Changes in neutrophil/lymphocyte and platelet/lymphocyte ratios after chemotherapy correlate with chemotherapy response and prediction of prognosis in patients with unresectable gastric cancer

Abstract

The aim of the study was to investigate the application value of neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) in the prediction of chemotherapy response and prognosis in patients with advanced gastric cancer. In total, 120 patients with unresectable gastric cancer were included and separated into two groups according to the median values of NLR or PLR (NLR low: <4.62 or NLR high: ≥4.62 and PLR low: <235 or PLR high: ≥235, respectively). Low baseline NLR level correlated with improved clinicopathological characteristics, including smaller tumor size, well differentiation and less metastasis. Low baseline PLR level also associated with less metastasis. Patients with a low baseline level of NLR or PLR had an improved response to chemotherapy. Patients with a higher baseline NLR and PLR had decreased progression-free survival (PFS) and overall survival (OS) ratios. Alterations in the NLR and PLR levels were associated with therapeutic efficacy and prognosis. The patients who remained in or switched to the low NLR level subgroup subsequent to first-line chemotherapy had an improved response and improved OS ratios, compared to the patients remaining in or switching to the high NLR level group. Similar results were observed when the PLR level was investigated. In conclusion, baseline NLR and PLR measurements, as well as changes of NLR and PLR following chemotherapy can predict the prognostic results in patients with unresectable gastric cancer.

Systemic Inflammatory Reaction in Gastric Cancer: Biology and Practical Implications of Neutrophil to Lymphocyte Ratio, Glasgow Prognostic Score and Related Parameters

“…Treatment-induced changes in NLR also predicted survival. Both baseline NLR and changes upon initiation of treatment predicted treatment outcomes [38]. This finding is in accordance with Cho et al, who also reported significantly higher chemotherapeutic disease control rate in metastatic advanced gastric cancer patients having low NLR, defined as less or equal to 3.0 [50].…”

“…The biological differences were remarkable: the median survival associated with low vs. high NLR was 1209 vs. 587 days, respectively [16]. High NLR is associated with older age in some studies [9,20,44,47,54,55] while others report no association [22,38].…”

“…In patients who have had curative surgery for gastric cancer, high NLR is significantly associated with poor prognosis [39], including overall survival [16,[47][48][49], cancer-specific survival [47], cancer-free survival [16,47] and progression-free survival [25,38,50].…”

“…Only few meta-analyses have been conducted [21,[35][36][37]. Few data are available on SIR parameters after treatment although it is known that post-chemotherapy NLR correlates with the response in patients with unresectable gastric cancer [38].…”

Peripheral blood neutrophil count as a prognostic factor for patients with hepatocellular carcinoma treated with sorafenib

“…Recent studies have suggested that a systemic inflammatory state is associated with the malignant biological behavior of the tumor (14,15). In particular, the neutrophil-lymphocyte ratio (NLR) has been evaluated as a predictor of prognosis in various types of solid tumor, including gastric, colorectal, pancreatic, breast and lung cancers (16)(17)(18)(19)). An elevated NLR has already been shown to be associated with poor prognosis in patients with HCC treated by liver transplantation, surgical resection, or TACE (20)(21)(22).…”