Elevated preoperative neutrophil-to-lymphocyte ratio is associated with poor prognosis in gastrointestinal stromal tumor patients

Abstract

Chang Jiang,1–3,* Wan-Ming Hu,2–4,* Fang-Xin Liao,1–3 Qiong Yang,1–3 Ping Chen,1–3 Yu-Ming Rong,1–3 Gui-Fang Guo,1–3 Chen-Xi Yin,2,3,5 Bei Zhang,1–3 Wen-Zhuo He,1–3 Liang-Ping Xia1–3 1VIP Department, Sun Yat-sen University Cancer Center, 2State Key Laboratory of Oncology in South China, 3Collaborative Innovation Center for Cancer Medicine, 4Department of Pathology, 5Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China *These authors contributed equally to this work Purpose: To investigate the prognostic relevance of preoperative peripheral neutrophil-to-lymphocyte ratio (NLR) in gastrointestinal stromal tumor (GIST) patients.Materials and methods: We enrolled 129 consecutive GIST patients who underwent initial curative surgical resection with or without adjuvant/palliative imatinib treatment in our study. Blood NLR was calculated as neutrophil count (number of neutrophils ×109/L) divided by lymphocyte count (number of lymphocytes ×109/L). Survival curves were constructed by using the Kaplan–Meier method. Univariate and multivariate Cox proportional hazard regression models were performed to identify associations with outcome variable. All tests were two-sided, and P<0.05 was considered statistically significant.Results: The optimal cut-off value of NLR was 2.07 in the receiver operating characteristic curve analysis. The median overall survival (OS) of high NLR group was 113.0 months, whereas that of the low NLR group had not reached the median OS both in the general (P<0.001) and subgroup analyses. The elevated NLR suggested shorter OS in the high malignant potential groups (P=0.01) and the combined low and moderate groups (P=0.02). Increased NLR indicated poor OS in patients regardless of whether if received imatinib treatment or not (P=0.005, and P=0.032, respectively). High NLR indicated poor OS of patients in stage I and II disease (P=0.005) and a clear tendency that increased level of NLR is inimical to OS.Conclusion: Elevated NLR was detected as an independent adverse prognostic factor. Elevated preoperative NLR predicts poor clinical outcome in GIST patients and may serve as a cost-effective and broadly available independent prognostic biomarker. Keywords: neutrophil-to-lymphocyte ratio, overall survival, biomarker, GIST

Keywords

• Neutrophil-to-lymphocyte ratio
• Overall survival
• Biomarker
• GIST