A novel predictive model based on preoperative blood neutrophil-to-lymphocyte ratio for survival prognosis in patients with gastric neuroendocrine neoplasms.
OBJECTIVE
Evaluate the predictive value of the preoperative blood neutrophil-to-lymphocyte ratio (NLR) on the clinical outcomes of patients with gastric neuroendocrine neoplasms (g-NENs) after radical surgery.


RESULTS
The NLR was significantly higher in patients with g-NENs than in matched normal volunteers (P < 0.05). A higher blood NLR was not significantly associated with clinical characteristics (all P > 0.05). According to the multivariate analysis, the NLR was an independent prognostic factor of RFS and OS. Nomograms, including the NLR, Ki-67 index and lymph node ratio, had superior discriminative abilities to predict clinical outcomes. The recurrence rate was 37% (55/147). The median time to recurrence was 9 months; 48 (87%) patients experienced recurrence within the first 2 years. Both the NLR and Ki-67 index were correlated with liver metastases (both P < 0.05) and were also negatively correlated with recurrence time (both P < 0.05).


METHODS
We enrolled 147 patients who were diagnosed with g-NENs and underwent radical surgery. Receiver operating characteristic curve analysis was used to identify the optimal value for blood NLR. Univariate and multivariate survival analysis were used to identify prognostic factors for g-NENs. A nomogram was adopted to predict RFS and OS after surgery.


CONCLUSIONS
As an independent prognostic factor for g-NENs, blood NLR can improve the predictability of RFS and OS. We recommend that g-NEN patients with a high blood NLR or high Ki-67 index undergo surveillance during the first month and then every 3 months for 2 years post-surgery.
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Long-Long
LL
Cao
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Jun
J
Lu
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Jian-Xian
JX
Lin
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Chao-Hui
CH
Zheng
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Ping
P
Li
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Jian-Wei
JW
Xie
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Jia-Bin
JB
Wang
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Qi-Yue
QY
Chen
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Mi
M
Lin
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Ru-Hong
RH
Tu
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People's Republic of China.
Chang-Ming
CM
Huang
D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008207:Lymphatic Metastasis; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D018358:Neuroendocrine Tumors / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D009504:Neutrophils / Q000166:cytology*; D049451:Nomograms; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012008:Recurrence; D012984:Software; D013274:Stomach Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D016896:Treatment Outcome
D019394:Ki-67 Antigen
gastric neuroendocrine neoplasms; preoperative blood neutrophil-to-lymphocyte ratio; prognosis; surveillance strategy; tumor recurrence