title: Predictive Ability of Blood Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Gastrointestinal Stromal Tumors.
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.
authors.affiliation: Department of Surgical Oncology, University of Toronto, Toronto, ON, Canada.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Racz
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Cleghorn
authors.forename: M Carolina
authors.initials: MC
authors.lastname: Jimenez
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.forename: Lakshmikumar
authors.initials: L
authors.lastname: Venkat Raghavan
authors.forename: Fayez A
authors.initials: FA
authors.lastname: Quereshy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D049451:Nomograms; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate