Do Nutritional and Inflammatory Indices Predict Response in Geriatric Gastric Cancer Patients Treated with Neoadjuvant FLOT Regimen?

Introduction: Docetaxel-based chemotherapy is a standardized neoadjuvant treatment for gastric cancer. There are still no reliable indicators to predict tumor response and prognosis of geriatric patients prior to chemotherapy. The aim of our study was to investigate the value of pretreatment prognostic nutritional index (PNI), serum albumin, total lymphocyte, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) in predicting the response to treatment in geriatric gastric cancer patients treated with FLOT (5-Fluorouracil, leucovorin, oxaliplatin, and docetaxel) regimen as neoadjuvant chemotherapy.Methods: A total of 91 geriatric gastric cancer patients (≥65-year-old) who received a neoadjuvant FLOT regimen were retrospectively analyzed. Pretreatment data, including demographic characteristics, complete blood count, serum albumin level (g/dL), serum tumor markers (CEA and CA19-9), PNI values and other clinicopathological parameters, were collected. Independent sample t-tests and Mann-Whitney U tests were used to analyze quantitative independent data. In the analysis of independent qualitative data, the chi-squared test and Fischer's exact test were used when the chi-squared test conditions were not met.Results: The mean age was 69.9 ± 4. There were 22 patients in the treatment-responsive group and 69 in the treatment-nonresponsive group. Serum albumin levels were significantly higher in the treatment-responsive group. The lymphocyte counts were significantly lower in the treatment-responsive group. Additionally, both disease-free survival and overall survival were significantly extended in patients who responded to treatment.Conclusion: We demonstrated that serum albumin and total lymphocyte counts, which are easily accessible blood parameters routinely examined before treatment, may predict the response in geriatric gastric cancer patients receiving neoadjuvant FLOT treatment. However, larger prospective, multicenter studies are required to confirm this relationship.