title: Blood neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are independent prognostic factors for surgically resected gastrointestinal stromal tumors.
abstract: BACKGROUND
  Recent studies have demonstrated that the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are prognostic for various malignancies; however, there are limited data to date demonstrating their usefulness for gastrointestinal stromal tumors (GISTs). The aim of this study was to determine whether NLR and PLR are prognostic for GIST.
  
  
  METHODS
  Three hundred patients who underwent operative resection for primary localized GIST with preoperative results for neutrophil, platelet, and lymphocyte counts available were retrospectively reviewed. Optimal cutoff values for high NLR (≥ 3.0) and PLR (≥ 275) in predicting recurrence-free survival (RFS) were determined. Prognostic factors of RFS were determined using univariate and multivariate Cox regression analyses for the 266 patients who did not receive adjuvant imatinib.
  
  
  RESULTS
  On univariate analyses, tumor size, mitotic count, location, and both a high NLR and PLR were significant prognostic indicators of decreased RFS (hazard ratio [HR], 2.89 [95% CI; 1.609-5.179 P < .001] and HR, 3.572 [95% CI, 2.094-6.096; P < .001], respectively). On multivariate analyses, tumor size, mitotic count, tumor location, and both high NLR and PLR were independent prognostic factors of RFS in GIST. Both a high NLR and PLR were significant prognostic factors for GISTs within the National Institutes of Health (NIH) and Armed Forces Institute of Pathology (AFIP) high-risk categories. Addition of NLR or PLR to the NIH or AFIP improved the accuracy of these systems.
  
  
  CONCLUSIONS
  High NLR and PLR were independent prognostic factors of RFS in GIST. NLR and PLR would be useful as a preoperative prognostic tool and its incorporation into current prognostication systems improved their accuracy.
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, Singapore. Electronic address: bsgkp@hotmail.com.
authors.forename: Brian K P
authors.initials: BK
authors.lastname: Goh
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Aik-Yong
authors.initials: AY
authors.lastname: Chok
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.
authors.forename: John C
authors.initials: JC
authors.lastname: Allen
authors.affiliation: Division of Medical Oncology, National Cancer Centre, Singapore.
authors.forename: Richard
authors.initials: R
authors.lastname: Quek
authors.affiliation: Division of Surgical Oncology, National Cancer Centre, Singapore.
authors.forename: Melissa C C
authors.initials: MC
authors.lastname: Teo
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, Singapore.
authors.forename: Pierce K H
authors.initials: PK
authors.lastname: Chow
authors.affiliation: Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Singapore.
authors.forename: Alexander Y F
authors.initials: AY
authors.lastname: Chung
authors.affiliation: Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore.
authors.forename: Hock-Soo
authors.initials: HS
authors.lastname: Ong
authors.affiliation: Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore.
authors.forename: Wai-Keong
authors.initials: WK
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D001792:Blood Platelets / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000097:blood / Q000401:mortality / Q000601:surgery*; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D015415:Biomarkers