Derived Neutrophil to Lymphocyte Ratio and Monocyte to Lymphocyte Ratio May Be Better Biomarkers for Predicting Overall Survival of Patients with Advanced Gastric Cancer

Background And Objectives: Preoperative systemic inflammatory response and nutritional status play important roles in the tumorigenesis, progression, and prognosis of gastric cancer (GC). This research is designed to investigate the prognostic value of the biomarkers including the neutrophil to lymphocyte ratio (NLR), derived neutrophil to lymphocyte ratio (dNLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI) in predicting overall survival in patients with GC.

Methods: A total of 1,990 consecutive GC patients who underwent gastrectomy from 2007 to 2011 were enrolled and divided into high level and low level based on the optimal cut-off points for NLR, dNLR, MLR, PLR, and PNI, respectively. The clinicopathological characteristics of the two levels were comparatively analyzed. Overall survival analysis was executed using these biomarkers and clinicopathological characteristics.

Results: The number of metastatic lymph nodes, distant metastasis, American Joint Committee on Cancer TNM stage, radicality, tumor size, metastatic lymph nodes ratio, ascites, and Hb were all significantly associated with NLR, dNLR, MLR, PLR, and PNI. All of these five biomarkers were closely associated with overall survival in univariate analyses, but only dNLR and MLR were significant in multivariate model. dNLR and MLR can be bonded to predict survival, but whether separate or together, dNLR and MLR were mainly significant in advanced stages.

Conclusion: Although preoperative NLR, dNLR, MLR, PLR, and PNI in peripheral blood proved significant prediction of prognoses of postoperative GC patients, dNLR and MLR may be better biomarkers for predicting overall survival, especially in advanced GC patients.