The clinical value and usage of inflammatory and nutritional markers in survival prediction for gastric cancer patients with neoadjuvant chemotherapy and D2 lymphadenectomy

Li, Ziyu; Li, Shuangxi; Ying, Xiangji; Zhang, Lianhai; Shan, Fei; Jia, Yongning; Ji, Jiafu

doi:10.1007/s10120-019-01027-6

Cited by 54 publications

(55 citation statements)

References 23 publications

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“…However, the post-treatment NRL shows less significance than the pre-treatment NRL. This could be partly explained by the bone morrow suppression of the NAD-CT and other biological parameters, as already reported by several authors [9,35,36].…”

Section: Discussionsupporting

confidence: 72%

Predictive value of NLR, TILs (CD4+/CD8+) and PD-L1 expression for prognosis and response to preoperative chemotherapy in gastric cancer

Zurlo

Schino

Strippoli

et al. 2021

Cancer Immunol Immunother

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The combination of perioperative chemotherapy plus complete surgical resection is currently accounted as the first-choice strategy in patients with locally advanced Gastric Cancer (LAGC). Nevertheless, the partial response rate makes it necessary to search biological parameters useful to select patients who would benefit most from neoadjuvant chemotherapy (NAD-CT). We performed a retrospective analysis on a cohort of 65 LAGC cases, EBV negative and without MMR defect, submitted to perioperative chemotherapy plus surgical resection. We evaluated the neutrophil-lymphocytes ratio (NLR) in peripheral blood, the TILs density (reported as CD4/CD8 tissue ratio) and PD-L1 expression by immunohistochemistry on bioptic tissues before the treatment. Results were correlated with the biological features, histological response (TRG) and clinical outcome (PFS and OS). We found that NLR, TILs and PD-L1 expression showed a significant correlation with TNM stage, lymphovascular invasion and response to NAD-CT (TRG). Correlating the NLR, TILs and PD-L1 expression with PFS and OS, we found that patients with lower NLR levels (< 2.5 ratio), lower TILs (< 0.2 ratio) and higher PD-L1 level (CPS ≥ 1) had a significantly better PFS and OS than those with higher NLR, higher TILs and lower PD-L1 expression (p < 0.0001). Multivariate and multiple regression analyses confirmed the predictive and prognostic role of all three parameters, especially when all three parameters are combined. Our study demonstrated that pre-treatment NLR, TILs and PD-L1 expression are predictive and prognostic parameters in NAD-CT-treated LAGC suggesting a pivotal role of the systemic and tumor microenvironment immunological profile in the response to chemotherapy.

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Section: Discussionsupporting

confidence: 72%

Predictive value of NLR, TILs (CD4+/CD8+) and PD-L1 expression for prognosis and response to preoperative chemotherapy in gastric cancer

Zurlo

Schino

Strippoli

et al. 2021

Cancer Immunol Immunother

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“…Data from the JCOG0405 [42], JCOG1002 [43] and JCOG0210 [44] studied performed in Japan also showed that LAGC cases combined with swollen lymph nodes, a tumor diameter > 7 cm and linitis plastica greatly benefit from NAT. As for inflammation and immune related factors such as PLR and NLR, one group [45] also confirmed that elevated pre-treatment NLR levels showed value in survival prediction. One Germany study included a retrospective GC cohort of 410 patients revealed that tumor originated in the upper 2/3 part of the stomach tend to had a better response to NAT [46].…”

Section: Discussionmentioning

confidence: 60%

Indications of neoadjuvant chemotherapy for locally advanced Gastric Cancer patients based on pre-treatment clinicalpathological and laboratory parameters

Wang¹,

Zhang²,

Guo³

et al. 2020

J. Cancer

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Objective: There are controversial indications for neoadjuvant chemotherapy (NAT) in the treatment of locally advanced gastric cancer (LAGC). Here, we aimed to identify indications for NAT based on pre-treatment clinicopathological and laboratory parameters. Methods: This study included a retrospective cohort of 1083 LAGC patients who had underwent radical D2 gastrectomy in the Cancer Hospital of China Medical University between 2012 and 2016. After propensity score matching, 756 patients were recruited and were separated into NAT (n=378) or primary surgery (PS) (n=378) groups. Cox regression identified pre-treatment risk factors for overall survival (OS). A nomogram was established to predict OS and calculate scores for risk factors. Recursive partitioning analysis (RPA) determined cut off values, where the entire patient cohort was divided into low and high risk groups. Results: Seven risk factors that were significantly related to OS were incorporated in the nomogram. These risk factors included age, tumor size, tumor site, carbohydrate antigen 199 (CA199), carcino-embryonic antigen (CEA), clinical T stage (cT) and clinical N stage (cN). The model contained a C-index of 0.637. The calibration curve revealed anticipated values that were reflective of actual values. The decision curve revealed an achievement of optimal clinical impact when threshold possibility was 0-54%. Next, the cohort was split into low (≤ 252 points) or high (> 252 points) risk groups based on the 5-year OS projected by RPA. The PS group showed a worse OS compared to the NAT group for high-risk patients (P =0.004). There was no significant difference when comparing OS between the PS and NAT groups for low-risk patients (P =0.407). Conclusions: A feasible, quantifiable and practical prognostic tool was generated to screen for potential survival benefits for patients receiving NAT. Surgeons can use this model to identify optimal treatment regimens for individualized treatment strategies during the diagnosis of LAGC patients. For these patients, NAT is suggested for high-risk patients.

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“…The cut-off value is an important factor that affects the predictive power of SII. When Huang (32,33). We observed that the cut-off value suitable for different ages may not be consistent.…”

Section: Discussionmentioning

confidence: 81%

Prognostic value of systemic immune-inflammatory index in survival outcome in gastric cancer: a meta-analysis

S¹,

Jin²,

Tan³

et al. 2021

J Gastrointest Oncol

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Background: In recent years, many studies have reported that the systemic immune-inflammatory index (SII) can be used to predict the prognosis of cancer patients; however, this finding remains controversial in gastric cancer (GC). Therefore, the purpose of this study was to systematically and comprehensively probe the prognostic role of SII in GC. Methods: Relevant publications were extracted from PubMed, EMBASE, Cochrane Library databases, and WANFANG DATA (Chinese database). The included studies had patients with pathologically confirmed GC and long-term follow-up data. The patient's outcome was death, recurrence, or status at the end of follow-up. The studies included randomized controlled tests, case-control studies, or cohort studies using a multivariate proportional hazard model adjusted for survival outcomes. Cochran's Q test and Higgins' I-squared statistic were performed to assess heterogeneity. Publication bias was assessed by visual inspection of a Begg's funnel plot. Results: A total of 6,925 patients in 11 studies were included. The pooled hazard ratio (HR) indicated that a higher SII value was significantly associated with worse overall survival (OS) [HR: 1.53, 95% confidence interval (CI): 1.27-1.83] and worse disease-free survival (DFS) (HR: 1.57, 95% CI: 1.24-1.97) in GC patients. In the subgroup analysis, the HR was 1.72 (95% CI: 1.51-1.95) and 1.27 (95% CI: 0.96-1.67) in the group of patients aged <59 and ≥59 years, respectively. Conclusions: The pooled HR indicates that a higher SII in younger patients with GC predicts a poor prognosis. In elderly patients with GC, the prognostic role of SII needs further research.

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The clinical value and usage of inflammatory and nutritional markers in survival prediction for gastric cancer patients with neoadjuvant chemotherapy and D2 lymphadenectomy

Cited by 54 publications

References 23 publications

Predictive value of NLR, TILs (CD4+/CD8+) and PD-L1 expression for prognosis and response to preoperative chemotherapy in gastric cancer

Predictive value of NLR, TILs (CD4+/CD8+) and PD-L1 expression for prognosis and response to preoperative chemotherapy in gastric cancer

Indications of neoadjuvant chemotherapy for locally advanced Gastric Cancer patients based on pre-treatment clinicalpathological and laboratory parameters

Prognostic value of systemic immune-inflammatory index in survival outcome in gastric cancer: a meta-analysis

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