Clinical significance of neutrophil-to-lymphocyte ratio as a predictor of lymph node metastasis in gastric cancer

• Published in: BMC cancer Vol. 19; no. 1; pp. 1187 - 7
• Main Authors: Kosuga, Toshiyuki, Konishi, Tomoki, Kubota, Takeshi, Shoda, Katsutoshi, Konishi, Hirotaka, Shiozaki, Atsushi, Okamoto, Kazuma, Fujiwara, Hitoshi, Kudou, Michihiro, Arita, Tomohiro, Morimura, Ryo, Murayama, Yasutoshi, Kuriu, Yoshiaki, Ikoma, Hisashi, Nakanishi, Masayoshi, Otsuji, Eigo
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05.12.2019; BioMed Central; BMC
• Subjects: Abdomen; Accuracy; Adult; Aged; Aged, 80 and over; Blood; Cancer; Cancer metastasis; Cancer treatment; CAT scans; Clinical significance; Computed tomography; Diagnosis; Diagnostic imaging; Endoscopy; Female; Gastrectomy; Gastric cancer; Humans; Lymph node metastasis; Lymph nodes; Lymphatic Metastasis - diagnosis; Lymphatic system; Lymphocyte Count; Lymphocytes; Male; Medical research; Medical schools; Metastases; Metastasis; Middle Aged; Multivariate analysis; Neutrophil-to-lymphocyte ratio; Neutrophils; Neutrophils - metabolism; Preoperative Period; Prognosis; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Staging; Stomach cancer; Stomach Neoplasms - blood; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Tomography; Japan; Taiwan; Lymph node metastasis; Gastrectomy; Neutrophil-to-lymphocyte ratio; Staging; Gastric cancer
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-019-6404-8

Precise staging is indispensable to select the appropriate treatment strategy for gastric cancer (GC); however, the diagnostic accuracy of conventional modalities needs to be improved. This study investigated the clinical significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) for the prediction of pathological lymph node metastasis (pN+) in GC. This was a retrospective study of 429 patients with GC who underwent curative gastrectomy. The predictive ability of NLR for pN+ was examined in comparison with that of computed tomography. The preoperative NLR ranged from 0.6 to 10.8 (median, 2.0), and the optimal cut-off value for predicting pN+ was 1.6 according to the receiver operating characteristic curve with the maximal Youden index. Multivariate analysis identified a NLR ≥ 1.6 (odds ratio (OR) 3.171; 95% confidence interval (CI) 1.448-7.235, p = 0.004) and cN+ (OR 2.426; 95% CI 1.221-4.958, p = 0.011) to be independent factors associated with pN+ in advanced GC (cT2-T4). On the other hand, a NLR ≥ 1.6 was not useful for predicting pN+ in early GC (cT1). In advanced GC, a NLR ≥ 1.6 detected pN+ with a higher sensitivity (84.9%) and negative predictive value (NPV) (63.9%) than conventional modalities (50.0 and 51.7%, respectively). When the subjects were limited to those with advanced GC with cN0, the sensitivity and NPV of a NLR ≥ 1.6 for pN+ increased further (90.7 and 81.0%, respectively). The preoperative NLR may be a useful complementary diagnostic tool for predicting pN+ in advanced GC because of its higher sensitivity and NPV than conventional modalities.