Comprehensive Analysis of Prognostic Factors in Advanced Gastric Cancer Patients Treated with Chemotherapy

Abstract

Objective: To evaluate the strongest prognostic factors in advanced gastric cancer.

Study design: Observational study.

Place and duration of study: Department of Medical Oncology, Tekirdag Namik Kemal University, Tekirdag, Turkey, between March 2012 and April 2022.

Methodology: Adult patients with metastatic cancer who had completed at least two months of chemotherapy, without any other comorbidity were included. Using Kaplan-Meier methodology and Cox regression methods, potential prognostic factors were analysed for overall survival. Two different models were created for multivariate analysis by using statistically significant factors in univariate analysis.

Results: The median overall survival in 216 patients was 7.8 months. The univariate analysis showed that body-mass index, performance status, liver metastasis, albumin, gamma-glutamyl transferase, carcinoembryonic antigen, carbohydrate antigen (CA 19-9), neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index, albumin-to-alkaline phosphatase ratio, sodium-globulin ratio (SGR) prognostic nutritional index (PNI), albumin-bilirubin ratio, and albumin-globulin ratio were associated with survival. In Model 1, which included only laboratory indices, multivariate analyses revealed that NLR (p=0.001), SGR (p=0.025), and PNI (p=0.032) were prognostic for overall survival. In Model 2, established with all parameters, NLR (p=0.003), albumin (p=0.003), performance status (p<0.001), and CA 19-9 (p<0.001) were found to be independent prognostic factors.

Conclusion: Pretreatment NLR, SGR, PNI, albumin, performance status, and CA 19-9 are strong prognostic factors in patients with advanced gastric cancer. These prognostic factors, which are easily accessible in clinical practice, may be utilised as useful tools for clinicians.

Key words: Gastric cancer, Prognosis, Overall survival, Chemotherapy, Metastasis, Prognostic biomarkers.