Prognostic value of the dynamic change of platelets to lymphocytes ratio and neutrophil to lymphocyte ratio for gastric cancer patients receiving curative surgery.

Abstract

Background: The inflammatory biomarkers play a prominent role in tumorigenesis and progression of gastric cancer. Inflammatory response has shown to be promising candidate for monitoring the survival prediction in various cancer. Certain percent of cancer related deaths are closely associated with chronic inflammation. Our study aims to focus a precise estimation on the prognostic significance of preoperative Neutrophil to Lymphocyte ratio (NLR), Platelets to Lymphocyte ratio (PLR), derived Neutrophil to Lymphocyte ratio (ΔNLR) and derived Platelet to Lymphocyte ratio (ΔPLR) following gastric cancer.Methods: A retrospective analysis was conducted in patients with gastric cancer in Shanghai East Hospital affiliated with Tong ji University between December 2012 and June 2015, and total 145 patients were identified eligible. NLR, PLR, Δ NLR and ΔPLR values were calculated from peripheral blood cell count taken before surgery and 6-month post-surgery. Optimal cutoff value was determined by Receiver operating curve (ROC). Kaplan-Meier analysis was used to calculate the overall survival (OS) and Recurrence Free Survival (RFS). Cox regression analysis was performed to assess the prognostic factors. Continuous data with normal distribution was presented as mean ± standard deviation, and non-parametrical data were presented as median with interquartile range (IQR). Categorical data was described by frequency. The Student’s t test or one-way ANOVA (Analysis of Variance) was used for comparing continuous variables whereas Fisher’s exact test or χ2 test was used for categorical dataResults: The median follow-up duration was 26 months (IQR, 17–35). Patients were stratified in two groups by NLR (≤ 2.9,>2.9) and PLR (≤ 147,>147).3 years RFS of low ΔNLR and high ΔNLR is 59.0% and 76.7% respectively. Similarly, RFS of low ΔPLR and high ΔPLR group is 58.0% and 76.2%respectively. Multivariate analysis reviled elevated PLR [HR = 1.008,95%CI = 1.002–1.014, P-value = 0.011, for OS and HR = 1.009,95%CI = 1.004–1.014, P-value = 0.001, for RFS] and ΔPLR [HR = .994,95%CI = 0.990–0.999, P-value = 0.016 for OS and HR = 0.991 95%CI = 0.987–0.996 P-value = < 0.001 for RFS] were significantly associated with OS and RFS.Conclusions: Pre-operative PLR and derived(ΔPLR) are independent prognostic factors of OS and RFS in Gastric Cancer (GC) patients undergoing radical gastrectomy. The reduction of PLR and NLR after surgery might be helpful to predict cancer recurrence in patients who have undergone gastrectomy.