Szor Daniel José, Roncon Dias Andre, Pereira Marina A, Ramos Marcus F K P, Zilberstein Bruno, Cecconello Ivan, Ribeiro Ulysses
Cancer Institute, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.
J Surg Oncol. 2018 Apr;117(5):851-857. doi: 10.1002/jso.25036. Epub 2018 Mar 6.
The role of inflammation in cancer development is a well-known phenomenon that may be represented by the neutrophil-lymphocyte ratio (NLR). The present research intends to determine the impact of NLR on the survival outcome of patients with gastric cancer (GC), and to evaluate its use as a stratification factor for the staging groups.
Data regarding clinical characteristics, surgery, pathology, and follow-up were retrospectively collected from our single-center prospective database. Blood samples were obtained before surgery.
A total of 383 patients (231 males) who underwent gastrectomy with lymphadenectomy were evaluated between 2009 and 2016. NLR established cutoff was 2.44, and patients were divided in NLR ≥2.44 (hNLR) and <2.44 (lNLR). hNLR patients (38.4% of the cases) had lower disease-free survival and overall survival (OS) compared to lNLR patients (P = 0.047 and P = 0.045, respectively). Risk stratification according to NLR value was done in same tumor depth (T4 and <T4), stage (III and <III) and lymph node status (N+ and N-) group of patients. The OS was significantly lower when NLR was high in same tumor depth (P = 0.032) and stage (P = 0.020), but not in same lymph node status patients (P = 0.184). In a multivariate analysis, NLR was an independent factor of worse OS (HR 1.50 95%CI 1.27-4.21, P = 0.048).
A high NLR was an independent risk factor for reduced survival in GC patients submitted to potentially curative resection. Calculating NLR is easily reproducible and may be incorporated in pre-operative evaluation.
炎症在癌症发展中的作用是一个众所周知的现象，中性粒细胞与淋巴细胞比值（NLR）可能是其代表指标。本研究旨在确定NLR对胃癌（GC）患者生存结局的影响，并评估其作为分期组分层因素的应用价值。
回顾性收集我们单中心前瞻性数据库中有关临床特征、手术、病理及随访的数据。术前采集血样。
2009年至2016年间，共评估了383例行胃切除术及淋巴结清扫术的患者（231例男性）。NLR的设定临界值为2.44，患者被分为NLR≥2.44（高NLR，hNLR）和<2.44（低NLR，lNLR）两组。与lNLR患者相比，hNLR患者（占病例的38.4%）的无病生存期和总生存期（OS）较低（分别为P = 0.047和P = 0.045）。对相同肿瘤深度（T4和<T4）、分期（III期和<III期）及淋巴结状态（N+和N-）组的患者，根据NLR值进行风险分层。在相同肿瘤深度（P = 0.032）和分期（P = 0.020）的患者中，NLR高时OS显著较低，但在相同淋巴结状态的患者中并非如此（P = 0.184）。多因素分析显示，NLR是OS较差的独立因素（风险比1.50，95%置信区间1.27 - 4.21，P = 0.048）。
高NLR是接受潜在根治性切除的GC患者生存降低的独立危险因素。计算NLR易于重复，可纳入术前评估。
