Stage-Dependent Changes in Albumin, NLR, PLR, and AFR are Correlated with Shorter Survival in Patients with Gastric Cancer.

BACKGROUND

To some extent, albumin levels reflect patient nutritional status and fibrinogen, neutrophils, lymphocytes, and platelets reflect chronic inflammation. These markers may be used to evaluate prognosis in gastric cancer.

METHODS

Four hundred gastric cancer patients who underwent treatment in our hospital between 2010 and 2012 were retrospectively analyzed. The aims of our study were to assess the association of preoperative albumin, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and albumin to fibrinogen ratio (AFR) with tumor stage and survival in gastric cancer (GC) patients.

RESULTS

Albumin, PLR, and AFR impacted survival when accompanied by low serum albumin levels, high PLR, and low AFR. Universal analysis showed that CEA, CA19-9, serum albumin, T, N, and nerve invasion were significantly correlated with the overall survival of gastric cancer patients. Multivariate analysis indicated that lower serum albumin levels correlated with decreased survival in gastric cancer patients (HR: 1.785, 95% confidence interval 1.139 - 2.797, p < 0.05). Apart from serum albumin levels, patients with advanced cancer with deep invasion (T3 + 4) and lymph node metastasis (N1-3) had significantly decreased survival. Albumin, AFR, PLR, and NLR were associated with the T stage, and albumin, AFR, and PLR were associated with the N stage. Albumin, AFR, NLR, and PLR were significantly different between gastric cancer patients and healthy controls.

CONCLUSIONS

Serum albumin, AFR, PLR, and NLR are associated with prognosis in gastric cancer patients, indicating that these four markers impact inflammation, tumor metastasis, and patient nutrition, and are important independent markers of gastric cancer progression and patient survival.