The effect of pre-treatment inflammatory response markers on survival in locally advanced unresectable and metastatic gastric cancer: a retrospective cross-sectional study

Öz

Purpose: We evaluated the effect of pre-treatment inflammation response markers on overall survival (OS) and progression-free survival (PFS) in patients with locally advanced unresectable and metastatic gastric cancer. Material and method: Patients with locally advanced unresectable and metastatic gastric cancer between January 2016 and December 2021 were included. Among these patients, 114 patients with ECOG (Eastern Cooperative Oncology Group) Performance status 0-2, who received at least one line of chemotherapy, had no comorbidities and brain metastases were included in the study. Pre-treatment platelet, lymphocyte, leukocyte, neutrophil, monocyte, albumin, C-reactive protein (CRP), lactatedehydrogenase (LDH) levels, histology types, age, surgical history, treatment history and ECOG Performance status were retrospectively analysed from their records. Threshold values were determined by ROC analysis. Kaplan-Meier survival analyses were used for survival analyses. Hazard ratio (HR) and confidence intervals (CI) of the factors affecting overall survival (OS) and progression-free survival (PFS) were calculated using Coxproportional-hazards model. Results: The median age of the patients was 63.5±11.9 (28-80). Among the patients, 69 (60.5%) were in metastatic stage. One hundred and six (93.0%) patients had poorly differentiated carcinoma histology. Progression developed in 88.6% (101) of patients and 98 patients (86%) were deceased. In the whole group, mPFS was 9.4±0.9 (95%CI 7.7-11.0) months and mOS was 14.1±1.6 (95%CI 10.8-17.2) months. When the Coxproportional-hazards model was used, the factors affecting OS were advanced age, metastatic stage, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), derived neutrophil lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH), while the factors affecting PFS were advanced age, metastatic stage, NLR, dNLR and LDH. Conclusion: While NLR, PLR, dNLR, dNLR and LDH affect OS, LDH affects PFS. Systemic inflammatory markers of locally advanced unresectable and metastatic gastric cancers before chemotherapy can be used to predict prognosis.

Anahtar Kelimeler

• Gastric cancer
• neutrophil-lymphocyte ratio
• platelet-lymphocyte ratio
• prognosis

Lokal ileri rezeke edilemeyen ve metastatik mide kanserinde tedavi öncesi inflamasyon yanıtı belirteçlerinin sağkalım üzerine etkisi

Öz

Amaç: Lokal ileri rezeke edilemeyen ve metastatik mide kanserli hastalarda tedavi öncesi inflamasyon yanıtı belirteçlerinin tüm sağkalım (TSK) ve progresyonsuz sağkalım (PSK) üzerine etkisini değerlendirildi. Gereç ve yöntem: Ocak 2016-Aralık 2021 tarihleri arasında lokal ileri rezeke edilemeyen ve metastatik mide kanserli hastalar alındı. Bu hastalardan en az bir sıra kemoterapi almış ECOG (Eastern Cooperative Oncology Group) Performans durumu 0-2 olan, komorbiditesi ve beyin metastazı olmayan 114 hasta çalışmaya dahil edildi. Tedavi öncesi platelet, lenfosit, lökosit, nötrofil, monosit, albümin, C-reaktif protein (CRP), laktatdehidrogenaz (LDH) düzeyleri, histoloji tipleri, yaşı, cerrahi öyküsü, tedavi öyküsü ve ECOG Performans durumu dosyalarından retrospektif olarak incelendi. Tüm değerlerin eşik değeri ROC analizi ile belirlendi. Sağkalım analizleri için Kaplan-Meier Sağkalım analizleri kullanıldı. Coxproportional-hazards modeli kullanılarak tüm sağkalım (TSK) ve progresyonsuz sağkalım (PSK)’ı etkileyen faktörlerin hazardratio (HR) ve güven aralıkları (CI) hesaplandı. Bulgular: Hastaların ortanca yaşı 63,5±11,9 (28-80) yıl. Hastaların 69 (%60,5)’u metastatik evredeydi. Yüzaltı (%93,0) hastanın histolojisi az differasiye karsinomdu. Hastaların %88,6’sında (101) progresyon gelişti ve 98 hasta (%86) vefat etti. Tüm grupta mPSK 9,4+0,9 (%95CI 7,7-11,0) ay ve mOS 14,1+1,6 (%95CI 10,8-17,2) ay saptandı. Coxproportional-hazards modeli kullanıldığında TSK’i etkileyen faktörler ileri yaş, metastatik evre, nötrofil lenfosit oranı (NLO), platelet lenfosit oranı (PLO), derive nötrofil lenfosit oranı (dNLO) ve laktak dehidrogenaz (LDH) iken; PSK’yi etkileyen faktörler ileri yaş, metastatik evre, NLO, dNLO ve LDH olarak bulundu. Sonuç: Tedavi öncesi inflamasyon yanıtı belirteçlerinden NLO, PLO, dNLO ve LDH OS’yi etkilerken; LDH PSK’yi etkilemektedir. Lokal ileri rezeke edilemeyen ve metastatik evre mide kanserlerinin kemoterapi öncesi sistemik inflamatuvar belirteçleri prognozu öngörmede kullanılabilir.

Anahtar Kelimeler

• Mide kanseri
• nötrofil-lenfosit oranı
• platelet-lenfosit oranı
• prognoz

Kaynakça

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