Comparison of the prognostic impact and combination of preoperative inflammation-based and/or nutritional markers in patients with stage II gastric cancer

BACKGROUND: The aim of this study was to evaluate and compare the prognostic value of preoperative established inflammation-based and/or nutritional markers, C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, Prognostic Nutritional Index (PNI), Glasgow Prognostic Score, and prognostic index in patients with stage II gastric cancer. We then developed a new prognostic index based on the results of our investigation. METHODS: This study retrospectively reviewed 240 consecutive patients who underwent R0 resection for stage II gastric cancer. Time-dependent receiver operating characteristic curve analyses were performed to assess discrimination ability and to determine optimal cut-off values. Prognostic factors predicting overall survival (OS) were analyzed using Cox proportional hazards models. RESULTS: Among inflammation-based and/or nutritional markers, multivariate analyses demonstrated CAR and PNI as independent prognostic factors for OS (hazard ratio (HR) 1.707, 95% confidence interval (CI) 1.016-2.867, p=0.044 and HR 0.415, 95%CI 0.234-0.736, p=0.003, respectively). CAR-PNI score, constructed as the combination of CAR and PNI, was significantly associated with OS, relapse-free survival and cancer-specific survival (p<0.001 each). Multivariate analysis revealed CAR-PNI score as an independent prognostic factor for OS (HR for CAR-PNI score 1: 2.432, 95%CI 1.155-5.118; HR for CAR-PNI score 2: 4.099, 95%CI 1.835-9.157; p=0.002). CONCLUSIONS: CAR and PNI are independent prognostic factors providing superior prediction of survival compared to other inflammation-based and/or nutritional markers. CAR-PNI score offers a novel and promising prognostic indicator for patients with stage II gastric cancer.