title: Predictive Value of the Neutrophil/Lymphocyte Ratio in Peritoneal and/or Metastatic Disease at Staging Laparoscopy for Gastric and Esophageal Adenocarcinoma.
abstract: BACKGROUND
  Despite advances in imaging techniques, peritoneal and/or metastatic disease have been identified by staging laparoscopy in up to 50 % of patients with a negative preoperative imaging. Neutrophil to lymphocyte ratio (NLR) has been recently shown as a prognostic factor in gastric and esophageal cancers.
  
  
  METHODS
  We retrospectively reviewed the medical records of 117 patients with early gastric and lower esophagus adenocarcinoma that were referred for staging laparoscopy in the last two years in the University College Hospital, London. Complete blood count was performed preceding staging laparoscopy. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count; a high NLR was defined ≥3.28. We evaluated the predictive power of a high NLR for a positive staging laparoscopy.
  
  
  RESULTS
  The median age was 66.7 years; 87 (74.4 %) were male. Forty-four percent of the tumors were located at the gastroesophageal junction, 18 % were esophageal, and 38 % were gastric. Twenty-five (21.4 %) patients were found to have peritoneal or metastatic disease on staging laparoscopy. NLR ≥3.28 was an independent predicting factor for the discovery of peritoneal and/or metastatic disease (OR 3.9, 95 % CI: 1.54-9.86, p = 0.005). The median value of NLR was significantly higher in patients for whom the laparoscopy had discovered peritoneal or metastatic disease, than in those it had not (3.3 vs. 2.2, p = 0.011).
  
  
  CONCLUSIONS
  Our findings suggest that the NLR may be reliable for predicting the presence of peritoneal or metastatic involvement on staging laparoscopy, in patients with early gastric cancer or lower esophageal cancer.
authors.affiliation: Institute of Oncology, Shaare Zedek Medical Center, P.O. Box 3235, 91031, Jerusalem, Israel, talgrenader65@hotmail.com.
authors.forename: Tal
authors.initials: T
authors.lastname: Grenader
authors.forename: Yevgeni
authors.initials: Y
authors.lastname: Plotkin
authors.forename: Borzoueh
authors.initials: B
authors.lastname: Mohammadi
authors.forename: Khaled
authors.initials: K
authors.lastname: Dawas
authors.forename: Majid
authors.initials: M
authors.lastname: Hashemi
authors.forename: Muntzer
authors.initials: M
authors.lastname: Mughal
authors.forename: John A
authors.initials: JA
authors.lastname: Bridgewater
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008214:Lymphocytes / Q000166:cytology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009504:Neutrophils / Q000166:cytology / Q000378:metabolism*; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000556:secondary*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000601:surgery*