Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 106517
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.106517
Prognostic impact of histopathological features and serum inflammatory markers in patients with gastric cancer undergoing neoadjuvant therapy
Nilufer Bulut, Gokmen U Erdem, Tanju Kapagan, Vedat B Erol, Tunahan Sahin, Murat Yakin, Ayberk Bayramgil, Özgecan Dülgar
Nilufer Bulut, Gokmen U Erdem, Tanju Kapagan, Vedat B Erol, Tunahan Sahin, Murat Yakin, Department of Medical Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul 34303, Türkiye
Ayberk Bayramgil, Özgecan Dülgar, Department of Medical Oncology, Umraniye Training and Research Hospital, Istanbul 34760, Türkiye
Author contributions: Bulut N procured data from Oncology Department of Hospital; Erdem GU, Kapagan T, Bayramgil A, and Dülgar Ö made tables, figure, and statistical analyses, and included their patients in the study; Bulut N, Erdem GU, Kapagan T, Erol VB, Sahin T, Yakin M, Bayramgil A, and Dülgar Ö have read and approved the final version of the manuscript.
Institutional review board statement: This study is approved by Basaksehir Cam and Sakura City Hospital (No. KAEK/03.04.2024.242).
Informed consent statement: There is no informed consent statement because the analysis used anonymous clinical data retrospectively.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data is available upon reasonable request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nilufer Bulut, Associate Professor, Department of Medical Oncology, Basaksehir Cam and Sakura City Hospital, Şehir Hastanesi Cad 2L, Istanbul 34303, Türkiye. ferlut@gmail.com
Received: February 28, 2025
Revised: April 1, 2025
Accepted: May 6, 2025
Published online: June 27, 2025
Processing time: 91 Days and 19.5 Hours
Abstract
BACKGROUND

Neoadjuvant therapies induce tumor regression, resulting in improved surgical resection and pathologic complete response rates, as well as long-term disease-free and overall survival (OS). In addition to the tumor regression score, serum inflammatory markers, including neutrophil, lymphocyte, platelet, and serum albumin levels, are used to determine prognosis.

AIM

To investigate the effect of histological features and serum inflammatory markers on the prognosis of gastric cancer following neoadjuvant treatment.

METHODS

Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and serum albumin levels were retrospectively recorded for 177 patients receiving neoadjuvant 5-fluorouracil, leucovorin, oxaliplatin and docetaxel chemotherapy. Disease-free and OS were analyzed based on tumor histopathological features, type of surgery, regression scores, and serum inflammatory markers.

RESULTS

Patients over 65 years of age, those with lymphovascular or perineural invasion, hypoalbuminemia, and those who did not receive adjuvant therapy were found to be at higher risk for shorter recurrence/relapse intervals [hazard ratio (HR): 1.64, P = 0.04; HR: 4.20, P < 0.001; HR: 1.87, P = 0.03; HR: 3.5, P < 0.001; and HR: 2.73, P = 0.01, respectively]. Lymphovascular invasion, R1 resection, lack of adjuvant treatment, and hypoalbuminemia negatively influenced OS (HR: 3.68, P < 0.003; HR: 2.37, P = 0.01; HR: 3.99, P < 0.001; and HR: 2.50, P = 0.01, respectively). No effect of NLR and PLR was observed.

CONCLUSION

Current neoadjuvant therapies prolong disease-free and OS. The practical application of serum inflammatory markers (NLR and PLR) is limited due to the lack of standard cut-off values. Nutritional status, hypoalbuminemia, and incomplete perioperative chemotherapy have been associated with poor prognosis.

Keywords: Gastric cancer; Neoadjuvant therapy; Neutrophil/lymphocyte ratio; Albumin; Survival

Core Tip: Serum inflammatory markers and nutritional status influence surgical mortality. Perioperative chemotherapy contributes to survival by improving pathological response and prognosis. In addition to the tumor regression score, serum inflammatory markers, such as neutrophil, lymphocyte, platelet levels, and serum albumin levels, are used to determine prognosis. As there are no specific cut-off values for inflammatory markers reported in literature, we investigated the effect of serum levels of these markers and histopathological features on tumor prognosis.