Significance of Systemic Inflammatory Markers as Prognostic Predictors in Stage II/III Gastric Cancer Among Older Patients

Background/Aim: Determining treatment for older patients is difficult because of their life expectancy and reduced physiological function. Recently, systemic inflammatory markers have been recognized as prognostic predictors in various cancers. However, few studies have focused on older patients with advanced gastric cancer. This study compared the prognostic significance of various markers in stage II and III gastric cancer in patients ≥75 years old.

Patients and Methods: In total, 133 cases of R0 excision for stage II/III gastric cancer in patents ≥75 years old were analyzed. The ratio of neutrophils to lymphocytes (NLR), the ratio of platelets to lymphocytes (PLR), C-reactive protein to albumin (CAR), the prognostic nutritional index (PNI), and the Glasgow Prognostic Score (GPS) were used as preoperative markers. Cutoff value was determined based on the time-dependent ROC curve with the 5-year survival rate as the endpoint. Patients were divided into two groups based on these cutoff values, and their prognoses were compared.

Results: The cutoff values for NLR, PLR, CAR, and PNI were 2.83, 272, 0.06, and 44.8, respectively. In multivariate analysis for overall survival (OS), NLR (HR=1.972, 95%CI=1.231-3.158, p=0.005), CAR (HR=1.855, 95%CI=1.166-2.952, p=0.009), and PNI (HR=0.585, 95%CI=0.356-0.960, p=0.034) were independent prognostic factors. The NLR-CAR score, calculated based on the NLR and CAR cutoff values, was also an independent prognostic factor for OS (HR=1.883, 95%CI=1.162-3.051, p=0.010). In patients treated with adjuvant chemotherapy, the group with a high NLR-CAR score had significantly worse OS than the group with a low NLR-CAR score (p=0.001).

Conclusion: The combination of NLR and CAR may be useful for predicting the prognosis of older patients with advanced gastric cancer.