Elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis of patients with primary gastrointestinal stromal tumor

Wei-Long Chang,Tao Wang,Kai-Xiong Tao,Cheng-Guo Li,Rui-Zhi Zhang,Zhen Xiong,Xiang-Yu Zeng,Wen-Chang Yang,Peng Zhang

doi:10.1186/s12876-020-01275-2

Abstract

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are considered to reflect the systemic inflammatory response and clinical prognosis. However, the independent prognostic values of the NLR and PLR for patients with gastrointestinal stromal tumor (GIST) remain debatable. This study aims to evaluate the prognostic value of preoperative NLR and PLR in GIST patients.MethodsWe retrospectively reviewed all GIST patients diagnosed and surgically treated at Union Hospital between 2005 and 2018. The preoperative NLR and PLR were calculated to evaluate recurrence-free survival (RFS) and overall survival (OS) by Kaplan-Meier analysis. Univariate and multivariate Cox regression analyses were performed to estimate the independent prognostic values.ResultsThe median follow-up time was 49 months (interquartile range, 22–74 months). The preoperative PLR was significantly increased in the GIST patients with intermediate and high tumor risks. Increases in the NLR (≥2.34) and PLR (≥185.04) were associated with shorter RFS and OS (P < 0.01). Moreover, the multivariate analysis revealed that elevated PLR was an independent factor for shorter RFS (hazard ratio [HR]: 3.041; 95% confidence interval [CI]: 2.001–4.622; P < 0.001) and OS (HR: 1.899; 95% CI: 1.136–3.173; P = 0.014).ConclusionsThe preoperative PLR is a potential biomarker of GIST and is related to the clinical outcome. An elevated preoperative PLR predicts poor prognosis of patients with primary GIST after complete surgical resection.

Highlights

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are considered to reflect the systemic inflammatory response and clinical prognosis
The median recurrence-free survival (RFS) and overall survival (OS) of the high PLR group were 83 months (95% confidence interval (CI): 68.6– 97.4) and 124 months, respectively
NLR neutrophil-to-lymphocyte ratio, PLR platelet-to-lymphocyte ratio, RFS recurrence-free survival, OS overall survival Bold values indicate statistical significance at P < 0.05 with a shorter RFS and OS (HR: 1.899; 95% Confidence interval (CI): 1.136–3.173; P = 0.014), as outlined in Tables 3 and 4

Summary

Introduction

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are considered to reflect the systemic inflammatory response and clinical prognosis. The independent prognostic values of the NLR and PLR for patients with gastrointestinal stromal tumor (GIST) remain debatable. This study aims to evaluate the prognostic value of preoperative NLR and PLR in GIST patients. GIST was once considered a leiomyoma or leiomyosarcoma, it is distinguished from other mesenchymal tumors because it originates from interstitial cells of Cajal or their precursor cells and possesses a characteristic activating mutation in c-KIT or platelet-derived growth factor receptor α (PDGFRA) [3]. The tumor mitotic rate, size, location and tumor rupture are considered important independent factors predicting GIST recurrence [6], and postoperative adjuvant tyrosine kinase inhibitor (TKI) treatment may delay recurrence [7]. An assessment of the risks of recurrence and progression of GIST has become increasingly important for patients, and studies exploring additional prognostic factors for recurrence risk stratification might increase the prognostic accuracy [8]

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