Pretreatment neutrophil to lymphocyte ratio independently predicts disease-specific sur vival in resectable gastroesophageal junction and gastric adenocarcinoma

Sam C. Wang, Joanne F. Chou, Vivian E. Strong, Murray F. Brennan, Marinela Capanu, Daniel G. Coit

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objective: Preoperative methods to estimate disease-specific survival (DSS) for resectable gastroesophageal (GE) junction and gastric adenocarcinoma are limited. We evaluated the relationship between DSS and pretreatment neutrophil to lymphocyte ratio (NLR). Background: The patient's inflammatory state is thought to be associated with oncologic outcomes, and NLR has been used as a simple and convenient marker for the systemic inflammatory response. Previous studies have suggested that NLR is associated with cancer-specific outcomes. Methods: A retrospective review of a prospectively maintained institutional database was undertaken to identify patients who underwent potentially curative resection for GE junction and gastric adenocarcinoma from 1998 to 2013. Clinicopathologic findings, pretreatment leukocyte values, and follow-up status were recorded. The Kaplan-Meier method was used to estimate DSS, and Cox proportional hazards models were used to evaluate the association between variables and DSS. Results: We identified 1498 patients who fulfilled our eligibility criteria. Univariate analysis showed that male sex, Caucasian race, increased T and N stage, GE junction location, moderate/poor differentiation, nonintestinal Lauren histology, and vascular and perineural invasion were associated with worse DSS. Elevated NLR was also associated with worse DSS [hazard ratio (HR) = 1.11; 95% CI: 1.08-1.14; P <0.01]. On multivariate analysis, pretreatment NLR as a continuous variable was a highly significant independent predictor of DSS. For every unit increase in NLR, the risk of cancer-associated death increases by approximately 10% (HR = 1.10; 95% CI: 1.05-1.13; P <0.0001). Conclusions: In patients with resectable GE junction and gastric adenocarcinoma, pretreatment NLR independently predicts DSS. This and other clinical variables can be used in conjunction with cross-sectional imaging and endoscopic ultrasound as part of the preoperative risk stratification process.

Original languageEnglish (US)
Pages (from-to)292-297
Number of pages6
JournalAnnals of Surgery
Volume263
Issue number2
DOIs
StatePublished - 2016

Fingerprint

Esophagogastric Junction
Stomach
Adenocarcinoma
Neutrophils
Lymphocytes
Survival
Proportional Hazards Models
Blood Vessels
Ultrasonography
Neoplasms
Histology
Leukocytes
Multivariate Analysis
Odds Ratio
Databases

Keywords

  • Gastric cancer
  • Gastroesophageal junction cancer
  • Neutrophil to lymphocyte ratio
  • NLR

ASJC Scopus subject areas

  • Surgery

Cite this

Pretreatment neutrophil to lymphocyte ratio independently predicts disease-specific sur vival in resectable gastroesophageal junction and gastric adenocarcinoma. / Wang, Sam C.; Chou, Joanne F.; Strong, Vivian E.; Brennan, Murray F.; Capanu, Marinela; Coit, Daniel G.

In: Annals of Surgery, Vol. 263, No. 2, 2016, p. 292-297.

Research output: Contribution to journalArticle

Wang, Sam C. ; Chou, Joanne F. ; Strong, Vivian E. ; Brennan, Murray F. ; Capanu, Marinela ; Coit, Daniel G. / Pretreatment neutrophil to lymphocyte ratio independently predicts disease-specific sur vival in resectable gastroesophageal junction and gastric adenocarcinoma. In: Annals of Surgery. 2016 ; Vol. 263, No. 2. pp. 292-297.
@article{1665969518854c518b32b9415e542aae,
title = "Pretreatment neutrophil to lymphocyte ratio independently predicts disease-specific sur vival in resectable gastroesophageal junction and gastric adenocarcinoma",
abstract = "Objective: Preoperative methods to estimate disease-specific survival (DSS) for resectable gastroesophageal (GE) junction and gastric adenocarcinoma are limited. We evaluated the relationship between DSS and pretreatment neutrophil to lymphocyte ratio (NLR). Background: The patient's inflammatory state is thought to be associated with oncologic outcomes, and NLR has been used as a simple and convenient marker for the systemic inflammatory response. Previous studies have suggested that NLR is associated with cancer-specific outcomes. Methods: A retrospective review of a prospectively maintained institutional database was undertaken to identify patients who underwent potentially curative resection for GE junction and gastric adenocarcinoma from 1998 to 2013. Clinicopathologic findings, pretreatment leukocyte values, and follow-up status were recorded. The Kaplan-Meier method was used to estimate DSS, and Cox proportional hazards models were used to evaluate the association between variables and DSS. Results: We identified 1498 patients who fulfilled our eligibility criteria. Univariate analysis showed that male sex, Caucasian race, increased T and N stage, GE junction location, moderate/poor differentiation, nonintestinal Lauren histology, and vascular and perineural invasion were associated with worse DSS. Elevated NLR was also associated with worse DSS [hazard ratio (HR) = 1.11; 95{\%} CI: 1.08-1.14; P <0.01]. On multivariate analysis, pretreatment NLR as a continuous variable was a highly significant independent predictor of DSS. For every unit increase in NLR, the risk of cancer-associated death increases by approximately 10{\%} (HR = 1.10; 95{\%} CI: 1.05-1.13; P <0.0001). Conclusions: In patients with resectable GE junction and gastric adenocarcinoma, pretreatment NLR independently predicts DSS. This and other clinical variables can be used in conjunction with cross-sectional imaging and endoscopic ultrasound as part of the preoperative risk stratification process.",
keywords = "Gastric cancer, Gastroesophageal junction cancer, Neutrophil to lymphocyte ratio, NLR",
author = "Wang, {Sam C.} and Chou, {Joanne F.} and Strong, {Vivian E.} and Brennan, {Murray F.} and Marinela Capanu and Coit, {Daniel G.}",
year = "2016",
doi = "10.1097/SLA.0000000000001189",
language = "English (US)",
volume = "263",
pages = "292--297",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Pretreatment neutrophil to lymphocyte ratio independently predicts disease-specific sur vival in resectable gastroesophageal junction and gastric adenocarcinoma

AU - Wang, Sam C.

AU - Chou, Joanne F.

AU - Strong, Vivian E.

AU - Brennan, Murray F.

AU - Capanu, Marinela

AU - Coit, Daniel G.

PY - 2016

Y1 - 2016

N2 - Objective: Preoperative methods to estimate disease-specific survival (DSS) for resectable gastroesophageal (GE) junction and gastric adenocarcinoma are limited. We evaluated the relationship between DSS and pretreatment neutrophil to lymphocyte ratio (NLR). Background: The patient's inflammatory state is thought to be associated with oncologic outcomes, and NLR has been used as a simple and convenient marker for the systemic inflammatory response. Previous studies have suggested that NLR is associated with cancer-specific outcomes. Methods: A retrospective review of a prospectively maintained institutional database was undertaken to identify patients who underwent potentially curative resection for GE junction and gastric adenocarcinoma from 1998 to 2013. Clinicopathologic findings, pretreatment leukocyte values, and follow-up status were recorded. The Kaplan-Meier method was used to estimate DSS, and Cox proportional hazards models were used to evaluate the association between variables and DSS. Results: We identified 1498 patients who fulfilled our eligibility criteria. Univariate analysis showed that male sex, Caucasian race, increased T and N stage, GE junction location, moderate/poor differentiation, nonintestinal Lauren histology, and vascular and perineural invasion were associated with worse DSS. Elevated NLR was also associated with worse DSS [hazard ratio (HR) = 1.11; 95% CI: 1.08-1.14; P <0.01]. On multivariate analysis, pretreatment NLR as a continuous variable was a highly significant independent predictor of DSS. For every unit increase in NLR, the risk of cancer-associated death increases by approximately 10% (HR = 1.10; 95% CI: 1.05-1.13; P <0.0001). Conclusions: In patients with resectable GE junction and gastric adenocarcinoma, pretreatment NLR independently predicts DSS. This and other clinical variables can be used in conjunction with cross-sectional imaging and endoscopic ultrasound as part of the preoperative risk stratification process.

AB - Objective: Preoperative methods to estimate disease-specific survival (DSS) for resectable gastroesophageal (GE) junction and gastric adenocarcinoma are limited. We evaluated the relationship between DSS and pretreatment neutrophil to lymphocyte ratio (NLR). Background: The patient's inflammatory state is thought to be associated with oncologic outcomes, and NLR has been used as a simple and convenient marker for the systemic inflammatory response. Previous studies have suggested that NLR is associated with cancer-specific outcomes. Methods: A retrospective review of a prospectively maintained institutional database was undertaken to identify patients who underwent potentially curative resection for GE junction and gastric adenocarcinoma from 1998 to 2013. Clinicopathologic findings, pretreatment leukocyte values, and follow-up status were recorded. The Kaplan-Meier method was used to estimate DSS, and Cox proportional hazards models were used to evaluate the association between variables and DSS. Results: We identified 1498 patients who fulfilled our eligibility criteria. Univariate analysis showed that male sex, Caucasian race, increased T and N stage, GE junction location, moderate/poor differentiation, nonintestinal Lauren histology, and vascular and perineural invasion were associated with worse DSS. Elevated NLR was also associated with worse DSS [hazard ratio (HR) = 1.11; 95% CI: 1.08-1.14; P <0.01]. On multivariate analysis, pretreatment NLR as a continuous variable was a highly significant independent predictor of DSS. For every unit increase in NLR, the risk of cancer-associated death increases by approximately 10% (HR = 1.10; 95% CI: 1.05-1.13; P <0.0001). Conclusions: In patients with resectable GE junction and gastric adenocarcinoma, pretreatment NLR independently predicts DSS. This and other clinical variables can be used in conjunction with cross-sectional imaging and endoscopic ultrasound as part of the preoperative risk stratification process.

KW - Gastric cancer

KW - Gastroesophageal junction cancer

KW - Neutrophil to lymphocyte ratio

KW - NLR

UR - http://www.scopus.com/inward/record.url?scp=84955571909&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955571909&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000001189

DO - 10.1097/SLA.0000000000001189

M3 - Article

C2 - 25915915

AN - SCOPUS:84955571909

VL - 263

SP - 292

EP - 297

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -