Letter to the Editor: Do Nutritional and Inflammatory Indices Predict Response in Geriatric Gastric Cancer Patients Treated With Neoadjuvant FLOT Regimen?

Dear Editor,

Congratulations to Urun and colleagues for their study on the predictive value of nutritional and inflammatory indices in geriatric gastric cancer patients treated with a neoadjuvant FLOT regimen. ¹ This single-center, retrospective trial involved 91 patients, of whom 22 responded positively to FLOT treatment. The study found that the treatment-responsive group had higher pre-treatment albumin levels and lower pre-treatment lymphocyte counts compared to the treatment-nonresponsive group. Additionally, the neutrophil-lymphocyte ratio (NLR) was higher in the treatment-responsive group. The authors hypothesized that elevated albumin levels, a high NLR, and low lymphocyte levels are associated with a positive treatment response. To gain a deeper understanding of this subject, it is important to address 2 concerns.

Firstly, the study did not address the confounding factors that could affect these indices. The use of corticosteroids, the presence of chronic immunosuppressive disorders, and/or subclinical infections—conditions that are common in elderly patients—may influence lymphocyte counts, the NLR, or nutritional indices such as albumin levels. ² Reporting these factors could enhance the value of the findings.

Secondly, the authors noted that lymphopenia and a high NLR were associated with a positive treatment response. This finding is surprising, as the existing literature typically associates lymphopenia and a high NLR with poor prognosis and ineffective treatment responses in various cancers, including gastric cancer.^3,4 Although the authors acknowledged this contradiction, they were unable to provide a clear biological explanation for it.

In conclusion, although the study offers valuable insights, it is essential to interpret the findings with caution. This is especially important given the small sample size, the selection criteria for patients, and the unusual prognostic patterns observed. Future studies should aim to control for confounding variables and further investigate the biological mechanisms behind inflammatory and nutritional indices in elderly cancer patients.