based on their age, and each group consisted of 56 patients. In both groups, high NLR and high Glasgow prognostic score were associated with poor OS (Y: p = 0.002 and p = 0.009; E: p < 0.001 and p = 0.045, respectively), whereas the platelet–lymphocyte ratio was not (Y: p = 0.296; E: p = 0.346). Univariate and multivariate Cox regression analyses revealed that poor performance status was correlated with poor OS in the Y group (hazard ratio: 2.56; 95% confidence interval: 1.02–6.43; p = 0.045). However, in the E group, NLR was the only independent prognostic factor of OS (hazard ratio: 4.22; 95% confidence interval: 1.69–10.56; p = 0.002). ConclusionsPoor performance status was an independent marker of poor prognosis in the Y group, whereas a high NLR was an independent marker in the E group. Thus, NLR may be a specific biomarker for predicting the OS of elderly patients with unresectable GC.