Medicine
®
OBSERVATIONAL STUDY
Prognostic Value of the Preoperative Neutrophil to Lymphocyte Ratio in Resectable Gastric Cancer Jun-Te Hsu, MD, Chun-Kai Liao, MD, Puo-Hsien Le, MD, Tsung-Hsing Chen, MD, Chun-Jung Lin, MD, Jen-Shi Chen, MD, Kun-Chun Chiang, MD, PhD, and Ta-Sen Yeh, MD, PhD
Abstract: This study aimed to investigate the prognostic value of the preoperative neutrophil to lymphocyte ratio (NLR) in resectable gastric cancer (GC). This was a retrospective review of 1030 patients with resectable GC managed between 2005 and 2011. Patients were stratified into 2 groups, those with a preoperative NLR >3.44 and those with a preoperative NLR 3.44. Clinicopathological data affecting patient prognosis were collected prospectively and analyzed. The high NLR (>3.44) group had a higher proportion of a platelet to lymphocyte ratio >132, tumor size >4.8 cm, T4 lesions, metastatic tumors, a ratio of metastatic to examined lymph nodes >0.18, positive resection margins, and presence of vascular or lymphatic invasion than the low NLR (3.44) group. Patients with a high preoperative NLR had significantly lower 3- and 5-year overall survival rates than those with a low preoperative NLR (55.1% vs 71.0% and 47.2% vs 64.1%, respectively; P < 0.001). Preoperative NLR was a prognostic factor for resectable GC in multivariate analysis. More aggressive tumor behavior was observed in patients with resectable GC with a high preoperative NLR than in those with a low preoperative NLR. High preoperative NLR was an independent unfavorable prognostic factor. Measurement of this ratio may serve as a clinically accessible and useful biomarker for patient outcomes.
death worldwide, after lung and liver malignancies, resulting in around 723,000 deaths in 2012.1 Although there have been advances in diagnosis and management, most GC patients present with locally advanced or metastatic disease with a 5-year survival rate of 48 Gender Male Female Platelet to lymphocyte ratio 132 >132 Gastrectomy Total Subtotal Location Upper Middle Lower Diffuse Tumor size, cm 4.8 >4.8 T status T1 T2 T3 T4 N status N0 N1 N2 N3 M status M0 M1 LN ratioy 0.18 >0.18 Resection margins Negative Positive Differentiated Yes No Vascular invasion Negative Positive Lymphatic invasion Negative Positive Perineural invasion Negative Positive
2
3.44 (%)
>3.44 (%)
773
257
101 (13.1) 672 (86.9)
31 (12.1) 226 (87.9)
P Value 0.677
y
0.120 488 (63.1) 285 (36.9)
In-hospital mortality 30-d mortality Chemotherapyz
176 (68.5) 81 (31.5)
z
3.44 (%)
>3.44 (%)
P Value
18 (2.3) 8 (1.0) 382 (70.2)
23 (9.9) 11 (4.3) 117 (56.0)
0.18 (n ¼ 326) M status M0 (n ¼ 909) M1 (n ¼ 80) Resection margins Negative (n ¼ 924) Positive (n ¼ 65) Vascular invasion Negative (n ¼ 841) Positive (n ¼ 134) Lymphatic invasion Negative (n ¼ 463) Positive (n ¼ 512) Perineural invasion Negative (n ¼ 541) Positive (n ¼ 432)
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Mean, mo
95% CI of Mean
3-yr
5-yr
65.26 64.76
61.94–68.58 60.41–69.11
67.5 67.0
60.4 59.9
54.53 66.74
47.3–61.7 63.9–69.6
57.3 68.9
45.6 62.5
68.25 52.80
65.12–70.95 47.30–58.45
71.0 55.1
64.1 47.2
71.37 59.33
67.76–74.99 55.59–63.07
75.5 59.9
68.1 53.0
51.24 70.90
46.24–56.25 67.90–75.89
51.7 74.0
41.9 67.9
56.10 68.45 68.15 19.38
50.16–62.03 62.69–74.22 64.78–71.51 14.26–24.50
61.6 70.9 70.2 17.5
49.2 63.1 65.2 0.0
75.94 44.52
73.00–78.87 40.15–48.89
80.5 42.6
73.5 35.4
76.85 57.51
73.19–80.51 54.02–60.99
79.5 59.5
74.5 51.0
93.70 78.36 63.28 45.15
91.97–95.42 72.00–84.71 56.67–69.89 41.38–48.91
98.2 84.4 66.2 44.6
97.6 73.1 63.9 35.5
88.79 67.61 59.90 33.27
86.31–91.26 61.21–74.01 52.76–67.03 29.28–37.26
94.1 74.3 57.7 33.7
91.5 65.7 51.5 20.1
81.05 30.73
79.90–85.05 31.68–39.35
85.4 29.2
80.7 15.8
69.90 11.10
67.26–72.54 9.13–13.07
73.0 3.7
65.6 0.0
68.29 17.40
65.64–70.95 13.00–21.81
70.7 17.7
64.2 3.0
68.37 36.46
65.61–71.13 29.61–43.31
71.8 30.4
63.8 30.4
83.65 45.75
80.84–86.46 42.12–49.37
88.4 46.7
84.0 36.4
79.43 45.24
76.51–82.35 41.35–49.14
82.8 46.8
78.5 35.7
P Value 0.93
0.002
®
OBSERVATIONAL STUDY
Prognostic Value of the Preoperative Neutrophil to Lymphocyte Ratio in Resectable Gastric Cancer Jun-Te Hsu, MD, Chun-Kai Liao, MD, Puo-Hsien Le, MD, Tsung-Hsing Chen, MD, Chun-Jung Lin, MD, Jen-Shi Chen, MD, Kun-Chun Chiang, MD, PhD, and Ta-Sen Yeh, MD, PhD
Abstract: This study aimed to investigate the prognostic value of the preoperative neutrophil to lymphocyte ratio (NLR) in resectable gastric cancer (GC). This was a retrospective review of 1030 patients with resectable GC managed between 2005 and 2011. Patients were stratified into 2 groups, those with a preoperative NLR >3.44 and those with a preoperative NLR 3.44. Clinicopathological data affecting patient prognosis were collected prospectively and analyzed. The high NLR (>3.44) group had a higher proportion of a platelet to lymphocyte ratio >132, tumor size >4.8 cm, T4 lesions, metastatic tumors, a ratio of metastatic to examined lymph nodes >0.18, positive resection margins, and presence of vascular or lymphatic invasion than the low NLR (3.44) group. Patients with a high preoperative NLR had significantly lower 3- and 5-year overall survival rates than those with a low preoperative NLR (55.1% vs 71.0% and 47.2% vs 64.1%, respectively; P < 0.001). Preoperative NLR was a prognostic factor for resectable GC in multivariate analysis. More aggressive tumor behavior was observed in patients with resectable GC with a high preoperative NLR than in those with a low preoperative NLR. High preoperative NLR was an independent unfavorable prognostic factor. Measurement of this ratio may serve as a clinically accessible and useful biomarker for patient outcomes.
death worldwide, after lung and liver malignancies, resulting in around 723,000 deaths in 2012.1 Although there have been advances in diagnosis and management, most GC patients present with locally advanced or metastatic disease with a 5-year survival rate of 48 Gender Male Female Platelet to lymphocyte ratio 132 >132 Gastrectomy Total Subtotal Location Upper Middle Lower Diffuse Tumor size, cm 4.8 >4.8 T status T1 T2 T3 T4 N status N0 N1 N2 N3 M status M0 M1 LN ratioy 0.18 >0.18 Resection margins Negative Positive Differentiated Yes No Vascular invasion Negative Positive Lymphatic invasion Negative Positive Perineural invasion Negative Positive
2
3.44 (%)
>3.44 (%)
773
257
101 (13.1) 672 (86.9)
31 (12.1) 226 (87.9)
P Value 0.677
y
0.120 488 (63.1) 285 (36.9)
In-hospital mortality 30-d mortality Chemotherapyz
176 (68.5) 81 (31.5)
z
3.44 (%)
>3.44 (%)
P Value
18 (2.3) 8 (1.0) 382 (70.2)
23 (9.9) 11 (4.3) 117 (56.0)
0.18 (n ¼ 326) M status M0 (n ¼ 909) M1 (n ¼ 80) Resection margins Negative (n ¼ 924) Positive (n ¼ 65) Vascular invasion Negative (n ¼ 841) Positive (n ¼ 134) Lymphatic invasion Negative (n ¼ 463) Positive (n ¼ 512) Perineural invasion Negative (n ¼ 541) Positive (n ¼ 432)
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Mean, mo
95% CI of Mean
3-yr
5-yr
65.26 64.76
61.94–68.58 60.41–69.11
67.5 67.0
60.4 59.9
54.53 66.74
47.3–61.7 63.9–69.6
57.3 68.9
45.6 62.5
68.25 52.80
65.12–70.95 47.30–58.45
71.0 55.1
64.1 47.2
71.37 59.33
67.76–74.99 55.59–63.07
75.5 59.9
68.1 53.0
51.24 70.90
46.24–56.25 67.90–75.89
51.7 74.0
41.9 67.9
56.10 68.45 68.15 19.38
50.16–62.03 62.69–74.22 64.78–71.51 14.26–24.50
61.6 70.9 70.2 17.5
49.2 63.1 65.2 0.0
75.94 44.52
73.00–78.87 40.15–48.89
80.5 42.6
73.5 35.4
76.85 57.51
73.19–80.51 54.02–60.99
79.5 59.5
74.5 51.0
93.70 78.36 63.28 45.15
91.97–95.42 72.00–84.71 56.67–69.89 41.38–48.91
98.2 84.4 66.2 44.6
97.6 73.1 63.9 35.5
88.79 67.61 59.90 33.27
86.31–91.26 61.21–74.01 52.76–67.03 29.28–37.26
94.1 74.3 57.7 33.7
91.5 65.7 51.5 20.1
81.05 30.73
79.90–85.05 31.68–39.35
85.4 29.2
80.7 15.8
69.90 11.10
67.26–72.54 9.13–13.07
73.0 3.7
65.6 0.0
68.29 17.40
65.64–70.95 13.00–21.81
70.7 17.7
64.2 3.0
68.37 36.46
65.61–71.13 29.61–43.31
71.8 30.4
63.8 30.4
83.65 45.75
80.84–86.46 42.12–49.37
88.4 46.7
84.0 36.4
79.43 45.24
76.51–82.35 41.35–49.14
82.8 46.8
78.5 35.7
P Value 0.93
0.002
