Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2020; 12(10): 1146-1166
Published online Oct 15, 2020. doi: 10.4251/wjgo.v12.i10.1146
Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer
Qiong Li, Lin-Yi Huang, Hui-Ping Xue
Qiong Li, Lin-Yi Huang, Hui-Ping Xue, Department ofGastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, China
Author contributions: Xue HP is the corresponding author of the article; Li Q and Huang LY contributed equally to the article; Li Q collected the data, performed statistical analysis, and wrote the draft manuscript; Huang LY collected required documents, performed statistical analysis, refined figures and tables, and supplemented the manuscript; Xue HP designed and supervised the research and revised the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.
Informed consent statement: Informed consent was waived by the Ethics Committee of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.
Conflict-of-interest statement: All of the authors have no financial relationship to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Ping Xue, MD, Professor, Department of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 145 Middle Shandong Road, Shanghai 200001, China. xuehuiping@renji.com
Received: June 4, 2020
Peer-review started: June 4, 2020
First decision: July 21, 2020
Revised: August 4, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: October 15, 2020
Abstract
BACKGROUND

Gastric cancer (GC) is one of the most common malignant tumors in the world. Although in recent years tremendous progress has been made in its early detection, the postoperative overall survival (OS) of GC patients remains extremely low. A number of studies have shown that age, to varying degrees, affects the prognosis of patients with GC. Therefore, this study retrospectively analyzed the clinical and pathologic data of patients with GC to explore the differences in the clinical characteristics and prognostic factors in different age groups.

AIM

To explore the difference in clinicopathological characteristics and prognostic factors in GC patients in different age groups.

METHODS

In this retrospective study, we analyzed 1037 GC patients admitted to Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2010 to January 2013. The patients were divided into two groups based on age: Younger group (less than 70 years old) and older group (no less than 70 years old). In the younger group, we subdivided the patients in two subgroups by a cut-off value of 45 years. The clinical features and prognostic factors were analyzed in both groups. Subsequently, we retrieved studies that evaluated the predictive role of neutrophil-lymphocyte ratio (NLR) by searching two medical databases, PubMed and EMBASE, to conduct a meta-analysis. Random-effects model was used to pool the data.

RESULTS

In the retrospective study, the mean OS time of the younger group (64.7 mo) was significantly longer than that of the older group (48.1 mo) (P < 0.001). Among patients under 70 years of age, hospitalization time, tumor–node–metastasis (TNM) stage, vascular invasion, and preoperative low pre-albumin were independently associated with OS (P < 0.005). In patients aged 70 years and above, TNM stage, esophageal invasion, histological type, and preoperative NLR were independent factors for OS (P < 0.05). The OS of these older patients was also significantly shorter (P < 0.05). In the meta-analysis, 19 retrieved studies included a total of 8312 patients, among whom 3558 had elevated NLR values. The results showed that high NLR value was a risk factor for the prognosis of GC (P < 0.01).

CONCLUSION

The OS of elderly patients is significantly worse than that of younger patients. There are significant differences in clinicopathological characteristics and prognostic factors between younger and older patients. NLR is a convenient, inexpensive, and reproducible marker that can be used as an important predictor of the prognosis of GC.

Keywords: Gastric cancer, Neutrophil-lymphocyte ratio, Age, Prognosis, Overall survival, Meta-analysis

Core Tip: This is a retrospective study that explored the prognostic factors in different age groups and the prognostic significance of neutrophil-lymphocyte ratio in gastric cancer patients. We compared the clinicopathological features of patients in two age groups (< 70 years and ≥ 70 years), analyzed the prognostic factors, and performed a thorough meta-analysis. The findings indicated that the improvement of preoperative nutritional status may be beneficial to the prognosis in younger patients, while the alleviation of inflammatory status should be emphasized for older patients before surgery. The conclusion can provide reliable reference for clinicians to identify and rectify the independent prognostic influencing factors in gastric cancer patients.