Skip to main content

Advertisement

SpringerLink
Log in

Significance of blood neutrophil-to-lymphocyte ratio for prognostic stratification of patients with gastroesophageal junction adenocarcinoma in the era of the 8th edition of the American Joint Committee on Cancer (AJCC8) staging

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

The prognosis of patients with gastroesophageal junction (GOJ) adenocarcinoma depends mainly on the clinical staging, as described by the new AJCC8 (American Joint Committee on Cancer 8th edition). Evidence suggests that peripheral blood neutrophil-to-lymphocyte ratio (NLR) may be of prognostic significance in patients with upper gastrointestinal cancers. We examined the prognostic significance of NLR in the era of the new AJCC8 staging system. In this single-centre cohort study, retrospective data on patients with operable GOJ adenocarcinoma treated with perioperative chemotherapy were analysed. The prognostic significance of baseline NLR in combination with AJCC8 clinical staging and other patient characteristics was examined for both time-to-progression (TTP) and overall survival (OS). Of 316 patients, 245 (77.5%) underwent radical surgery. Fifty-one patients (16.2%) developed unresectable disease due to early disease progression. NLR was the only baseline factor independently associated with the development of early disease progression. AJCC8 clinical staging was significantly associated with TTP and OS. In addition, NLR ≥ 3 was predictive of poorer TTP (p = 0.001) and OS (p = 0.002), confirmed in multivariate Cox-regression analysis. NLR ≥ 3 was prognostic, especially in patients with clinical stage III for TTP (p = 0.006) and OS (p = 0.025) and in patients with clinical stage IVA for OS (p = 0.017). NLR significantly improved the prognostic classification of patients by different AJCC8 clinical stages, with a c-index improved from 0.554 to 0.592 (p < 0.001). NLR was confirmed to be an independent prognostic factor in this cohort and could be used in combination with AJCC8 clinical staging to improve the baseline prognostic stratification of patients with newly diagnosed resectable GOJ adenocarcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/stomach-cancer/survival#heading-Zero. Accessed December 2016.

  2. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, Smith DB, Langley RE, Verma M, Weeden S, Chua YJ. MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11–20.

    Article  CAS  PubMed  Google Scholar 

  3. Shapiro J, et al. CROSS study group. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090–8.

    Article  PubMed  Google Scholar 

  4. Davies Andrew R, et al. Tumor stage after neoadjuvant chemotherapy determines survival after surgery for adenocarcinoma of the esophagus and esophagogastric junction. J Clin Oncol. 2014;32(27):2983–90.

    Article  PubMed  Google Scholar 

  5. Amin et al. AJCC Cancer Staging Manual. 8th edition. Springer International Publishing 2016.

  6. Templeton AJ, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 2014; 106(6):dju124.

  7. Hanahan Douglas, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646–74.

    Article  CAS  PubMed  Google Scholar 

  8. Guthrie GJK, et al. The systemic inflammation-based neutrophil–lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218–30.

    Article  PubMed  Google Scholar 

  9. Wang SC, et al. Pretreatment neutrophil to lymphocyte ratio independently predicts disease-specific survival in resectable gastroesophageal junction and gastric adenocarcinoma. Ann Surg. 2016;263(2):292–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Malietzis G, et al. A preoperative neutrophil to lymphocyte ratio of 3 predicts disease-free survival after curative elective colorectal cancer surgery. Ann Surg. 2014;260(2):287–92.

    Article  PubMed  Google Scholar 

  11. Shimada Hideaki, et al. High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer. 2010;13(3):170–6.

    Article  PubMed  Google Scholar 

  12. Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, Park KJ, Roh MS, Kim SG, Kim HJ, Lee JH. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012;17(3):216–22. doi:10.3109/1354750X.2012.656705 Epub 2012 Mar 17.

    Article  CAS  PubMed  Google Scholar 

  13. Lee YY, Choi CH, Kim HJ, Kim TJ, Lee JW, Lee JH, Bae DS, Kim BG. Pretreatment neutrophil:lymphocyte ratio as a prognostic factor in cervical carcinoma. Anticancer Res. 2012;32(4):1555–61.

    PubMed  Google Scholar 

  14. Luo G, Guo M, Liu Z, Xiao Z, Jin K, Long J, Liu L, Liu C, Xu J, Ni Q, Yu X. Blood neutrophil-lymphocyte ratio predicts survival in patients with advanced pancreatic cancer treated with chemotherapy. Ann Surg Oncol. 2015;22(2):670–6. doi:10.1245/s10434-014-4021-y Epub 2014 Aug 26.

    Article  PubMed  Google Scholar 

  15. Chua W, Charles KA, Baracos VE, Clarke SJ. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 2011;104(8):1288–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Chrom P, Stec R, Semeniuk-Wojtas A, Bodnar L, Spencer NJ, Szczylik C. Fuhrman grade and neutrophil-to-lymphocyte ratio influence on survival in patients with metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitors. Clin Genitourin Cancer. 2016;14(5):457–64.

    Article  PubMed  Google Scholar 

  17. Gooden MJM, et al. The prognostic influence of tumour-infiltrating lymphocytes in cancer: a systematic review with meta-analysis. Br J Cancer. 2011;105(1):93–103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Wculek SK, Malanchi I. Neutrophils support lung colonization of metastasis-initiating breast cancer cells. Nature. 2015;528(7582):413–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Zheng TL, Cao K, Liang C, Zhang K, Guo HZ, Li DP, et al. Prognostic value of C-reactive protein in esophageal cancer: a meta-analysis. Asian Pac J Cancer Prev. 2014;15:8075–81.

    Article  PubMed  Google Scholar 

  20. Nozoe T, Saeki H, Sugimachi K. Significance of preoperative elevation of serum C-reactive protein as an indicator of prognosis in esophageal carcinoma. Am J Surg. 2001;182:197–201.

    Article  CAS  PubMed  Google Scholar 

  21. Shimada H, Nabeya Y, Okazumi S, Matsubara H, Shiratori T, Aoki T, et al. Elevation of preoperative serum C-reactive protein level is related to poor prognosis in esophageal squamous cell carcinoma. J Surg Oncol. 2003;83:248–52.

    Article  PubMed  Google Scholar 

  22. Zingg U, Forberger J, Rajcic B, Langton C, Jamieson GG. Association of C-reactive protein levels and long-term survival after neoadjuvant therapy and esophagectomy for esophageal cancer. J Gastrointest Surg. 2010;14:462–9.

    Article  PubMed  Google Scholar 

  23. Grenader T, et al. Prognostic value of neutrophil to lymphocyte ratio in advanced oesophago-gastric cancer: exploratory analysis of the REAL-2 trial. Ann Oncol. 2016: mdw012.

  24. Yodying H, et al. Prognostic significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in oncologic outcomes of esophageal cancer: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23:646–65.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Christie Hospital Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK

    Alicia-Marie Conway, Zena Salih, George Papaxoinis, Kimberly Fletcher, Jamie Weaver, Ana Patrao, Robert Noble, Sofia Stamatopoulou, Vikki Owen-Holt & Wasat Mansoor

  2. Scholar of Hellenic Society of Medical Oncology (HESMO), Leof. Alexandras, 1147S, Athens, Greece

    Sofia Stamatopoulou

Authors
  1. Alicia-Marie Conway
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zena Salih
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George Papaxoinis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kimberly Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jamie Weaver
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ana Patrao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Robert Noble
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sofia Stamatopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vikki Owen-Holt
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wasat Mansoor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wasat Mansoor.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Conway, AM., Salih, Z., Papaxoinis, G. et al. Significance of blood neutrophil-to-lymphocyte ratio for prognostic stratification of patients with gastroesophageal junction adenocarcinoma in the era of the 8th edition of the American Joint Committee on Cancer (AJCC8) staging. Med Oncol 34, 116 (2017). https://doi.org/10.1007/s12032-017-0976-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-017-0976-4

Keywords

Search

Navigation