Evaluating and validating the predictive ability of preoperative systemic inflammatory/immune cells in gastric cancer following R0 resection

Abstract

The present study aimed to compare the predictive abilities of preoperative systemic inflammatory/immune cell ratios in gastric cancer (GC) following curative R0 resection, and to screen the optimal parameter incorporated into nomograms to predict the postoperative overall survival (OS) and recurrence-free survival (RFS). A total of 679 patients with GC were included in the study, divided into a primary cohort (300 cases), an internal validation cohort (278 cases), and an external validation cohort (101 cases). In the primary cohort, the prognostic abilities of all systemic inflammatory/immune cell accounts or ratios were compared by receiver operating characteristic (ROC) curve analysis. The area under the ROC curve (AUC) of the neutrophil-monocyte-lymphocyte ratio (NMLR) was largest for the prediction of OS (AUC=0.728) and RFS (AUC=0.695). The independent predictive factors for OS or RFS, including NMLR, degree of differentiation (DD), T-stage and N-stage were used to establish the 2 nomograms. The comprehensive predictive power of nomograms was compared with that of the tumor-nodes-metastasis (TNM) staging system and validated by bootstrap resampling. The concordance indexes (C-indexes) of the nomograms for OS [C-index, 0.851; 95% confidence interval (CI), 0.817–0.883] and RFS (C-index, 0.860; 95% CI, 0.831–0.889), were increased compared with those for the DD, the NMLR and the TNM stage. The AUCs of the 2 nomograms (0.933 for OS and 0.944 for RFS) were largest among all predictive scoring systems. In the internal validation cohort, the C-indexes of the nomograms for OS and RFS were 0.840 and 0.916, respectively. In the external validation cohort, the C-indexes of the nomograms for OS and RFS nomograms were 0.827 and 0.891, respectively. The present study demonstrated that the NMLR was an independent prognostic factor for patients with GC. The proposed nomograms were demonstrated to have a good predictive ability with improved sensitivity and accuracy in survival and recurrence in patients with GC undergoing R0 resection.

Correlation of peripheral blood biomarkers with clinical outcomes in NSCLC patients with high PD-L1 expression treated with pembrolizumab

“…For this hypothesis, we based on that WBC, composed primarily of neutrophils, monocytes and lymphocytes, are key markers of immune function and inflammatory response, and several studies have shown that high levels of baseline WBC are correlated with poor prognosis in NSCLC patients (34,(45)(46)(47). Furthermore, NMLR, which groups ANC, AMC and ALC, has been described as a powerful marker for survival outcomes in patients with different solid tumours (29,48). Our results for WBC and NMLR are in good agreement with those described in the bibliography for both PFS and OS (Figure S2 and Table S1).…”

“…The results, shown in Table 5, revealed that the low NLR (HR: 0.19, 95% CI: 0.09-0.44, P<0.001) and PLR (HR: 0.46, 95% CI: 0.23-0.92, P=0.03) groups were independently associated with improved PFS, and low ECOG (HR: 0.39, 95% CI: 0.16-0.94, P<0.036), NLR (HR: 0.07, 95% CI: 0.02-0.19, P<0.001), MLR (HR: 0.34, 95% CI: 0.15-0.76, P=0.01) and PLR (HR: 0.29, 95% CI: 0.13-0.67, P=0.004) were independently associated with better OS. Finally, we hypothesized that the combination of two markers, NMLR and WBC, which provided good results separately (29,34), could be correlated with survival outcomes. Therefore, NMLR and WBC were used to create a new risk score, RBB.…”

“…S e v e r a l s t u d i e s h a v e s u g g e s t e d t h a t t u m o u rassociated inflammation plays a decisive role in the immune response of patients with malignant neoplasms and could be applied to ICI therapies (20)(21)(22). In this context, different blood-derived parameters related to the systemic inflammatory response have been proposed, such as absolute neutrophil count (ANC) ( 23), neutrophil-to-lymphocyte ratio (NLR) (24), derived neutrophil-to-lymphocyte ratio (dNLR) (25), platelet-tolymphocyte ratio (PLR) (26), monocyte-to-lymphocyte ratio (MLR) (27), systemic immune-inflammation index (SII) (28) or neutrophil-monocyte-to-lymphocyte ratio (NMLR) (29). In addition, scores involving various blood parameters, such as neutrophil-platelet score (NPS) (30) and inflammatory response biomarker (IRB) (31), have been developed.…”

WITHDRAWN: Relationship between NMLR and all-cause mortality in patients with chronic obstructive pulmonary disease: National Health and Nutrition Examination Survey, 1999–2018

“…The NMLR has been used as a prognostic indicator for in ammation and immune-related diseases [14,19] . One of the earliest peripheral blood NMLRs was used in patients with HCC after radical hepatectomy, where it was found to be a useful prognostic indicator of the study [11] .…”

“…The NMLR can re ect the immune and in ammatory status of the patient, and is very easy to collect. Previously, the NMLR has been used to assess the prognosis of patients with different tumors that are associated with both immunity and in ammation [14,15]. However, although COPD is also affected by immunity and in ammation, few studies have evaluated the association between the NMLR and all-cause mortality in patients with COPD.…”