title: Blood neutrophil-lymphocyte ratio predicts survival for stages III-IV gastric cancer treated with neoadjuvant chemotherapy.
abstract: BACKGROUND
  Accurate predictors of survival for patients with advanced gastric cancer treated with neoadjuvant chemotherapy are currently lacking. In this study, we aimed to evaluate the prognostic significance of the neutrophil-lymphocyte ratio (NLR) in patients with stage III-IV gastric cancer who received neoadjuvant chemotherapy.
  
  
  METHODS
  We enrolled 46 patients in this study. The NLR was divided into two groups: high (>2.5) and low (≤2.5). Univariate analysis on progression-free survival (PFS) and overall survival(OS) was performed using the Kaplan-Meier and log-rank tests, and multivariate analysis was conducted using the Cox proportional hazards regression model. We analyzed whether chemotherapy normalized high NLR or not, and evaluated the prognostic significance of normalization on survival.
  
  
  RESULTS
  The univariate analysis showed that PFS and OS were both worse for patients with high NLR than for those with low NLR before chemotherapy (median PFS 16 and 49 months, respectively, P = 0.012; median OS 21 and 52 months, P = 0.113). PFS and OS were also worse for patients with high NLR than for those with low NLR before surgery (median PFS 12 and 35 months, P = 0.019; median OS 21 and 52 months, P = 0.082). Multivariate analysis showed that both NLR before chemotherapy and surgery were independent prognostic factors of PFS. Neoadjuvant chemotherapy normalized high NLR in 11 of 24 patients, and these 11 patients had better median PFS and OS than the 13 patients who had high NLR both before chemotherapy and before surgery (PFS: 35.0 and 10.0 months, P = 0.003; OS: 60 and 16 months, P = 0.042).
  
  
  CONCLUSIONS
  NLR may serve as a potential biomarker for survival prognosis in patients with stage III-IV gastric cancer receiving neoadjuvant chemotherapy.
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Medical College, Zhejiang University, No, 79, Qingchun Road, Hangzhou, Zhejiang Province 310003, China.
authors.forename: Hailong
authors.initials: H
authors.lastname: Jin
authors.forename: Geer
authors.initials: G
authors.lastname: Zhang
authors.forename: Xiaosun
authors.initials: X
authors.lastname: Liu
authors.forename: Xiaokun
authors.initials: X
authors.lastname: Liu
authors.forename: Chao
authors.initials: C
authors.lastname: Chen
authors.forename: Hang
authors.initials: H
authors.lastname: Yu
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Huang
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.forename: Jiren
authors.initials: J
authors.lastname: Yu
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor