Zhang Lu, Chen Yan-Ping, Ji Min, Ying Le-Qian, Huang Chun-Chun, Zhou Jing-Yi, Liu Lin
Department of Oncology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, Jiangsu Province, China.
World J Gastrointest Oncol. 2024 Sep 15;16(9):3875-3886. doi: 10.4251/wjgo.v16.i9.3875.
Inflammation-related markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and prognostic nutritional index (PNI) could reflect tumor immune microenvironment and predict prognosis of cancers. However, it had not been explored in alpha-fetoprotein (AFP) producing gastric cancer (GC).
To determine the predictive value of inflammation-related peripheral blood markers including as NLR, PLR, MLR, SII, SIRI and PNI in the prognosis of AFP- producing GC (AFPGC). Besides, this study would also compare the differences in tumor immune microenvironment, clinical characteristics and prognosis between AFPGC and AFP- GC patients to improve the understanding of this disease.
573 patients enrolled were retrospectively studied. They were divided into AFP+ group (AFP ≥ 20 ng/mL) and AFP- group (AFP < 20 ng/mL), comparing the levels of NLR/PLR/MLR/SII/SIRI/PNI and prognosis. In AFP+ group, the impact of NLR/PLR/MLR/SII/SIRI/PNI and their dynamic changes on prognosis were further explored.
Compared with AFP- patients, AFP+ patients had higher NLR/PLR/MLR/SII/SIRI and lower PNI levels and poorer overall survival (OS). In the AFP+ group, mortality was significantly lower in the lower NLR/PLR/MLR/SII/SIRI group and higher PNI group. Moreover, the dynamic increase (NLR/PLR/MLR/SII/SIRI) or decrease (PNI) was associated with the rise of mortality within 1 year of follow-up.
Compared with AFP- patients, the level of inflammation-related peripheral blood markers significantly increased in AFP+ patients, which was correlated with OS of AFP+ patients. Also, the gradual increase of SII and SIRI was associated with the risk of death within one year in AFP+ patients. AFPGC should be considered as a separate type and distinguished from AFP- GC because of the difference in tumor immune microenvironment. It requires basic experiments and large clinical samples in the future.
包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、单核细胞与淋巴细胞比值（MLR）、全身免疫炎症指数（SII）、全身炎症反应指数（SIRI）和预后营养指数（PNI）在内的炎症相关标志物可反映肿瘤免疫微环境并预测癌症预后。然而，其在甲胎蛋白（AFP）产生型胃癌（GC）中的情况尚未得到研究。
确定包括NLR、PLR、MLR、SII、SIRI和PNI在内的炎症相关外周血标志物对AFP产生型GC（AFPGC）预后的预测价值。此外，本研究还将比较AFPGC与AFP阴性GC患者在肿瘤免疫微环境、临床特征和预后方面的差异，以增进对该疾病的了解。
对纳入的573例患者进行回顾性研究。将他们分为AFP阳性组（AFP≥20 ng/mL）和AFP阴性组（AFP＜20 ng/mL），比较NLR/PLR/MLR/SII/SIRI/PNI水平及预后。在AFP阳性组中，进一步探讨NLR/PLR/MLR/SII/SIRI/PNI及其动态变化对预后的影响。
与AFP阴性患者相比，AFP阳性患者的NLR/PLR/MLR/SII/SIRI更高，PNI水平更低，总生存期（OS）更差。在AFP阳性组中，NLR/PLR/MLR/SII/SIRI较低且PNI较高的组死亡率显著更低。此外，在随访1年内，NLR/PLR/MLR/SII/SIRI的动态升高或PNI的动态降低与死亡率升高相关。
与AFP阴性患者相比，AFP阳性患者炎症相关外周血标志物水平显著升高，这与AFP阳性患者的OS相关。此外，SII和SIRI的逐渐升高与AFP阳性患者1年内的死亡风险相关。由于肿瘤免疫微环境的差异，应将AFPGC视为一种单独的类型并与AFP阴性GC区分开来。未来需要基础实验和大量临床样本。
