*3.2.1. Local tumour spread: T*

was associated with GPS [43]. By univariate analysis, both NLR and PLR were associated with overall survival of gastric cancer patients after gastrectomy. However, none of these parameters was identified as an independent factor by multivariate analysis in this study [45]. A study of 1986 consecutive gastric cancer patients was directly targeting the issue if PLR of NLR is better as a prognostic factor of gastric cancer. Although high PLR was significantly associated with poor prognosis it was not an independent risk factor for decreased

Finally, negative results are reported. In a multicentre study of 245 gastric cancer patients,

In advanced gastric cancer, many studies have revealed significant and independent associa-

High PLR (exceeding 160) along with high NLR (reaching or exceeding 2.57) and high abso-

with shorter median overall survival of 168 locally advanced gastric cancer patients. The

In advanced unresectable gastric cancer, low PLR (less than 235) correlated with less metastasis and improved response to chemotherapy, longer overall survival and progression-free survival. Changes in PLR after first-line chemotherapy also were indicative of prognosis: survival and response to treatment was better in cases that retained low PLR or switched to low

In a cohort of 109 metastatic gastric cancer patients treated by chemotherapy, high PLR (exceeding the cut-off 160) was associated with significantly shorter progression-free and

In 174 advanced gastric cancer cases treated by chemotherapy, low PLR and normalisation of PLR after one cycle of chemotherapy were independent prognostic markers for better overall survival. Normalisation of PLR was also associated with longer progression-free survival: 5.6

In a relatively small study group, PLR lacked prognostic role in 53 patients affected by local gastric cancer and treated with surgery and adjuvant chemotherapy while it had significant prognostic meaning in 50 advanced cases treated by chemotherapy. Interestingly, high platelet count was associated with better overall survival in patients having local disease [56].

Again, many studies have identified significant but not independent association between PLR and survival. In 439 patients affected by metastatic or recurrent gastric cancer, PLR (along with NLR, modified Glasgow prognostic score, previous histology with neural and vascular invasion, albumin, CRP and haemoglobin level) was significantly associated with overall survival, but it was not an independent prognostic factor. In this study design, modified Glasgow prognostic score was the only inflammation-related parameter that was independently associated with survival by multivariate analysis [60]. In 384 patients affected by inoperable advanced or metastatic gastric cancer and treated by palliative chemotherapy, PLR (as well as NLR, leucocytosis, elevated number of neutrophils or platelets, decreased lymphocyte count, hypoalbuminemia, high CRP and Glasgow prognostic score) showed association with

) were significantly associated

tion between PLR and survival. However, controversial findings still are reported.

overall survival in contrast to NLR. Thus, NLR was preferred [39].

lute number of lymphocytes (reaching or exceeding 1500/mm3

median survival in high vs. low PLR groups was 27 vs. 45 months [41].

PLR was not associated with survival [61].

PLR group during treatment [38].

overall survival [67].

166 Gastric Cancer

months vs. 3.4 months [57].

PLR has been evaluated for the association with tumour features, mainly—TNM parameters, representing the oncological mainstay. The association between high PLR and deeper invasion has been confirmed in 162 patients diagnosed with resectable gastric cancer [16], in a larger cohort of 451 surgically treated gastric cancer patients [83] and in a multicentre study of 245 gastric cancer patients [61]. In a meta-analysis of 8 studies comprising 4513 patients with gastric cancer, elevated PLR also showed association with deeper invasion (T3–T4). The relevant odds ratios was 2.01 (95% CI 1.49–2.73) as reported by Xu et al. [85]. In addition, in a large cohort of 451 surgically treated gastric cancer patients, high PLR was associated with larger tumour size [83].
