ABSTRACT
Gastric cancer continues to be a major cause of morbidity and mortality worldwide. Recently, there has been a growing interest in the host inflammatory response and there is increasing evidence that the neutrophil to lymphocyte ratio (NLR), which is a useful marker of systemic inflammation, can be an effective prognostic indicator in various types of malignant diseases. A total of 110 patients with stage IV gastric cancer who received chemotherapy of S-1 plus cisplatin were enrolled in this study. Eleven patients did not complete four cycles of the chemotherapy. The patients were divided into two groups with 3.0 of NLR. The percentage of patients with a partial response to chemotherapy was significantly higher in the group of patients with a lower NLR (<3) (19.1 vs. 38.5%, high vs. low NLR group, respectively; P<0.05). The percentage of patients with progressive disease was higher in the high vs. low NLR group (57.4 vs. 25.0%, respectively; P<0.05). NLR levels were significantly inversely correlated with serum levels of prealbumin (P<0.01) and retinol binding protein (P<0.05). NLR levels were also significantly correlated with c-reactive protein levels (P<0.05), white blood cell count (P<0.05) and inversely with the stimulation index (a marker of cell-mediated immune function; P<0.05). Overall survival was significantly longer in patients with a lower NLR (≤ 3.0) than in those with a higher NLR (>3.0). The present study demonstrated that the NLR is a useful marker for resistance to chemotherapy, malnutrition, systemic inflammation and immune suppression. Moreover, the NLR was demonstrated to be a strong prognostic indicator in these patients.
ABSTRACT
BACKGROUND: S-1 is an oral anticancer drug widely used in postoperative adjuvant therapy for patients in Japan with stage II/III gastric cancer. Candidates for more intense adjuvant treatments need to be identified, particularly among patients with stage III cancer. METHODS: Univariate and multivariate analyses were conducted for patients with stage II/III gastric cancer who underwent surgery and received S-1 postoperatively between 2000 and 2010. RESULTS: Factors indicating poor prognosis identified by univariate analysis include male sex (P = 0.022), age ≥67 years (P = 0.021), intestinal-type histology (P = 0.049), lymph node ratio ≥16.7 % (P < 0.0001), open surgery (P = 0.039), as well as the 13th JGCA stage (P < 0.0001) and the 14th JGCA/7th International Union Against Cancer (UICC) stage (P < 0.0001). Multivariate analysis revealed that lymph node ratio ≥16.7 % and intestinal-type histology were significant as predictors of prognosis, independent from the pathological stages. Based on these and other findings, stage IIIC cancer on the 14th JGCA/7th UICC stage system in combination with the lymph node ratio could identify patients with extremely high risk for recurrence CONCLUSIONS: Our current findings suggest that lymph node ratio ≥16.7 % in combination with the new staging system could be a useful prognostic indicator in advanced gastric cancer. Because these high-risk patients cannot be identified preoperatively by any diagnostic tool, further improvement in postoperative adjuvant therapy is warranted.
