High inflammatory markers tied to poor prognosis, survival in patients with gastric cancer
CHARLOTTE, N.C. — Elevated baseline neutrophil-to-lymphocyte ratio was associated with distant metastases and poor survival in patients with gastric cancer, according to a presenter at the ACG Annual Scientific Meeting.
The study is one of the first to assess the predictive value of these inflammatory markers in detecting distant metastases in patients with gastric cancer, Osama Abu-Shawer, MD, MS, an internal medicine specialist at the Cleveland Clinic, said.
“The presence of distant metastases is the most worrisome prognostic feature of gastric cancer,” Osama Abu-Shawer, MD, MS, an internal medicine specialist at the Cleveland Clinic, said.
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“Elevated baseline [neutrophil-to-lymphocyte ratio (NLR)] is an independent predictive factor for the presence of baseline distant metastases in gastric cancer,” he told Healio. “This inflammatory-distant metastases association might have implications regarding distant metastases surveillance in patients with high NLR and probably considering prophylactic approaches in this patient subset.”
While other studies have identified high NLR as an independent predictive factor for baseline presence of distant metastases in non-small-cell lung cancer and breast cancer, Abu-Shawer said it was unknown whether NLR is associated with the presence of distant metastases in gastric cancer.
To identify whether this relationship exists, Abu-Shawer and colleagues performed a retrospective chart review of 502 patients (median age, 54 years; 56% men) with gastric adenocarcinoma who were treated at a tertiary care cancer center from 2012 to 2018. Researchers used multivariable logistic regression analyses to assess the relationships between NLR, absolute eosinophil count (AEC), absolute lymphocyte count, absolute monocytic count, absolute neutrophil count (ANC), monocyte-to-lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) with the presence of baseline distant metastases.
Based on receiver operator characteristic findings, they used 3.9 µL as the cutoff value for NLR.
According to results, an elevated NLR (> 3.9 µL) was an independent factor for the presence of distant metastasis at presentation (OR = 0.5; 95% CI, 0.3-0.7).
Further, patients with elevated baseline ANC ( 6,015/µL), AEC ( 215/µL) and PLR ( 0.15) had more distant metastases compared with patients with low baseline ANC, AEC and PLR. High baseline ANC, NLR, MLR and PLR also were associated with poor overall survival.
“The presence of distant metastases is the most worrisome prognostic feature of gastric cancer,” Abu-Shawer said. “Using simple tests, such as CBC, to predict the presence of distant metastasis upon diagnosis and probably predicting the likelihood of subsequent development of distant metastases might have a direct impact on gastric cancer patients’ care.”
He added, “Surveillance for distant metastases through more frequent imaging and consideration for prophylactic approaches in patients with high NLR could be an attractive area for future research.”
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Abu-Shawer O, et al. Paper 29. Prognostic value of systemic inflammatory markers in patients with gastric adenocarcinoma. Presented at: ACG Annual Scientific Meeting; Oct. 21-26, 2022; Charlotte, N.C. (hybrid).
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