Combination of CRP and NLR: a better predictor of postoperative survival in patients with gastric cancer

Abstract

ObjectivesC-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) were independent predictive factors for gastric cancer (GC). Our study was designed to prove the prognostic value of the combination of CRP and NLR (COC-NLR) in GC patients.Materials and methodsA total of 1,058 GC patients who underwent D2 resection from Sun Yat-Sen University Cancer Center between 2003 and 2013 were included. They were divided into three groups (low: NLR ≤2.5, CRP ≤6.1; medium: NLR >2.5, CRP ≤4.5; high: NLR >2.5, CRP >4.5 or NLR ≤2.5, CRP >6.1) by the random forest method. Survival analysis stratified by COC-NLR groups was performed.ResultsThe mean survival time for each group was: for the low group 75.44 months (95% CI: 72.48–78.40), the medium group 56.50 months (95% CI: 50.68–62.31), and the high group 38.65 months (95% CI: 34.51–42.97). The low group showed obviously better overall survival (OS) than other two groups (p<0.001). Survival analysis showed that COC-NLR had statistical significance in both univariate and multivariate analyses (p<0.01).ConclusionThis study showed that COC-NLR could work as an independent prognostic factor in GC and provide more accurate prediction than single NLR or CRP.

Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios as Prognostic Markers of Survival in Patients with Head and Neck Tumours—Results of a Retrospective Multicentric Study

“…Similar to elevated platelet count, high PLR has been found to be associated with worse survival in a variety of solid (hepatocellular, ovarian, cervix, colorectal, bile duct, breast, lung, renal cell, gastric, prostate, and oesophageal) tumours [30][31][32][33][34][35][36][37][38][39][40]. Moreover, several studies confirmed the relationship between elevated NLR and a worse prognosis in patients with malignant oesophageal [41], colorectal [42,43], pancreas [44,45], prostate [46,47], hepatic [48,49], bile duct [50], breast [51], gastric [52,53], cutaneous melanocytic [54], thyroid medullary [55], and lung [56] tumours. It is important to note, however, that NLR may be elevated also in many benign disorders [57,58].…”

Preoperative systemic immune-inflammation index predicts prognosis and guides clinical treatment in patients with non-small cell lung cancer

“…Systemic inflammation could be monitored by using peripheral hematologic markers, such as neutrophils, leukocytes and platelets. Based on the relationship between inflammation and cancer, in recent years, inflammatory marker-based scores, such as NLR and PLR have been reported to be associated with the prognosis of patients with various cancers, including lung cancer [8], breast cancer [10,23], gastric cancer [11,24] and colorectal cancer [25]. However, NLR and PLR only include two types of cells.…”

“…However, these genomic technologies are expensive at present and more genomic information needs to be integrated due to the biological complexity of NSCLC [7]. Recently, systemic inflammatory response indicators, such as peripheral neutrophils, lymphocytes and platelets, play important roles in the progression and prognosis of various cancers, including lung cancer [8,9], breast cancer [10] and gastric cancer [11]. Moreover, these peripheral markers can be detected with an easy, convenient method, and its application in prognosis prediction deserves attention.…”

“…These inflammatory indicators are expressed by inflammatory scores, such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), and have been reported to be associated with the prognosis of patients with malignant tumors [8,10,11]. Recently, a new inflammatory index, the systemic immune-inflammation index (SII), defined as neutrophil × platelet/lymphocyte, integrates three inflammatory cells and has been shown to be promising [12].…”

The prognostic significance of NLR in non-metastatic renal cell carcinoma undergoing nephrectomy, A meta-analysis

“…Peviouse research have shown that Neutrophil to Lymphocyte ratio (NLR) being used as a biomarker for the prognosis of RCC [8] [9] . NLR was an indicator of general immune response to various stress, it has been proved to be a prognosis related marker in various malignancies, including RCC [10][11] [12] . Earlier meta-analysis on NLR in patients with metastasis renal cancer described that elevated baseline NLR remained an independent predictor of OS and PFS [13] .…”