Explorations of the Clinical Pathology and Prognosis of Gastric Cancer Based on Systemic Immune Inflammation Index and Ferritin Expression

Zhi XIE; Lang YANG; Xiaolong ZHANG

Article Contents

Article Navigation > Journal of Kunming Medical University > 2025 > Corrected proof

Zhi XIE, Lang YANG, Xiaolong ZHANG. Explorations of the Clinical Pathology and Prognosis of Gastric Cancer Based on Systemic Immune Inflammation Index and Ferritin Expression[J]. Journal of Kunming Medical University.

Citation:

PDF( 878 KB)

Explorations of the Clinical Pathology and Prognosis of Gastric Cancer Based on Systemic Immune Inflammation Index and Ferritin Expression

Department of Gastroenterology，Chengdu Qingbaijiang District People’s Hospital，Chengdu Sichuan 610300，China

Received Date: 2025-04-18
Available Online: 2025-08-12

Abstract

Abstract

Objective To explore the relationship between systemic immune inflammatory index and ferritin （SF） and the clinicopathologic features and prognosis of gastric cancer （GC）. Methods A retrospective analysis was conducted on 152 gastric cancer patients who underwent D2 gastrectomy at the Radiation Oncology Department of Qingbaijiang District People's Hospital in Chengdu from January 2017 to December 2020. Neutrophil count was divided by lymphocyte count to calculate Neutrophil to lymphocyte ratio （NLR）. The SF level in plasma was evaluated by ELISA kit. According to the results of multivariate analysis, a new prognosis prediction system including NLR-SF score （NSS） was established. Results Multivariate Cox regression analysis showed that NLR （HR = 1.053, 95%CI = 1.014～1.094, P = 0.007）, tumor grade （HR = 1.944, 95%CI = 1.279～2.955, P = 0.002） and SF （HR = 1.005, 95%CI = 1.002～1.008, P = 0.002） were independent factors affecting the prognosis of GC patients. ROC analysis showed that when the cutoff value of SF was 215.5, the AUC of predicting the death of GC patients was 0.800 （95%CI = 0.731～0.869）, the sensitivity was 68.5%, and the specificity was 86.7%. When the cutoff value of NLR was 3.36, the AUC of predicting the death of GC patients was 0.869 （95%CI = 0.810～0.928）, the sensitivity was 81.5%, and the specificity was 91.7%. Higher NSS was significantly correlated with the number of lymph node metastasis > 3 cases, the number of deaths, the increase of neutrophil, platelet, SF, NLR and PLR levels （P < 0.05）, and the decrease of lymphocytes （P < 0.05）. Kaplan-Meier survival curve analysis showed that the higher the NSS, the shorter the survival time （χ² =75.168, P < 0.001）. ROC analysis showed that the AUC of NSS in predicting the death of GC patients was 0.902 （95%CI = 0.852～0.952）, the sensitivity was 90.2%, and the specificity was 80.0%. Conclusions This study confirms that NLR and SF are independent prognostic factors of GC patients, and the NSS constructed by combining them is of great value in predicting the overall postoperative survival.
- Neutrophil to lymphocyte ratio,
- Ferritin,
- Gastric cancer,
- Prognosis

FullText(HTML)

References(26)

References

[1]	Frick C,Rumgay H,Vignat J,et al. Quantitative estimates of preventable and treatable deaths from 36 cancers worldwide: A population-based study[J]. Lancet Glob Health,2023,11(11):e1700-e1712. doi: 10.1016/S2214-109X(23)00406-0
[2]	López M J,Carbajal J,Alfaro A L,et al. Characteristics of gastric cancer around the world[J]. Crit Rev Oncol Hematol,2023,181:103841. doi: 10.1016/j.critrevonc.2022.103841
[3]	Matsas S,Aguiar Jr P N,Del Giglio A. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as biomarkers to prognosticate survival in advanced gastric cancer patients in the era of immunotherapy: A systematic review and meta-analysis[J]. J Gastrointest Oncol,2024,15(1):33-51. doi: 10.21037/jgo-23-808
[4]	Lazzati A,Poghosyan T,Touati M,et al. Risk of esophageal and gastric cancer after bariatric surgery[J]. JAMA Surg,2023,158(3):264-271. doi: 10.1001/jamasurg.2022.6998
[5]	Hirano T. IL-6 in inflammation,autoimmunity and cancer[J]. Int Immunol,2021,33(3):127-148. doi: 10.1093/intimm/dxaa078
[6]	Hou J,Karin M,Sun B. Targeting cancer-promoting inflammation-have anti-inflammatory therapies come of age?[J]. Nat Rev Clin Oncol,2021,18(5):261-279. doi: 10.1038/s41571-020-00459-9
[7]	Lin G S,Lu J,Lin J,et al. Value of the preoperative D-dimer to albumin ratio for survival and recurrence patterns in gastric cancer[J]. Ann Surg Oncol,2023,30(2):1132-1144. doi: 10.1245/s10434-022-12625-7
[8]	Saboorifar H,Zafarani Y,Gholampour G,et al. Serum inflammatory markers as prognostic marker for nasopharyngeal carcinoma with liver metastasis: A multi-center retrospective study[J]. Eur Arch Otorhinolaryngol,2024,281(8):4315-4324.
[9]	Ramírez-Carmona W,Díaz-Fabregat B,Yuri Yoshigae A,et al. Are serum ferritin levels a reliable cancer biomarker? A systematic review and meta-analysis[J]. Nutr Cancer,2022,74(6):1917-1926. doi: 10.1080/01635581.2021.1982996
[10]	Zhou D,Zeng C,Zhang L,et al. Serum ferritin is associated with sarcopenia and predicts long-term survival for gastric cancer undergoing radical gastrectomy[J]. Eur J Gastroenterol Hepatol,2023,35(12):1341-1348. doi: 10.1097/MEG.0000000000002659
[11]	Wang F H,Zhang X T,Tang L,et al. The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer,2023[J]. Cancer Commun,2024,44(1):127-172 doi: 10.1002/cac2.12516
[12]	Ma X,Zhou X H,Guo J X,et al. CA19‑9 is a significant prognostic factor in stage III gastric cancer patients undergoing radical gastrectomy[J]. BMC Surg,2024,24(1):31. doi: 10.1186/s12893-024-02324-3
[13]	Gao C,Tong Y X,Zhu L,et al. Short-term prognostic role of peripheral lymphocyte subsets in patients with gastric cancer[J]. Int Immunopharmacol,2023,115:109641. doi: 10.1016/j.intimp.2022.109641
[14]	Liu M,Hu Z,Wang C,et al. The TLR/MyD88 signalling cascade in inflammation and gastric cancer: The immune regulatory network of Helicobacter pylori[J]. J Mol Med,2023,101(7):767-781. doi: 10.1007/s00109-023-02332-5
[15]	Wang H,Gong H,Tang A,et al. Neutrophil/lymphocyte ratio predicts lymph node metastasis in patients with gastric cancer[J]. Am J Transl Res,2023,15(2):1412.
[16]	Yang S,Sun B,Li J,et al. Neutrophil extracellular traps promote angiogenesis in gastric cancer[J]. Cell Commun Signal,2023,21(1):176. doi: 10.1186/s12964-023-01196-z
[17]	Ito S,Ohgaki K,Kawazoe T,et al. Survival benefits of laparoscopic gastrectomy in elderly patients with gastric cancer: Focusing on preoperative nutritional and inflammatory status[J]. Anticancer Res,2023,43(5):2055-2067. doi: 10.21873/anticanres.16366
[18]	Hirahara N,Matsubara T,Kaji S,et al. Novel inflammation-combined prognostic index to predict survival outcomes in patients with gastric cancer[J]. Oncotarget,2023,14:71-82. doi: 10.18632/oncotarget.28353
[19]	Zhang S,Qiu C,Yu H,et al. Prognostic value of neutrophil to lymphocyte ratio in gastric cancer patients receiving immune checkpoint inhibitors: A systematic review and meta-analysis[J]. Front Oncol,2023,13:1070019. doi: 10.3389/fonc.2023.1070019
[20]	Nouri Z,Choi S W,Choi I J,et al. Exploring connections between oral microbiota,short-chain fatty acids,and specific cancer types: A study of oral cancer,head and neck cancer,pancreatic cancer,and gastric cancer[J]. Cancers,2023,15(11):2898. doi: 10.3390/cancers15112898
[21]	Wang F,Deng G,Liang N,et al. Serum ferritin level is an effective prognostic factor for lung cancer immunotherapy[J]. Cancer Biol Ther,2023,24(1):2285367. doi: 10.1080/15384047.2023.2285367
[22]	Zhao Y,Zhao J,Ma H,et al. High hepcidin levels promote abnormal iron metabolism and ferroptosis in chronic atrophic gastritis[J]. Biomedicines,2023,11(9):2338. doi: 10.3390/biomedicines11092338
[23]	Chun J H,Kim D J. Risk factors for ferritin depletion in patients with post-gastrectomy gastric cancer and normal baseline ferritin levels[J]. Foregut Surgery,2024,4(1):17-26. doi: 10.51666/fs.2024.4.e1
[24]	Chen Z,Liang Z,Chen K,et al. Serum ferritin predicted prognosis in patients with nasopharyngeal carcinoma[J]. Sci Rep,2024,14(1):4311. doi: 10.1038/s41598-024-54627-3
[25]	Skórzewska M,Pikuła A,Gęca K,et al. Systemic inflammatory response markers for prediction of response to neoadjuvant chemotherapy in patients with advanced gastric cancer[J]. Cytokine,2023,172:156389. doi: 10.1016/j.cyto.2023.156389
[26]	Deng D,Zhang Y,Zhang R,et al. Circulating proteins and metabolite biomarkers in gastric cancer: A systematic review and meta-analysis[J]. Arch Med Res,2023,54(2):124-134. doi: 10.1016/j.arcmed.2022.12.012

Relative Articles(20)

Relative Articles

[1]	Shubin JIN, Xiaoyan LIU, Wenhua GENG, Jianjun JIAO. Expression and Prognostic Correlation Analysis of NUTF2 in Head and Neck Squamous Cell Carcinoma （HNSCC） Patients. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20250613
[2]	Zuohua WANG, Rongfeng WU, Xiaoyan ZHANG, Huiping WANG. Relationship of Serum IL-27，CysC，GAPDH Antibodies with Disease Severity and Prognosis in Children with Neuromyelitis Optica Spectrum Disorder. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20250718
[3]	Xiaoxiao FAN, Xuan ZENG, Pingping ZHOU, Xi LIU, Feifei ZHU, Yanji LUO, Yi WU. Relationship between the Platelet Autophagy-related Factor Expression and Peritoneal Metastasis of Gastric Cancer. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20250715
[4]	Huanhuan LIN, Dongguang YANG, Yanping LI, Haiyun LI, Jinqiao HAN. Expression of PG Ⅰ/PG Ⅱ，NAP1L1，SERPINB5 in Serum of Gastric Cancer Patients and Cox Regression Analysis on Prognosis. Journal of Kunming Medical University,
[5]	Lizhu ZHAO, Ying DONG, Yue DENG, Lihua YANG. Correlation between Epithelial Cell Related Genes and Prognosis of Patients with Ovarian Cancer based on Single Cell Sequencing. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240402
[6]	Chunyan LIU, Bingqing CHANG, Chao LI, Xin REN, Xiaoqin LIU. The Relationship between T Lymphocyte Subsets and Pathological Characteristics of Acute Myeloid Leukemia and the Value of Predicting Chemotherapy Prognosis. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240518
[7]	Qi NIE, Li LIU, Yue TIAN, Xiaoyan MAO, Qulian GUO, Xin TIAN. Abnormal Clinical Features and Prognosis of ACTH in Pediatric Acute B Lymphocytic Leukemia. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20241012
[8]	Ruiting ZHANG, Bin YAN, Zuyan LI, Jinmin SUN, Jin YAO. Relations between Peripheral Blood Blast Clearance Time and Albumin Level at Initial Diagnosis during Induction Chemotherapy and Genetic Mutations and Prognosis in Patients with Acute Myeloid Leukemia. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240817
[9]	Fen LI, Jie ZHAO, Haixi ZHANG, Lin ZHANG, Xuezhong GU. The Correlation of Iron Metabolism Indexes，Cytokines，and Liver Function in Patients with Hemophagocytic Syndrome. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20241115
[10]	Xinyi MEN, Jing ZHAO, Yongchun SHEN, Hui JI, Xiuxia WANG. The Relationship between Peripheral Blood Immunoglobulin，Erythrocyte Sedimentation Rate，Homocysteine and the Degree of Central Nervous System Vasculitis in Children and Their Influence on Prognosis. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20241217
[11]	Xiaohua LU, Hongxin YUAN. The Analysis of the Correlation between BTLA，CTLA-4 Gene Polymorphisms and the Efficacy and Prognosis of TACE Combined Targeted Therapy for Liver Cancer. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230927
[12]	Liang ZHANG, Baoquan WANG, Xifeng LEI, Xu WANG, Yang KE, Wei ZHANG. M2 Macrophage-derived Exosome miR-1246 Regulates the Growth and Invasion of Gastric Cancer Cells. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230724
[13]	Jiadai TANG, Jing YANG, Hongli SONG, Jiaojiao CHEN, Zhonghui MIAO, Lin XIE. Correlation of Metastatic and Prognostic Factors in 318 Cases of Primary Gastric Cancer. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230218
[14]	Changmeng HU, Lin WU. Correlation Between Silva Type and Prognosis of Cervical HPV-associated Adenocarcinoma. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20220817
[15]	Jia-dai TANG, Lin XIE, Hong-li SONG, Jiao-jiao CHEN. Correlation between Metabolic Syndrome and the Occurrence and Development of Gastric Cancer. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20211130
[16]	Jian-pei SU, Wei-meng TIAN, Jun GU, Mi-yu HE. Association between C-reactive Protein/Albumin Ratio and Long-term Prognosis in Elderly Patients with Heart Failure. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20201236
[17]	Wu Wen Juan . Combination of Heart-type Fatty Acid-binding Protein and Simple Pulmonary Embolism Severity Index for the Assessment of the Short-term Prognosis in Patients with Acute Pulmonary Embolism. Journal of Kunming Medical University,
[18]	Xu Jian Xin . . Journal of Kunming Medical University,
[19]	Song Ji . . Journal of Kunming Medical University,
[20]	Liu Jian Gang . . Journal of Kunming Medical University,