The Prognostic Value of Neutrophil-to-lymphocyte Ratio and Monocyte-to-lymphocyte Ratio in Metastatic Gastric Cancer Treated with Systemic Chemotherapy

e15505 Background: Inflammation seems to be significant factor in carcinogenesis and tumor progression of numerous cancers. Blood calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), lactate dehydrogenase (LDH), international normalized ratio (INR) can be evaluated as systemic inflammation markers and prognostic biomarker for many aims: survival outcomes, lymph node metastasis and recurrence, treatment responses in a variety of cancers. The purpose of this study was to investigate baseline associations between blood test parameters (NLR, PLR, LDH, CRP, INR) and their prognostic biomarker role for patient with metastatic gastric cancer, undergoing first-line chemotherapy Methods: Potential baseline inflammatory markers (platelets, neutrophils, lymphocytes, the platelet-lymphocyte ratio, the neutrophil-lymphocyte ratio, the serum C-reactive protein [CRP], the serum LDH, INR) were retrospectively analyzed in 32 patients with metastatic gastric cancer, IV stage (median of age – 60,50). Multivariate analyses were used to identify prognostic factors for overall survival (OS). Baseline values were compared with tumor characteristic and median survival times (MSTs). Results: Multivariate analysis identified due to Cox proportional-hazards regression showed significant longest OS in patients with: localization of primary tumor in antral part of gastric (HR 0,45, 95% CI 0,25-0,80, p = 0,0065); low baseline’s level of WBC (HR 1,17, 95% CI 1.02 - 1,35, p = 0,0219); low baseline’s level of neutrophil (HR 1,18, 95% CI 1.02 - 1,34, p = 0,0251). Level of LDH, CRP, INR didn’t show significant ratio for this cohort of patient. Peritoneum metastatic also didn’t significant affect on OS in patient with metastatic gastric cancer. Patients with low baseline’s platelet to lymphocyte ratio (HR 1,004, 95% CI 1,0009-1,0072, p = 0,0125) and low (from 0 to 3,0) neutrophil to lymphocyte ratio (HR 1,81, 95% CI 1,09-2,99, p = 0,0212) had a significantly longest OS time. Conclusions: Inflammatory markers can predict overall survival in stage IV gastric cancer. Simple and useful.

Download Full-text

Neutrophil-to-Lymphocyte Ratio (NLR) Predicts PD-1 Inhibitor Survival in Patients with Metastatic Gastric Cancer

Journal of Immunology Research ◽

10.1155/2021/2549295 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Miaomiao Gou ◽

Tongtong Qu ◽

Zhikuan Wang ◽

Huan Yan ◽

Yanhai Si ◽

...

Keyword(s):

Gastric Cancer ◽

Response Rate ◽

Univariate Analysis ◽

Objective Response ◽

Progression Free Survival ◽

Metastatic Gastric Cancer ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Formula Group

Background and Aims. Biomarkers for systemic inflammation have been introduced into clinical practice for risk-rating in cancer patients’ treatment. This study is aimed at confirming the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) as an effective biomarker for patients with metastatic gastric cancer (MGC) receiving anti-PD-1 agents. Method. Patients with MGC who received anti-PD-1 treatment at the Chinese PLA General Hospital between January 2016 and November 2020 were reviewed. The study analyzed the association of NLR and overall survival (OS) or progression-free survival (PFS) and antitumor response rate with PD-1 inhibitors. Results. 137 patients were included in the final analysis. The area under the curve value of NLR for 6-month OS was 0.71. The best cut-off value for NLR was 3.23. NLR < 3.23 was associated with longer OS ( HR = 0.38 , 95% CI, 0.26-0.57, p < 0.001 ) and PFS ( HR = 0.42 , 95% CI, 0.29-0.62, p < 0.001 ) in patients with MGC. No significant difference was observed in the objective response rate (ORR) (35.8% vs. 28.6%, p = 0.377 ) and disease control rate (DCR) (86.4% vs. 78.6%, p = 0.229 ) in the NLR < 3.23 group and in the NLR ≥ 3.23 group, respectively. Univariate analysis and multivariate analysis found that NLR was an independent prognosis biomarker for PFS and OS. Conclusions. Pretreatment elevated NLR was significantly associated with inferior PFS and OS in patients with MGC who received anti-PD-1 inhibitors. Clinicians need to consider patients with elevated NLR for decisions on immunotherapy strategy.

Download Full-text

Prognostic effect of high pretreatment neutrophil to lymphocyte ratio on survival of patients with gastric adenocarcinoma in China

The International Journal of Biological Markers ◽

10.5301/jbm.5000123 ◽

2015 ◽

Vol 30 (1) ◽

pp. 96-103 ◽

Cited By ~ 5

Author(s):

Miaozhen Qiu ◽

Yixin Zhou ◽

Ying Jin ◽

Xiao-li Wei ◽

De-shen Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Gastric Adenocarcinoma ◽

Prognostic Value ◽

Neutrophil To Lymphocyte Ratio ◽

Healthy Individuals ◽

Poor Survival ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Gastric Cancer Patients

Background A high neutrophil to lymphocyte ratio (NLR) is a strong predictor of poor survival in patients with colorectal, breast, pancreatic and lung cancers, while the prognostic value of NLR in gastric cancer is still controversial. The aim of our study was to determine the prognostic value of pretreatment NLR in a Chinese population of patients with gastric adenocarcinoma. Methods Our retrospective study used an unselected cohort of gastric adenocarcinoma patients treated in the Cancer Center of Sun Yat-sen University between January 2001 and December 2008. We used the data from 341 healthy individuals as controls to understand the difference of NLR between the gastric cancer patients and normal individuals. A total of 706 patients had a complete blood count (CBC) record prior to treatment. Cox regression analysis was used to evaluate the prognostic value of NLR. Results Gastric adenocarcinoma patients had a significantly higher NLR as well as neutrophilic granulocyte and lower lymphocyte counts compared with healthy individuals. By combining the nearby groups of NLR whose survival had no significant difference, we got a cutoff value for NLR of 3. Patients with a high NLR had a significantly lower survival rate than patients with a low NLR. On multivariate analysis, after adjusting for tumor stage and other clinicopathologic factors, high NLR turned out to be an independent risk factor for poor survival (p=0.016). Conclusions Gastric cancer patients had a significantly higher incidence rate of high NLR compared with healthy individuals. High pretreatment NLR in gastric cancer was an independent prognostic factor.

Download Full-text

Prognostic Value of the Preoperative Neutrophil to Lymphocyte Ratio in Resectable Gastric Cancer

Medicine ◽

10.1097/md.0000000000001589 ◽

2015 ◽

Vol 94 (39) ◽

pp. e1589 ◽

Cited By ~ 17

Author(s):

Jun-Te Hsu ◽

Chun-Kai Liao ◽

Puo-Hsien Le ◽

Tsung-Hsing Chen ◽

Chun-Jung Lin ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Value ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Resectable Gastric Cancer

Download Full-text

The neutrophil-to-lymphocyte ratio prechemotherapy and postchemotherapy as a prognostic marker in metastatic gastric cancer

The Korean Journal of Internal Medicine ◽

10.3904/kjim.2016.293 ◽

2018 ◽

Vol 33 (5) ◽

pp. 990-999 ◽

Cited By ~ 4

Author(s):

Hyunho Kim ◽

Sang Mi Ro ◽

Ji Hyun Yang ◽

Joon Won Jeong ◽

Ji Eun Lee ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Marker ◽

Metastatic Gastric Cancer ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio

Download Full-text

Association of ascitic neutrophil to lymphocyte ratio with prognosis in patients with advanced gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.443 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 443-443

Author(s):

Jae-Joon Kim ◽

So Yeon Oh ◽

Kwonoh Park ◽

Sang-Bo Oh

Keyword(s):

Gastric Cancer ◽

Prognostic Factor ◽

Prognostic Significance ◽

Metastatic Gastric Cancer ◽

Malignant Ascites ◽

Initial Result ◽

Neutrophil To Lymphocyte Ratio ◽

Poor Prognostic Factor ◽

Lymphocyte Ratio ◽

Gastric Cancer Patients

443 Background: Approximately 40% of metastatic gastric cancer patients develop peritoneal carcinomatosis, and this condition leads patients to grave prognosis. Blood neutrophil to lymphocyte ratio (NLR) is associated with prognosis in various solid tumors, such as non-small cell lung cancer, colorectal cancer, and gastric cancer. We performed this study to investigate the prognostic significance of NLR of ascitic fluid. Methods: This is retrospective study. Patients were consecutive included if they; 1) had histologically confirmed gastric adenocarcinoma, poorly cohesive carcinoma, or poorly differentiated carcinoma, 2) were relapsed after curative resection or initially metastatic, 3) had ascites due to peritoneal metastases of gastric cancer, 4) had received paracentesis at least once and the result of ascites exam is available. Patients with clinically active infection in the time of paracentesis is excluded. If multiple times of paracentesis was done, we used initial result. Results: From March 2012 to August 2018, total 157 patients who were visited in Pusan National University Yangsan Hospital met the inclusion criteria. Median age is 58 (29-86) years and male patients was 63% (n = 99). In 38.9% (n = 61) patients, gastric cancer was diagnosed in primary site and in ascites synchronously. At the time of first paracentesis, 47.1% (n = 74) of patients had already been received palliative chemotherapy due to metastatic gastric cancer. In the ascites, mean and median NLR is 2.2±6.8 and 0.3 (0-65). All except 3 patients were expired, and the median survival time form paracentesis was 47 (95% confidence interval 38.6-55.4) days. In the Kaplan-Meier survival analysis, patients with higher NLR (≥0.33) have shorter survival from paracentesis (39 days, 95% CI 32.5-45.4) in compared to lower NLR ( < 0.33) (61 days, 95% CI 29.4-92.6, log-rank p = 0.011). In the additional analyses, higher neutrophil count (41 vs 72 days, p = 0.045) and lower protein level (32 vs 61 days, p = 0.018) of ascites are also poor prognostic factor. Conclusions: High NLR of malignant ascites is poor prognostic factor in patients with gastric cancer. The role of neutrophil in the malignant ascites should be tested in a new perspective.

Download Full-text

Prognostic value of neutrophil-to-lymphocyte ratio in advanced oesophago-gastric cancer: exploratory analysis of the REAL-2 trial

Annals of Oncology ◽

10.1093/annonc/mdw012 ◽

2016 ◽

Vol 27 (4) ◽

pp. 687-692 ◽

Cited By ~ 33

Author(s):

T. Grenader ◽

T. Waddell ◽

C. Peckitt ◽

J. Oates ◽

N. Starling ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Value ◽

Exploratory Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

The Real ◽

Lymphocyte Ratio

Download Full-text

The Neutrophil to Lymphocyte Ratio is an Independent Prognostic Factor in Patients with Metastatic Gastric Cancer

Asian Pacific Journal of Cancer Prevention ◽

10.7314/apjcp.2016.17.3.1309 ◽

2016 ◽

Vol 17 (3) ◽

pp. 1309-1312 ◽

Cited By ~ 5

Author(s):

Fatma Yalcin Musri ◽

Hasan Mutlu ◽

Melek Karakurt Eryilmaz ◽

Derya Kivrak Salim ◽

Seyda Gunduz ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Factor ◽

Metastatic Gastric Cancer ◽

Independent Prognostic Factor ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio

Download Full-text

Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and hemoglobin (Hb) predict immunotherapy outcomes in patients with advanced or metastatic gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16075 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16075-e16075

Author(s):

Miaomiao Gou ◽

Yong Zhang ◽

Huan Yan ◽

Haiyan Si ◽

Zhikuan Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Response Rate ◽

Objective Response ◽

Progression Free Survival ◽

Final Analysis ◽

Metastatic Gastric Cancer ◽

Neutrophil To Lymphocyte Ratio ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Significant Difference

e16075 Background: This study aimed to confirm the prognostic role of pretreatment neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), hemoglobin (Hb) levels as effective and convenient biomarkers for patients with advanced or metastatic gastric cancer (AGC or MGC) receiving immunotherapy. Methods: patients with AGC and MGC who received anti-PD-1 treatment at the Chinese PLA General Hospital between January 2016 and November 2020 were reviewed. The receiver operating characteristic analyses for predicting 6 months PFS by the NLR, PLR was used to identify an appropriate cut-off value. The study analyzed the association of NLR, PLR, Hb and overall survival (OS) or progression-free survival (PFS) and anti-tumor response rate with immunotherapy respectively. Results: 137 patients were included in the final analysis. 71 patients were administered immunotherapy in the first line and the rest of the patients in the second or further line. 92 patients had received immunotherapy combined with chemotherapy, whereas 45 patients had undertaken immunotherapy monotherapy or with anti-angiogenesis. The best cut-off value for NLR was 3.23 and for PLR was 816.43. NLR <3.23 was associated with longer OS (HR = 0.38, 95% CI, 0.26-0.57, p < 0.001) and PFS (HR = 0.42, 95% CI, 0.29-0.62, p < 0.001) in patients with AGC or MGC. Patients in PLR<816.43 group had prolonged PFS (7.9m vs 4.3m, p<0.001) and OS (11.1m vs9.2m, p<0.001) than in PLR>=816.43 group. The median PFS was 7.8m in the normal Hb level group (Hb>=110g/L) and 4.3m in the decreased Hb group (Hb<110g/L) (HR=0.5, 95% CI 0.31, 0.81, P=0.004). The OS was 14.4m with normal Hb level as compared with 8.2m with decreased Hb level( HR=0.59, 95% CI 0.37, 0.94, P=0.024). No significant difference was observed in objective response rate (ORR) and disease control rate (DCR) in the different NLR, PLR, Hb group, respectively. Univariate and multivariate analysis found that NLR, PLR, Hb were independent prognostic biomarkers for PFS and OS (p<0.05). Conclusions: pre-treatment NLR, PLR, Hb was significantly associated with PFS and OS in patients with AGC and MGC who received immunotherapy. Clinicians need to consider patients with elevated NLR and PLR or decreased Hb level for decisions on immunotherapy strategy.

Download Full-text