Prognostic value of preoperative glucose to lymphocytes ratio in patients with resected gastric cancer

Abstract

Background/Aim: There are no definitive tests that determine postoperative survival in gastric cancer. Simple and cheap laboratory markers are needed for clinicians to guide them preoperatively. The aims of our study were to analyze the importance of preoperative glucose-lymphocyte ratio (GLR) in the prognosis of patients with gastric cancer (GC), and to compare the success of GLR in predicting prognosis with the success of neutrophil-lymphocyte ratio (NLR) and C-reactive protein-albumin ratio (CAR). Methods: We carried out a cross-sectional study on 196 GC patients. CAR, NLR and GLR values were calculated from the blood samples taken 24 hours before the surgery. Lymphovascular invasion, serosal invasion, and the number of metastatic lymph nodes were determined, and the prediction ability of glucose to lymphocyte ratio (GLR), neutrophil to lymphocyte ratio (NLR), and C-reactive protein to albumin ratio (CAR) were evaluated. In addition, the effect of GLR and NLR on the ability to predict overall survival was assessed. The mean follow-up period was 37 (6-69) months. Results: A moderate and weak positive correlation was found between GLR, NLR and the number of metastatic lymph nodes (r=0.415, P<0.001; r=0.193, P=0.007, respectively). GLR and NLR were significant for predicting lymphovascular and serosal invasion (P<0.001). CAR was insufficient in lymphovascular invasion differentiation (AUC (95% CI): 0.582 (0.501-0.662)) (P=0.529) and serosal invasion differentiation (P=0.529). GLR significantly predicted overall survival (P=0.002). Patients with a GLR value of <4.12 had a significantly longer overall survival than those with GLR>4.12. NLR was insignificant for overall survival (P=0.233). Conclusion: GLR value may contribute to the planning of the therapy process by predicting both the prognosis of the disease and the overall survival before surgery.

Keywords

• Overall survival
• Gastric cancer
• Predict
• Glucose-Lymphocyte ratio

Kaynakça

1. 1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2021;71(3):209–49.
2. 2. Survival for stomach cancer | Cancer Research UK [Internet]. [cited 2021 Aug 29]. Available from: https://www.cancerresearchuk.org/about-cancer/stomach-cancer/survival
3. 3. Zali H, Rezaei-Tavirani M, Azodi M. Gastric cancer: prevention, risk factors and treatment. Gastroenterol Hepatol Bed Bench. 2011;4(4):175–85.
4. 4. Jiang L, Yang K-H, Guan Q-L, Zhao P, Chen Y, Tian J-H. Survival and recurrence free benefits with different lymphadenectomy for resectable gastric cancer: A meta-analysis. Journal of Surgical Oncology. 2013;107(8):807–14.
5. 5. Solanki S, Chakinala RC, Haq KF, Khan MA, Kifayat A, Linder K, et al. Inpatient burden of gastric cancer in the United States. Annals of Translational Medicine. 2019 Dec;7(23):772–772.
6. 6. Sano T, Coit DG, Kim HH, Roviello F, Kassab P, Wittekind C, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer. 2017 Mar;20(2):217–25.
7. 7. Kim M-R, Kim A-S, Choi H-I, Jung J-H, Park JY, Ko H-J. Inflammatory markers for predicting overall survival in gastric cancer patients: A systematic review and meta-analysis. PLOS ONE. 2020 Jul 27;15(7):e0236445.
8. 8. Toyokawa T, Muguruma K, Yoshii M, Tamura T, Sakurai K, Kubo N, et al. Clinical significance of prognostic inflammation-based and/or nutritional markers in patients with stage III gastric cancer. BMC Cancer. 2020 Jun 3;20(1):517.

9. 9. Jiang X, Hiki N, Nunobe S, Kumagai K, Kubota T, Aikou S, et al. Prognostic importance of the inflammation-based Glasgow prognostic score in patients with gastric cancer. Br J Cancer. 2012 Jul;107(2):275–9.
10. 10. Rice CM, Davies LC, Subleski JJ, Maio N, Gonzalez-Cotto M, Andrews C, et al. Tumour-elicited neutrophils engage mitochondrial metabolism to circumvent nutrient limitations and maintain immune suppression. Nat Commun. 2018 Nov 30;9(1):5099.
11. 11. Hirakawa Y, Ninomiya T, Mukai N, Doi Y, Hata J, Fukuhara M, et al. Association Between Glucose Tolerance Level and Cancer Death in a General Japanese Population: The Hisayama Study. American Journal of Epidemiology. 2012 Nov 15;176(10):856–64.
12. 12. Zhong A, Cheng C-S, Kai J, Lu R, Guo L. Clinical Significance of Glucose to Lymphocyte Ratio (GLR) as a Prognostic Marker for Patients With Pancreatic Cancer. Front Oncol. 2020;10:520330.
13. 13. Sahiner Y. Can the C-reactive protein-to-plasma albumin ratio be an alternative scoring to show mortality and morbidity in patients with colorectal cancer? Ulus Travma Acil Cerrahi Derg [Internet]. 2020 [cited 2021 Aug 29]; Available from: http://www.tjtes.org/eng/jvi.aspx?pdir=travma&plng=eng&un=UTD-34412
14. 14. Sert ÖZ, Bozkurt H, Ölmez T, Aray E, Uzun O, Gülmez S, et al. C-Reactive Protein to Albumin Ratio: A Reliable Marker in Colorectal Cancer. tjcd. 2021 Mar 1;31(1):35–42.
15. 15. Yalav O, Topal U, Ünal AG, Eray İC, Rencüzoğulları A. Clinical Value of Neutrophil/Lymphocyte Ratio in Predicting Postoperative Complications and Prognosis in Patients with Colorectal Cancer Undergoing Surgical Treatment. tjcd. 2020 Mar 1;30(1):49–56.
16. 16. Saito H, Kono Y, Murakami Y, Shishido Y, Kuroda H, Matsunaga T, et al. Prognostic Significance of the Preoperative Ratio of C-Reactive Protein to Albumin and Neutrophil–Lymphocyte Ratio in Gastric Cancer Patients. World J Surg. 2018 Jun 1;42(6):1819–25.
17. 17. Lee J-H, Kim MG, Jung M-S, Kwon SJ. Prognostic significance of lymphovascular invasion in node-negative gastric cancer. World J Surg. 2015 Mar;39(3):732–9.
18. 18. Chen S, Cai M-Y, Chen Y-B, Li Y-F, Feng X-Y, Zhou Z-W. Serosa-penetration in human T4aN0M0 gastric carcinoma correlates with worse prognosis after D2 gastrectomy. Chin Med J (Engl). 2012 Mar;125(6):1158–62.
19. 19. Yasuda K, Shiraishi N, Inomata M, Shiroshita H, Izumi K, Kitano S. Prognostic significance of macroscopic serosal invasion in advanced gastric cancer. Hepatogastroenterology. 2007 Nov;54(79):2028–31.
20. 20. Takiguchi N, Nunomura M, Koda K, Oda K, Suzuki H, Miyazaki M. Neoadjuvant chemotherapy with CDDP and 5-fluorouracil for gastric cancer with serosal invasion. Oncol Rep. 2003 Apr;10(2):433–8.
21. 21. Xu A-M, Huang L, Liu W, Gao S, Han W-X, Wei Z-J. Neoadjuvant Chemotherapy Followed by Surgery versus Surgery Alone for Gastric Carcinoma: Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLOS ONE. 2014 Jan 30;9(1):e86941.
22. 22. Togano S, Yashiro M, Miki Y, Yamamato Y, Sera T, Kushitani Y, et al. Microscopic distance from tumor invasion front to serosa might be a useful predictive factor for peritoneal recurrence after curative resection of T3-gastric cancer. PLOS ONE. 2020 Jan 15;15(1):e0225958.
23. 23. Zhao B-W, Chen Y-M, Jiang S-S, Chen Y-B, Zhou Z-W, Li Y-F. Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer. PLOS ONE. 2015 Jul 8;10(7):e0129531.
24. 24. Ding Y-B, Chen G-Y, Xia J-G, Zang X-W, Yang H-Y, Yang L, et al. Correlation of tumor-positive ratio and number of perigastric lymph nodes with prognosis of gastric carcinoma in surgically-treated patients. World J Gastroenterol. 2004 Jan 15;10(2):182–5.
25. 25. Berkeşoğlu M, Çağlar R, Ölmez A, Canbaz H, Taşdelen B, Dirlik MM, et al. Evaluation of the Factors Affecting Survival in Patients with Gastric Cancer According to the 8th Edition of the Tumor, Node and Metastasis Classification. Haseki. 2019 Jun 1;57(2):153–61.
26. 26. Koşmaz K, Bostancı MT, Çaparlar MA, Başak F, Şişik A, Kalcan S, et al.. Predicting survival in gastric cancer: A prospective cohort study with 102 patients. J Surg Med. 2019; 3(5):361-5.
27. 27. Xin-Ji Z, Yong-Gang L, Xiao-Jun S, Xiao-Wu C, Dong Z, Da-Jian Z. The prognostic role of neutrophils to lymphocytes ratio and platelet count in gastric cancer: A meta-analysis. Int J Surg. 2015 Sep;21:84–91.