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
Processing time: 132 Days and 8.1 Hours
ARTICLE HIGHLIGHTS
Research background

Gastric cancer (GC) is one of the most common malignant tumors in the world. The postoperative overall survival (OS) of GC patients remains extremely low. Therefore, we attempted to analyze the clinical and pathologic data of GC patients in different age groups to explore the differences in the clinical characteristics and prognostic factors.

Research motivation

We attempted to provide reliable reference for clinicians to identify and rectify the independent prognostic influencing factors for GC patients in different age groups.

Research objectives

We designed this retrospective study to analyze the clinical and pathologic data of patients with GC, and explore the differences in the clinical characteristics and prognostic factors between different age groups.

Research methods

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). The clinical features and prognostic factors were analyzed in both groups. Further, a meta-analysis was conducted to explore the prognostic significance of neutrophil-lymphocyte ratio (NLR) in GC patients.

Research results

In the retrospective study, the mean OS 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, TNM stage, vascular invasion, and preoperative low pre-albumin were independently associated with OS (P < 0.005), whereas in patients older than 70 years, TNM stage, esophageal invasion, histological type, and preoperative NLR were independent factors for OS (P < 0.005). The OS of these older patients was significantly shorter (P < 0.005). In meta-analysis, the results showed that high NLR value was a risk factor for the prognosis of GC.

Research conclusions

There are significant differences in clinicopathological characteristics and prognostic factors between the two age groups of GC patients. NLR is a convenient, inexpensive, and reproducible marker that can be used as an important predictor of the prognosis of GC. The OS of elderly patients is significantly worse than that of younger patients. Elderly patients should focus more on the improvement of inflammatory status, whereas preoperative nutritional status improvement may be particularly beneficial for the prognosis of younger patients. There is still little research to assess the significance of pre-albumin in the prognosis of GC, which needs to be stressed in the future.

Research perspectives

Clinicians should attach great importance to the impact of objective indicators on the prognosis of GC, identifying high-risk patients as many as possible and improving their overall prognosis. NLR is a widely used, inexpensive, and reproducible marker that can be used as an important predictor of the prognosis of GC. In particular, elderly patients should be focused more on the improvement of inflammatory status preoperatively if NLR values are high, whereas preoperative nutritional status improvement may be especially beneficial for the prognosis of younger patients.