Clinical value of change of preoperative and postoperative neutrophil-lymphocyte ratio in evaluating prognosis of patients with gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHAO Yang ¹ , CHENG Jing ²

1. Department of General Surgery, Panjin Liao-Oil Gem Flower Hospital, Panjin, Liaoning 124010, P. R. China;
2. Department of Clinical Laboratory, Panjin Liao-Oil Gem Flower Hospital, Panjin, Liaoning 124010, P. R. China;

Corresponding?author：

ZHAO Yang, Email: zhaoyang197410@sohu.com

Keywords：

gastric cancer; neutrophil-lymphocyte ratio; prognosis

DOI：

10.7507/1007-9424.202003158

Video：

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Objective To investigated the clinical significance of preoperative and postoperative neutrophil-lymphocyte ratio (NLR) change in evaluating long-term prognosis of patients with gastric cancer.Methods The clinicopathologic data of the patients who underwent the gastric cancer resection from January 2010 to December 2014 in the Panjin Liao-Oil Gem Flower Hospital were analyzed retrospectively. The patients were designed into an increased NLR group (preoperative NLR was lower than postoperative NLR) and decreased NLR group (preoperative NLR was higher than postoperative NLR) according to the change of NLR before and after operation. The differences of clinicopathologic characteristics between the two groups were compared and the influencing factors of 5-year survival rate of patients with gastric cancer were analyzed.Results In this study, 194 patients were included, 145 of whom in the decreased NLR group and 49 in the increased NLR group. The proportions of the later TNM stage (stage Ⅲ), total gastrectomy, preoperative CEA level >5 μg/L, and with postoperative complications in the increased NLR group were significantly higher than those in the decreased NLR group (P<0.05). The results of multivariate analysis showed that the later TNM stage (stage Ⅲ), with postoperative complications, increased NLR, and postoperative adjuvant chemotherapy deficiency were the independent risk factors for the 5-year survival rate of patients with gastric cancer (P<0.05), and the survival of patients in the increased NLR group was worse than in the decreased NLR group by the Kaplan-Meier analysis (P=0.011).Conclusion The change of preoperative and postoperative NLR has an important clinical value in evaluating the long-term prognosis of patients with gastric cancer.

Citation： ZHAO Yang, CHENG Jing. Clinical value of change of preoperative and postoperative neutrophil-lymphocyte ratio in evaluating prognosis of patients with gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(12): 1538-1542. doi: 10.7507/1007-9424.202003158 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	劉鳳林, 秦新裕. 胃癌根治術現狀與展望. 中國普外基礎與臨床雜志, 2019, 26(7): 769-771.
3.	Ueno D, Matsumoto H, Kubota H, et al. Prognostic factors for gastrectomy in elderly patients with gastric cancer. World J Surg Oncol, 2017, 15(1): 59-70.
4.	Fuse N, Kuboki Y, Kuwata T, et al. Prognostic impact of HER2, EGFR, and c-MET status on overall survival of advanced gastric cancer patients. Gastric Cancer, 2016, 19(1): 183-191.
5.	Higaki E, Kuwata T, Nagatsuma AK, et al. Gene copy number gain of EGFR is a poor prognostic biomarker in gastric cancer: evaluation of 855 patients with bright-field dual in situ hybridization (DISH) method. Gastric Cancer, 2016, 19(1): 63-73.
6.	Okugawa Y, Toiyama Y, Hur K, et al. Metastasis-associated long non-coding RNA drives gastric cancer development and promotes peritoneal metastasis. Carcinogenesis, 2014, 35(12): 2731-2739.
7.	Kurokawa Y, Matsuura N, Kimura Y, et al. Multicenter large-scale study of prognostic impact of HER2 expression in patients with resectable gastric cancer. Gastric Cancer, 2015, 18(4): 691-697.
8.	Park HJ, Ahn JY, Jung HY, et al. Clinical characteristics and outcomes for gastric cancer patients aged 18-30 years. Gastric Cancer, 2014, 17(4): 649-660.
9.	Nam DH, Lee YK, Park JC, et al. Prognostic value of early postoperative tumor marker response in gastric cancer. Ann Surg Oncol, 2013, 20(12): 3905-3911.
10.	Rashtak S, Ruan X, Druliner BR, et al. Peripheral neutrophil to lymphocyte ratio improves prognostication in colon cancer. Clin Colorectal Cancer, 2017, 16(2): 115-123.
11.	Kim DS, Kwon NS, Yun HY. Leucine rich repeat LGI family member 3: integrative analyses reveal its prognostic association with non-small cell lung cancer. Oncol Lett, 2019, 18(3): 3388-3398.
12.	趙陽, 程靜. 系統免疫炎癥指數與接受新輔助化療胰腺導管腺癌患者預后的關系. 中國癌癥防治雜志, 2020, 12(2): 222-227.
13.	Najjar M, Agrawal S, Emond JC, et al. Pretreatment neutrophil-lymphocyte ratio: useful prognostic biomarker in hepatocellular carcinoma. J Hepatocell Carcinoma, 2018, 5: 17-28.
14.	Kim JH, Han DS, Bang HY, et al. Preoperative neutrophil-to-lymphocyte ratio is a prognostic factor for overall survival in patients with gastric cancer. Ann Surg Treat Res, 2015, 89(2): 81-86.
15.	Kumar R, Geuna E, Michalarea V, et al. The Neutrophil-lymphocyte ratio and its utilisation for the management of cancer patients in early clinical trials. Br J Cancer, 2015, 112(7): 1157-1165.
16.	Templeton AJ, McNamara MG, ?eruga 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(6): dju124.
17.	Lee S, Oh SY, Kim SH, et al. Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer, 2013, 13: 350-360.
18.	Timerbulatov VM, Timerbulatov SV, Timerbulatov MV. Classification of surgical complications. Khirurgiia (Mosk), 2018, (9): 62-67.
19.	Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today, 2016, 46(6): 668-685.
20.	孫建兵, 吉翔, 汪亞輝, 等. 循環腫瘤細胞與胃癌患者臨床病理特征及預后的關系研究. 中國普外基礎與臨床雜志, 2019, 26(1): 25-30.
21.	Yamada D, Eguchi H, Asaoka T, et al. The basal nutritional state of PDAC patients is the dominant factor for completing adjuvant chemotherapy. Surg Today, 2017, 47(11): 1361-1371.
22.	Yamamoto M, Kurokawa Y, Kobayashi N, et al. Prognostic value of the combined index of plasma fibrinogen and the neutrophil-lymphocyte ratio in gastric cancer. World J Surg, 2020, 44(1): 207-212.
23.	Hayashi T, Yoshikawa T, Aoyama T, et al. Impact of infectious complications on gastric cancer recurrence. Gastric Cancer, 2015, 18(2): 368-374.
24.	Takaya S, Saito H, Ikeguchi M. Upregulation of immune checkpoint molecules, PD-1 and LAG-3, on CD4⁺ and CD8⁺ T cells after gastric cancer surgery. Yonago Acta Med, 2015, 58(1): 39-44.
25.	Sánchez-Zauco N, Torres J, Gómez A, et al. Circulating blood levels of IL-6, IFN-γ, and IL-10 as potential diagnostic biomarkers in gastric cancer: a controlled study. BMC Cancer, 2017, 17(1): 384-393.
26.	Di Bartolomeo M, Pietrantonio F, Pellegrinelli A, et al. Osteopontin, E-cadherin, and β-catenin expression as prognostic biomarkers in patients with radically resected gastric cancer. Gastric Cancer, 2016, 19(2): 412-420.
27.	Briones-Orta MA, Avenda?o-Vázquez SE, Aparicio-Bautista DI, et al. Osteopontin splice variants and polymorphisms in cancer progression and prognosis. Biochim Biophys Acta Rev Cancer, 2017, 1868(1): 93-108.
28.	Karakasheva TA, Lin EW, Tang Q, et al. IL-6 mediates cross-talk between tumor cells and activated fibroblasts in the tumor microenvironment. Cancer Res, 2018, 78(17): 4957-4970.
29.	Kindlund B, Sj?ling ?, Yakkala C, et al. CD4⁺ regulatory T cells in gastric cancer mucosa are proliferating and express high levels of IL-10 but little TGF-β. Gastric Cancer, 2017, 20(1): 116-125.
30.	Choi Y, Kim JW, Nam KH, et al. Systemic inflammation is associated with the density of immune cells in the tumor microenvironment of gastric cancer. Gastric Cancer, 2017, 20(4): 602-611.
31.	張東陽, 陳小龍, 宋小海, 等. 胃癌患者外周血中 CD45^–CD44⁺CD54⁺細胞亞群含量及其臨床意義. 中國普外基礎與臨床雜志, 2020, 27(4): 434-441.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 劉鳳林, 秦新裕. 胃癌根治術現狀與展望. 中國普外基礎與臨床雜志, 2019, 26(7): 769-771.
3. Ueno D, Matsumoto H, Kubota H, et al. Prognostic factors for gastrectomy in elderly patients with gastric cancer. World J Surg Oncol, 2017, 15(1): 59-70.
4. Fuse N, Kuboki Y, Kuwata T, et al. Prognostic impact of HER2, EGFR, and c-MET status on overall survival of advanced gastric cancer patients. Gastric Cancer, 2016, 19(1): 183-191.
5. Higaki E, Kuwata T, Nagatsuma AK, et al. Gene copy number gain of EGFR is a poor prognostic biomarker in gastric cancer: evaluation of 855 patients with bright-field dual in situ hybridization (DISH) method. Gastric Cancer, 2016, 19(1): 63-73.
6. Okugawa Y, Toiyama Y, Hur K, et al. Metastasis-associated long non-coding RNA drives gastric cancer development and promotes peritoneal metastasis. Carcinogenesis, 2014, 35(12): 2731-2739.
7. Kurokawa Y, Matsuura N, Kimura Y, et al. Multicenter large-scale study of prognostic impact of HER2 expression in patients with resectable gastric cancer. Gastric Cancer, 2015, 18(4): 691-697.
8. Park HJ, Ahn JY, Jung HY, et al. Clinical characteristics and outcomes for gastric cancer patients aged 18-30 years. Gastric Cancer, 2014, 17(4): 649-660.
9. Nam DH, Lee YK, Park JC, et al. Prognostic value of early postoperative tumor marker response in gastric cancer. Ann Surg Oncol, 2013, 20(12): 3905-3911.
10. Rashtak S, Ruan X, Druliner BR, et al. Peripheral neutrophil to lymphocyte ratio improves prognostication in colon cancer. Clin Colorectal Cancer, 2017, 16(2): 115-123.
11. Kim DS, Kwon NS, Yun HY. Leucine rich repeat LGI family member 3: integrative analyses reveal its prognostic association with non-small cell lung cancer. Oncol Lett, 2019, 18(3): 3388-3398.
12. 趙陽, 程靜. 系統免疫炎癥指數與接受新輔助化療胰腺導管腺癌患者預后的關系. 中國癌癥防治雜志, 2020, 12(2): 222-227.
13. Najjar M, Agrawal S, Emond JC, et al. Pretreatment neutrophil-lymphocyte ratio: useful prognostic biomarker in hepatocellular carcinoma. J Hepatocell Carcinoma, 2018, 5: 17-28.
14. Kim JH, Han DS, Bang HY, et al. Preoperative neutrophil-to-lymphocyte ratio is a prognostic factor for overall survival in patients with gastric cancer. Ann Surg Treat Res, 2015, 89(2): 81-86.
15. Kumar R, Geuna E, Michalarea V, et al. The Neutrophil-lymphocyte ratio and its utilisation for the management of cancer patients in early clinical trials. Br J Cancer, 2015, 112(7): 1157-1165.
16. Templeton AJ, McNamara MG, ?eruga 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(6): dju124.
17. Lee S, Oh SY, Kim SH, et al. Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer, 2013, 13: 350-360.
18. Timerbulatov VM, Timerbulatov SV, Timerbulatov MV. Classification of surgical complications. Khirurgiia (Mosk), 2018, (9): 62-67.
19. Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today, 2016, 46(6): 668-685.
20. 孫建兵, 吉翔, 汪亞輝, 等. 循環腫瘤細胞與胃癌患者臨床病理特征及預后的關系研究. 中國普外基礎與臨床雜志, 2019, 26(1): 25-30.
21. Yamada D, Eguchi H, Asaoka T, et al. The basal nutritional state of PDAC patients is the dominant factor for completing adjuvant chemotherapy. Surg Today, 2017, 47(11): 1361-1371.
22. Yamamoto M, Kurokawa Y, Kobayashi N, et al. Prognostic value of the combined index of plasma fibrinogen and the neutrophil-lymphocyte ratio in gastric cancer. World J Surg, 2020, 44(1): 207-212.
23. Hayashi T, Yoshikawa T, Aoyama T, et al. Impact of infectious complications on gastric cancer recurrence. Gastric Cancer, 2015, 18(2): 368-374.
24. Takaya S, Saito H, Ikeguchi M. Upregulation of immune checkpoint molecules, PD-1 and LAG-3, on CD4⁺ and CD8⁺ T cells after gastric cancer surgery. Yonago Acta Med, 2015, 58(1): 39-44.
25. Sánchez-Zauco N, Torres J, Gómez A, et al. Circulating blood levels of IL-6, IFN-γ, and IL-10 as potential diagnostic biomarkers in gastric cancer: a controlled study. BMC Cancer, 2017, 17(1): 384-393.
26. Di Bartolomeo M, Pietrantonio F, Pellegrinelli A, et al. Osteopontin, E-cadherin, and β-catenin expression as prognostic biomarkers in patients with radically resected gastric cancer. Gastric Cancer, 2016, 19(2): 412-420.
27. Briones-Orta MA, Avenda?o-Vázquez SE, Aparicio-Bautista DI, et al. Osteopontin splice variants and polymorphisms in cancer progression and prognosis. Biochim Biophys Acta Rev Cancer, 2017, 1868(1): 93-108.
28. Karakasheva TA, Lin EW, Tang Q, et al. IL-6 mediates cross-talk between tumor cells and activated fibroblasts in the tumor microenvironment. Cancer Res, 2018, 78(17): 4957-4970.
29. Kindlund B, Sj?ling ?, Yakkala C, et al. CD4⁺ regulatory T cells in gastric cancer mucosa are proliferating and express high levels of IL-10 but little TGF-β. Gastric Cancer, 2017, 20(1): 116-125.
30. Choi Y, Kim JW, Nam KH, et al. Systemic inflammation is associated with the density of immune cells in the tumor microenvironment of gastric cancer. Gastric Cancer, 2017, 20(4): 602-611.
31. 張東陽, 陳小龍, 宋小海, 等. 胃癌患者外周血中 CD45^–CD44⁺CD54⁺細胞亞群含量及其臨床意義. 中國普外基礎與臨床雜志, 2020, 27(4): 434-441.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical value of change of preoperative and postoperative neutrophil-lymphocyte ratio in evaluating prognosis of patients with gastric cancer

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