Prognostic value of neutrophil-to-lymphocyte ratio in advanced oesophago-gastric cancer: exploratory analysis of the REAL-2 trial

Grenader, Tal; Waddell, Tom; Peckitt, Clare; Oates, J.; Starling, Naureen; Cunningham, David; Bridgewater, John

doi:10.1093/annonc/mdw012

Cited by 87 publications

(63 citation statements)

References 18 publications

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“…Based on these studies, we analysed CRP and albumin levels in the present NEC cohort, however neither CRP nor albumin levels were prognostic factors in this population. The NLR reflects the immune status of patients and a high NLR is associated with poorer survival in biliary tract cancer8 and in gastric cancer7. After analysis of NLR with the two cut-off levels used in other studies, neither a cut-off value of 3 or 4 were prognostic factors in this population.…”

Section: Discussionmentioning

confidence: 78%

“…The NLR was calculated and was considered high if NLR ≥ 378 or ≥ 4 25. For all statistical analysis of biological data, we first analysed the median value as a cut-off.…”

Section: Methodsmentioning

confidence: 99%

“…Some authors have investigated biological data for use as prognostic factors in neuroendocrine tumour (NET) and NEC patients, and these have included lactate dehydrogenase (LDH)34, CgA34, neuron-specific enolase (NSE)4, platelets, haemoglobin, white blood cell count, alkaline phosphatase (ALP), and C-reactive protein (CRP)3. Several studies in other aggressive types of cancer have described biological characteristics as prognostic tools, such as LDH and ALP levels in small cell lung cancer56, or neutrophil-to-lymphocyte ratio (NLR) in biliary tract and gastric cancers78. Recent studies have also reported the potential of blood transcript analysis as a predictive and prognostic marker of progression in well-differentiated NET910, but this was not studied in NEC patients.…”

mentioning

confidence: 99%

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Prognostic factors in neuroendocrine carcinoma: biological markers are more useful than histomorphological markers

Freis

Graillot

Rousset

et al. 2017

Sci Rep

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Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are a very aggressive type of cancer, for which prognostic factors are lacking. We analysed clinical and histomorphological prognostic markers of overall survival (OS), completed with a record of biological and haematological data of patients diagnosed between December 2002 and December 2015. The median OS was 16 months (95% CI 13.9–18.1). After univariate analysis, performance status (PS) ≥ 2 and stage IV were associated with a worse outcome (9 months and 14 months, respectively), as well as patients with lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels ≥ 2 ULN (9 months and 8 months, respectively). After multivariate analysis, LDH and AST levels were the only factors that remained significantly associated with better survival: HR 0.36 (p = 0.04) and 0.31 (p = 0.03), respectively. When patients had elevated LDH and AST levels, OS was 20 months, when they had high LDH or AST levels, 13 months and 8 months in the group with low LDH and AST levels (p < 0.001). Therefore, biological data appeared to be more relevant prognostic factors than usual factors described in other studies (PS, stage, and Ki-67). Considering LDH and AST levels at diagnosis could help physicians to predict survival and to stratify patients for clinical trials.

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Section: Discussionmentioning

confidence: 78%

“…The NLR was calculated and was considered high if NLR ≥ 378 or ≥ 4 25. For all statistical analysis of biological data, we first analysed the median value as a cut-off.…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Prognostic factors in neuroendocrine carcinoma: biological markers are more useful than histomorphological markers

Freis

Graillot

Rousset

et al. 2017

Sci Rep

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“…Although many organ systems act in the activation of systemic inflammatory responses, the common measurements of the magnitude of activation are circulating cellular components and acute-phase proteins. In particular, several common peripheral blood-derived inflammation-based scores, such as the Glasgow Prognostic Score (GPS), NLR, and PLR, have been demonstrated as promising prognostic predictors in various malignancies 26–28. However, the measurement of serum C-reactive protein was not routinely taken in our hospital before 2005, and therefore, the prognostic value of GPS was not examined in the current study.…”

Section: Discussionmentioning

confidence: 97%

A cumulative score based on preoperative fibrinogen and the neutrophil–lymphocyte ratio to predict outcomes in resectable gastric cancer

Liu

Lin

et al. 2018

CMAR

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BackgroundRecent studies have revealed that preoperative fibrinogen and the neutrophil–lymphocyte ratio (NLR) are associated with poor outcome in gastric cancer (GC). We aimed to evaluate whether the fibrinogen and the NLR score had a consistent prognostic value for resectable GC.MethodsWe analyzed 1,293 consecutive patients who underwent curative surgery for GC. The F-NLR score was 2 for patients with hyperfibrinogenemia (>400 mg/dL) and elevated NLR (≥5.0), 1 for those with one abnormal index, and 0 for those with no abnormal indices.ResultsWe found that higher F-NLR scores were associated with larger tumor size, deeper tumor invasion and more lymph node metastasis (all P<0.05). In a multivariate analysis, F-NLR independently predicted postoperative survival (P<0.001). When stratified by tumor–node–metastasis (TNM) stage, the prognostic value of F-NLR was still maintained for stages I–II (P<0.001) and stage III (P=0.003). Of note, F-NLR also effectively stratified overall survival (OS) irrespective of age, adjuvant chemotherapy administration, tumor location and histological grade (all P<0.05). Furthermore, F-NLR and TNM stratified 5-year OS from 61% (F-NLR 0) to 15% (F-NLR 2) and from 92% (stage I) to 37% (stage III), respectively. Utilizing both F-NLR and TNM, 5-year OS ranged from 93% (F-NLR 0, TNM I) to 6% (F-NLR 2, TNM III).ConclusionThe F-NLR score independently predicts outcomes in GC patients after curative surgery. Therefore, it should be implemented in routine clinical practice for identifying more high-risk patients.

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“…However, ICC often presents at an advanced stage, and in some series only 15-20% of the patients have resectable tumors [15]. Patients with advanced BTC have an ex- [5,7,18,19]. Phase II and III trials were conducted in 2010 in patients with advanced BTC including ICC, and a meta-analysis showed that ICC patients benefited more from GC therapy than did those patients with other BTC tumors [20].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors for Survival in Patients with Advanced Intrahepatic Cholangiocarcinoma Treated with Gemcitabine plus Cisplatin as First-Line Treatment

Ishimoto¹,

Kondo²,

Ohba³

et al. 2017

Oncology

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Objectives: Intrahepatic cholangiocarcinoma (ICC) is a rare type of liver cancer. No clinically useful prognostic factors have been reported for patients with advanced ICC. In the present study, we aimed to evaluate the clinical prognostic factors of patients with advanced ICC receiving gemcitabine plus cisplatin combination therapy (GC) as standard first-line chemotherapy. Methods: A retrospective analysis was performed of the data of patients with ICC treated at our institution from March 2011 to January 2016. We used the Cox regression model and estimated the hazard ratios of potential prognostic factors for survival. Results: Of 216 patients with biliary tract cancer receiving GC as first-line chemotherapy, we extracted data for 77 patients who were diagnosed with ICC and received GC as first-line chemotherapy. The median overall survival was 13.8 months (95% CI, 8.9-18.6). In multivariate analysis, pretreatment serum lactate dehydrogenase (hazard ratio [HR]: 2.53, p = 0.005), C-reactive protein (HR: 3.06, p = 0.001), and carcinoembryonic antigen (HR: 2.39, p = 0.03) levels were significantly associated with overall survival. Conclusions: Readily available clinical laboratory values reliably predicted the prognosis of ICC patients receiving GC therapy. If validated in other studies, these results may provide a useful tool for individual patient-risk evaluation and the design and interpretation of future trials.

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Prognostic value of neutrophil-to-lymphocyte ratio in advanced oesophago-gastric cancer: exploratory analysis of the REAL-2 trial

Abstract: Our results confirm that high NLR status had a significant negative prognostic effect in the REAL-2 trial population. Based on the multivariate analysis, this effect was independent of other known prognostic factors.

Cited by 87 publications

References 18 publications

Prognostic factors in neuroendocrine carcinoma: biological markers are more useful than histomorphological markers

Prognostic factors in neuroendocrine carcinoma: biological markers are more useful than histomorphological markers

A cumulative score based on preoperative fibrinogen and the neutrophil–lymphocyte ratio to predict outcomes in resectable gastric cancer

Prognostic Factors for Survival in Patients with Advanced Intrahepatic Cholangiocarcinoma Treated with Gemcitabine plus Cisplatin as First-Line Treatment

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Prognostic value of neutrophil-to-lymphocyte ratio in advanced oesophago-gastric cancer: exploratory analysis of the REAL-2 trial

Abstract: Our results confirm that high NLR status had a significant negative prognostic effect in the REAL-2 trial population. Based on the multivariate analysis, this effect was independent of other known prognostic factors.

Cited by 87 publications

References 18 publications

Prognostic factors in neuroendocrine carcinoma: biological markers are more useful than histomorphological markers

Prognostic factors in neuroendocrine carcinoma: biological markers are more useful than histomorphological markers

A cumulative score based on preoperative fibrinogen and the neutrophil&ndash;lymphocyte ratio to predict outcomes in resectable gastric cancer

Prognostic Factors for Survival in Patients with Advanced Intrahepatic Cholangiocarcinoma Treated with Gemcitabine plus Cisplatin as First-Line Treatment

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A cumulative score based on preoperative fibrinogen and the neutrophil–lymphocyte ratio to predict outcomes in resectable gastric cancer