Identification of prognostic factors for survival in patients with metastatic gastric adenocarcinoma in a Mexican population

Abstract

Introduction and aims: Gastric adenocarcinoma is among the high-ranking tumors, with respect to frequency and mortality, worldwide. The inflammatory process and immune system activity are associated with oncologic control. Our aim was to identify whether the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and other variables are prognostic factors for survival in patients with metastatic gastric cancer in a Mexican population. Material and methods: Patients diagnosed with metastatic gastric adenocarcinoma, hospitalized within the time frame of December 2011 to 2021, were analyzed. The NLR, PLR, and albumin and hemoglobin levels obtained from blood samples were calculated. Functional status (ECOG and Karnofsky), sex, histology, and the presence of signet ring cells were also considered possible prognostic factors. Each factor’s prognostic value for overall survival was determined through univariate and multivariate analyses. Results: The study included 956 patients diagnosed with metastatic gastric cancer, of whom 494 (51.7%) were men and 462 (48.3%) were women. The main histologic finding was diffuse adenocarcinoma (n = 619, 64.7%), followed by intestinal adenocarcinoma (n = 293, 30.6%), and the presence of signet ring cells was found in 659 (68.9%) patients. Diagnostic laparoscopy was performed on 238 patients (24.9%) to confirm peritoneal carcinomatosis. The multivariate analysis showed that an NLR above 3.2 (HR 1.51, 95% CI 1.27–1.8; p < 0.001), albumin below 3.5 g/dl (HR 1.25, CI 1.06–1.47; p = 0.006), and an ECOG performance status of 2 or higher (HR 1.39, CI 1.10–1.76; p = 0.005) were independent factors that predicted a lower survival rate, whereas a Karnofsky score above 70% (HR 0.69, CI 0.53–0.91; p = 0.008) was associated with a better survival rate. Lastly, the PLR was not statistically significant in the multivariate analysis. Conclusions: The NLR, nutritional status assessed through albumin measurement, and functional status can act as independent prognostic survival factors in hospitalized Mexican patients diagnosed with metastatic gastric adenocarcinoma and be taken into account during therapeutic decision-making. Resumen: Introducción y objetivos: El adenocarcinoma gástrico se ubica entre las neoplasias malignas con mayor frecuencia y mortalidad en el mundo. Se ha observado que el proceso inflamatorio y la actividad del sistema inmunológico están asociados al control oncológico. Nuestro objetivo es identificar si el índice neutrófilo/linfocito (INL), índice plaqueta/linfocito (IPL) y otros factores son pronósticos para supervivencia en pacientes con cáncer gástrico metastásico en nuestra población. Material y métodos: Pacientes con diagnóstico de adenocarcinoma gástrico metastásico, admitidos de diciembre 2011 a 2021. A partir de una muestra de sangre al ingreso se calculó el INL, IPL, albumina y hemoglobina. Además, se consideró el estado funcional (ECOG y Karnofsky), sexo, histología y presencia de células en anillo de sello como otros factores que pudieran ser pronósticos. Por medio de un análisis univariado y multivariado se determinó el valor pronóstico de cada factor para supervivencia global. Resultados: Se incluyeron 956 pacientes con diagnóstico de cáncer gástrico metastásico, 494 (51.7%) fueron hombres y 462 (48.3%) mujeres, la principal histología fue el adenocarcinoma difuso 619 (64.7%) seguido por adenocarcinoma intestinal 293 (30.6%) y del total de pacientes, 659 (68.9%) tuvieron presencia de células en anillo de sello. En 238 pacientes (24.9%) se realizó laparoscopia diagnóstica para confirmar la carcinomatosis peritoneal. El análisis multivariado demostró que un INL mayor a 3.2 (HR 1.51, IC 95% 1.27-1.8; p < 0.001), albumina menor a 3.5 g/dl (HR 1.25, IC 1.06 - 1.47; p = 0.006) y un ECOG de 2 o mayor (HR 1.39, IC 1.10-1.76; p = 0.005) fueron factores independientes que predijeron una menor supervivencia mientras que el Karnofsky mayor a 70% (HR 0.69, IC 0.53-0.91; p = 0.008) se asoció a mejor supervivencia y finalmente, el IPL no tuvo significancia estadística para este análisis. Conclusiones: El INL, el estado nutricional midiendo la albúmina y el estado funcional pueden ser factores independientes pronósticos de supervivencia en pacientes mexicanos que ingresan con diagnóstico de adenocarcinoma gástrico metastásico y pudieran ser considerados durante la toma de decisiones terapéuticas.

Keywords

• Cáncer gástrico metastásico
• Factores pronósticos
• Índice neutrófilo-linfocito
• Albúmina
• Estado funcional