Neutrophil-lymphocyte ratio change after curative gastrectomy for gastric cancer: a subgroup analysis

Abstract

Objective:To evaluate the impact of neutrophil-lymphocyte ratio change after curative surgery for gastric cancer.Methods:A retrospective analysis of patients with gastric cancer who underwent curative surgery between 2009 and 2017 was performed. A cutoff value was established for the neutrophil-lymphocyte ratio in the pre- and postoperative periods, according to the median value, and four subgroups were formed (low-low/low-high/high-low/high-high). Clinical-pathological and survival data were analyzed and related to these subgroups.Results:A total of 325 patients were included in the study. The cutoff values of the neutrophil-lymphocyte ratio were 2.14 and 1.8 for the pre and postoperative periods, respectively. In patients with stages I and II, the high-high subgroup presented worse overall survival (p=0.016) and disease-free survival (p=0.001). Complications were higher in the low-high subgroup of patients.Conclusion:The neutrophil-lymphocyte ratio is a low cost, efficient and reproducible marker. The prognosis individualization can be performed according to the identification of subgroups at a higher risk of complications and worse prognosis.

Prognostic Value of Postoperative Neutrophil and Albumin: Reassessment One Month After Gastric Cancer Surgery

“…This finding is consistent with our results. In a study evaluating NLR before and after surgery, high NLR values in both periods were associated with poorer survival (3). Although dynamic changes such as delta values between preoperative and postoperative values have been evaluated for various organ cancers, postoperative absolute values have been most commonly evaluated for colorectal cancer, hepatocellular carcinoma, and pancreatic carcinoma (24)(25)(26)(27)(28).…”

“…There is little previous evidence regarding the prognostic value of neutrophil counts, as most studies have not evaluated neutrophil count as a single independent factor. Its prognostic value has primarily been evaluated using neutrophil-containing parameters, such as NLR, SII, or neutrophil–albumin ratio (NAR) ( 3 , 13 , 14 ). Our previous study demonstrated that preoperative neutrophil count was a strong independent prognostic factor for OS and RFS after adjusting for clinical and pathologic characteristics.…”

“…TNM staging is the standard method of prognosis prediction; however, parameters reflecting inflammatory status may also have a role in prognosis prediction. Preoperative neutrophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and albumin level have all been associated with survival (2)(3)(4)(5)(6)(7). We previously demonstrated that among many complex parameters, the simple parameter of a high preoperative neutrophil count is a useful prognostic marker for poor overall survival (OS) and recurrence-free survival (RFS) (7,8).…”

“…While a number of gastric cancer studies focused on preoperative status, few studies explored the implications of postoperative parameters (3)(4)(5). Patients are often reassessed 1 month after gastrectomy, prior to initiating adjuvant therapy.…”

Parâmetros metabólicos prognósticos do PET/TC 18F-FDG em pacientes com carcinoma de esôfago submetidos a terapia trimodal

“…A investigação dos fatores prognósticos em câncer de estômago, transição esôfago-gástrica e esôfago é uma das linhas de pesquisa do grupo no Departamento de Gastroenterologia no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo e Instituto do Câncer de São Paulo (HC-FMUSP/ICESP). Diversos trabalhos publicados pelo presente grupo têm revelado fatores de prognóstico relacionados a biomarcadores séricos [14][15][16][17] achados histopatológicos, 18,19 achados endoscópicos, 20 relacionados a cirurgia, 21,22 entre outros. O conhecimento de marcadores prognósticos se faz importante por ajudar a avaliar a chance de sucesso do manejo da doença, individualizando o atendimento ao paciente.…”