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Neutrophil-to-lymphocyte ratio and C-reactive protein–to–albumin ratio as prognostic factors for unresectable advanced or recurrent gastric cancer

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Abstract

Purpose

This study evaluated the prognostic value of C-reactive protein–to–albumin (CAR) and neutrophil-to-lymphocyte ratios (NLR) in conjunction with host-related factors in patients with unresectable advanced or recurrent gastric cancer.

Methods

A total of 411 patients with unresectable advanced gastric cancer were treated at Kochi Medical School between 2007 and 2019. Associations between clinicopathological parameters and systemic inflammatory and nutritional markers, including CAR and NLR, with overall survival were analyzed retrospectively.

Results

The optimal cut-off values of predicted median survival time were 0.096 (sensitivity, 74.9%; specificity, 42.5%) for CAR and 3.47 (sensitivity, 64.1%; specificity, 57.5%) for NLR, based on the results of receiver operating characteristic analysis. A weak significant positive correlation was identified between CAR and NLR (r = 0.388, P < 0.001). The median survival time was significantly higher in patients with intestinal-type than those with diffuse-type histology (18.3 months vs. 9.5 months; P = 0.001), CAR < 0.096 than those with CAR ≥ 0.096 (14.8 months vs. 9.9 months; P < 0.029), and those with NLR < 3.47 than NLR ≥ 3.47 (14.7 months vs. 8.8 months; P < 0.001). Multivariate survival analysis revealed that diffuse-type histology (hazard ratio (HR) 1.865; 95% confidence interval (CI) 1.397–2.490; P < 0.001)), 1 or more performance status (HR 11.510; 95% CI 7.941–16.683; P < 0.001), and NLR ≥ 3.47 (HR 1.341; 95% CI 1.174–1.769; P = 0.023) were significantly associated with independent predictors of worse prognosis.

Conclusions

High CAR and NLR are associated with poor survival in patients with unresectable and recurrent gastric cancer.

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Acknowledgements

We would like to acknowledge the contributions of the colleagues of the Department of Surgery, Kochi Medical School.

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Authors and Affiliations

  1. Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan

    Tsutomu Namikawa, Shigeto Shimizu, Keiichiro Yokota, Nobuhisa Tanioka, Masaya Munekage, Sunao Uemura, Hiroyuki Kitagawa & Kazuhiro Hanazaki

  2. Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan

    Hiromichi Maeda & Michiya Kobayashi

Authors
  1. Tsutomu Namikawa
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  2. Shigeto Shimizu
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  3. Keiichiro Yokota
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  4. Nobuhisa Tanioka
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  5. Masaya Munekage
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  6. Sunao Uemura
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  7. Hiromichi Maeda
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  8. Hiroyuki Kitagawa
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  10. Kazuhiro Hanazaki
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Contributions

Study conception and design: Tsutomu Namikawa. Acquisition of data: Tsutomu Namikawa, Shigeto Shimizu, Keiichiro Yokota, Nobuhisa Tanioka, Masaya Munekage, Sunao Uemura, Hiroyuki Kitagawa, and Michiya Kobayashi. Analysis and interpretation of data: Tsutomu Namikawa and Hiromichi Maeda. Drafting of manuscript: Tsutomu Namikawa. Critical revision of the manuscript: Tsutomu Namikawa and Kazuhiro Hanazaki.

Corresponding author

Correspondence to Tsutomu Namikawa.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of Kochi Medical School, Kochi, Japan (approval number: 2020–136).

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Informed consent was obtained from all individual participants or their family included in the study.

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The authors declare no competing interests.

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Namikawa, T., Shimizu, S., Yokota, K. et al. Neutrophil-to-lymphocyte ratio and C-reactive protein–to–albumin ratio as prognostic factors for unresectable advanced or recurrent gastric cancer. Langenbecks Arch Surg 407, 609–621 (2022). https://doi.org/10.1007/s00423-021-02356-w

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