J Cancer 2020; 11(14):4205-4212. doi:10.7150/jca.39575 This issue

Research Paper

The Prognostic Value of Neutrophil-to-lymphocyte Ratio and Monocyte-to-lymphocyte Ratio in Metastatic Gastric Cancer Treated with Systemic Chemotherapy

Danyang Zhou1,2, Ying Wu2, Ying Zhu1, Zhenyu Lin1, Dandan Yu1*✉, Tao Zhang1*✉

1. Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
2. Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Rd, Guangzhou, 510060, China
*Equal contribution

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Zhou D, Wu Y, Zhu Y, Lin Z, Yu D, Zhang T. The Prognostic Value of Neutrophil-to-lymphocyte Ratio and Monocyte-to-lymphocyte Ratio in Metastatic Gastric Cancer Treated with Systemic Chemotherapy. J Cancer 2020; 11(14):4205-4212. doi:10.7150/jca.39575. Available from https://www.jcancer.org/v11p4205.htm

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Background: The prognostic value of neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) in metastatic gastric cancer (mGC) treated with systemic chemotherapy is largely unknown, especially second-line chemotherapy. We retrospectively investigated the prognostic value of baseline NLR and MLR in the progression of mGC with systemic chemotherapy.

Methods: Patients with mGC diagnosed by pathology from January 2010 to December 2018 were identified. Baseline NLR and MLR were collected before treatment. The time to progression during or after first-line therapy from diagnosis (PFS1), and during or after second-line chemotherapy (PFS2) were primary endpoint. Overall survival (OS) was calculated from diagnosis to the date of death or final follow-up.

Results: 537 patients with first-line chemotherapy were included in the retrospective study. The cutoff values of NLR and MLR were 2.610 and 0.285, respectively. Pretreatment NLR and MLR were significantly independent prognostic factors for PFS1 (hazard ratio [HR]=1.597, 95% CI 1.261-2.022, P<0.001 and HR=1.574, 95% CI 1.239-1.999, P<0.001) and OS (HR=1.448, 95% CI 1.030-2.034, P=0.033 and HR=1.622, 95% CI 1.148-2.291, P=0.006). For 172 patients treated with second-line chemotherapy, the cutoff value of MLR was 0.355 and MLR maintained a significant association with PFS2 (HR=1.589, 95% CI 1.073-2.354, P=0.021) in multivariate analysis.

Conclusions: Elevated NLR and MLR were markedly related to the worse PFS1 and OS in mGC performed with first-line chemotherapy. In patients with second-line therapy, MLR was more closely connected to prognosis and was a significantly independent prognostic factor for PFS2.

Keywords: neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, progression-free survival, metastatic gastric cancer, systemic chemotherapy