Prognostic significance of immune-inflammatory markers and tumor markers in locally advanced gastric adenocarcinoma patients receiving neoadjuvant chemotherapy

Aim: In this study, we aimed to investigate the effect of neutrophil, lymphocyte, monocyte, platelet, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), prognostic nutritional index (PNI), and clinical-pathological factors on survival in patients with gastric cancer treated with neoadjuvant chemotherapy. Material and Methods: Forty-seven patients from a single center were included in this study. Patient medical records were reviewed retrospectively. In addition to demographic and clinical characteristics, the effects of pre-treatment levels of hemoglobin, neutrophils, lymphocytes, monocytes, platelets, albumin, NLR, PLR, PNI, and tumor markers (CEA, CA19-9), along with postoperative pathological features, on survival were evaluated. Disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Factors affecting both DFS and OS were analyzed using univariate and multivariate Cox regression analyses. Results: The median OS was 27 months, and the median DFS was 17 months. In the univariate analysis for DFS, increasing monocyte count at diagnosis (p = 0.009, HR: 7.0 [1.6–30]) and D1 lymph node dissection (p = 0.034, HR: 5.1 [1.1–23.3]) were found to be associated with poor prognosis. In the multivariate analysis for DFS, increasing CEA levels (p = 0.03, HR: 1.02 [1–1.03]) and increasing monocyte count at diagnosis (p = 0.05, HR: 10.4 [2.03–53.5]) were identified as poor prognostic factors. In the multivariate analysis for OS, only increasing CEA levels at diagnosis were associated with poor prognosis (p = 0.02, HR: 1.01 [1.00–1.02]). Conclusion: Increasing monocyte count at diagnosis were associated with reduced disease-free survival in locally advanced gastric cancer. Likewise, increasing CEA levels at diagnosis correlated with poorer overall survival. Readily available and cost-effective biomarkers such as monocyte count and CEA may serve as valuable indicators for predicting disease course in early-stage gastric cancer.