Skip to main content

Advertisement

SpringerLink
Log in

Predictive Ability of Blood Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Gastrointestinal Stromal Tumors

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recent findings have shown that the neutrophil-to-lymphocyte ratio (NLR) is prognostic for gastrointestinal stromal tumors (GIST). The platelet-to-lymphocyte ratio (PLR) can predict outcome for several other disease sites. This study evaluates the prognostic utility of NLR and PLR for patients with GIST.

Methods

All patients who had undergone surgical resection for primary, localized GIST from 2001 to 2011 were identified from a prospectively maintained database. Recurrence-free survival (RFS) was calculated by the Kaplan–Meier method and compared by the log-rank test. Univariate Cox proportional hazard regression models were used to identify associations with outcome variables.

Results

The study included 93 patients. High PLR [≥245; hazard ratio (HR) 3.690; 95 % confidence interval (CI) 1.066–12.821; p = 0.039], neutrophils (HR 1.224; 95 % CI 1.017–1.473; p = 0.033), and platelets (HR 1.005; 95 % CI 1.001–1.009; p = 0.013) were associated with worse RFS. Patients with high PLR had 2- and 5-year RFS of 57 and 57 %, compared with 94 and 84 % for those with low PLR. High NLR (≥2.04) was not associated with reduced RFS (p = 0.214). Whereas more patients in the high PLR group had large tumors (p = 0.047), more patients in the high NLR group had high mitotic rates (p = 0.016) than in the low-ratio cohorts. Adjuvant therapy was given to 41.2 % of the patients with high PLR (p = 0.022). The patients with high PLR/NLR had worse nomogram-predicted RFS than the patients with low PLR/NLR.

Conclusions

High PLR was associated with reduced RFS. The prognostic ability of PLR to predict recurrence suggests that it may play a role in risk-stratification schemes used to determine which patients will benefit from adjuvant therapy.

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

Similar content being viewed by others

References

  1. Connolly EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumours. Br J Surg. 2003;90:1178–86.

    Article  CAS  PubMed  Google Scholar 

  2. Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumours. Ann Chir Gynaecol. 1998;87:278–81.

    CAS  PubMed  Google Scholar 

  3. Hasegawa T, Matsuno Y, Shimoda T, Hirohashi S. Gastrointestinal stromal tumor: consistent CD117 immunostaining for diagnosis, and prognostic classification based on tumor size and MIB-1 grade. Hum Pathol. 2002;33:669–76.

    Article  PubMed  Google Scholar 

  4. Hirota S, Isozaki K, Moriyama Y, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998;279:577–80.

    Article  CAS  PubMed  Google Scholar 

  5. Heinrich MC, Corless CL, Duensing A, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science. 2003;299:708–10.

    Article  CAS  PubMed  Google Scholar 

  6. Blay JY, von Mehren M, Blackstein ME. Perspective on updated treatment guidelines for patients with gastrointestinal stromal tumors. Cancer. 2010;116:5126–37.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol. 2005;100:162–8.

    Article  PubMed  Google Scholar 

  8. Nilsson B, Bumming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era: a population-based study in western Sweden. Cancer. 2005;103:821–9.

    Article  PubMed  Google Scholar 

  9. Di Matteo G, Pescarmona E, Peparini N, et al. Histopathological features and clinical course of the gastrointestinal stromal tumors. Hepatogastroenterology. 2002;49:1013–6.

    PubMed  Google Scholar 

  10. Tornoczky T, Kalman E, Hegedus G, et al. High mitotic index associated with poor prognosis in gastrointestinal autonomic nerve tumour. Histopathology. 1999;35:121–8.

    Article  CAS  PubMed  Google Scholar 

  11. Wang X, Mori I, Tang W, et al. Helpful parameter for malignant potential of gastrointestinal stromal tumors (GIST). Jpn J Clin Oncol. 2002;32:347–51.

    Article  PubMed  Google Scholar 

  12. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436–44.

    Article  CAS  PubMed  Google Scholar 

  13. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140:883–99.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88:218–30.

    Article  PubMed  Google Scholar 

  15. Perez DR, Baser RE, Cavnar MJ, et al. Blood neutrophil-to-lymphocyte ratio is prognostic in gastrointestinal stromal tumor. Ann Surg Oncol. 2013;20:593–9.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Smith RA, Bosonnet L, Raraty M, Sutton R, Neoptolemos JP, Campbell F, Ghaneh P. Preoperative platelet–lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. Am J Surg. 2009;197:466–72.

    Article  PubMed  Google Scholar 

  17. Asher V, Lee J, Innamaa A, Bali A. Preoperative platelet–lymphocyte ratio as an independent prognostic marker in ovarian cancer. Clin Transl Oncol. 2011;13:499–503.

    Article  PubMed  Google Scholar 

  18. Kwon HC, Kim SH, Oh SY, et al. Clinical significance of preoperative neutrophil–lymphocyte versus platelet–lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012;17:216–22.

    Article  CAS  PubMed  Google Scholar 

  19. Feng JF, Huang Y, Zhao Q, Chen QX. Clinical significance of preoperative neutrophil–lymphocyte ratio versus platelet–lymphocyte ratio in patients with small cell carcinoma of the esophagus. Sci World J. 2013;2013:504365.

    Google Scholar 

  20. Wang D, Yang JX, Cao DY, et al. Preoperative neutrophil–lymphocyte and platelet–lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther. 2013;6:211–6.

    PubMed Central  PubMed  Google Scholar 

  21. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33:459–65.

    Article  PubMed  Google Scholar 

  22. Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol. 2008;39:1411–9.

    Article  PubMed  Google Scholar 

  23. Gold JS, Gonen M, Gutierrez A, et al. Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis. Lancet Oncol. 2009;10:1045–52.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Ong SL, Garcea G, Thomasset SC, et al. Surrogate markers of resectability in patients undergoing exploration of potentially resectable pancreatic adenocarcinoma. J Gastrointest Surg. 2008;12:1068–73.

    Article  CAS  PubMed  Google Scholar 

  25. Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review. Eur J Cancer. 2002;38(Suppl 5):S39–51.

    Article  PubMed  Google Scholar 

  26. Miettinen M, Lasota J. Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch. 2001;438:1–12.

    Article  CAS  PubMed  Google Scholar 

  27. Racz JM, Brar SS, Cleghorn MC, et al. The accuracy of three predictive models in the evaluation of recurrence rates for gastrointestinal stromal tumours. J Surg Oncol. 2014 (in press).

  28. Proctor MJ, Morrison DS, Talwar D, et al. A comparison of inflammation-based prognostic scores in patients with cancer: a Glasgow Inflammation Outcome Study. Eur J Cancer. 2011;47:2633–41.

    Article  PubMed  Google Scholar 

  29. Raungkaewmanee S, Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, Thavaramara T. Platelet-to-lymphocyte ratio as a prognostic factor for epithelial ovarian cancer. J Gynecol Oncol. 2012;23:265–73.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Sakka N, Smith RA, Whelan P, et al. A preoperative prognostic score for resected pancreatic and periampullary neuroendocrine tumours. Pancreatology. 2009;9:670–6.

    Article  PubMed  Google Scholar 

  31. Smith RA, Ghaneh P, Sutton R, Raraty M, Campbell F, Neoptolemos JP. Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9 levels and platelet–lymphocyte ratio. J Gastrointest Surg. 2008;12:1422–8.

    Article  PubMed  Google Scholar 

  32. Bhatti I, Peacock O, Lloyd G, Larvin M, Hall RI. Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil–lymphocyte versus platelet–lymphocyte ratio. Am J Surg. 2010;200:197–203.

    Article  PubMed  Google Scholar 

  33. Buergy D, Wenz F, Groden C, Brockmann MA. Tumor–platelet interaction in solid tumors. Int J Cancer. 2012;130:2747–60.

    Article  CAS  PubMed  Google Scholar 

  34. Goubran HA, Burnouf T, Radosevic M, El-Ekiaby M. The platelet–cancer loop. Eur J Intern Med. 2013;24:393–400.

    Article  CAS  PubMed  Google Scholar 

  35. Kinoshita A, Onoda H, Imai N, et al. Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer. 2012;107:988–93.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Leitch EF, Chakrabarti M, Crozier JE, McKee RF, Anderson JH, Horgan PG, McMillan DC. Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer. 2007;97:1266–70.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Gondo T, Nakashima J, Ohno Y, et al. Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology. 2012;79:1085–91.

    Article  PubMed  Google Scholar 

  38. Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K. Combination of platelet count and neutrophil-to-lymphocyte ratio is a useful predictor of postoperative survival in patients with colorectal cancer. Br J Cancer. 2013;109:401–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Disclosure

The authors have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada

    Jennifer M. Racz MD, MBA, FRCSC & Fayez A. Quereshy MD, MBA, FRCSC

  2. Division of General Surgery, University Health Network, Toronto, ON, Canada

    Michelle C. Cleghorn MSc, M. Carolina Jimenez MD, MSc, Timothy D. Jackson MD, MPH, FRCSC, FACS, Allan Okrainec MDCM, MHPE, FRCSC, FACS & Fayez A. Quereshy MD, MBA, FRCSC

  3. Department of Biostatistics, Princess Margaret Cancer Center, Toronto, ON, Canada

    Eshetu G. Atenafu MSc, PStat

  4. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Timothy D. Jackson MD, MPH, FRCSC, FACS, Allan Okrainec MDCM, MHPE, FRCSC, FACS & Fayez A. Quereshy MD, MBA, FRCSC

  5. Department of Anesthesia, University Health Network, University of Toronto, Toronto, ON, Canada

    Lakshmikumar Venkat Raghavan MD, FRCPC

Authors
  1. Jennifer M. Racz MD, MBA, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michelle C. Cleghorn MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Carolina Jimenez MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eshetu G. Atenafu MSc, PStat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Timothy D. Jackson MD, MPH, FRCSC, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Allan Okrainec MDCM, MHPE, FRCSC, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lakshmikumar Venkat Raghavan MD, FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fayez A. Quereshy MD, MBA, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fayez A. Quereshy MD, MBA, FRCSC.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Racz, J.M., Cleghorn, M.C., Jimenez, M.C. et al. Predictive Ability of Blood Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Gastrointestinal Stromal Tumors. Ann Surg Oncol 22, 2343–2350 (2015). https://doi.org/10.1245/s10434-014-4265-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-4265-6

Keywords

Search

Navigation