Combination of preoperative platelet/lymphocyte and neutrophil/lymphocyte rates and tumor-related factors to predict lymph node metastasis in patients with gastric cancer

Abstract

ObjectiveLymph node (LN) metastasis is widely accepted as a poor prognosis indicator in patients with gastric cancer. An accurate preoperative prediction of LN status is of crucial importance for the planning treatment. The aim of the present study was to assess the predictive value of the preoperative platelet/lymphocyte (PLR) and neutrophil/lymphocyte rates (NLR) on the LN metastasis in gastric cancer patients and to develop a new preoperative score system to predict LN metastasis.Patients and methodsA total of 492 operable patients with gastric cancer were enrolled in our study. The clinical utility of the PLR and NLR was evaluated by receiver operating characteristic (ROC) curves. The logistic analysis was used to identify the independent parameters associated with LN metastasis. Then, a score system including those independent parameters that can be detected preoperatively was established, which was also tested by an ROC curve.ResultsThe ideal cutoff values for predicting LN metastasis were 1.59 for NLR and 155.67 for PLR according to the ROC curve. Multivariate analyses showed that both PLR and NLR are significantly associated with LN metastasis independent of depth of invasion, lymphatic invasion, macroscopic type, and tumor size. The area under the ROC curve of the score system was 0.830 (95% confidence interval 0.782–0.878), showing a reliable ability to evaluate the status of nodal involvement.ConclusionPreoperative PLR and NLR are useful biomarkers to predict LN metastasis and the score system in our study may serve as a reliable instrument to predict LN metastasis in gastric cancer patients.

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

“…The applied cut-off levels again vary widely. Thus, the association with increased depth of invasion has been demonstrated in patients whose high preoperative NLR level was defined as higher than or equal to 4.02 [16] or as exceeding the ROC-set cut-off value of 1.59 [55]. Significant difference in T1-2 vs. T3-4 distribution was reported by Deng et al The mean NLR was 4.02 in T1-2 cases and 6.54 in T3-4 cases [47].…”

“…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].…”

“…The relative risk was as high as 4.15 and 7.09 in regard to high number of metastases and N stage, respectively [70]. NLR at the cut-off level 1.59 (detected by ROC) was an independent factor associated with lymph node metastasis; however, higher informativity reflected by higher AUC was achieved by complex score (see further) including NLR, PLR and tumour-related factors [55]. The conclusions are justified by other researchers reporting correlation between NLR and N parameter since the early reports [65] until recent studies [77].…”

“…Presence of lymph node metastases also limits and changes the treatment options as endoscopic resection is not feasible anymore but D2 lymphadenectomy becomes more appropriate than D1 lymphadenectomy. In addition, neoadjuvant treatment can be offered now to gastric cancer patients affected by lymph node metastases [55]. NLR can be used to predict lymph node metastasis.…”

The era of laparoscopic surgery for gastric cancer: what is the present territory and what will be next?

“…Consequently, the development of methods to accurately predict the presence of lymph node metastases is a current research focus, and this issue must be addressed in order to actively propagate minimally invasive surgery for gastric cancer. Numerous prior studies have tried to predict lymph node metastases preoperatively using various clinical variables (14)(15)(16). However, the methods reported in these studies are not yet sufficiently accurate for translation into clinical use.…”