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. 2015 Jun 17:8:1375-85.
doi: 10.2147/OTT.S82437. eCollection 2015.

A comparison of the prognostic value of preoperative inflammation-based scores and TNM stage in patients with gastric cancer

Qun-Xiong Pan  1 , Zi-Jian Su  1 , Jian-Hua Zhang  1 , Chong-Ren Wang  1 , Shao-Ying Ke  1
Affiliations

A comparison of the prognostic value of preoperative inflammation-based scores and TNM stage in patients with gastric cancer

Qun-Xiong Pan et al. Onco Targets Ther. .

Abstract

Background: People's Republic of China is one of the countries with the highest incidence of gastric cancer, accounting for 45% of all new gastric cancer cases in the world. Therefore, strong prognostic markers are critical for the diagnosis and survival of Chinese patients suffering from gastric cancer. Recent studies have begun to unravel the mechanisms linking the host inflammatory response to tumor growth, invasion and metastasis in gastric cancers. Based on this relationship between inflammation and cancer progression, several inflammation-based scores have been demonstrated to have prognostic value in many types of malignant solid tumors.

Objective: To compare the prognostic value of inflammation-based prognostic scores and tumor node metastasis (TNM) stage in patients undergoing gastric cancer resection.

Methods: The inflammation-based prognostic scores were calculated for 207 patients with gastric cancer who underwent surgery. Glasgow prognostic score (GPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic nutritional index (PNI), and prognostic index (PI) were analyzed. Linear trend chi-square test, likelihood ratio chi-square test, and receiver operating characteristic were performed to compare the prognostic value of the selected scores and TNM stage.

Results: In univariate analysis, preoperative serum C-reactive protein (P<0.001), serum albumin (P<0.001), GPS (P<0.001), PLR (P=0.002), NLR (P<0.001), PI (P<0.001), PNI (P<0.001), and TNM stage (P<0.001) were significantly associated with both overall survival and disease-free survival of patients with gastric cancer. In multivariate analysis, GPS (P=0.024), NLR (P=0.012), PI (P=0.001), TNM stage (P<0.001), and degree of differentiation (P=0.002) were independent predictors of gastric cancer survival. GPS and TNM stage had a comparable prognostic value and higher linear trend chi-square value, likelihood ratio chi-square value, and larger area under the receiver operating characteristic curve as compared to other inflammation-based prognostic scores.

Conclusion: The present study indicates that preoperative GPS and TNM stage are robust predictors of gastric cancer survival as compared to NLR, PLR, PI, and PNI in patients undergoing tumor resection.

Keywords: Glasgow prognostic score; gastric cancer; inflammation-based prognostic score; prognosis.

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Figures

Figure 1
Figure 1
Kaplan–Meier survival curves showing the relationship between the information-based scores and overall survival in patients with (A) TNM, (B) GPS, (C) NLR, (D) PLR, (E) PI, and (F) PNI. Abbreviations: TNM, tumor node metastasis; GPS, Glasgow prognostic score; NLR, neutrophil lymphocyte ratio; PLR, platelet lymphocyte ratio; PI, prognostic index; PNI, prognostic nutritional index.
Figure 2
Figure 2
Comparison of the area under the ROC curve for outcome prediction between the inflammation-based prognostic scores at (A) 1 year, (B) 3 years, and (C) 5 years in patients with GPS, TNM, NLR, PLR, PI, and PNI. Abbreviations: ROC, receiver operating characteristic; GPS, Glasgow prognostic score; TNM, tumor node metastasis; NLR, neutrophil lymphocyte ratio; PLR, platelet lymphocyte ratio; PI, prognostic index; PNI, prognostic nutritional index.
See this image and copyright information in PMC

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