aot2022v55i2

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Acta Oncologica Turcica 2022; 55: 116-127116Original ArticlePlatelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratioin Patients with Locally Advanced Gastric CancersLokal İleri Mide Kanserli HastalardaTrombosit Lenfosit Oranı ve Nötrofil Lenfosit OranıAhmet Karayiğit 1 , Dursun Burak Özdemir 2 , Hayrettin Dizen 3 , Murat Ulaş 41Department of Surgical Oncology, SBU Adana City Training and Research Hospital, Adana, Turkey2Department of Surgical Oncology, SBU Samsun Training and Research Hospital, Samsun, Turkey3Department of General Surgery, Acıbadem Eskisehir Hospital, Eskisehir, Turkey4Department of Surgical Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskisehir,TurkeyABSTRACTAim: This study aimed to determine the relationship between preoperative neutrophil-to-lymphocyteratio (NLR) and platelet-to-lymphocyte ratio (PLR) levels with prognosis of locally advanced gastriccancers (GC).Methods: This was a retrospective single centre study conducted between January 2011 and January2016 at the Department of General Surgery of Osmangazi University Medical Faculty. A total of 83patients histologically diagnosed with GC who received curative surgery were included in the study.Results: Median (first-third quartile) NLR value was 2.62 (1.93-4) and PLR value was 148.1 (117.73-221.43). ROC analysis did not yield optimal cut-off values for NLR and PLR to predict mortality. Loweroverall survival rates were reported in GC patients with extracapsular invasion, perineural invasion,lymphovascular invasion, surgical margin positivity, various clinical findings (leakage, infection andrecurrence), and lower albumin level (all, p<0.05). Cox regression analysis demonstrated thatpreoperative NLR and PLR were non-significant factors for mortality (p=0.302 and 0.147, respectively).Tumour size, perineural invasion, N3 stage, leakage and lower albumin level were independentprognostic determinants for mortality.Conclusion: Our results indicate that preoperative NLR and PLR were not associated with prognosisand could not be used as prognostic indicators for mortality in patients with GC. Greater tumour size,perineural invasion, N3 stage, leakage and hypoalbuminemia were significantly associated withprognosis. Further prospective studies with longer patient follow-up and larger sample sizes will help toverify our current data on prognostic indicators for GC.Keywords: Gastric cancer, NLR, PLR, prognosis, overall survivalÖZETAmaç: Bu çalışma, ameliyat öncesi nötrofil-lenfosit oranı (NLO) ve trombosit-lenfosit oranı (PLO)düzeylerinin mide kanserinin (MK) prognozu ile ilişkisini belirlemeyi amaçladı.Gereç ve Yöntem: Bu, Ocak 2011-Ocak 2016 tarihleri arasında Eskişehir Osmangazi Üniversitesi TıpFakültesi Genel Cerrahi Kliniğinde yürütülen retrospektif tek merkezli bir çalışmadır. Çalışmayahistolojik olarak GK tanısı konan ve küratif cerrahi uygulanan toplam 83 hasta dahil edildi.Bulgular: Medyan (1.-3. çeyrek) NLO değeri 2.62 (1.93-4) ve PLO değeri 148.1 (117.73-221.43) idi.NLO ve PLO ile mortaliteyi tahmin etmek için yapılan ROC analizinde uygun bir kesim noktası eldeedilmedi. Ekstrakapsüler invazyon, perinöral invazyon, lenfovasküler invazyon, cerrahi sınır pozitifliği,çeşitli klinik bulgular (sızıntı, enfeksiyon ve nüks) ve düşük albümin düzeyi (p<0.05) olan MKhastalarında daha düşük genel sağkalım oranları belirlendi. Cox regresyon analizi, preoperatif NLO vePLO'nun mortalite için anlamlı olmayan faktörler olduğunu gösterdi (sırasıyla p=0,302 ve 0,147).First Received: 23.12.2021, Accepted: 22.02.2022doi: 10.5505/aot.2022.36450
Acta Oncologica Turcica 2022; 55: 116-127117Tümör boyutu, perinöral invazyon, N3 evresi, sızıntı ve düşük albümin düzeyi mortalite için bağımsızprognostik belirleyiciler olarak bulundu.Sonuç: Sonuçlarımız, preoperatif NLO ve PLO'nun prognozla ilişkisinin olmadığını ve MK'li hastalardamortalite için prognostik göstergeler olarak kullanılamayacağını göstermektedir. Daha büyük tümörboyutu, perinöral invazyon, N3 evresi, sızıntı ve hipoalbüminemi prognoz ile anlamlı olarak ilişkiliydi.Hastaların daha uzun süre takip edildiği ve daha büyük örneklem büyüklüklüğüne sahip ileri prospektifçalışmalar, MK için prognostik göstergeler hakkındaki mevcut verilerimizi doğrulamaya yardımcıolacaktır.Anahtar Kelimeler: Mide kanseri, NLO, PLO, prognoz, genel sağkalımIntroductionGastric Cancer (GC) is the third leading causeof cancer-associated mortality, causing about800,000 deaths worldwide, partially becausemost patients are diagnosed at an inoperable,advanced stage of disease [1]. Patients usuallypresent with regional or distant metastasis atthe time of diagnosis, and their overall 5-yearsurvival still remains below 50%, even withpotentially curative surgery [2]. Managementapproaches to GC are primarily based onclinical prognosis assessment via the tumournode metastasis (TNM) staging system, butpatients defined to have the same TNM stagedemonstrate heterogeneous clinical courseand varying prognosis [3]. In addition, somemethods, including magnetic resonanceimaging, computed tomography andendoscopic ultrasonography, may be helpfulin predicting preoperative tumour stage andprognosis to some extent, but they areexpensive and do little to eliminateuncertainty [4]. The ability to identifyindividualized risk factors and estimateprognosis are essential to implement optimalmanagement and follow-up strategies.Although various factors have beeninvestigated to classify survival in patientswith GC, there is still an urgent need fortimesaving, reliable and routine prognosticindicators associated with prognosis.Recently, in vivo and in vitro studies havereported that the tumour microenvironment isassociated with both systemic and localinflammatory response and may play a criticalrole in cancer tumorigenesis and progressionthrough tumour proliferation, invasion,www.actaoncologicaturcica.comangiogenesis and metastasis [5]. Given therelationship between inflammatory responseand overall survival, inflammation-basedparameters, including C-reactive protein, IL-6, albumin, Glasgow prognostic score,platelet-to-lymphocyte ratio (PLR) andneutrophil-to-lymphocyte ratio (NLR), havebeen demonstrated to have prognostic value incancer patients [6]. NLR and PLR aredetermined simply, by routine laboratoryassessment and are widely used to assess theextent of systemic inflammatory response forvarious types of cancer and have beenvaluable to predict prognosis in patients withcancer [7]. However, the prognosticsignificance of preoperative NLR and PLRlevels for GC remains complicated andimprecise.The aim of the study was to determine theassociations between preoperative NLR andPLR values and clinicopathological featuresof locally advanced GC and to investigatetheir prognostic value in locally advanced GCpatients who underwent surgery.Materials and MethodsThis was a retrospective single centre studyconducted between January 2011 and January2016 at the Department of General Surgery ofOsmangazi University Medical Faculty.Ethical approval was obtained from the localethics committee. A total of 83 patientshistologically diagnosed with GC whoreceived curative surgery were included in thestudy. The inclusion criteria for patientsinvolved the following criteria: histopathologicallyproven diagnosis of GC,Copyright©Ankara Onkoloji Hastanesi
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