Neoadjuvan kemoterapi alan lokal ileri evre mide adenokanserli hastalarda immün-inflamasyon ve tümör belirteçlerinin prognostik özellikleri

Yıl 2026, Sayı: 1, - , 03.02.2026

Oğur Karhan , Sezai Tunç

https://doi.org/10.18663/tjcl.1753449

Öz

Amaç: Bu çalışmada, lokal ileri evre mide adenokarsinomlu hastalarda, neoadjuvan kemoterapi tedavisi öncesinde nötrofil, lenfosit, monosit, trombosit, nötrofil lenfosit oranı (NLR), trombosit lenfosit oranı (PLR), prognostik nutrisyonel indeks (PNİ) ve klinikopatolojik faktörlerin sağkalım üzerindeki etkisini incelemeyi amaçladık.
Gereç ve Yöntemler: Bu çalışmaya tek merkezden 47 hasta dahil edildi. Hasta dosyaları retrospektif olarak incelendi. Hastaların demografik ve klinik özelliklerine ek olarak, tedavi öncesi hemoglobin, nötrofil, lenfosit, monosit, trombosit, albümin, NLR, PLR, PNİ, tümör markerleri (CEA, CA19-9) değerleri ile operasyon sonrası patolojik özelliklerinin sağkalım üzerindeki etkisi incelendi. Hastaların hastalıksız sağkalım (DFS) ve genel sağkalım (OS) değerleri Kaplan-Meier analizi ile hesaplandı. Hem DFS hem de OS'yi etkileyen faktörler, univariate ve multivariate olarak Cox regresyon analizi ile değerlendirildi.
Bulgular: Median OS 27 ay ve median DFS 17 ay olarak bulundu. DFS açısından yapılan univariate analizde, tanıda monosit değerindeki artış (p: 0.009, HR: 7,0 [1,6–30]) ve D1 lenf nodu diseksiyonunun kötü prognostik değere sahip olduğu bulundu (p: 0.034, HR: 5,1 [1,1–23,3]). DFS açısından yapılan multivariate analizde, CEA değerindeki artış (p: 0.03, HR: 1,02 [1–1,03]) ve monosit değerindeki artış kötü prognoz ile ilişkili olduğu saptandı (p: 0.05, HR: 10,4 [2,03–53,5]). OS açısından yapılan multivariate analizde ise sadece tanıda CEA değerinin yükselmesi kötü prognozla ilişkili olduğu saptandı (p: 0.02, HR: 1,01 [1,00–1,02]).
Sonuç: Tanı sırasında monosit değerindeki artış lokal ileri evre mide kanserinde hastalıksız sağkalımda kötüleşme ile ilgili saptandı. Yine, tanıda CEA değerindeki artış kötü sağkalımla ilişkili olduğu belirlendi. Monosit ve CEA gibi kolay ulaşılabilir ve ucuz parametrelerle, erken evre mide kanserinde hastalığın gidişatı gösterilebilir.

Anahtar Kelimeler

mide kanseri , monosit , sağkalım analizi , neoadjuvan kemoterapi , inflamasyon

Etik Beyan

This study was approved by the Ethics Committee of the University of Dicle (Approval Number :18, Approval Date: 12.12.2022).

Prognostic significance of immune-inflammatory markers and tumor markers in locally advanced gastric adenocarcinoma patients receiving neoadjuvant chemotherapy

Öz

Aim: In this study, we aimed to investigate the effect of neutrophil, lymphocyte, monocyte, platelet, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and clinical-pathological factors on survival in patients with gastric cancer treated with neoadjuvant chemotherapy.
Material and Methods: Forty-seven patients from a single center were included in this study. Patient medical records were reviewed retrospectively. In addition to demographic and clinical characteristics, the effects of pre-treatment levels of hemoglobin, neutrophils, lymphocytes, monocytes, platelets, albumin, NLR, PLR, PNI, and tumor markers (CEA, CA19-9), along with postoperative pathological features, on survival were evaluated. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Factors affecting both DFS and OS were analyzed using univariate and multivariate Cox regression analyses.
Results: The median OS was 27 months, and the median DFS was 17 months. In the univariate analysis for DFS, increasing monocyte count at diagnosis (p = 0.009, HR: 7.0 [1.6–30]) and D1 lymph node dissection (p = 0.034, HR: 5.1 [1.1–23.3]) were found to be associated with poor prognosis. In the multivariate analysis for DFS, increasing CEA levels (p = 0.03, HR: 1.02 [1–1.03]) and increasing monocyte count at diagnosis (p = 0.05, HR: 10.4 [2.03–53.5]) were identified as poor prognostic factors. In the multivariate analysis for OS, only increasing CEA levels at diagnosis were associated with poor prognosis (p = 0.02, HR: 1.01 [1.00–1.02]).
Conclusion: Increasing monocyte count at diagnosis were associated with reduced disease-free survival in locally advanced gastric cancer. Likewise, increasing CEA levels at diagnosis correlated with poorer overall survival. Readily available and cost-effective biomarkers such as monocyte count and CEA may serve as valuable indicators for predicting disease course in early-stage gastric cancer.

Anahtar Kelimeler

gastric cancer , monocyte , survival analysis , neoadjuvant chemotherapy , inflammation

Etik Beyan

This study was approved by the Ethics Committee of the University of Dicle (Approval Number :18, Approval Date: 12.12.2022).

Kaynakça

• Morgan E, Arnold M, Camargo MC, Gini A, Kunzmann AT, Matsuda T et al. The current and future incidence and mortality of gastric cancer in 185 countries, 2020-40: A population-based modelling study. EClinicalMedicine 2022; 47: 101404.
• Nakayama I, Ohashi M, Nunobe S. Perioperative or neoadjuvant chemotherapy for locally advanced gastric or gastroesophageal junction cancer: from independent evidence in the West, the East, and Japan to global collaboration. Chin Clin Oncol 2024; 13: 8.
• Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20.
• Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 2019; 393: 1948-57.
• Hu K, Wang S, Wang Z, Li L, Huang Z, Yu W et al. Clinicopathological risk factors for gastric cancer: a retrospective cohort study in China. BMJ Open 2019; 9: e030639.
• Mantziari S, St Amour P, Abboretti F, Teixeira-Farinha H, Figueiredo SG, Gronnier C et al. A Comprehensive Review of Prognostic Factors in Patients with Gastric Adenocarcinoma. Cancers (Basel) 2023; 15: 4105.
• Lai IR, Lee WJ, Huang MT, Lin HH. Comparison of serum CA72-4, CEA, TPA, CA19-9 and CA125 levels in gastric cancer patients and correlation with recurrence. Hepatogastroenterology 2002; 49: 1157-60.
• Zou P, Yang E, Li Z. Neutrophil-to-lymphocyte ratio is an independent predictor for survival outcomes in cervical cancer: a systematic review and meta-analysis. Sci Rep 2020; 10: 21917.
• Luo D, Zhong Q, Yue H, Wang J, Liang Q, Liu W et al. The predictors of lymphopenia and its effects on survival in locally advanced esophageal squamous cell carcinoma. Cancer Biol Ther 2024; 25: 2371632.
• Garcia-Flores LA, Dawid De Vera MT, Pilo J, Rego A, Gomez-Casado G, Arranz-Salas I et al. Increased neutrophil counts are associated with poor overall survival in patients with colorectal cancer: a five-year retrospective analysis. Front Immunol 2024; 15: 1415804.
• Zhang X, Wang X, Li W, Sun T, Diao D, Dang C. Predictive value of neutrophil-to-lymphocyte ratio for distant metastasis in gastric cancer patients. Sci Rep 2022; 12: 10269.
• Ürün YY, Ürün M. Do Nutritional and Inflammatory Indices Predict Response in Geriatric Gastric Cancer Patients Treated with Neoadjuvant FLOT Regimen? Cancer Control 2025; 32: 10732748251335367.
• Fu M, Zhang X, Shen F, Ma J, Li Z. Prognostic value of peripheral blood neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, pan-immune-inflammation value and systemic immune-inflammation index for the efficacy of immunotherapy in patients with advanced gastric cancer. Immunotherapy 2024; 16: 551-63.
• Huang R, Kang T, Chen S. The role of tumor-associated macrophages in tumor immune evasion. J Cancer Res Clin Oncol 2024; 150: 238.
• Wilcox RA, Wada DA, Ziesmer SC, Elsawa SF, Comfere NI, Dietz AB et al. Monocytes promote tumor cell survival in T-cell lymphoproliferative disorders and are impaired in their ability to differentiate into mature dendritic cells. Blood 2009; 114: 2936-44.
• Wen J, Ye F, Huang X, Li S, Yang L, Xiao X et al. Prognostic Significance of Preoperative Circulating Monocyte Count in Patients With Breast Cancer: Based on a Large Cohort Study. Medicine (Baltimore) 2015; 94: e2266.
• Shen SL, Fu SJ, Huang XQ, Chen B, Kuang M, Li SQ et al. Elevated preoperative peripheral blood monocyte count predicts poor prognosis for hepatocellular carcinoma after curative resection. BMC Cancer 2014; 14: 744.
• Wen S, Chen N, Hu Y, Huang L, Peng J, Yang M et al. Elevated peripheral absolute monocyte count related to clinicopathological features and poor prognosis in solid tumors: Systematic review, meta-analysis, and meta-regression. Cancer Med 2021; 10: 1690-714.
• Feng F, Zheng G, Wang Q, Liu S, Liu Z, Xu G et al. Low lymphocyte count and high monocyte count predicts poor prognosis of gastric cancer. BMC Gastroenterol 2018; 18: 148.
• Urakawa S, Yamasaki M, Goto K, Haruna M, Hirata M, Morimoto-Okazawa A et al. Peri-operative monocyte count is a marker of poor prognosis in gastric cancer: increased monocytes are a characteristic of myeloid-derived suppressor cells. Cancer Immunol Immunother 2019; 68: 1341-50.
• Janjigian YY, Ajani JA, Moehler M, Shen L, Garrido M, Gallardo C et al. First-Line Nivolumab Plus Chemotherapy for Advanced Gastric, Gastroesophageal Junction, and Esophageal Adenocarcinoma: 3-Year Follow-Up of the Phase III CheckMate 649 Trial. J Clin Oncol 2024; 42: 2012-20.
• Ezdoglian A, Tsang ASM, Khodadust F, Burchell G, Jansen G, de Gruijl T et al. Monocyte-related markers as predictors of immune checkpoint inhibitor efficacy and immune-related adverse events: a systematic review and meta-analysis. Cancer Metastasis Rev 2025; 44: 35.
• Mei P, Feng W, Zhan Y, Guo X. Prognostic value of lymphocyte-to-monocyte ratio in gastric cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis. Front Immunol 2023; 14: 1321584.
• Jia Y, Wang Y, Li H, Yang Y, Sun M. Clinical value of CA125, AFP, and CEA for combined diagnosis and assessment of gastric cancer prognosis. Front Oncol 2025; 15: 1530522.
• Feng F, Tian Y, Xu G, Liu Z, Liu S, Zheng G et al. Diagnostic and prognostic value of CEA, CA19-9, AFP and CA125 for early gastric cancer. BMC Cancer 2017; 17: 737.