Preoperative neutrophil-to-lymphocyte ratio behaves as an independent prognostic factor even in patients with postoperative complications after curative resection for gastric cancer

Abstract

Purpose The 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. Methods A 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. Results The 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. Conclusion The preoperative inflammatory state of patients with gastric cancer measured by NLR behaves as an independent prognostic factor, even in patients with POC.

Prognostic significance of a novel index score based on the inflammation‐based prognostic scores of patients with colorectal cancer

“…We searched and summarized the literature review related to the use of IBPSs for predicting the prognosis of gastrointestinal cancers. [7][8][9][13][14][15][16][21][22][23][24][25][26][27][28][29][30] Although the results of these studies vary, the cut-off values and tendencies are generally similar (Table S2). Aside from IBPS, male sex, age ≥ 75 years, and a CEA level of > 5 were also associated with poor OS.…”

“…A single IBPS can predict the prognosis of malignant tumors to a certain degree. We searched and summarized the literature review related to the use of IBPSs for predicting the prognosis of gastrointestinal cancers 7–9,13–16,21–30 . Although the results of these studies vary, the cut‐off values and tendencies are generally similar (Table S2).…”

Effects of perioperative low-dose naloxone on the immune system in patients undergoing laparoscopic-assisted total gastrectomy: a randomized controlled trial

“…Tur-Martíne’s [ 28 ] findings suggest that systemic inflammation caused by the WBC count and neutrophil count has harmful effects on postoperative gastric cancer patients. An elevated leukocyte count is also a valuable indicator of stress response, wound infection, and lung infection.…”

Prognostic Relevance of Preoperative Immune, Inflammatory, and Nutritional Biomarkers in Patients Undergoing Gastrectomy for Resectable Gastric Adenocarcinoma: An Observational Multicentre Study

“…Although postoperative complications are known to be a prognostic factor [ 9 , 24 ], they were not included in the multivariate analysis because the aim of the present study was to assess preoperative prognostic markers. Previous studies have analysed postoperative complications in relation to preoperative inflammatory markers, showing that they also had an impact on long-term prognosis [ 24 ]. The influence of the preoperative biomarkers according to pathological nodal stage has also been described [ 38 ] but was not the aim of the present study.…”

“…Postoperative complications were grouped as minor (C-D grade I–II); major (C-D grade III–IV); and mortality (C-D grade V). They were also classified as infectious or non-infectious [ 24 ].…”