J Korean Surg Soc.  2012 Dec;83(6):352-359. 10.4174/jkss.2012.83.6.352.

The effectiveness of postoperative neutrophils to lymphocytes ratio in predicting long-term recurrence after stomach cancer surgery

• Kim YH
• Choi WJ

• KMID: 1437530
• DOI: http://doi.org/10.4174/jkss.2012.83.6.352

Abstract

PURPOSE
Immunosuppression is a characteristic of cancer recurrence after curative resection. The neutrophil-to-lymphocyte ratio (NL ratio) in peripheral blood is associated with immune function. However, it is not clear whether the postoperative NL ratio is a predictor for cancer relapse after resection. Thus, we investigated the effectiveness of the short-term postoperative NL ratio in the prediction of disease recurrence within 5 years after stomach cancer surgery by a retrospective chart review.
METHODS
Ninety-three patients with stomach cancer were enrolled. Significant risk factors for cancer recurrence were determined by multivariate Cox regression. Independent variables to increase the NL ratio to >7.7 by postoperative day (POD) 3 were examined by multivariate logistic regression analysis.
RESULTS
The 5-year risk of cancer recurrence after gastrectomy was 4.2 times higher for patients with a POD3 NL ratio of >7.7 (P = 0.005), 3.4 times higher for normal-weight patients compared with overweight patients (P = 0.008), and 20 times higher for stage III compared with stage 0 according to the tumor-node-metastasis cancer staging system (P = 0.003). The surgical duration (hours) increased the chance of high NL ratio >7.7 (odds ratio, 2.5; P = 0.006).
CONCLUSION
The postoperative NL ratio, especially the POD3 NL ratio, predicts long-term recurrence after stomach cancer surgery.

Keyword

Immunosuppression; Lymphocyte; Neoplasm recurrence; Neutrophil

MeSH Terms

Gastrectomy
Humans
Immunosuppression
Logistic Models
Lymphocytes
Neoplasm Staging
Neutrophils
Overweight
Recurrence
Retrospective Studies
Risk Factors
Stomach
Stomach Neoplasms

Figure

• 

  Fig. 1 Receiver operating characteristic (ROC) curves for neutrophil-to-lymphocyte ratio (NL ratio) on pre- and postoperative day 3 and 7 in predicting the probability of a cancer recurrence in all patients.

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  Fig. 2 Box-and-whisker plots showing distributions of neutrophil-to-lymphocyte ratio (NL ratio) values on pre- and postoperative 3 and 7 day for the groups of cancer nonrecurrence (n = 63) and cancer recurrence (n = 30) 5 years after gastrectomy. The bottoms and tops of the boxes are the 25th and 75th percentiles, and the horizontal lines of the boxes are median values. The whiskers represent the lowest and highest value in the 25th percentile minus 1.5 times the interquartile range (IQR) and 75th percentile plus 1.5 IQR regions, respectively. The suspected outliers (○) are 1.5 IQR or more above the 75th percentile, and the outliers (*) are 3 IQR or more above the 75th percentile. The numbers marked on outliers are the registration numbers of patients.

• 

  Fig. 3 Kaplan-Meier plot of recurrence free-survival after surgery comparing between neutrophil-to-lymphocyte ratio (NL ratio) at postoperative day 3 less than and above 7.7 in the patients with stomach cancer (log rank test P = 0.009).

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