Comparison of Prognostic Abilities Among Preoperative Laboratory Data Indices in Patients with Resectable Gastric and Esophagogastric Junction Adenocarcinoma

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), modified Glasgow prognostic score (mGPS) and prognostic nutritional index (PNI) are simple indices determined employing laboratory data alone and have been used to predict the clinical outcomes of patients with esophagogastric tumors. However, prior results were generally based on analyzing dichotomous data with arbitrary cutoff values. This retrospective study aims to assess prognostic utilities of preoperative NLR, PLR, LMR, mGPS and PNI, as continuous variables, in gastric cancer (GC) and adenocarcinoma of esophagogastric junction (AEG).

Methods: Preoperative data from 1363 patients who underwent surgery for GC/AEG were retrospectively examined. Survival time was evaluated applying the Cox proportional hazard model to both univariate and multivariate estimates of clinicopathological factors and the aforementioned indices as continuous variables.

Results: Preoperatively, each index value was significantly associated with T and N stages, as well as lymphatic involvement and venous involvement. On univariate Cox regression analysis, preoperative NLR, PLR, LMR and PNI were significantly associated with overall survival (OS) and relapse-free survival (RFS). Preoperative mGPS was associated only with RFS. On multivariate Cox regression analysis, preoperative PNI was independently associated with OS and RFS (hazard ratio [HR] 0.62 per 10-unit increase, 95% CI 0.47-0.82, p < 0.001; HR 0.60, 95% CI 0.46-0.78, p < 0.001, respectively), as age, gender, tumor location, T and N stages and venous involvement, while other indices lost independence on multivariate analysis.

Conclusions: Preoperative PNI, a score related to nutritional status, is of importance for predicting long-term outcomes in patients with GC and AEG.