An Increase in the Neutrophil-to-lymphocyte Ratio During Adjuvant Chemotherapy Indicates a Poor Prognosis in Patients with Stage II or III Gastric Cancer

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2018 Dec 19

PMID 30558575

Citations 16

Authors

Mikito Mori

Kiyohiko Shuto

Chihiro Kosugi

Kazuo Narushima

Hideki Hayashi

Hisahiro Matsubara

Keiji Koda

Affiliations

Soon will be listed here.

Abstract

Background: The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are associated with poor prognoses in patients with gastric cancer; however, few studies have focused on the dynamic changes in these ratios during the treatment of patients with gastric cancer. Here, we assessed the clinical utility of changes in these ratios as prognostic indicators in patients with stage II or III gastric cancer who received adjuvant chemotherapy.

Methods: We retrospectively reviewed 100 patients who received S-1 adjuvant chemotherapy at ≥70% of the relative dose intensity, and their NLRs and PLRs were evaluated at different times: prior to gastrectomy and upon commencement and termination of adjuvant chemotherapy. To assure the clinical utility of the changes in NLR and PLR as prognostic indicators, other clinical factors were assessed as well.

Results: Disease recurred in 35 patients as follows: lymph node metastasis (17 patients, 17.0%), peritoneal metastasis (12 patients, 12.0%), and hematogenous metastasis (6 patients, 6.0%); 24 patients died. An increase in the NLR during adjuvant chemotherapy with S-1 was identified as an independent indicator associated with overall survival (hazard ratio [HR] 6.736, 95% confidence interval [CI] 2.420-18.748; P < 0.001), and relapse-free survival (HR 5.309, 95% CI 2.585-10.901; P < 0.001).

Conclusion: An increase in the NLR during S-1 adjuvant chemotherapy may be a useful prognostic indicator in patients with stage II or III gastric cancer.

Citing Articles

Preoperative Neutrophil-to-Lymphocyte Ratio as a Predictive Marker of Postoperative Infectious Complications in Pediatric Patients With Acute Appendicitis.

Chandni , Wasay A, Chaudhary M, Qureshi M Cureus. 2024; 16(10):e71353.

PMID: 39624500 PMC: 11610530. DOI: 10.7759/cureus.71353.

Comparative Analysis of Inflammatory Indexes in Lung Cancer Patients With and Without Brain Metastases.

Tamas F, Tamas C, Suciu B, Manu D, Cehan A, Balasa A Cureus. 2024; 16(5):e60921.

PMID: 38910770 PMC: 11193412. DOI: 10.7759/cureus.60921.

Association between neutrophil-lymphocyte ratio and lymph node metastasis in gastric cancer: A meta-analysis.

Kotecha K, Singla A, Townend P, Merrett N Medicine (Baltimore). 2022; 101(25):e29300.

PMID: 35758361 PMC: 9276313. DOI: 10.1097/MD.0000000000029300.

Preoperative neutrophil-to-lymphocyte ratio may contribute to the prediction of postoperative infectious complications in patients with acute appendicitis: a retrospective study.

Mori M, Narushima K, Hirano A, Kano Y, Chiba F, Edamoto Y BMC Surg. 2022; 22(1):78.

PMID: 35241053 PMC: 8892689. DOI: 10.1186/s12893-022-01529-8.

Neutrophil Extracellular Traps (NETs) in Cancer Metastasis.

Kaltenmeier C, Simmons R, Tohme S, Yazdani H Cancers (Basel). 2021; 13(23).

PMID: 34885240 PMC: 8657162. DOI: 10.3390/cancers13236131.

References

Balkwill F, Mantovani A . Inflammation and cancer: back to Virchow?. Lancet. 2001; 357(9255):539-45. DOI: 10.1016/S0140-6736(00)04046-0. View

Coussens L, Werb Z . Inflammation and cancer. Nature. 2002; 420(6917):860-7. PMC: 2803035. DOI: 10.1038/nature01322. View

Dunn G, Old L, Schreiber R . The immunobiology of cancer immunosurveillance and immunoediting. Immunity. 2004; 21(2):137-48. DOI: 10.1016/j.immuni.2004.07.017. View

Lohrisch C, Paltiel C, Gelmon K, Speers C, Taylor S, Barnett J . Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2006; 24(30):4888-94. DOI: 10.1200/JCO.2005.01.6089. View

Leitch E, Chakrabarti M, Crozier J, McKee R, Anderson J, Horgan P . Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer. 2007; 97(9):1266-70. PMC: 2360467. DOI: 10.1038/sj.bjc.6604027. View

Smith R, Bosonnet L, Raraty M, Sutton R, Neoptolemos J, Campbell F . Preoperative platelet-lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. Am J Surg. 2008; 197(4):466-72. DOI: 10.1016/j.amjsurg.2007.12.057. View

Mantovani A, Allavena P, Sica A, Balkwill F . Cancer-related inflammation. Nature. 2008; 454(7203):436-44. DOI: 10.1038/nature07205. View

Teramukai S, Kitano T, Kishida Y, Kawahara M, Kubota K, Komuta K . Pretreatment neutrophil count as an independent prognostic factor in advanced non-small-cell lung cancer: an analysis of Japan Multinational Trial Organisation LC00-03. Eur J Cancer. 2009; 45(11):1950-8. DOI: 10.1016/j.ejca.2009.01.023. View

Aliustaoglu M, Bilici A, Ustaalioglu B, Konya V, Gucun M, Seker M . The effect of peripheral blood values on prognosis of patients with locally advanced gastric cancer before treatment. Med Oncol. 2009; 27(4):1060-5. DOI: 10.1007/s12032-009-9335-4. View

10.

Shimada H, Takiguchi N, Kainuma O, Soda H, Ikeda A, Cho A . High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer. 2010; 13(3):170-6. DOI: 10.1007/s10120-010-0554-3. View

11.

Kao S, Pavlakis N, Harvie R, Vardy J, Boyer M, van Zandwijk N . High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res. 2010; 16(23):5805-13. DOI: 10.1158/1078-0432.CCR-10-2245. View

12.

Chua W, Charles K, Baracos V, Clarke S . Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 2011; 104(8):1288-95. PMC: 3078587. DOI: 10.1038/bjc.2011.100. View

13.

Jung M, Park Y, Jeong O, Seon J, Ryu S, Kim D . Elevated preoperative neutrophil to lymphocyte ratio predicts poor survival following resection in late stage gastric cancer. J Surg Oncol. 2011; 104(5):504-10. DOI: 10.1002/jso.21986. View

14.

Fairfield K, Murray K, Lucas F, Wierman H, Earle C, Trimble E . Completion of adjuvant chemotherapy and use of health services for older women with epithelial ovarian cancer. J Clin Oncol. 2011; 29(29):3921-6. DOI: 10.1200/JCO.2010.34.1552. View

15.

Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T . Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol. 2011; 29(33):4387-93. DOI: 10.1200/JCO.2011.36.5908. View

16.

Ohno Y, Nakashima J, Ohori M, Gondo T, Hatano T, Tachibana M . Followup of neutrophil-to-lymphocyte ratio and recurrence of clear cell renal cell carcinoma. J Urol. 2011; 187(2):411-7. DOI: 10.1016/j.juro.2011.10.026. View

17.

Sato H, Tsubosa Y, Kawano T . Correlation between the pretherapeutic neutrophil to lymphocyte ratio and the pathologic response to neoadjuvant chemotherapy in patients with advanced esophageal cancer. World J Surg. 2012; 36(3):617-22. DOI: 10.1007/s00268-011-1411-1. View

18.

Bang Y, Kim Y, Yang H, Chung H, Park Y, Lee K . Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012; 379(9813):315-21. DOI: 10.1016/S0140-6736(11)61873-4. View

19.

Aoyama T, Yoshikawa T, Shirai J, Hayashi T, Yamada T, Tsuchida K . Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol. 2012; 20(6):2000-6. DOI: 10.1245/s10434-012-2776-6. View

20.

Jin H, Zhang G, Liu X, Liu X, Chen C, Yu H . Blood neutrophil-lymphocyte ratio predicts survival for stages III-IV gastric cancer treated with neoadjuvant chemotherapy. World J Surg Oncol. 2013; 11:112. PMC: 3665689. DOI: 10.1186/1477-7819-11-112. View