Persistent elevation of postoperative neutrophil-to-lymphocyte ratio: A better predictor of survival in gastric cancer than elevated preoperative neutrophil-to-lymphocyte ratio

Abstract

Postoperative neutrophil-to-lymphocyte ratio change (NLRc) reflects the dynamic change of balance between host inflammatory response and immune response after treatment. In gastric cancer, an elevated initial NLR (iNLR) is reported to be a prognostic predictor, but the clinical application of the NLRc remains unclear. The NLRc was assessed in 734 patients undergoing total/subtotal gastrectomy and endoscopic submucosal dissection for gastric adenocarcinoma. The iNLR and NLRc were recorded within 10 days of the first diagnosis and 3–6 months after surgery, respectively. Using receiver operating characteristic (ROC) curves, we investigated the relationship between NLRc or iNLR and patient survival. The analysis revealed a higher predictive power for correlating patient survival with the NLRc compared with iNLR. NLRc was defined as negative (lower than iNLR) and positive (higher than iNLR). A positive NLRc was frequently observed in patients with advanced AJCC stage, local recurrence, distant metastasis, perineural invasion, and adjuvant chemotherapy (all p < 0.05). Univariate and multivariate analyses revealed a significant relationship between patient survival and NLRc (all p < 0.05) but no association between survival and iNLR. The NLRc could be a better indicator than iNLR for predicting survival in patients with gastric cancer.

Does the preoperative platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio predict morbidity after gastrectomy for gastric cancer?

“…Inflammation and tumor growth are dependent factors, and increasing numbers of studies have elucidated the role of systemic inflammatory response mediators in various solid cancers [13,14]. Among them, GC is one of the popular foci of these investigations that evaluated cancerrelated inflammation and possible predictors in the preoperative period [6][7][8]. The decrease in lymphocyte count leads to depression of the immune response and cytotoxic destruction, whereas increased platelets and neutrophils induce tumor progression and angiogenesis [3].…”

“…Hence, this study was implemented to investigate the predictive power and the relations of the PLR and NLR with morbidity, mainly Clavien-Dindo grade ≥ 3, and mortality in patients with GC. Although the exact mechanism by which the PLR or NLR influences outcomes in GC patients is not clear, the NLR and PLR are widely used and easily obtained at very low costs [6,11].…”

“…Two other meta-analyses investigated the correlations of the PLR with clinicopathologic characteristics, morbidity, and mortality in colorectal cancer patients [19,20]. Growing data and studies about inflammatory markers and prognosis in GC patients indicate the use of these markers as predictors [3,[6][7][8].…”

“…Although the clinicopathological prognostic indicators of GC, which are the American Joint Committee on Cancer (AJCC) stage and size, histological type and grade, and lymphovascular and perineural invasion, are the most significant prognostic factors, a simple and easily provided predictive index requirement has been emphasized in recent studies. In addition, it was also claimed that patients with identical clinicopathological properties did not experience homogenous clinical outcomes [6]. The estimation of possible complications, morbidity, and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit (ICU) [7].…”

The Preoperative and the Postoperative Neutrophil-to-Lymphocyte Ratio Both Predict Prognosis in Gastric Cancer Patients

“…There is increasing evidence that the local immune response and systemic in ammation support tumor progression in patients with established cancer, adversely affecting their survival [3]. Recent investigations have shown a signi cant relationship between postoperative in ammatory markers, including C-reactive protein (CRP), leukocytosis, thrombocytosis, and elevated neutrophil-to-lymphocyte ratio (NLR) or platelet-tolymphocyte ratio, and poor survival in patients with various cancers [4][5][6][7][8][9][10][11]. However, a few studies have examined the association between markers of postoperative in ammation, especially the NLR, and the prognosis of patients with gastric cancer [5,[9][10][11].…”