Perioperative treatment is currently the gold standard approach in Europe for locally advanced
gastric cancer (GC). Unfortunately, the phenomenon of patients dropping out of treatment has been frequently observed. The primary aims of this study were to verify if routine blood parameters, inflammatory response markers,
sarcopenia, and the depletion of adipose tissues were associated with compliance to neoadjuvant/perioperative
chemotherapy.
METHODS AND STUDY DESIGN: Blood samples were considered before the first and second cycles of
chemotherapy.
Sarcopenia and adipose indices were calculated with a CT scan before starting
chemotherapy and before surgery. Odds ratios (OR) from univariable and multivariable models were calculated with a 95% confidence interval (95% CI).
RESULTS: A total of 84 patients with locally advanced GC were identified between September 2010 and January 2021. Forty-four patients (52.4%) did not complete the treatment according to the number of cycles planned/performed. Eight patients (9.5%) decided to suspend
chemotherapy, seven patients (8.3%) discontinued because of clinical decisions, fourteen patients (16.7%) discontinued because of toxicity and fifteen patients (17.9%) discontinued for miscellaneous causes. Seventy-nine (94%) out of eighty-four patients underwent
gastrectomy, with four patients having surgical complications, which led to a
suspension of treatment.
Sarcopenia was present in 38 patients (50.7%) before
chemotherapy began, while it was present in 47 patients (60%) at the CT scan before the
gastrectomy. At the univariable analysis, patients with basal platelet to lymphocyte ratio (PLR) ≥ 152 (p = 0.017) and a second value of PLR ≥ 131 (p = 0.007) were more frequently associated with an interruption of
chemotherapy. Patients with increased PLR (p = 0.034) compared to the cut-off were associated with an interruption of
chemotherapy, while patients with increased monocytes between the first and second cycles were associated with a lower risk of treatment interruption (p = 0.006); patients who underwent
5-fluorouracil plus
cisplatin or
oxaliplatin had a higher risk of interruption (p = 0.016) compared to patients who underwent a
5-fluorouracil plus
leucovorin,
oxaliplatin and
docetaxel (FLOT) regimen. The multivariable analysis showed a higher risk of interruption for patients who had higher values of PLR compared to the identified cut-off both at pretreatment and second-cycle evaluation (OR: 5.03; 95% CI: 1.34-18.89; p = 0.017) as well as for patients who had a lower PLR than the identified cut-off at pretreatment evaluation and had a higher PLR value than the cut-off at the second cycle (OR: 4.64; 95% CI: 1.02-21.02; p = 0.047). Becker regression was neither affected by a decrease of
sarcopenia ≥ 5% (p = 0.867) nor by incomplete compliance with
chemotherapy (p = 0.281).
CONCLUSIONS: Changes in PLR values which tend to increase more than the cut-off seem to be an immediate
indicator of incomplete compliance with neoadjuvant/perioperative treatment. Fat loss and
sarcopenia do not appear to be related to compliance. More information is needed to reduce the causes of interruption.