Clinical significance of neutrophil-to-lymphocyte ratio as a predictor of lymph node metastasis in gastric cancer

Abstract

BackgroundPrecise staging is indispensable to select the appropriate treatment strategy for gastric cancer (GC); however, the diagnostic accuracy of conventional modalities needs to be improved. This study investigated the clinical significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) for the prediction of pathological lymph node metastasis (pN+) in GC.MethodsThis was a retrospective study of 429 patients with GC who underwent curative gastrectomy. The predictive ability of NLR for pN+ was examined in comparison with that of computed tomography.ResultsThe preoperative NLR ranged from 0.6 to 10.8 (median, 2.0), and the optimal cut-off value for predicting pN+ was 1.6 according to the receiver operating characteristic curve with the maximal Youden index. Multivariate analysis identified a NLR ≥ 1.6 (odds ratio (OR) 3.171; 95% confidence interval (CI) 1.448–7.235, p = 0.004) and cN+ (OR 2.426; 95% CI 1.221–4.958, p = 0.011) to be independent factors associated with pN+ in advanced GC (cT2-T4). On the other hand, a NLR ≥ 1.6 was not useful for predicting pN+ in early GC (cT1). In advanced GC, a NLR ≥ 1.6 detected pN+ with a higher sensitivity (84.9%) and negative predictive value (NPV) (63.9%) than conventional modalities (50.0 and 51.7%, respectively). When the subjects were limited to those with advanced GC with cN0, the sensitivity and NPV of a NLR ≥ 1.6 for pN+ increased further (90.7 and 81.0%, respectively).ConclusionThe preoperative NLR may be a useful complementary diagnostic tool for predicting pN+ in advanced GC because of its higher sensitivity and NPV than conventional modalities.

Establishment and validation of a nomogram to predict the risk of ovarian metastasis in gastric cancer: Based on a large cohort

“…An increase in the NLR may predict an increase in the positive rate of lymph node metastasis in patients with gastric cancer. The study by Kosuga et al[ 26 ] showed that the NLR can be used as an independent predictor of lymph node metastasis in advanced gastric cancer. In this study, the cut-off value of the NLR was used as the grouping standard, and the results showed that an NLR > 2.16 could be an independent risk factor for ovarian metastasis of gastric cancer.…”

The infection rate in new diagnosis and relapsed/refractory multiple myeloma patients who had bortezomib-based chemotherapy and relationship between development of infection and lymphocyte/monocyte ratio

“…It has been shown that absolute neutrophil value, absolute lymphocyte value, and absolute monocyte value and their ratio to each other are independent variables in solid tumors and hematological cancers and in the course of the disease after autologous stem cell transplantation [22][23][24][25][26]. In most of these studies, it was shown that high neutrophil/lymphocyte ratio and low lymphocyte/monocyte ratio were associated with poor prognosis.…”

A potential novel biomarker in predicting lymph node metastasis of gastric signet ring cell carcinoma: A derived monocyte to lymphocyte ratio

“…Approximately 10-30% of patients with GC with cN0 diagnosed using preoperative abdominal enhanced computed tomography (CT) were diagnosed with positive lymph nodes at postoperative pathological diagnosis. 5 Recent studies have demonstrated that preoperative inflammatory biomarkers can predict lymph node metastasis (LNM) in patients with GC with better sensitivity as compared with enhanced CT. 6,7 However, the predictive value of inflammatory biomarkers in gastric SRCC has not been investigated independently and remains unknown. Therefore, this study aimed to evaluate the predictive ability of a classical inflammatory biomarker (neutrophil to lymphocyte ratio [NLR]) and two combinations of inflammatory factors (derived monocyte to lymphocyte ratio [dMLR] and eosinophil to lymphocyte ratio [ELR]) for the prognosis of LNM in patients with gastric SRCC.…”