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Inflammatory markers for predicting overall survival in gastric cancer patients: A systematic review and meta-analysis

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  • Mi-Rae Kim
  • A-Sol Kim
  • Hye-In Choi
  • Jae-Hun Jung
  • Ji Yeon Park
  • Hae-Jin Ko

Abstract

Systemic inflammatory biomarkers have begun to be used in clinical practice to predict prognosis and survival of cancer patients, but the approach remains controversial. We conducted a meta-analysis to determine the predictive value of the c-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and Glasgow prognostic score (GPS)/modified Glasgow prognostic score (mGPS) in the clinical outcome of gastric cancer (GC) patients. We searched literature databases to identify relevant studies. All articles identified in the search were independently reviewed based on predetermined selection criteria. Meta-analysis was conducted to calculate the hazard ratio (HR) and 95% confidence intervals (CI) of overall survival of the included studies. A total of 41 eligible cohort studies, involving a total of 18,348 patients meeting the inclusion criteria, were considered for meta-analysis. Increases in CRP (HR = 1.654, 95% CI: 1.272–2.151), NLR (HR = 1.605, 95% CI: 1.449–1.779), and GPS/mGPS (HR = 1.648, 95% CI: 1.351–2.011) were significantly associated with poorer survival in patients with GC. Substantial heterogeneities were noted in all three markers (I2 = 86.479%, 50.799%, 69.774%, in CRP, NLR, and GPS/mGPS, respectively). Subgroup analysis revealed a significant positive correlation between each marker and poor survival, regardless of country, study quality, cancer stage, study design, or the inclusion of patients undergoing chemotherapy. This meta-analysis demonstrates that CRP, NLR, and GPS/mGPS are associated with poor survival in patients with GC. Further prospective studies using standardized measurements are warranted to conclude the prognostic value of various inflammatory markers.

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  • Mi-Rae Kim & A-Sol Kim & Hye-In Choi & Jae-Hun Jung & Ji Yeon Park & Hae-Jin Ko, 2020. "Inflammatory markers for predicting overall survival in gastric cancer patients: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-17, July.
    • Handle: RePEc:plo:pone00:0236445
    DOI: 10.1371/journal.pone.0236445
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    References listed on IDEAS

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    1. Xi Zhang & Wei Zhang & Li-jin Feng, 2014. "Prognostic Significance of Neutrophil Lymphocyte Ratio in Patients with Gastric Cancer: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(11), pages 1-7, November.
    2. Xuechao Liu & Shangxiang Chen & Jianjun Liu & Dazhi Xu & Wei Li & Youqing Zhan & Yuanfang Li & Yingbo Chen & Zhiwei Zhou & Xiaowei Sun, 2017. "Impact of systemic inflammation on gastric cancer outcomes," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-13, March.
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