Abstract
BackgroundSeveral inflammatory response materials could be used for prediction of prognosis of cancer patients. The neutrophil lymphocyte ratio (NLR), and the platelet lymphocyte ratio (PLR) have been introduced for prognostic scoring system in various cancers. The objective of this study was to determine whether the NLR or the PLR would predict the clinical outcomes in advanced gastric cancer patients treated with oxaliplatin/ 5-fluorouracil (FOLFOX).MethodsThe study population consisted of 174 advanced gastric cancer patients. Patients were treated with 85 mg/m2 of oxaliplatin as a 2-h infusion at day 1 plus 20 mg/m2 of leucovorin over 10 min, followed by 5-FU bolus 400 mg/m2 and 22-h continuous infusion of 600 mg/m2 at days 1-2. Treatment was repeated in 2-week intervals. The NLR and PLR were calculated from complete blood counts in laboratory test before and after first cycle of chemotherapy.ResultsNLR was a useful prognostic biomarker for predicting inferior overall survival (OS) (p = 0.005), but was not associated with progression free survival (PFS) (p = 0.461). The normalization of NLR after one cycle of chemotherapy was found to be in association with significant improvement in PFS (5.3 months vs. 2.4 months, p < 0.001), and OS (11.9 months vs. 4.6 months, p < 0.001). The normalization of PLR was also associated with longer PFS (5.6 months vs. 3.4 months, p = 0.006), and OS (16.9 months vs. 10.9 months, p = 0.002). In multivariate analysis, changes in NLR were associated with PFS (Hazard ratio (HR): 2.297, 95% confidence interval (CI): 1.429-3.693, p = 0.001). The NLR, (HR: 0.245, 95% CI: 0.092-0.633, p = 0.004), PLR (HR: 0.347, 95% CI: 0.142-0.847, p = 0.020), changes in NLR (HR: 2.468, 95% CI: 1.567-3.886, p < 0.001), and changes in PLR (HR: 1.473, 95% CI: 1.038-2.090, p = 0.030) were independent prognostic markers for OS.ConclusionThis study demonstrates that NLR, PLR, and changes in NLR or PLR are independent prognostic factor for OS in patients with advanced gastric cancer treated with chemotherapy. These specific factors may also help in identifying the patients, who are more sensitive to FOLFOX regimen.
Highlights
Several inflammatory response materials could be used for prediction of prognosis of cancer patients
This study demonstrates that neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and changes in NLR or PLR are independent prognostic factor for overall survival (OS) in patients with advanced gastric cancer treated with chemotherapy
We have reported that immunohistochemical staining for ERCC1 may be useful in prediction of the clinical outcome in advanced gastric cancer patients treated with modified FOLFOX4 [19]
Summary
Several inflammatory response materials could be used for prediction of prognosis of cancer patients. The objective of this study was to determine whether the NLR or the PLR would predict the clinical outcomes in advanced gastric cancer patients treated with oxaliplatin/ 5-fluorouracil (FOLFOX). Gastric cancer remains a significant health problem despite its declining incidence in the West. It is the fourth most common cancer worldwide, accounting for 8.6% of all new cancer diagnoses in 2002 [1]. The chemotherapeutic agent, 5-fluorouracil (5-FU) remains the main agent for the treatment of gastric cancer, and combination chemotherapy with 5-FU has demonstrated improved clinical outcomes. The 5-FU with cisplatin has shown an effective clinical outcome, the extent of toxicities were considerable [4] Oxaliplatin, another platinum-based agent, has a more favorable tolerability profile than cisplatin. Increasing emphasis on the need for improved techniques for the prediction of treatment response and survival may facilitate the tailoring of chemotherapy and risk-related therapy, resulting in significantly better survival
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