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PROGNOSTIC SIGNIFICANCE OF SERUM INFLAMMATORY MARKERS IN GASTRIC CANCER
Arfon G. Powell*1, Tarig Abdelrahman2, Chris Brown2, Neil Patel2, Tim Havard2, Xavier Escofet2, Wyn G. Lewis2
1Division of Cancer and genetics, Cardiff University, Cardiff, United Kingdom; 2Department of Surgery, Cardiff and Vale University Health Board, Cardiff, United Kingdom
Introduction
Cancer related inflammation plays a significant role in cancer progression and is an important determinant of survival, yet it remains unknown which inflammatoryserum markers offer the greatest prognostic information for patients undergoing potentially curative gastric cancer surgery.
Methods
Consecutive 388 patients undergoing surgery in a tertiary referral centre were identified from a prospectively maintained database. Serum C-reactive Protein (CRP), Albumin and Full Blood Count differential were recorded prior to surgery, and the Modified Glasgow Prognostic Score (MGPS, based on CRP and Albumin), Neutrophil-Lympocyte Ratio (NLR) and Platellet-Lymphocyte Ratio (PLR) were calculated. NLR and PLR were dichotomised based on a threshold of 5.5 and 150 respectively. The primary measures of outcome were overall (OS) and disease free survival (DFS).
Results
During the 5-year follow-up period, 101 (26.0%) patients developed recurrent cancer and 171 (44.1%) died. On univariable OS analysis, pTNM (p<0.001), vascular invasion (p<0.001), poor differentiation (p=0.007), CRP (p<0.001) and MGPS (p<0.001) were associated with poor survival but not Albumin (p=0.358), NLR (p=0.701) or PLR (p=0.259). On multivariable OS analysis, MGPS (Hazard Ratio (HR) 1.70, 95% CI 1.27-2.72, p<0.001) was the only inflammatory marker to retain independent significance.
On univariable DFS analysis, pTNM (p<0.001), vascular invasion (p<0.001), poor differentiation (p=0.001), CRP (p=0.003) and MGPS (p=0.006) were associated with poor survival but not Albumin (p=0.450), NLR (p=0.695) or PLR (p=0.114). On multivariable DFS analysis, MGPS (HR 1.76, 95% CI 1.01-2.10, p=0.043) was again the only inflammatory marker to retain independent significance.
Conclusion
MGPS is an important prognostic indicator and delineating the physiological reasons may offer the potential for novel therapeutic targets in gastric cancer.
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