Abstract
BackgroundInflammatory blood count biomarkers may improve recurrence risk stratification and inform long-term prognosis of cancer patients. Here, we quantify the prognostic impact of blood-based biomarkers on recurrence risk and long-term survival in a large cohort of gastrointestinal stroma tumor (GIST) patients after curative surgery.MethodsOne-hundred-forty-nine consecutive GIST patients were followed-up for a median period of 4.8 years. Local recurrence, distant metastasis, and death occurred in 9, 21, and 31 patients, respectively. Time-to-event and competing risk analysis were applied to study the association between haemoglobin (Hb) level, white blood cell count (WBC), neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), lymphocyte/monocyte ratio (LMR), and platelet/lymphocyte ratio (PLR) with risk of local or distant recurrence (RR), recurrence free survival (RFS), and overall survival (OS).ResultsA low Hb (p = 0.029), and elevations in the parameters WBC (p = 0.004), NLR (p = 0.015) and dNLR (p = 0.037) were associated with a poor OS in GIST patients in multivariate analysis. Moreover, a low Hb (p = 0.049) and an elevated WBC (p = 0.001), NLR (p = 0.007), dNLR (p = 0.043) and PLR (p = 0.024) were independently associated with decreased RFS after adjusting for Miettinen score. However, only an increase of dNLR/NLR showed a significant association to higher RR (p = 0.048). Inclusion of NLR or PLR to Miettinen risk score did not reasonably improve the clinical risk prediction of 2-year RFS.ConclusionLow Hb, elevated WBC, elevated dNLR, and elevated PLR are independent prognostic factors for a worse clinical outcome in GIST patients after curative resection.
Highlights
Gastrointestinal stroma tumors (GIST) are mesenchymal malignancies that represent the most frequent subtype of sarcomas and are usually characterized by mutations in the KIT and PDGFRA proto-oncogenes [1,2,3,4]
Time-to-event and competing risk analysis were applied to study the association between haemoglobin (Hb) level, white blood cell count (WBC), neutrophil/lymphocyte ratio (NLR), derived NLR, lymphocyte/monocyte ratio (LMR), and platelet/ lymphocyte ratio (PLR) with risk of local or distant recurrence (RR), recurrence free survival (RFS), and overall survival (OS)
We firstly aimed to investigate whether haemoglobin (Hb) level, white blood cell count (WBC), LMR, PLR, NLR or derived NLR associate with local recurrence, distant metastasis, and survival outcomes in gastrointestinal stroma tumor (GIST) patients
Summary
Gastrointestinal stroma tumors (GIST) are mesenchymal malignancies that represent the most frequent subtype of sarcomas and are usually characterized by mutations in the KIT and PDGFRA proto-oncogenes [1,2,3,4]. A major part of GISTs are detected in a localized and operable stage [6, 7]. Operative resection is the standard treatment in a localized stadium and should be carried out whenever feasible. Estimating the risk of tumor recurrence is of great clinical impact in the management of operable GIST, because in the era of adjuvant imatinib treatment, the accurate determination of the risk for tumor recurrence is increasingly important to select the appropriate patients for adjuvant therapy [8]. Inflammatory blood count biomarkers may improve recurrence risk stratification and inform long-term prognosis of cancer patients. We quantify the prognostic impact of bloodbased biomarkers on recurrence risk and long-term survival in a large cohort of gastrointestinal stroma tumor (GIST) patients after curative surgery
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