| OBJECTIVE: Advanced gastric cancer has a poor prognosis because of advanced gastric cancer is prone to metastasis.It is urgent for us to find an indicator to predict the prognosis of gastric cancer in a timely fashion.Research has revealed that inflammation has an important role in predicting survival in some cancers.The purpose of this study was to evaluate the significance of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)on the prognosis of metastatic gastric cancer(GC).Methods:This was a retrospective review of one hundred ten patients were at presentation diagnosed with stage IV metastatic GC and all patients received palliative chemotherapy between January 2012 and January 2016 at the Affiliated Hospital of Qingdao University.The patients’ s gender,age,ECOG score,specific site of metastasis,HER2 expression were collected.Pre-treatment NLR and PLR,as well as clinicopathological characteristics were collected.Patients were divided into high and low groups according to the cutoff values for NLR and PLR.Based on the receiver operating characteristic(ROC)curve,the optimal cut-off value for NLR and PLR was 2.48 and 143.39.The Kaplan-Meier method was performed to analyze OS and PFS.A chi-square test or Fisher’s exact probability test was used to assess the correlation of clinicopathologic characteristics with NLR and PLR.Univariate and multivariate Cox regression analyses were applied to examine the independent predictors for OS,PFS.All analyses were performed using the SPSS 24.0 statistical software program(Inc.,Chicago,IL,USA).All tests were two tailed and a P < 0.05 was considered to indicate a statistically significant difference.Results: 1.One hundred ten patients were enrolled.84 patients were males,26 patients were females,61 patients were ≥ 65 years of age,and 49 patients were <65 years of age.The ECOG score of most patients(n=107)ranged from 0-1.Ten patients were human epidermal growth factor receptor 2(HER2)-positive.71 patients presented with an elevated CEA level and 49 patients had an elevated CA199 level.The median duration of follow-up was 11.6 months.2.The increased NLR level was significantly associated with age(P = 0.008),liver metastases(P < 0.001),H.pylori infection(P = 0.008),peritoneal metastasis(P=0.003),CEA level(P=0.031).The PLR was associated with liver metastasis(P = 0.021),gender(P=0.048),and with H.pylori infection(P = 0.008).And the PLR was not associated with age,HER2,CA199 level,metastatic sites,and left cervical lymph node metastases.3.Patients with high NLR had poor OS(P<0.001)and poor PFS(P=0.001)compared to those who had low NLR,patients with high PLR had poor OS(P=0.013)and poor PFS(P<0.001)compared to those who had low PLR.4.In univariate analysis,age(P=0.013),liver metastasis(P=0.001),more than one metastatic sites(P=0.028),higher NLR(P<0.001)and higher PLR(P=0.014)were identified as poor prognostic factors associated with OS.Liver metastasis(P=0.028)、higher NLR(P<0.001)、higher PLR(P=0.002)were identified as poor prognostic factors associated with PFS。5.Our multivariate analysis had indicated that high NLR(HR:1.622,95%CI:1.040-2.529,P=0.033)and peritoneal metastasis(HR:1.664,95%CI:1.059-2.614,P=0.027)were independent risk factors for OS.Higher NLR(HR:3.123,95%CI:1.936-5.172,P<0.001)and higher PLR(HR:1.820,95%CI:1.034-2.965,P=0.023)were independent risk factors for PFS;Conclusions: This study suggests that patients with increased NLR and PLR have poor OS and PFS.NLR is related to the poor clinicopathological characteristics of gastric cancer patients,and is an independent prognostic risk factor for OS and PFS.PLR is an independent risk factor for PFS.Therefore,NLR and PLR can be used as important biomarkers for the prognosis of patients with metastatic gastric cancer before treatment. |
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