Prognostic role of inflammatory response markers in gastric adenocarcinoma

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Abstract

BACKGROUND: Prognostic assessment of survival in patients with cancer is essential for guiding treatment strategies, particularly in gastric cancer, which is associated with high morbidity and mortality.

AIM: The study aimed to evaluate the association between inflammatory response markers and survival outcomes in patients with gastric adenocarcinoma.

MATERIAL AND METHODS: The study included 152 patients with histologically confirmed gastric adenocarcinoma. Patients were distributed by stage as follows: 25 (16.45%) with stage I, 25 (16.45%) with stage II, 34 (22.4%) with stage III, and 68 (44.7%) with stage IV disease. Inflammatory response parameters were collected, calculated, and evaluated. The resulting data were analyzed and compared to identify statistically significant associations with overall survival. The inflammatory response parameters included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as well as two specific indices, systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), which reflect the activity of inflammatory response in cancer patients and may serve as additional independent prognostic factors. The Mann–Whitney U test was used for two-group comparisons and the Kruskal–Wallis test for comparisons across more than two groups. Spearman’s rank correlation coefficient was used to assess the relationship between inflammatory markers and overall survival. Statistical analysis was performed using MedCalc version 20.104.

RESULTS: No significant associations were observed between inflammatory markers and patients’ age or sex. All inflammatory markers were significantly associated with overall survival (p < 0.001 for NLR, PLR, SII, and SIRI; p = 0.013 for MLR). Elevated levels of these markers correlated with shorter overall survival and a higher probability of stage IV disease.

CONCLUSION: Changes in hematologic markers reflecting systemic immune inflammation and inflammatory response are significantly correlate with survival outcomes in patients with gastric cancer.

About the authors

Ilgiz G. Gataullin

Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education

Email: ilgizg@list.ru
ORCID iD: 0000-0001-5115-6388
SPIN-code: 3049-2957

MD, Dr. Sci. (Med.), Prof., Depart. Of Oncology, Radiology and Palliative Medicine

Russian Federation, 36 Butlerova st, Kazan 420012

Bulat I. Gataullin

Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education; Kazan (Volga Region) Federal University

Email: bulatg@list.ru
ORCID iD: 0000-0003-1695-168X
SPIN-code: 2977-2970

MD, Cand. Sci. (Med.), Assoc. Prof., Assistant Prof., Depart. Of Surgery, assistant of Depart., Depart. of Oncology, Radiology and Palliative Medicine

Russian Federation, 36 Butlerova st, Kazan 420012; Kazan

Rishat M. Dinov

Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: rishatdinov@mail.ru
ORCID iD: 0009-0000-8570-5904
SPIN-code: 3954-5643

Resident, Depart. of Oncology, Radiology and Palliative Medicine

Russian Federation, 36 Butlerova st, Kazan 420012

Yana A. Erpert

Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education

Email: yana.erpert@bk.ru
ORCID iD: 0009-0007-0937-928X
SPIN-code: 5599-3392

Resident, Depart. of Oncology, Radiology and Palliative Medicine

Russian Federation, 36 Butlerova st, Kazan 420012

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2. Fig. 1. Dependence of the five-year survival rate on the neutrophil to lymphocyte ratio. NLR had a statistically significant inverse relationship with overall survival (p <0.0001, rho=–0.522). An increase in NLR was associated with a decrease in the overall survival rate of patients with gastric cancer. Each value marked with a dot corresponds to one patient with their NLR and 5-year survival values. The graph shows a trend in the overall survival rate from the NLR index

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3. Fig. 2. The relationship between 5-year survival and platelet-to-lymphocyte ratio (PLR) showed a significant inverse correlation with overall survival (p < 0.0001, rho = −0.330). Increased PLR was associated with decreased overall survival in patients with gastric cancer. Each value marked with a circle corresponds to one patient with their corresponding PLR and 5-year survival. The line indicates a trend for change in overall survival versus PLR.

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4. Fig. 3. The relationship between 5-year survival and monocyte-to-lymphocyte ratio (MLR) demonstrated a significant weak inverse correlation with overall survival (p = 0.0249, rho = −0.182). Increased MLR was associated with decreased overall survival in patients with gastric cancer. Each value marked with a circle corresponds to one patient with their corresponding MLR and 5-year survival. The line indicates a trend for change in overall survival versus MLR.

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5. Fig. 4. Relationship between 5-year survival and SII (p < 0.0001, rho = −0.421). SII showed a significant inverse correlation with overall survival. Increased SII was associated with decreased overall survival in patients with gastric cancer. Each value marked with a circle corresponds to one patient with their corresponding SII and 5-year survival. The line indicates a trend for change in overall survival versus SII.

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6. Fig. 5. Relationship between 5-year survival and SIRI (p < 0.0001, rho = −0.315). SIRI showed a significant inverse correlation with overall survival. Increased SIRI was associated with decreased overall survival in patients with gastric cancer. Each value marked with a circle corresponds to one patient with their corresponding SIRI and 5-year survival. The line indicates a trend for change in overall survival versus SIRI.

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