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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2013

01-02-2013 | Bone and Soft Tissue Sarcomas

Blood Neutrophil-to-Lymphocyte Ratio is Prognostic in Gastrointestinal Stromal Tumor

Authors: Daniel R. Perez, MD, Raymond E. Baser, MS, Michael J. Cavnar, MD, Vinod P. Balachandran, MD, Cristina R. Antonescu, MD, William D. Tap, MD, Vivian E. Strong, MD, Murray F. Brennan, MD, Daniel G. Coit, MD, Samuel Singer, MD, Ronald P. DeMatteo, MD

Published in: Annals of Surgical Oncology | Issue 2/2013

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Abstract

Background

The immune system has been shown to play an important role in gastrointestinal stromal tumor (GIST). The neutrophil-to-lymphocyte ratio (NLR) in blood is an easily assessable parameter of systemic inflammatory response. The aim of this study was to determine whether the NLR is prognostic in GIST.

Methods

A total of 339 previously untreated patients with primary, localized GIST operated at our institution between 1995 and 2010 were identified from a prospectively collected sarcoma database. NLR was assessed preoperatively. Patients who received adjuvant imatinib treatment were excluded from the analysis (n = 64). Cox regression models were calculated and correlation analyses were performed.

Results

On univariate analysis, NLR was associated with recurrence-free survival (RFS) (P = 0.003, hazard ratio 3.3, 95 % confidence interval 1.5–7.4). Patients with a low NLR had a 1- and 5-year RFS of 98 and 91 %, compared with 89 and 76 % in those with a high NLR. The median RFS was not reached. Positive correlations were found between NLR and mitotic rate (Pearson correlation coefficient [r] = 0.15, P = 0.03), and NLR and tumor size (r = 0.36, P = 0.0001). RFS in patients with a GIST >5 cm with low NLR was significantly longer compared to patients with high NLR (P = 0.002). Flow cytometry analysis of freshly obtained GISTs revealed that neutrophils constituted a minimal percentage of intratumoral immune cells.

Conclusions

NLR is a surrogate for high-risk tumor features. Elevated blood NLR appears to represent systemic inflammation in patients with high-risk GIST.
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Metadata
Title
Blood Neutrophil-to-Lymphocyte Ratio is Prognostic in Gastrointestinal Stromal Tumor
Authors
Daniel R. Perez, MD
Raymond E. Baser, MS
Michael J. Cavnar, MD
Vinod P. Balachandran, MD
Cristina R. Antonescu, MD
William D. Tap, MD
Vivian E. Strong, MD
Murray F. Brennan, MD
Daniel G. Coit, MD
Samuel Singer, MD
Ronald P. DeMatteo, MD
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2682-y

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