Abstract
Background
Multimodality therapy has been used in the management of gastric cancer associated with locoregional spread. However, the accurate clinical staging still remains to be established. The neutrophil/lymphocyte ratio (NLR) in the peripheral blood is reported to be an easily assessable prognostic factor in cancer patients. We evaluated the predictive significance of the NLR and other serological parameters in patients with wall-penetrating gastric cancer.
Methods
Two hundred sixty-two patients who underwent gastric cancer surgery between 2002 and 2005 were identified retrospectively. Wall penetration was defined as wall invasion deeper than the muscularis propria (≥T2). Blood data were collected from routinely performed blood examinations before treatment and were analyzed with respect to T stage, nodal status, and histological features. A high NLR was defined as less than 3.2 based on ROC curve analysis, and the predictive value of a high NLR for T4 cancer was evaluated.
Results
Elevated levels of NLR (P = 0.004) and C-reactive protein (CRP) (P = 0.017) and the decrease in lymphocyte count (Lym, P = 0.032) and serum hemoglobin (Hb, P < 0.001) were correlated with the T stage, but there was no meaningful correlation with either positive nodal status or histological differentiation. With respect to the predictive value for stage T4, an elevated NLR (OR = 2.206, 95% CI = 1.187–4.100; P = 0.012), decrease of Hb (OR = 1.875, 95% CI = 1.005–3.500; P = 0.048), and poorly differentiated histology (OR = 3.134, 95% CI = 1.593–6.167; P = 0.001) were identified as independent predictive factors.
Conclusion
Our findings suggest that the preoperative values of the NLR may be reliable for predicting T4 disease.
Similar content being viewed by others
References
Jemal A, Siegel R, Ward E et al (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249
Noguchi Y, Yoshikawa T, Tsuburaya A et al (2000) Is gastric carcinoma different between Japan and the United States? Cancer 89:2237–2246
Maruyama K, Okabayashi K, Kinoshita T (1987) Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 11:418–425. doi:10.1007/BF01655804
Sakuramoto S, Sasako M, Yamaguchi T et al (2007) Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820
Cunningham D, Allum WH, Stenning SP et al (2006) Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 355:11–20
Macdonald JS, Smalley SR, Benedetti J et al (2001) Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 345:725–730
Brennan MF (2005) Current status of surgery for gastric cancer: a review. Gastric Cancer 8:64–70
Chen CY, Hsu JS, Wu DC et al (2007) Gastric cancer: preoperative local staging with 3D multi-detector row CT—correlation with surgical and histopathologic results. Radiology 242:472–482
Habermann CR, Weiss F, Riecken R et al (2004) Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology 230:465–471
Hwang SW, Lee DH, Lee SH et al (2010) Preoperative staging of gastric cancer by endoscopic ultrasonography and multidetector-row computed tomography. J Gastroenterol Hepatol 25:512–518
Kumano S, Murakami T, Kim T et al (2005) T staging of gastric cancer: role of multi-detector row CT. Radiology 237:961–966
de Graaf GW, Ayantunde AA, Parsons SL et al (2007) The role of staging laparoscopy in oesophagogastric cancers. Eur J Surg Oncol 33:988–992
Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420:860–867
Mantovani A, Allavena P, Sica A et al (2008) Cancer-related inflammation. Nature 454:436–444
Aliustaoglu M, Bilici A, Ustaalioglu BB et al (2010) The effect of peripheral blood values on prognosis of patients with locally advanced gastric cancer before treatment. Med Oncol 27(4):1060–1065
Crumley AB, McMillan DC, McKernan M et al (2006) An elevated C-reactive protein concentration, prior to surgery, predicts poor cancer-specific survival in patients undergoing resection for gastro-oesophageal cancer. Br J Cancer 94:1568–1571
Mohri Y, Tanaka K, Ohi M et al (2010) Prognostic significance of host- and tumor-related factors in patients with gastric cancer. World J Surg 34:285–290. doi:10.1007/s00268-009-0302-1
Ray-Coquard I, Cropet C, Van Glabbeke M et al (2009) Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res 69:5383–5391
Satomi A, Murakami S, Ishida K et al (1995) Significance of increased neutrophils in patients with advanced colorectal cancer. Acta Oncol 34:69–73
Shimada H, Takiguchi N, Kainuma O et al (2010) High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer 13:170–176
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(7):742–747
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 73:215–220
Sobin LH, Wittekind C (eds) (2010) TMN Classification of Malignant Tumours (UICC). Wiley-Blackwell, Chichester, UK
Serhan CN, Brain SD, Buckley CD et al (2007) Resolution of inflammation: state of the art, definitions and terms. FASEB J 21:325–332
Eck M, Schmausser B, Scheller K et al (2003) Pleiotropic effects of CXC chemokines in gastric carcinoma: differences in CXCL8 and CXCL1 expression between diffuse and intestinal types of gastric carcinoma. Clin Exp Immunol 134:508–515
Coussens LM, Tinkle CL, Hanahan D et al (2000) MMP-9 supplied by bone marrow-derived cells contributes to skin carcinogenesis. Cell 103:481–490
Kido S, Kitadai Y, Hattori N et al (2001) Interleukin 8 and vascular endothelial growth factor—prognostic factors in human gastric carcinomas? Eur J Cancer 37:1482–1487
Yancopoulos GD, Davis S, Gale NW et al (2000) Vascular-specific growth factors and blood vessel formation. Nature 407:242–248
Crumley AB, Stuart RC, McKernan M et al (2008) Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG-ps) in patients receiving palliative chemotherapy for gastroesophageal cancer. J Gastroenterol Hepatol 23:e325–e329
McMillan DC (2008) An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc 67:257–262
Disclosure
The authors have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Aizawa, M., Gotohda, N., Takahashi, S. et al. Predictive Value of Baseline Neutrophil/Lymphocyte Ratio for T4 Disease in Wall-Penetrating Gastric Cancer. World J Surg 35, 2717–2722 (2011). https://doi.org/10.1007/s00268-011-1269-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-011-1269-2