The Neutrophil-Lymphocyte Ratio Is an Independent Prognostic Factor for Overall Survival in Hispanic Patients with Gastric Adenocarcinoma

  • A. Ramos-EsquivelEmail author
  • E. Cordero-García
  • D. Brenes-Redondo
  • W. Alpízar-Alpízar
Original Research



High values of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are related with poor prognosis in patients with gastric cancer. However, this association has been rarely assessed in Hispanic populations that show important clinicopathological differences to Asian and Caucasian patients. In this study, we determined the prognostic value of these biomarkers in Hispanic patients from Costa Rica.

Materials and Methods

We retrieved data regarding pre-treatment NLR and PLR, as well as clinical variables from medical records of 381 consecutive gastric cancer patients treated in four major hospitals in Costa Rica between 2009 and 2012. Univariate and multiple Cox regression analyses were performed to assess the value of NLR and PLR as predictors of overall survival (OS) and disease-free survival (DFS). The best cutoff point was based on the maximization of the Log-rank test.


Median follow-up was 13.21 months. In univariate analysis, a NLR ≥ 5 was associated with reduced DFS (hazard ratio (HR) 2.31; 95% confidence interval (CI) 1.78–3.00; p < 0.001) and poor OS (HR 2.24; 95% CI 1.72–2.92; p < 0.001). Similarly, a PLR ≥ 350 was associated with worse DFS (HR 2.28; 95% CI 1.70–3.06; p < 0.001) and poor OS (HR 2.33; 95% CI 1.73–3.13; p < 0.001). After adjustment for potential confounders, multivariate analysis revealed that only the NLR ≥ 5 was independently associated with worse DFS (HR 1.97; 95% CI 1.44–2.47) and OS (HR 1.59; 95%CI 1.15–2.28).


NLR ≥ 5 was independently associated with worse OS and DFS in Hispanic patients with gastric cancer.


Gastric cancer Lymphocyte Neutrophil Platelet Prognosis 


Compliance with Ethical Standards

The study was approved by the Ethical Scientific Committee of the University of Costa Rica (no. 817-B2-371) and the Institutional Scientific Ethics Committee of the Caja Costarricense del Seguro Social (R013-SABI-00048). *The abstract of this manuscript was presented at the ESMO XX World Congress on Gastrointestinal Cancer 2018, Barcelona, Spain.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    International Agency for Research on Cancer. World Health Organization. Available at: Accessed on August 1st, 2017.
  2. 2.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.CrossRefPubMedGoogle Scholar
  3. 3.
    Registro Nacional de Tumores. Ministerio de Salud, Gobierno de Costa Rica. Available at: Accessed on May 26th, 2018.
  4. 4.
    Sierra M, Cueva P, Bravo LE, Forman D. Stomach cancer burden in central and South America. Cancer Epidemiol. 2016;44:S62–73.CrossRefPubMedGoogle Scholar
  5. 5.
    Carioli G, La Vecchia C, Bertuccio P, et al. Cancer mortality predictions for 2017 in Latin America. Ann Oncol. 2017;28:2286–97.CrossRefPubMedGoogle Scholar
  6. 6.
    Yao JC, Tseng JF, Worah S, Hess KR, Mansfield PF, Crane CH, et al. Clinicopathologic behavior of gastric adenocarcinoma in Hispanic patients: analysis of a single institution's experience over 15 years. J Clin Oncol. 2005;23:3094–103.CrossRefPubMedGoogle Scholar
  7. 7.
    Rajabi B, Corral JC, Hakim N, Mulla ZD. Descriptive epidemiology of gastric adenocarcinoma in the state of Texas by ethnicity: Hispanic versus white non-Hispanic. Gastric Cancer. 2012;15:405–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Duma N, Sanchez LJ, Castro YS, Jennis AA, McCain D, Gutierrez ME, et al. Gastric adenocarcinoma: clinicopathologic differences among Hispanics and non-Hispanic whites. A single Institution’s experience over 14 years. Ann Gastroenterol. 2016;29:325–31.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Al-Rafaie WB, Tseng JF, Gay G, et al. The impact of ethnicity on the presentation and prognosis of patients with gastric adenocarcinoma. Results from the National Cancer Data Base. Cancer. 2008;113:461–9.CrossRefGoogle Scholar
  10. 10.
    Ramos-Esquivel A, Rodriguez-Porras L, Porras J. Neutrophil to lymphocyte ration and platelet to lymphocyte ratio as prognostic factors in non-metastatic breast cancer patients from a Hispanic population. Breast Dis. 2017;37:1–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Wu J, Jiang M, Qin Y, et al. Single and combined use of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and carcinoembryonic antigen in diagnosing gastric cancer. Clin Chem Acta. 2018;481:20–4.CrossRefGoogle Scholar
  12. 12.
    Contal C, O’Quigley J. An application of changepoint methods in studying the effect of age on survival in breast cancer. Comput Stat Data Anal. 1999;30:253–70.CrossRefGoogle Scholar
  13. 13.
    Binnewies M, Roberts EW, Kersten K, Chan V, Fearon DF, Merad M, et al. Understanding the tumor immune microenvironment (TIME) for effective therapy. Nat Med. 2018;24:541–50.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436–44.CrossRefPubMedGoogle Scholar
  15. 15.
    Finn OJ. Cancer immunology. N Engl J Med. 2008;358:2704–15.CrossRefPubMedGoogle Scholar
  16. 16.
    Gay L, Felding-Habermann B. Contribution of platelets to tumour metastasis. Nat Rev Cancer. 2011;11:123–34.CrossRefPubMedGoogle Scholar
  17. 17.
    Zhang X, Zhang W, Feng L. Prognostic significance of neutrophil lymphocyte ratio in patients with gastric cancer: a meta-analysis. PLoS One. 2014;9:e111906.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Templeton AJ, McNamara MG, Seruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106:dju124.CrossRefPubMedGoogle Scholar
  19. 19.
    XIn-Ji Z, Yong-Gang L, Xiao-Jun S, et al. The prognostic role of neutrophils to lymphocytes ratio and platelet count in gastric cancer: a meta-analysis. Int J Surg. 2015;21:84–91.CrossRefPubMedGoogle Scholar
  20. 20.
    Lieto E, Galizia G, Auricchio A, Cardella F, Mabilia A, Basile N, et al. Preoperative neutrophil to lymphocyte ratio and lymphocyte to monocyte ratio are prognostic factors in gastric cancers undergoing surgery. J Gastrointest Surg. 2017;21:1764–74.CrossRefPubMedGoogle Scholar
  21. 21.
    Altman DG, Lausen B, Sauerbrei W, Shumacher M. Danger of using optimal cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst. 1994;86:829–35.CrossRefPubMedGoogle Scholar
  22. 22.
    Choi JH, Suh YS, Choi Y, et al. Comprehensive analysis of the neutrophil-to-lymphocyte ratio for preoperative prognostic prediction nomogram in gastric cancer. World J Surg. 2018;

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Departamento de Farmacología, Escuela de MedicinaUniversidad de Costa RicaSan JoséCosta Rica
  2. 2.Instituto de Investigaciones Farmacéuticas, Facultad de FarmaciaUniversidad de Costa RicaSan PedroCosta Rica
  3. 3.Departamento de Oncología Médica, Caja Costarricense de Seguro SocialHospital Max PeraltaCartagoCosta Rica
  4. 4.Departamento de Bioquímica, Escuela de Medicina and Centro de Investigación en Estructuras Microscópicas (CIEMIC)Universidad de Costa RicaSan PedroCosta Rica

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