Accuracy of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting node positivity and metastatic disease in patients with gastrointestinal malignancies.

Abstract

462 Background: Accurate predictors of node positivity and metastatic disease for patients with gastrointestinal (GI) malignancies are currently lacking. Neutrophil-lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) have been introduced as a possible prognostic scoring system. We sought to evaluate the accuracy of NLR and PLR in predicting advanced disease in patients with GI malignancies. Methods: We queried a prospective GI oncology database to identify 116 patients. NLR and PLR were calculated from complete blood counts before and after neoadjuvant therapy (NT) and pre-operatively in patients not treated with NT. The associations between NLR and PLR and the clinicopathologic parameters were assessed via χ2 or Fisher’s exact tests where appropriate. All the tests were two-sided, and p < 0.05 was considered statistically significant. Results: We identified 49(42.2%) esophageal, 34 (29.3%) pancreatic, 14 (12.1%) colorectal, 13 (11.2%) gastric, and 6(5.2%) biliary cancers. There were 36 (31%) LN-, 52 (44.8%) LN+, and 28 (24.2%) patients with metastatic disease. The median NLR for LN – patients was 1.78 (0.2-4.5) and for LN + and metastatic patients was 4.48 (2.38-24.1) p < 0.00001. The median PLR for LN– patients was 123 (66-207) and for LN+ and metastatic patients was 212 (112-2185) p < 0.00001. The sensitivity (SENS), specificity (SPEC), positive predictive value (PPV) and negative predictive value (NPV) for a NLR > 2.25 was 98.8%, 72.2%, 89%, and 96% respectively with an overall accuracy of 91%. The SENS, SPEC, PPV, and NPV for PLR > 140 was 95%, 78%, 90%, and 88% respectively with an overall accuracy of 90%. Utilizing both NLR > 2.25 and PLR > 140 the SENS, SPEC, PPV and NPV was 95%, 89%, 95%, and 89% respectively and the overall accuracy was 93%. Conclusions: NLR and PLR can be used to identify patients with node positivity and metastatic disease. Individually, NLR has a higher sensitivity and NPV while PLR has a higher specificity and PPV. However, the combination of NLR and PLR has the highest accuracy of predicting advanced disease among all gastrointestinal malignancies.