J Cancer
2017; 8(7):1214-1222.
doi:10.7150/jca.18707 This issueCite
Research Paper
Elevated preoperative neutrophil-to-lymphocyte ratio can predict poor survival in early stage gastric cancer patients receiving radical gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study
Dan Hu1*, Hejun Zhang1*, Xiandong Lin1*, Gang Chen1, Chao Li1, Binying Liang2, Yan Chen3, Zhaolei Cui3, Feng Peng4✉, Xiongwei Zheng1✉, Wenquan Niu5✉
1. Department of Pathology, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China; 2. Department of Medical Record, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China; 3. Department of Clinical Laboratory, Fujian Provincial Cancer Hospital, The Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China; 4. Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China; 5. State Key Laboratory of Medical Genomics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. *Co- first authors.
✉ Corresponding authors: Wenquan Niu, Ph.D., Xiongwei Zheng, M.D. Ph.D. and Feng Peng, M.D. Ph.D. Address: Rui Jin Second Road 197, Huang Pu District, Shanghai 200025, China. Phone: +86-21-64370045 ext. 610905; Fax: +86-21-64333548; E-mail: niuwenquan_shcncom or nwq11588com.cn (W.N.) or agu1960com (X.Z.) or pengfengcom.cn (F.P.).More
Citation:
Hu D, Zhang H, Lin X, Chen G, Li C, Liang B, Chen Y, Cui Z, Peng F, Zheng X, Niu W. Elevated preoperative neutrophil-to-lymphocyte ratio can predict poor survival in early stage gastric cancer patients receiving radical gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study. J Cancer 2017; 8(7):1214-1222. doi:10.7150/jca.18707. https://www.jcancer.org/v08p1214.htm
Aims: This cohort study was conducted to evaluate the prognostic impact of blood-routine parameters before radical gastrectomy on gastric cancer mortality.
Methods: Total 3012 patients with gastric cancer were consecutively enrolled from a mono-center between 2000 and 2010, and the latest follow-up was completed in 2015.
Results: The median follow-up time was 44.05 months. Finally, 1331 out of 3012 gastric cancer patients died from gastric cancer. Per standard deviation increment in neutrophil (hazard ratio or HR=1.08, P<0.001), white blood cell count (HR=1.07, P=0.001), neutrophil-to-lymphocyte ratio or NLR (HR=1.08, P<0.001) and platelet-to-lymphocyte ratio (HR=1.08, P<0.001) was significantly associated with an increased risk of gastric cancer mortality, while that in lymphocyte (HR=0.69, P<0.001), hemoglobin (HR=0.82, P<0.001) and lymphocyte-to-monocyte ratio (HR=0.68, P<0.001) was associated with a reduced risk. Survival tree analysis indicated that in patients with TNM stage I/II, the contrasts of NLR>2.61 with ≤2.61 and NLR>1.87 with ≤1.87 were respectively associated with a 5.21-fold (P=0.004) and 2.36-fold (P=0.001) increased risk of gastric cancer mortality. The effect-size magnitude of NLR was further potentiated in patients with invasion depth T1/T2 (HR=1.73, P=0.001), regional lymph node metastasis N0 (HR=1.60, P<0.001), TNM stage I/II (HR=1.36, P=0.009) and tumor size ≤ 4.5 cm (HR=1.17, P<0.001).
Conclusions: Our findings consolidated the prognostic impact of preoperative NLR on gastric mortality, and demonstrated that elevated preoperative NLR was a robust indicator of poor survival in patients at early stage.
Hu, D., Zhang, H., Lin, X., Chen, G., Li, C., Liang, B., Chen, Y., Cui, Z., Peng, F., Zheng, X., Niu, W. (2017). Elevated preoperative neutrophil-to-lymphocyte ratio can predict poor survival in early stage gastric cancer patients receiving radical gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study. Journal of Cancer, 8(7), 1214-1222. https://doi.org/10.7150/jca.18707.
ACS
Hu, D.; Zhang, H.; Lin, X.; Chen, G.; Li, C.; Liang, B.; Chen, Y.; Cui, Z.; Peng, F.; Zheng, X.; Niu, W. Elevated preoperative neutrophil-to-lymphocyte ratio can predict poor survival in early stage gastric cancer patients receiving radical gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study. J. Cancer 2017, 8 (7), 1214-1222. DOI: 10.7150/jca.18707.
NLM
Hu D, Zhang H, Lin X, Chen G, Li C, Liang B, Chen Y, Cui Z, Peng F, Zheng X, Niu W. Elevated preoperative neutrophil-to-lymphocyte ratio can predict poor survival in early stage gastric cancer patients receiving radical gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study. J Cancer 2017; 8(7):1214-1222. doi:10.7150/jca.18707. https://www.jcancer.org/v08p1214.htm
CSE
Hu D, Zhang H, Lin X, Chen G, Li C, Liang B, Chen Y, Cui Z, Peng F, Zheng X, Niu W. 2017. Elevated preoperative neutrophil-to-lymphocyte ratio can predict poor survival in early stage gastric cancer patients receiving radical gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study. J Cancer. 8(7):1214-1222.
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