Neutrophil-to-Lymphocyte Ratio as a Prognostic Indicator in Patients With Unresectable Gastric Cancer

Background/Aim: Although many prognostic indicators have been identified for resectable gastric cancer (GC), prognostic indicators for unresectable GC (urGC) have not been widely studied. The aim of the current study was to investigate prognostic indicators that could be determined through routine blood examinations in patients with urGC. Patients and Methods: We retrospectively analyzed clinicopathological factors in 92 patients with unresectable advanced and recurrent gastric adenocarcinoma. Results: Based on receiver operating curve analysis, neutrophil-to-lymphocyte ratio (NLR) had the highest area under curve for 1-year survival among patients with urGC. Among patients with urGC, NLR was significantly higher in those with advanced disease compared to those with recurrent disease (p=0.0051); and in those with peritoneal metastasis compared to those without peritoneal metastasis (p=0.041). Patients were divided into NLRHigh (NLR >= 2.83) and NLRLow (NLR<2.83). Their median survival times were NLRHigh: 9.1 months and NLRLow: 17.1 months (p<0.0001). NLR was also inversely correlated with survival period (r=0.496, p<0.0001); and NLR measured one month after starting chemotherapy was significantly associated with the prognosis of both NLRLow and NLRHigh patients with urGC. Multivariate analysis showed NLR to be an independent predictor of overall survival in these patients. Conclusion: NLR is useful for predicting the prognosis of patients with unresectable GC.