Elevated Neutrophil–to–Lymphocyte Ratio Predicts Survival in Patients with Advanced Gastric Cancer Treated with Trastuzumab Combination Chemotherapy

Hwang, Gil Tae; Baek, Dong Won; Cho, Hee Jeong; Lee, Soo Jung; Chae, Yee Soo; Kang, Byung Woog; Lee, In Hee; Kim, Jong Gwang; Seo, An Na; Bae, Han Ik; Park, Ki Bum; Park, Ji Yeon; Kwon, Oh Kyoung; Lee, Seung Soo; Chung, Ho Young

doi:10.21873/anticanres.12578

Cited by 5 publications

(6 citation statements)

References 28 publications

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“…Recognized independent prognostic factors affecting the survival of AGC include tumor-related factors and systemic inflammatory factors [4]. Various hematological markers, such as neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP), and plasma fibrinogen levels, have been reported as effective prognostic indicators of AGC [5–8]. However, other laboratory markers which are widely available and inexpensive are also needed.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Serum Uric Acid and Gamma-Glutamyltransferase in Patients with Advanced Gastric Cancer

Yang

Liu³

et al. 2019

Disease Markers

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Purpose In this study, we aim to evaluate the prognostic role of serum uric acid and gamma-glutamyltransferase in advanced gastric cancer patients. Methods A total of 180 patients pathologically diagnosed with advanced gastric cancer were included in this retrospective study. We used time-dependent receiver operating characteristic (ROC) curves to identify the optimal cut-off value of serum uric acid (UA) and gamma-glutamyltransferase (GGT). Survival analysis was performed using the Kaplan–Meier method and log-rank test, and multivariate Cox regression analyses were applied. A nomogram was formulated, and the calibration and discrimination of the nomogram were determined by calibration curve and concordance index (C-index). We validated the results using bootstrap resampling and a separate study on 60 patients collected from 2015 to 2017 using the same criteria in other medical center. Results Both higher serum uric acid (>228 μmol/L) and higher gamma-glutamyltransferase (>14 U/L) had worse OS and PFS. Univariate analysis indicated that serum uric acid (UA) (p < 0.001 and p < 0.001) and gamma-glutamyltransferase (GGT) (p < 0.001 and p = 0.044) were significantly related to overall survival (OS) and progression-free survival (PFS), respectively. Multivariate analysis revealed serum uric acid (UA) and gamma-glutamyltransferase (GGT) were independent prognostic factors for OS (p = 0.012, p = 0.001). The optimal agreement between actual observation and nomogram prediction was shown by calibration curves. The C-indexes of the nomogram for predicting OS and PFS were 0.748 (95% CI: 0.70-0.79) and 0.728 (95% CI: 0.6741-0.7819), respectively. The results were confirmed in the validation cohort. Conclusion We observed that both serum UA and GGT were poor prognostic factors in patients with advanced gastric cancer. And we also formulated and validated a nomogram which can predict individual survival for advanced gastric cancer patients.

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Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Serum Uric Acid and Gamma-Glutamyltransferase in Patients with Advanced Gastric Cancer

Yang

Liu³

et al. 2019

Disease Markers

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“…The median DFS time was 54 months. Neutrophil to lymphocyte ratio (NLR) has been analyzed in connection with several types of cancer including lung cancer [15], gastric cancer [16], colorectal cancer [17], pancreatic cancer [18], hepatocellular carcinoma [8], ovarian cancer [19], and some hematological malignancies [20]. And low NLR ratios have been associated…”

Section: Resultsmentioning

confidence: 99%

The Prognostic Significance of Pre and Post Treatment Neutrophil to Lymphocyte Ratio in Breast Cancer Patients

Rayan¹,

Zaky²,

Eltyb³

et al. 2019

JCT

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Background: The neutrophil/lymphocyte ratio (NLR) has been reported to reflect systemic inflammation and independent prognostic significance in different types of cancer. In present study, we analyzed the association between NLR and clinicopathologic features and verified the significance of NLR as a prognostic factor for patients with breast cancer. Patients and Methods: A total of 388 patients with stage I -III breast cancer were retrospectively recruited into this study. Associations with clinicopathologic factors and NLR were assessed; disease-free survival and overall survival were estimated. Results: There was no significant association between NLR and clinicopathologic factors. Patients with low pre/post-treatment NLR had longer OS. Conclusion: A high pre/postoperative NLR may be considered an important factor for predicting poor prognosis in non-metastatic breast cancer patients.

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“…Previous reports on the prognostic value of NLR in AGC were consistent with our study. 12,[19][20][21] An elevated NLR has been shown to be associated with reduced OS and PFS in patients with HER2-positive AGC. Clinical studies have shown the relationship between NLR and tumor response to chemotherapy in metastatic cancers.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18] Several studies have shown that NLR before chemotherapy can help predict the prognosis of AGC progression. 12,[19][20][21] However, there is limited data on the clinical and prognostic significance of HER2 gene amplification and NLR in…”

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confidence: 99%

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Predictive Roles of HER2 Gene Amplification and Neutrophil-to-Lymphocyte Ratio on Survival in HER2-Positive Advanced Gastric Cancer Treated With Trastuzumab-Based Chemotherapy

Park¹,

Yeo²,

Kim³

et al. 2021

American Journal of Clinical Oncology

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Objectives: Trastuzumab is used as an agent against human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer (AGC). The aim of this study was to determine how HER2 gene amplification and neutrophil-to-lymphocyte ratio (NLR) could predict long-term survival in AGC patients that underwent trastuzumab-based chemotherapy.Methods: We retrospectively reviewed medical records of 112 patients between 28 and 91 years old (median of 66 y) with AGC treated with first-line trastuzumab-based chemotherapy. The level of HER2 gene amplification was determined by the HER2/centromere enumerator probe 17 (CEP17) ratio and HER2 gene copy number (GCN). NLR was calculated as the neutrophil count divided by the lymphocyte counts.Results: Median HER2/CEP17 ratio, HER2 GCN, and NLR values were 2.85, 7.1, and 2.81, respectively. Objective response rate in both high HER2/CEP17 ratio (59.4% vs. 28.1%, P = 0.012) and HER2 GCN groups (62.1% vs. 33.3%, P = 0.032) was higher than that of each group. High NLR correlated with significantly worse median overall survival (OS) (median OS, 8.2 vs. 18.9 mo, P = 0.002) and progression free survival (PFS) (median PFS: 5.1 vs. 8.0 mo, P = 0.005). However, median OS and PFS were not significantly different according to HER2/ CEP17 ratio or HER2 GCN. In the multivariate analysis, high NLR, Eastern Cooperative Group performance status, and poorly differentiated/signet ring cell type were independent factors for OS.Conclusions: NLR was a significant predictor of long-term survival in AGC patients treated with first-line trastuzumab-based chemotherapy. Future validation of prospective trials with larger patient populations will be needed.

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Elevated Neutrophil–to–Lymphocyte Ratio Predicts Survival in Patients with Advanced Gastric Cancer Treated with Trastuzumab Combination Chemotherapy

Abstract: This study found that a high NLR was associated with a shorter PFS and OS in patients with HER2-positive gastric cancer treated with trastuzumab.

Cited by 5 publications

References 28 publications

Prognostic Significance of Serum Uric Acid and Gamma-Glutamyltransferase in Patients with Advanced Gastric Cancer

Prognostic Significance of Serum Uric Acid and Gamma-Glutamyltransferase in Patients with Advanced Gastric Cancer

The Prognostic Significance of Pre and Post Treatment Neutrophil to Lymphocyte Ratio in Breast Cancer Patients

Predictive Roles of HER2 Gene Amplification and Neutrophil-to-Lymphocyte Ratio on Survival in HER2-Positive Advanced Gastric Cancer Treated With Trastuzumab-Based Chemotherapy

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