Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer

Tetsushi Hirahara†,
Takaaki Arigami†Email author View ORCID ID profile,
Shigehiro Yanagita,
Daisuke Matsushita,
Yasuto Uchikado,
Yoshiaki Kita,
Shinichiro Mori,
Ken Sasaki,
Itaru Omoto,
Hiroshi Kurahara,
Kosei Maemura,
Keishi Okubo,
Yoshikazu Uenosono,
Sumiya Ishigami and
Shoji Natsugoe

†Contributed equally

BMC Cancer201919:672

https://doi.org/10.1186/s12885-019-5903-y

Received: 28 December 2018
Accepted: 2 July 2019
Published: 8 July 2019

Open Peer Review reports

Abstract

Background

The neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) are representative blood markers of systemic inflammatory responses. However, the clinical significance of the combination of these markers is unclear. This study aimed to investigate the NLR and PLR in patients with advanced gastric cancer treated with chemotherapy and assess the clinical utility of a new blood score combining the NLR and PLR (NLR-PLR score) as a predictor of tumor response and prognosis.

Methods

We retrospectively analyzed 175 patients with gastric cancer receiving chemotherapy or chemoradiotherapy. These patients were categorized into progressive disease (PD) and non-PD groups according to tumor response. The NLR and PLR before treatment were examined, and the cut-off values were determined. The NLR-PLR score ranged from 0 to 2 as follows: score of 2, high NLR (> 2.461) and high PLR (> 248.4); score of 1, either high NLR or high PLR; score of 0, neither high NLR nor high PLR.

Results

With regard to tumor response, 64 and 111 patients had PD and non-PD, respectively. The NLR-PLR score was significantly higher in patients with PD than in those with non-PD (p = 0.0009). The prognosis was significantly poorer in patients with a higher NLR-PLR score than in those with a lower NLR-PLR score (p < 0.0001). Multivariate analysis demonstrated that the NLR-PLR score was an independent prognostic factor for prediction of overall survival (p = 0.0392).

Conclusion

Low-cost stratification according to the NLR-PLR score might be a promising approach for predicting tumor response and prognosis in patients with advanced gastric cancer.