Abstract
PurposeThe aim of this study was to determine if the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) could be modified by the presence of postoperative complications (POC) and their severity in patients with gastric adenocarcinoma resected with curative intent.MethodsA retrospective study based on a prospective database of patients with resectable gastric adenocarcinoma treated with radical intention (R0) between January 1998 and February 2012. The primary endpoint was overall survival according to preoperative peripheral blood NLR and postoperative complications. Clinicopathological variables, preoperative blood tests, POC and its severity (Clavien–Dindo classification), type of POC (infectious or not infectious) and mortality were registered. A univariate and multivariate analysis (step forward Cox regression) was performed. The Kaplan–Meier method was used to assess overall survival.ResultsThe 147 patients with gastric cancer who had undergone radical resection were included from an initial cohort of 209 patients. Univariant analysis: type of surgery, pT, pN, postoperative complications (Clavien–Dindo ≥ 3) and preoperative NLR ≥ 2.4 were significantly associated with survival (p < 0.05). Patients with POC showed worse long-term survival (p = 0.000), with no difference (p = 0.867) between infectious or non-infectious POC. NLR ≥ 2.4 was associated with infectious POC (p < 0.001). Patients with preoperative NLR ≥ 2.4 (p = 0.02) had a worse prognosis. Multivariate analysis: pN (p < 0.001), postoperative complications (p < 0.001) (HR 3.04; 95% CI: 1.97–4.70) and NLR ≥ 2.4 (p = 0.04) (HR = 1.55; 95% CI: 1.02–2.3) were independent prognostic factors.ConclusionThe preoperative inflammatory state of patients with gastric cancer measured by NLR behaves as an independent prognostic factor, even in patients with POC.
Highlights
It is known that preoperative systemic inflammatory response is related to the development, progression and invasion of tumour cells and to overall survival [1] in most tumours.Different biological parameters have been identified as markers of a systemic inflammatory state
This study shows that the preoperative systemic inflammatory response of the host correlates with overall survival independently in patients with curative gastric cancer resection
Postoperative complications and their severity were associated with the worst prognosis, but the inflammatory response of postoperative complications did not affect preoperative neutrophil-to-lymphocyte ratio (NLR)
Summary
It is known that preoperative systemic inflammatory response is related to the development, progression and invasion of tumour cells and to overall survival [1] in most tumours.Different biological parameters have been identified as markers of a systemic inflammatory state. It is known that preoperative systemic inflammatory response is related to the development, progression and invasion of tumour cells and to overall survival [1] in most tumours. Langenbeck's Archives of Surgery ([10 × albumin] + [0,005 × lymphocytes]) [5], Glasgow Prognosis Score (a combination of C reactive protein and albumin values) [6], systemic immune-inflammatory index (neutrophils × platelets/lymphocytes) [7] and derived neutrophil-to-lymphocyte ratio (neutrophil to white blood cells – neutrophils) [8]. Several studies have shown that a high preoperative neutrophil-to-lymphocyte ratio (NLR) value in peripheral blood tests represents an independent prognostic factor of overall survival in different types of tumours, including gastric cancer [3, 9].
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