Prognostic significance of Inflammatory and Nutritional Markers in Perioperative Period for Patients with Advanced Gastric Cancer

Abstract

Abstract Background: It has been reported that inflammatory and nutritional markers are related to prognosis in numerous malignancies. The present study analyzed the significance of these markers’ alterations during neoadjuvant chemotherapy in the long-term outcomes in patients with advanced gastric cancer. Methods: A retrospective review was performed of 437 advanced gastric cancer patients who underwent a neoadjuvant chemotherapy (NACT) regimen followed by surgical treatment. Blood samples for inflammatory and nutritional markers were collected from the patients before the first neoadjuvant chemotherapy and after the last neoadjuvant chemotherapy. Statistical analysis, including MannWhitney U or chisquare tests, the KaplanMeier method and Cox multivariate analysis, were performed to analyze the predictive value of these markers for overall survival outcomes (OS). Results: Most biomarkers, including lymphocyte, leucocyte, neutrophil, monocyte, platelet, LMR, PLR, SII, CRP, CAR, hemoglobulin and albumin levels, changed during NACT (P < 0.05). After separately grouping the patients according to the normal range of hematologic indexes and the change rate (α) of systemic inflammatory and nutritional markers by the cutoff value derived from X-tile (P < 0.05), we found that differentiation, TRG, pre-NACT BMI, pre-NACT platelet counts, post-NACT lymphocyte counts, the change in lymphocyte counts, change in platelet counts and LMR(α), PLR(α), SII(α), and CAR(α) were associated with OS. Multivariate analysis revealed that PLR (α) > -19% was correlated with a 3.193-fold (95% CI: 2.194–4.649) higher risk of death (P < 0.001) than others. Conclusion: NACT could significantly change several inflammatory and nutritional markers in the perioperative period; the platelet counts before NACT, and the change in lymphocytes during NACT truly correlated with long-term outcomes among patients with advanced gastric cancer. The systemic inflammatory marker PLR may be a reliable marker for the prediction of prognosis.