A Novel Scoring System Based on Fibrinogen and the Neutrophil-Lymphocyte Ratio as a Predictor of Chemotherapy Response and Prognosis in Patients with Advanced Gastric Cancer

Arigami, Takaaki; Uenosono, Yoshikazu; Ishigami, Sumiya; Okubo, Kan; Kijima, Takashi; Yanagita, Shigehiro; Okumura, Hiroshi; Uchikado, Yasuto; Kijima, Yuko; Nakajo, Akihiro; Kurahara, Hiroshi; Kita, Yoshiaki; Mori, Shinichiro; Maemura, Kosei; Natsugoe, Shoji

doi:10.1159/000444494

Cited by 33 publications

(36 citation statements)

References 27 publications

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“…In addition, simple and non-invasive immunomonitoring methods are required as markers for early stage cancer or tumor recurrence. Although several systems have been shown to strongly predict poor prognosis (19)(20)(21), personalized medicine requires the establishment of tumor-specific immunomonitoring systems for predicting tumor recurrence.…”

Section: Discussionmentioning

confidence: 99%

Peripheral Tr1 and Foxp3+ Treg as Markers of Recurrent Malignancies in Patients with Hepato-Biliary Pancreatic Cancers

Ikemoto

Shimada

Ishikawa

et al. 2017

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Abstract. Background Foxp3 + regulatory T cells (Foxp3 + Tregs) play an important role in tumor immunity (1-3). Populations of peripheral Foxp3 + Tregs were found to be greater in pancreatic cancer patients than in healthy controls, with peripheral Foxp3 + Treg populations strongly correlating with TMN classifications (4). In addition, peripheral Foxp3 + Treg populations were found to significantly correlate with the pathological aggressiveness of intraductal papillary mucinous neoplasms (IPMNs), a correlation dependent on Notch signaling (5). Although Treg populations have been reported to be higher in peritumoral lesions and in draining lymph nodes, the precise mechanism underlying the increase in peripheral Tregs in cancer patients has not been determined (6, 7).Treg expansion following organ transplantation has been reported to depend on indoleamine 2, 3-dioxygenase (IDO) activity of dendritic cells (DCs) (8). IDO is a critical enzyme for maintaining pregnancy (9) and plays an important role in tumor immunity (10,11). An investigation of the associations of IDO with IPMN aggressiveness and Treg immunity showed that Treg increases induced by IDO + DCs are associated with peritumoral lesions (12). However, the mechanism underlying the expansion of Tregs in peripheral blood, as well as in the peritumoral environment, remains unclear. Tregs are easily influenced by other factors that alter host immunology, such as infection and chemo/radiation therapy, suggesting the need for more precise and stable immunological parameters to evaluate tumor immunity, especially after surgery.CD4 + CD49b + LAG3 + regulatory T cells (type 1 regulatory T cells, or Tr1s) were recently reported to have strong regulatory activities in autoimmune diseases (13). Tr1s were originally found in the peripheral blood of patients with severe combined immunodeficiency and long-term mixed chimerism after human leukocyte antigen (HLA)-mismatched fetal liver hematopoietic stem cell transplantation (14). The primary 5541

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Section: Discussionmentioning

confidence: 99%

Peripheral Tr1 and Foxp3+ Treg as Markers of Recurrent Malignancies in Patients with Hepato-Biliary Pancreatic Cancers

Ikemoto

Shimada

Ishikawa

et al. 2017

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“…The created score indeed was significantly higher in patients having cancer progression during treatment; it also was an independent prognostic factor by multivariate analysis [103]. The same authors have elaborated similar combined score, based on the same parameters which by different cut-off levels are adjusted for another research target.…”

Section: Application Of Sir In Complex Scoring Systems For Gastric Camentioning

confidence: 89%

“…A complex score comprising evaluation of hyperfibrinogenemia (exceeding 400 mg/dL) and elevated NLR (exceeding 3.0) was associated with shorter survival. The combined score showed significantly different results in patients developing progressive disease despite chemotherapy or chemoradiotherapy [103]. Similar score comprising evaluation of hyperfibrinogenemia (reaching or exceeding 305 mg/dL) and elevated NLR (reaching or exceeding 2.34) was significantly associated with invasion depth, lymph node metastasis, lymphovascular invasion and stage [110].…”

Section: Fibrinogen In Gastric Cancer Evaluationmentioning

confidence: 90%

“…In multivariate analysis, modified Glasgow prognostic score was identified as an independent prognostic factor along with NLR, presence of lymph node metastasis and histological subtype [69]. In 68 patients affected by advanced gastric cancer and treated by chemotherapy with or without irradiation, high GPS predicted shorter survival [103]. High GPS was an independent prognostic factor in 384 inoperable advanced or metastatic gastric cancer patients treated with chemotherapy.…”

Section: Gastric Cancermentioning

confidence: 96%

“…Overall survival and chemotherapy response NLR (cut-off 3.0) and fibrinogen (cut-off 400 mg/dL) [103] Prognosis and cancer characteristics NLR (cut-off 2.34) and fibrinogen (cut-off 305 mg/dL) [110] Overall survival Canton score: Overall and cancer-specific survival Platelet count and NLR [29] Overall and cancer-free survival Recurrence Metachronous liver metastases Coagulation score: increased level of fibrinogen and D-dimers [125] Overall survival NLR, mGPS and patient-generated subjective global assessment score [26] Abbreviations: PLR, platelet to lymphocyte ratio; ROC, receiver operating characteristic curve; NLR, neutrophil to lymphocyte ratio; T, local spread of primary gastric cancer by tumour-nodes-metastasis (TNM) classification; CSS, cancer-specific survival; CFS, cancer-free survival; mGPS, modified Glasgow prognostic score. Table 6.…”

Section: Application Of Sir In Complex Scoring Systems For Gastric Camentioning

confidence: 99%

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Systemic Inflammatory Reaction in Gastric Cancer: Biology and Practical Implications of Neutrophil to Lymphocyte Ratio, Glasgow Prognostic Score and Related Parameters

Štrumfa¹,

Bogdanova²,

Kalva³

et al. 2017

Gastric Cancer

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Gastric cancer induces systemic inflammatory reaction (SIR) manifesting with changes in counts of white blood cell fractions and concentrations of acute phase proteins, clotting factors and albumins. Thus, protein-based scores or blood cell ratios (neutrophil to lymphocyte ratio (NLR); platelet to lymphocyte ratio (PLR)) are used to evaluate SIR. SIR tests are biologically justified by multiple clinically important and fascinating events including bone marrow activation, development of immune-suppressing immature myeloid cells, generation of pre-metastatic niches and neutrophil extracellular trap formation from externalised DNA network in bidirectional association with platelet activation. Despite biological complexity, clinical SIR assessment is widely available, patient-friendly and economically feasible. Here we present concise review on NLR, PLR, Glasgow prognostic score and fibrinogen -parameters that have prognostic role regarding overall, cancer-free and cancer-specific survival in early and advanced cases. Tumour burden can be predicted helping in preoperative detection of serosal or lymph node involvement. Practical consequences abound, including selection of surgical approach in respect to tumour burden, adjustments in treatment intensity by prognosis or evaluation of chemotherapy response. The chapter also scrutinises main controversies including different cut-off levels. Future developments should include elaboration of complex scores as described here. SIR parameters should be wisely incorporated in patients' treatment.

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The combination of plasma fibrinogen and neutrophil lymphocyte ratio (F‐NLR) is a predictive factor in patients with resectable non small cell lung cancer

Wang

Zhao

Zhang

et al. 2017

Journal Cellular Physiology

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The prognostic value of inflammation indexes in non small cell lung cancer (NSCLC) was not established. Therefore, we assessed the clinical applicability of the F-NLR score, which is based on fibrinogen (F) and the neutrophil-lymphocyte ratio (NLR), and the glasgow prognostic score (GPS) to predict the prognoses of NSCLC patients. We retrospectively identified 515 patients with stage I/II/IIIA who underwent surgery at our institution, and evaluated their preoperative serum levels of CRP, albumin, fibrinogen, neutrophil count, and the lymphocyte count. The cut-off values of the fibrinogen level and NLR were determined with receiver operating characteristic (ROC) curve. GPS was classified into three groups as previously described. The disease free survival (DFS) and overall survival (OS) were calculated by the Kaplan-Meier method. Categorical variables were compared using the χ test. Survival curves were estimated using the Kaplan-Meier method, and the Cox proportional hazard model was used to assess the prognostic factors. The F-NLR was significantly associated with sex (p = 0.000), smoking history (p = 0.014), lesion type (p = 0.000), histologic type (p = 0.000), T stage (p = 0.000), venous invasion (p = 0.000), lymphatic invasion (p = 0.000), and TNM stage (p = 0.000). The 5-year DFS rates in F-NLR groups 0, 1, and 2 were 46.7%, 36.4%, 30.1%, respectively (p = 0.000), and the 5-year overall survival (OS) rates in the above three groups were 52.0%, 39.8%, 32.1%, respectively (p = 0.000). Multivariate analysis showed that venous invasion (p = 0.036), lymph node metastasis (p = 0.000), and F-NLR (p = 0.034) were independent prognostic factors for DFS. Age (p = 0.015), venous invasion (p = 0.024), lymph node metastasis (p = 0.000), and F-NLR (p = 0.019) were independent prognostic factors for OS. Thus, F-NLR was the independent prognostic factor for both the DFS and OS. And patients with a high-risk preoperative F-NLR group may benefit from adjuvant therapy by subgroup analysis. Our results demonstrated that F-NLR, a novel inflammation-based grading system, as well as the GPS, appeared to have value as a promising clinical predictor of the prognosis for the resectable non small cell lung cancer patients.

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A Novel Scoring System Based on Fibrinogen and the Neutrophil-Lymphocyte Ratio as a Predictor of Chemotherapy Response and Prognosis in Patients with Advanced Gastric Cancer

Cited by 33 publications

References 27 publications

Peripheral Tr1 and Foxp3+ Treg as Markers of Recurrent Malignancies in Patients with Hepato-Biliary Pancreatic Cancers

Peripheral Tr1 and Foxp3+ Treg as Markers of Recurrent Malignancies in Patients with Hepato-Biliary Pancreatic Cancers

Systemic Inflammatory Reaction in Gastric Cancer: Biology and Practical Implications of Neutrophil to Lymphocyte Ratio, Glasgow Prognostic Score and Related Parameters

The combination of plasma fibrinogen and neutrophil lymphocyte ratio (F‐NLR) is a predictive factor in patients with resectable non small cell lung cancer

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