Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 8/2018

01-08-2018 | Original Scientific Report

Comprehensive Analysis of the Neutrophil-to-Lymphocyte Ratio for Preoperative Prognostic Prediction Nomogram in Gastric Cancer

Authors: Jong-Ho Choi, Yun-Suhk Suh, Yunhee Choi, Jiyeon Han, Tae Han Kim, Shin-Hoo Park, Seong-Ho Kong, Hyuk-Joon Lee, Han-Kwang Yang

Published in: World Journal of Surgery | Issue 8/2018

Login to get access

Abstract

Background

The role of neutrophil-to-lymphocyte ratio (NLR) and preoperative prediction model in gastric cancer is controversial, while postoperative prognostic models are available. This study investigated NLR as a preoperative prognostic indicator in gastric cancer.

Methods

We reviewed patients with primary gastric cancer who underwent surgery during 2007–2010. Preoperative clinicopathologic factors were analyzed with their interaction and used to develop a prognosis prediction nomogram. That preoperative prediction nomogram was compared to a nomogram using pTNM or a historical postoperative prediction nomogram. The contribution of NLR to a preoperative nomogram was evaluated with integrated discrimination improvement (IDI).

Results

Using 2539 records, multivariable analysis revealed that NLR was one of the independent prognostic factors and had a significant interaction with only age among other preoperative factors (especially significant in patients < 50 years old). NLR was constantly significant between 1.1 and 3.1 without any distinctive cutoff value. Preoperative prediction nomogram using NLR showed a Harrell’s C-index of 0.79 and an R2 of 25.2%, which was comparable to the C-index of 0.78 and 0.82 and R2 of 26.6 and 25.8% from nomogram using pTNM and a historical postoperative prediction nomogram, respectively. IDI of NLR to nomogram in the overall population was 0.65%, and that of patients < 50 years old was 2.72%.

Conclusions

NLR is an independent prognostic factor for gastric cancer, especially in patients < 50 years old. A preoperative prediction nomogram using NLR can predict prognosis of gastric cancer as effectively as pTNM and a historical postoperative prediction nomogram.
Appendix
Available only for authorised users
Literature
1.
Han DS, Suh YS, Kong SH et al (2012) Nomogram predicting long-term survival after d2 gastrectomy for gastric cancer. J Clin Oncol 30:3834–3840CrossRefPubMed
2.
Xu J, Cao H, Yang JY et al (2016) Is preoperative staging enough to guide lymph node dissection in clinically early gastric cancer? Gastric Cancer 19:568–578CrossRefPubMed
3.
4.
5.
6.
7.
Shamamian P, Schwartz JD, Pocock BJ et al (2001) Activation of progelatinase A (MMP-2) by neutrophil elastase, cathepsin G, and proteinase-3: a role for inflammatory cells in tumor invasion and angiogenesis. J Cell Physiol 189:197–206CrossRefPubMed
8.
Lakshmi Narendra B, Eshvendar Reddy K, Shantikumar S et al (2013) Immune system: a double-edged sword in cancer. Inflamm Res 62:823–834CrossRefPubMed
9.
Wang SC, Chou JF, Strong VE et al (2016) Pretreatment neutrophil to lymphocyte ratio independently predicts disease-specific survival in resectable gastroesophageal junction and gastric adenocarcinoma. Ann Surg 263:292–297CrossRefPubMed
10.
Shimada H, Takiguchi N, Kainuma O et al (2010) High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer 13:170–176CrossRefPubMed
11.
Ohno Y, Nakashima J, Ohori M et al (2012) Followup of neutrophil-to-lymphocyte ratio and recurrence of clear cell renal cell carcinoma. J Urol 187:411–417CrossRefPubMed
12.
Yamanaka T, Matsumoto S, Teramukai S et al (2007) The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology 73:215–220CrossRefPubMed
13.
Kao SC, Pavlakis N, Harvie R et al (2010) High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res 16:5805–5813CrossRefPubMed
14.
15.
Hirashima M, Higuchi S, Sakamoto K et al (1998) The ratio of neutrophils to lymphocytes and the phenotypes of neutrophils in patients with early gastric cancer. J Cancer Res Clin Oncol 124:329–334CrossRefPubMed
16.
Jeong JH, Lim SM, Yun JY et al (2012) Comparison of two inflammation-based prognostic scores in patients with unresectable advanced gastric cancer. Oncology 83:292–299CrossRefPubMed
17.
Jung MR, Park YK, Jeong O et al (2011) Elevated preoperative neutrophil to lymphocyte ratio predicts poor survival following resection in late stage gastric cancer. J Surg Oncol 104:504–510CrossRefPubMed
18.
Ubukata H, Motohashi G, Tabuchi T et al (2010) Evaluations of interferon-gamma/interleukin-4 ratio and neutrophil/lymphocyte ratio as prognostic indicators in gastric cancer patients. J Surg Oncol 102:742–747CrossRefPubMed
19.
Graziosi L, Marino E, De Angelis V et al (2015) Prognostic value of preoperative neutrophils to lymphocytes ratio in patients resected for gastric cancer. Am J Surg 209:333–337CrossRefPubMed
20.
Dutta S, Crumley AB, Fullarton GM et al (2012) Comparison of the prognostic value of tumour and patient related factors in patients undergoing potentially curative resection of gastric cancer. Am J Surg 204:294–299CrossRefPubMed
21.
Bosman FT, Carneiro F, Hruban RH et al (2010) WHO classification of tumours of the digestive system, 4th edn. IARC Press, Lyon
22.
Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRef
23.
Washington K (2010) 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 17:3077–3079CrossRefPubMed
24.
Hess KR (1994) Assessing time-by-covariate interactions in proportional hazards regression models using cubic spline functions. Stat Med 13:1045–1062CrossRefPubMed
25.
Altman DG, Lausen B, Sauerbrei W et al (1994) Dangers of using “optimal” cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst 86:829–835CrossRefPubMed
26.
O’Quigley J, Xu R, Stare J (2005) Explained randomness in proportional hazards models. Stat Med 24:479–489CrossRefPubMed
27.
Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387CrossRefPubMed
28.
Uno H, Tian L, Cai T et al (2013) A unified inference procedure for a class of measures to assess improvement in risk prediction systems with survival data. Stat Med 32:2430–2442CrossRefPubMed
29.
Cook NR, Ridker PM (2009) Advances in measuring the effect of individual predictors of cardiovascular risk: the role of reclassification measures. Ann Intern Med 150:795–802CrossRefPubMedPubMedCentral
30.
Ishizuka M, Oyama Y, Abe A et al (2014) Combination of platelet count and neutrophil to lymphocyte ratio is a useful predictor of postoperative survival in patients undergoing surgery for gastric cancer. J Surg Oncol 110:935–941CrossRefPubMed
31.
Lee S, Oh SY, Kim SH et al (2013) Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer 13:350CrossRefPubMedPubMedCentral
32.
Park YK, Kim JC, Koh YS et al (2006) Early gastric carcinoma in young patients. Int Surg 91:316–319PubMed
33.
Kim DY, Joo JK, Ryu SY et al (2005) Clinicopathologic characteristics of gastric carcinoma in elderly patients: a comparison with young patients. World J Gastroenterol 11:22–26CrossRefPubMedPubMedCentral
34.
35.
Hsieh MM, Everhart JE, Byrd-Holt DD et al (2007) Prevalence of neutropenia in the U.S. population: age, sex, smoking status, and ethnic differences. Ann Intern Med 146:486–492CrossRefPubMed
36.
Tak T, Tesselaar K, Pillay J et al (2013) What’s your age again? Determination of human neutrophil half-lives revisited. J Leukoc Biol 94:595–601CrossRefPubMed
37.
Pillay J, Ramakers BP, Kamp VM et al (2010) Functional heterogeneity and differential priming of circulating neutrophils in human experimental endotoxemia. J Leukoc Biol 88:211–220CrossRefPubMed
38.
Treffers LW, Hiemstra IH, Kuijpers TW et al (2016) Neutrophils in cancer. Immunol Rev 273:312–328CrossRefPubMed
39.
Youn JI, Collazo M, Shalova IN et al (2012) Characterization of the nature of granulocytic myeloid-derived suppressor cells in tumor-bearing mice. J Leukoc Biol 91:167–181CrossRefPubMedPubMedCentral
40.
Corzo CA, Cotter MJ, Cheng P et al (2009) Mechanism regulating reactive oxygen species in tumor-induced myeloid-derived suppressor cells. J Immunol 182:5693–5701CrossRefPubMed
41.
Verschoor CP, Johnstone J, Millar J et al (2013) Blood CD33(+)HLA-DR(−) myeloid-derived suppressor cells are increased with age and a history of cancer. J Leukoc Biol 93:633–637CrossRefPubMedPubMedCentral
42.
Harman MF, Ranocchia RP, Gorlino CV et al (2015) Expansion of myeloid-derived suppressor cells with arginase activity lasts longer in aged than in young mice after CpG-ODN plus IFA treatment. Oncotarget 6:13448–13461CrossRefPubMedPubMedCentral
43.
Arnold CR, Wolf J, Brunner S et al (2011) Gain and loss of T cell subsets in old age–age-related reshaping of the T cell repertoire. J Clin Immunol 31:137–146CrossRefPubMed
44.
45.
46.
Jagger A, Shimojima Y, Goronzy JJ et al (2014) Regulatory T cells and the immune aging process: a mini-review. Gerontology 60:130–137CrossRefPubMed
47.
Information Committee of Korean Gastric Cancer Association (2016) Korean gastric cancer association nationwide survey on gastric cancer in 2014. J Gastric Cancer 16:131–140CrossRef
48.
Fujitani K, Yang HK, Mizusawa J et al (2016) Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol 17:309–318CrossRefPubMed
49.
Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19CrossRef
50.
Hartgrink HH, van de Velde CJ, Putter H et al (2004) Neo-adjuvant chemotherapy for operable gastric cancer: long term results of the Dutch randomised FAMTX trial. Eur J Surg Oncol 30:643–649CrossRefPubMed
51.
Schuhmacher C, Gretschel S, Lordick F et al (2010) Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: European Organisation for Research and Treatment of Cancer randomized trial 40954. J Clin Oncol 28:5210–5218CrossRefPubMedPubMedCentral
52.
Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20CrossRefPubMed
53.
Metadata
Title
Comprehensive Analysis of the Neutrophil-to-Lymphocyte Ratio for Preoperative Prognostic Prediction Nomogram in Gastric Cancer
Authors
Jong-Ho Choi
Yun-Suhk Suh
Yunhee Choi
Jiyeon Han
Tae Han Kim
Shin-Hoo Park
Seong-Ho Kong
Hyuk-Joon Lee
Han-Kwang Yang
Publication date
01-08-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 8/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4510-4

Other articles of this Issue 8/2018

World Journal of Surgery 8/2018 Go to the issue

Original Scientific Report

Nonoperative Management of Blunt Splenic Trauma in Patients with Traumatic Brain Injury: Feasibility and Outcomes

Original Scientific Report

Impact of Hepatitis B Carrier Status on the Outcomes of Surgical Treatment of Colorectal Liver Metastases

Original Scientific Report

Laparoscopic Versus Open Approach for Formal Right and Left Hepatectomy: A Propensity Score Matching Analysis

Letter to the Editor

14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax: Size Does Not Matter

Original Scientific Report

Neonatal Gastric Perforation: Case Series and Literature Review

Original Scientific Report

Excellent Prognosis of Central Lymph Node Recurrence-Free Survival for cN0M0 Papillary Thyroid Carcinoma Patients Who Underwent Routine Prophylactic Central Node Dissection