Combination of PLR, MLR, MWR, and Tumor Size Could Significantly Increase the Prognostic Value for Gastrointestinal Stromal Tumors

Abstract

Systemic inflammation and immune response were associated with prognosis of tumors. However, data was limited due to the relatively low incidence of gastrointestinal stromal tumors (GISTs). The aim of the present study was to investigate the predictive value of preoperative peripheral blood cells in prognosis of GISTs.From September 2008 to July 2015, a total of 274 GIST patients in our department were enrolled in the present study. Clinicopathological features of GISTs were recorded. The association between preoperative peripheral blood cells and prognosis of GISTs were analyzed.Tumor location, tumor size, mitotic index, intratumoral necrosis, and National Institutes of Health (NIH) risk category were associated with prognosis of GISTs. High neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-white blood cell ratio (NWR), monocyte-to-white blood cell ratio (MWR) and low lymphocyte-to-white blood cell ratio (LWR) was associated with poor prognosis of GISTs (76.2% vs 83.7%, P = 0.010. 70.5% vs 98.7%, P = 0.000. 65.7% vs 96.4%, P = 0.004. 78.5% vs 82.5%, P = 0.044. 73.5% vs 97.8%, P = 0.004. 76.6% vs 83.6%, P = 0.012, respectively). However, tumor size was the only independent risk factor for prognosis according to multivariate analysis (P = 0.006). Tumor location, tumor size, mitotic index, and NIH risk category were significantly correlated with the above-mentioned parameters (all P < 0.05). The prognosis of GISTs with tumor size >5 cm, high MLR, high PLR, and high MWR was significantly lower than the remnant patients (P = 0.010).The peripheral blood routine test is convenient, reproducible, and inexpensive. High NLR, MLR, PLR, NWR, MWR, and low LWR were associated with poor prognosis of GISTs. The association between the above parameters and prognosis of GISTs may be attributed to their correlation with tumor size, mitotic index, and NIH risk category. The combination of tumor size, MLR, PLR, and MWR could further increase the predictive value of prognosis of GISTs.

Preoperative monocyte‐to‐lymphocyte ratio predicts recurrence in gastrointestinal stromal tumors

“…Perez et al first showed that a high level of NLR was correlated with poor prognosis, followed by Kargin et al, Goh et al, Stotz et al, and Feng et al On the other hand, the sixth study on this topic by Racz et al, did not find an association between NLR and recurrence, but between PLR and DFS. PLR was associated with DFS also by Stotz et al, Goh et al, and Feng et al. Feng et al added MLR, NWR, MWR, and LWR to the analysis of NLR and PLR, and obtained an association between all of them and DFS on univariate analysis.…”

“…Lymphocytosis and a high number of tumor‐infiltrating lymphocytes were associated with improved prognosis and a better response to cytotoxic treatment in a variety of cancers . The combination of lymphocytopenia and neutrophilia may reflect an inflammatory status where the high neutrophil count suppresses the cytolytic activity of lymphocytes, T cells, and NK cells …”

“…A high monocyte count has been associated with poor prognosis in breast, colorectal, and hematological cancers . As components of the inflammation system, monocytes might directly stimulate tumor cell growth, producing proinflammatory cytokines, such as tumor necrosis factor, interleukin‐1, and interleukin‐6.…”

“…As components of the inflammation system, monocytes might directly stimulate tumor cell growth, producing proinflammatory cytokines, such as tumor necrosis factor, interleukin‐1, and interleukin‐6. However, the role of the monocyte‐macrophage lineage has been more extensively studied in tumor infiltrate than in peripheral blood …”

“…Few articles are present in the literature that studied the prognostic significance of these biomarkers in GISTs . The aim of the current study was to investigate and compare the value of preoperative serum inflammation markers in predicting the prognosis of resected primary GISTs of all sites.…”