Online ISSN 2313-1519
Print    ISSN 1812-2892
Abstract - Prognostic Value of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Systemic Immune-Inflammatory Index in Resected Gastric Cancer
Hayriye Şahinli, Sema Türker


Objective: The prognostic value of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index has been studied in many cancer types. Our aim is to show the prognostic value of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index in resected gastric cancer patients. In addition, to determine which parameter is a better predictor of survival.

Material and methods: The study included 95 patients resected gastric cancer between 2014-2018. Receiver operating curve analysis was used to determine neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index cut-off values. Systemic immune-inflammatory index was evaluated as neutrophil × platelet/lymphocyte. Long rank and cox regression analysis were used.

Results: The median age was 62 (22-84) years. The median overall survival was 33 months. 49 (51.6%) patients were in stage 3 and 46 (48.4 %) patients were in stage 1-2. High neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index values, tumor depth, stage of metastatic lymph node and tumor-node-metastasis stage were poor prognostic factors for overall survival and disease-free survival. When multivariant cox regression analysis was performed, only platelet-lymphocyte ratio was found to be independent prognostic factor (p = 0.037 for overall survival, p = 0.024 for overall survival).

Conclusion: High neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index were found to be poor prognostic factors in predicting both overall survival and disease-free survival before treatment in patients who undergo curative resection for gastric cancer. As a result of multivariant analysis, only high platelet-lymphocyte ratio was determined as an independent poor prognostic factor for both overall survival and disease-free survival.

Keywords: gastric cancer, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, prognosis

Corresponding author: Hayriye Şahinli, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Medical Oncology, Ankara, Turkey. ORCİD No: 0000-0002-1561-9346. Tel.: 05536934969, E-mail:



1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-86.

2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65(2):87-108.

3. Powell A, Parkinson D, Patel N, Chan D, Christian A, Lewis WG. Prognostic Significance of Serum Inflammatory Markers in Gastric Cancer. J Gastrointest Surg. 2018; 22(4):595-605.

4. Zhang Y, Lu JJ, Du YP, Feng CX, Wang LQ, Chen MB. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in gastric cancer. Medicine (Baltimore). 2018;97(12):e0144.

5. Mellor KL, Powell A, Lewis WG. Systematic Review and Meta-Analysis of the Prognostic Significance of Neutrophil-Lymphocyte Ratio (NLR) After R0 Gastrectomy for Cancer. J Gastrointest Cancer. 2018; 49(3):237-44.

6. Zhu YL, Yang L, Sui ZQ, Liu L, Du JF. Clinicopathological features and prognosis of Borrmann type IV gastric cancer. J BUON. 2016; 21(6):1471-5.

7. Shah MA, Ajani JA. Gastric cancer--an enigmatic and heterogeneous disease. JAMA. 2010; 303(17):1753-4.

8. Zhang X, Zhang W, Feng LJ. Prognostic significance of neutrophil lymphocyte ratio in patients with gastric cancer: a meta-analysis. PLoS One. 2014;9(11):e111906.

9. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002; 420(6917):860-7.

10. Pardoll DM. Spinning molecular immunology into successful immunotherapy. Nat Rev Immunol. 2002;2(4):227-38.

11. Homey B, Muller A, Zlotnik A. Chemokines: agents for the immunotherapy of cancer? Nat Rev Immunol. 2002; 2(3):175-84.

12. Amedei A, Munari F, Bella CD, Niccolai E, Benagiano M, Bencini L, et al. Helicobacter pylori secreted peptidyl prolyl cis, trans-isomerase drives Th17 inflammation in gastric adenocarcinoma. Intern Emerg Med. 2014;9(3):303-9.

13. Kubota T, Hiki N, Nunobe S, Kumagai K, Aikou S, Watanabe R, et al. Significance of the inflammation-based Glasgow prognostic score for short- and long-term outcomes after curative resection of gastric cancer. J Gastrointest Surg. 2012;16(11):2037-44.

14. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646-74.

15. Todoric J, Antonucci L, Karin M. Targeting Inflammation in Cancer Prevention and Therapy. Cancer Prev Res (Phila). 2016; 9(12):895-905.

16. Shoda K, Komatsu S, Ichikawa D, Kosuga T, Okamoto K, Arita T, et al. Thrombocytosis Associated with Poor Prognosis in Patients with Gastric Cancer. Gan To Kagaku Ryoho. 2015; 42(12):1980-2.

17. Chen Y, Zhang L, Liu WX, Liu XY. Prognostic significance of preoperative anemia, leukocytosis and thrombocytosis in chinese women with epithelial ovarian cancer. Asian Pac J Cancer Prev. 2015;16(3):933-9.

18. Dunn GP, Old LJ, Schreiber RD. The immunobiology of cancer immunosurveillance and immunoediting. Immunity. 2004; 21(2):137-48.

19. Dupre A, Malik HZ. Inflammation and cancer: What a surgical oncologist should know. Eur J Surg Oncol. 2018; 44(5):566-70.

20. Digklia A, Voutsadakis IA. Thrombocytosis as a prognostic marker in stage III and IV serous ovarian cancer. ObstetGynecol Sci. 2014;57(6):457-63.

21. Voutsadakis IA. Thrombocytosis as a prognostic marker in gastrointestinal cancers. World J Gastrointest Oncol. 2014; 6(2):34-40.

22. Cao W, Yao X, Cen D, Zhi Y, Zhu N, Xu L. Prognostic role of pretreatment thrombocytosis on survival in patients with cervical cancer: a systematic review and meta-analysis. World J Surg Oncol. 2019; 17(1):132.

23. Hirahara T, Arigami T, Yanagita S, Matsushita D, Uchikado Y, Kita Y, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC Cancer. 2019;19(1):672.

24. Riedl J, Pabinger I, Ay C. Platelets in cancer and thrombosis. Hamostaseologie. 2014; 34(1):54-62.

25. Sasaki K, Kawai K, Tsuno NH, Sunami E, Kitayama J. Impact of preoperative thrombocytosis on the survival of patients with primary colorectal cancer. World J Surg. 2012; 36(1):192-200.

26. Guo T, Krzystanek M, Szallasi Z, Szallasi A. Thrombocytosis portends adverse prognostic significance in patients with stage II colorectal carcinoma. F1000Res. 2014; 3:180.

27. Graziosi L, Marino E, De Angelis V, Rebonato A, Cavazzoni E, Donini A. Prognostic value of preoperative neutrophils to lymphocytes ratio in patients resected for gastric cancer. Am J Surg. 2015; 209(2):333-7.

28. Sun X, Liu X, Liu J, Chen S, Xu D, Li W, et al. Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio in predicting survival for patients with stage I-II gastric cancer. Chin J Cancer. 2016;35(1):57.

29. Zhong JH, Huang DH, Chen ZY. Prognostic role of systemic immune-inflammation index in solid tumors: a systematic review and meta-analysis. Oncotarget. 2017;8(43):75381-8.


Volume 4, Number 54 (2019)