The neutrophil-to-lymphocyte ratio (NLR) predicts short-term and long-term outcomes in gastric cancer patients

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Abstract

Background

The preoperative neutrophil-to-lymphocyte ratio (NLR) is a well-known prognostic marker for gastric cancer patients. However, the utility of the NLR in predicting short-term outcomes in gastric cancer patients remains unclear. Here, we investigated whether the preoperative NLR is a predictor of short-term outcomes in gastric cancer patients.

Methods

We retrospectively evaluated 154 consecutive gastric cancer patients. We compared the perioperative outcomes and median survival times (MSTs). In particular, for stage II/III (UICC, 7th edition) gastric cancer patients, we compared median disease-free survival time (MDFST) between the low- and high-NLR groups.

Results

Between the low-NLR group (n = 110) and the high-NLR group (n = 44), significant differences were observed in perioperative outcomes, including postoperative complications (3 (2.7%) vs. 5 (11.3%); p = 0.015), intraoperative blood loss (158 ± 168 g vs. 232 ± 433 g; p = 0.022), and intraoperative blood transfusions (0 vs. 3 (6.8%); p = 0.042). MSTs and MDFSTs were also significantly different (812 vs. 594 days, p = 0.04; and 848 vs. 475 days, p = 0.03, respectively). Multivariate analysis identified the NLR (hazard ratio [HR], 2.015; p = 0.004), Glasgow Prognostic Score (GPS) (HR, 1.533; p = 0.012), and presence of stage III/IV disease (HR, 5.488; p < 0.001), preoperative symptoms (HR, 3.412; p = 0.008), or postoperative complications (HR, 2.698; p < 0.001) as independent prognostic factors.

Conclusions

We suggest that the preoperative NLR is an additional useful predictor of both long-term and short-term outcomes in gastric cancer patients.

Introduction

Gastric cancer is the second most common cause of cancer mortality worldwide in part because most patients are diagnosed with advanced, inoperable disease [1]. Even for patients with advanced gastric cancer who undergo potentially curative resection, corresponding to stage II/III (UICC, 7th edition) patients, the 5-year survival remains at 30–50% [2]. Therefore, in advanced gastric cancer patients, including stage II/III patients in particular, a surgery-based multidisciplinary treatment approach, including adjuvant chemotherapy, is warranted to improve both overall survival and quality of life [3]. In fact, a previous study reported that adjuvant chemotherapy with S-1, an oral fluoropyrimidine, had a significant effect on overall survival in patients with curatively resected locally advanced gastric cancer [4]. Consequently, to improve the overall survival of resected gastric cancer patients, adjuvant chemotherapy is required in the early postoperative period, improving short-term outcomes, including perioperative complications, or facilitating the early detection of cancer recurrence.

Recently, a variety of predictors have been identified and applied to predicting the short-term and long-term outcomes of gastric cancer patients. These predictors include cancer-related factors, host-related factors, surgery-related factors, and systemic inflammatory response markers [5], [6], [7], [8], [9], [10]. In particular, systemic inflammatory response markers, such as the serum C-reactive protein (CRP) level, lymphocyte count, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and Glasgow Prognostic Score (GPS), have been employed as preoperative factors that are potential predictors of the long-term outcomes of gastric cancer patients [8], [9], [11], [12], [13], [14]. However, in terms of short-term outcomes, the significance of these systemic inflammatory response markers remains controversial.

The preoperative NLR is well known as a highly repeatable, cost-effective and widely available marker of the long-term postoperative prognosis of gastric cancer patients [11], [15], [16]. Furthermore, recent studies have reported that the preoperative NLR can predict the prognosis of advanced gastric cancer patients treated with adjuvant chemotherapy [14], [17]. However, the utility of the preoperative NLR in predicting short-term outcomes or disease-free survival of resected gastric cancer patients remains unclear.

In the present study, we retrospectively addressed whether the preoperative NLR is a predictor of the short-term and long-term outcomes of gastric cancer patients. Furthermore, we examined the extent to which the preoperative NLR can affect not only the overall survival but also the disease-free survival of resected advanced gastric cancer patients treated with adjuvant chemotherapy.

Section snippets

Patients

We retrospectively evaluated 154 consecutive gastric cancer patients at the Tsukuba Medical Center Hospital, Tsukuba, Japan, between January 2014 and December 2016. The ethics committee of the Tsukuba Medical Center Hospital approved this study.

The preoperative NLR was calculated as the ratio of the number of neutrophils to the number of lymphocytes collected in a preoperative blood test. According to the NLR cut-off value, the present cohort was divided into two groups: a high-NLR group and a

Patient backgrounds

In the present cohort, the preoperative NLR was normally distributed. Given that previous studies often employed the mean or median NLR as the cut-off value, ranging from 1.44 to 5.00, the mean preoperative NLR (±standard deviation), which was 3.50 ± 2.88 (range, 0.9–18.8), was employed as the cut-off value in the present study [20]. We then divided the cohort into low- and high-NLR groups based on this cut-off value (n = 110 and n = 44, respectively). The backgrounds of the patients divided

Discussion

In this analysis of 154 gastric cancer patients, we confirmed that the preoperative NLR correlated with not only the long-term outcomes but also the perioperative outcomes of gastric cancer patients. Furthermore, we demonstrated that the preoperative NLR correlates with poor disease-free survival in resected stage II/III gastric cancer patients. Thus, the preoperative NLR is assumed to an additional useful marker for the prediction of short-term outcomes, including perioperative complications,

Conflict of interest statement

All authors disclose no financial and personal relationships with other people or organizations that could inappropriately influence our work.

There are no potential conflicts of interest to disclose.

Funding

None.

Acknowledgment

We have no acknowledgments.

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