title: Differential impact of the neutrophil-lymphocyte ratio on the survival of patients with stage IV gastric cancer.
abstract: OBJECTIVE
  The neutrophil to lymphocyte ratio (NLR) may be related to progression in several cancers. The aim of this study was to investigate the impact of pretreatment NLR in advanced gastric cancer on the prognosis of the patients stratified by metastatic pattern.
  
  
  METHODS
  We retrospectively investigated clinical data from 191 patients with stage IV gastric cancer who had undergone surgery for primary gastric cancer between 1997 and 2010 at the Department of Surgical Oncology of Osaka City University.
  
  
  RESULTS
  All patients had unresectable metastatic factors including peritoneal metastasis (P) and liver metastasis (H). Sixty-one (32%) patients had more than two unresectable factors. We determined a cutoff value of 2.5 for the NLR to be optimal to discriminate the patient's characteristics and divided patients into low (<2.5) and high (>2.5) NLR group for subsequent analysis. In the low NLR group, long survival was found in patients with H, P, or multiple site metastases.
  
  
  CONCLUSIONS
  Our results suggest that NLR well reflects the progression of critical metastasis and surgical resection might improve prognosis for patients with low NLR. In conclusion, NLR might be used as a predictive marker to decide on surgical therapy for patients with Stage IV gastric cancer.
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Kazuya
authors.initials: K
authors.lastname: Muguruma
authors.forename: Takahiro
authors.initials: T
authors.lastname: Toyokawa
authors.forename: Naoshi
authors.initials: N
authors.lastname: Kubo
authors.forename: Masaichi
authors.initials: M
authors.lastname: Ohira
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000401:mortality*; D006801:Humans; D007564:Japan; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009504:Neutrophils / Q000378:metabolism*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis
chemical_list: D015415:Biomarkers