Prognostic effect of high pretreatment neutrophil to lymphocyte ratio on survival of patients with gastric adenocarcinoma in China

Abstract

Background: A high neutrophil to lymphocyte ratio (NLR) is a strong predictor of poor survival in patients with colorectal, breast, pancreatic and lung cancers, while the prognostic value of NLR in gastric cancer is still controversial. The aim of our study was to determine the prognostic value of pretreatment NLR in a Chinese population of patients with gastric adenocarcinoma. Methods: Our retrospective study used an unselected cohort of gastric adenocarcinoma patients treated in the Cancer Center of Sun Yat-sen University between January 2001 and December 2008. We used the data from 341 healthy individuals as controls to understand the difference of NLR between the gastric cancer patients and normal individuals. A total of 706 patients had a complete blood count (CBC) record prior to treatment. Cox regression analysis was used to evaluate the prognostic value of NLR. Results: Gastric adenocarcinoma patients had a significantly higher NLR as well as neutrophilic granulocyte and lower lymphocyte counts compared with healthy individuals. By combining the nearby groups of NLR whose survival had no significant difference, we got a cutoff value for NLR of 3. Patients with a high NLR had a significantly lower survival rate than patients with a low NLR. On multivariate analysis, after adjusting for tumor stage and other clinicopathologic factors, high NLR turned out to be an independent risk factor for poor survival (p=0.016). Conclusions: Gastric cancer patients had a significantly higher incidence rate of high NLR compared with healthy individuals. High pretreatment NLR in gastric cancer was an independent prognostic factor.