全身炎症标志物作为老年II/III期胃癌预后预测指标的意义

Significance of Systemic Inflammatory Markers as Prognostic Predictors in Stage II/III Gastric Cancer Among Older Patients.

作者信息

Kuroda Kenji, Toyokawa Takahiro, Tsujio Gen, Miki Yuichiro, Yoshii Mami, Kasashima Hiroaki, Fukuoka Tatsunari, Tamura Tatsuro, Shibutani Masatsune, Lee Shigeru, Yashiro Masakazu, Maeda Kiyoshi

机构信息

Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.

Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan;

出版信息

Anticancer Res. 2025 Apr;45(4):1681-1694. doi: 10.21873/anticanres.17549.

DOI:10.21873/anticanres.17549

PMID:40155006

Abstract

BACKGROUND/AIM: Determining treatment for older patients is difficult because of their life expectancy and reduced physiological function. Recently, systemic inflammatory markers have been recognized as prognostic predictors in various cancers. However, few studies have focused on older patients with advanced gastric cancer. This study compared the prognostic significance of various markers in stage II and III gastric cancer in patients ≥75 years old.

PATIENTS AND METHODS

In total, 133 cases of R0 excision for stage II/III gastric cancer in patents ≥75 years old were analyzed. The ratio of neutrophils to lymphocytes (NLR), the ratio of platelets to lymphocytes (PLR), C-reactive protein to albumin (CAR), the prognostic nutritional index (PNI), and the Glasgow Prognostic Score (GPS) were used as preoperative markers. Cutoff value was determined based on the time-dependent ROC curve with the 5-year survival rate as the endpoint. Patients were divided into two groups based on these cutoff values, and their prognoses were compared.

RESULTS

The cutoff values for NLR, PLR, CAR, and PNI were 2.83, 272, 0.06, and 44.8, respectively. In multivariate analysis for overall survival (OS), NLR (HR=1.972, 95%CI=1.231-3.158, =0.005), CAR (HR=1.855, 95%CI=1.166-2.952, =0.009), and PNI (HR=0.585, 95%CI=0.356-0.960, =0.034) were independent prognostic factors. The NLR-CAR score, calculated based on the NLR and CAR cutoff values, was also an independent prognostic factor for OS (HR=1.883, 95%CI=1.162-3.051, =0.010). In patients treated with adjuvant chemotherapy, the group with a high NLR-CAR score had significantly worse OS than the group with a low NLR-CAR score (=0.001).

CONCLUSION

The combination of NLR and CAR may be useful for predicting the prognosis of older patients with advanced gastric cancer.

摘要

背景/目的：由于老年患者的预期寿命和生理功能下降，确定其治疗方案具有一定难度。近年来，全身炎症标志物已被公认为多种癌症的预后预测指标。然而，针对老年晚期胃癌患者的研究较少。本研究比较了多种标志物对75岁及以上II期和III期胃癌患者的预后意义。

患者与方法

共分析了133例75岁及以上II/III期胃癌患者的R0切除病例。中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、C反应蛋白与白蛋白比值（CAR）、预后营养指数（PNI）和格拉斯哥预后评分（GPS）被用作术前标志物。根据以5年生存率为终点的时间依赖性ROC曲线确定临界值。根据这些临界值将患者分为两组，并比较其预后。

结果

NLR、PLR、CAR和PNI的临界值分别为2.83、272、0.06和44.8。在总生存期（OS）的多因素分析中，NLR（HR=1.972，95%CI=1.231-3.158，P=0.005）、CAR（HR=1.855，95%CI=1.166-2.952，P=0.009）和PNI（HR=0.585，95%CI=0.356-0.960，P=0.034）是独立的预后因素。基于NLR和CAR临界值计算的NLR-CAR评分也是OS的独立预后因素（HR=1.883，95%CI=1.162-3.051，P=0.010）。在接受辅助化疗的患者中，高NLR-CAR评分组的OS明显低于低NLR-CAR评分组（P=0.001）。