Jaramillo-Reta KY, Velázquez-Dohorn ME, Medina-Franco H

Language: English
References: 49
Page: 117-121
PDF size: 202.30 Kb.

ABSTRACT

Background: Neutrophil-lymphocyte ratio (NLR) has been proposed as a marker of inflammatory response and as a prognostic tool in surgical procedures. Objective: To evaluate the role of high preoperative NLR ( › 4.5) as predictor of morbidity and mortality in patients with upper gastrointestinal tract resection, and survival in cancer patients. Methods: Retrospective study of patients undergoing upper gastrointestinal tract surgery from 2007 to 2012. Variables associated with morbidity, mortality, and survival were analyzed. Univariate and multivariate analyses were performed. Significance was considered at p ‹ 0.05. Results: 548 patients were included. The most common surgical procedures were Whipple (44.3%) and gastrectomy (30.7%). Surgical morbidity was 40.5% and mortality 6.4%. Factors associated with significant surgical complications were: low body mass index, AJCC stage ≥ III and ASA ≥ III. Factors associated with mortality were older patient age, high NLR, AJCC stage ≥ III, ASA ≥ III, blood transfusion and Charlson › 4. On multivariate analysis, only high NLR and Charlson › 4 remained significant. High NLR was significantly associated with reduced survival in patients with malignant neoplasms (three-year survival 76.1 vs. 65.7%; p = 0.04). Conclusion: High preoperative NLR appears to be a biomarker to predict surgical mortality and survival in patients undergoing complex surgery of the upper gastrointestinal tract.

REFERENCES

1. Grivennikov SI, Greten FR, Karin M. Immunity, inflammation and cancer. Cell. 2010;140:883-99.

2. Demaria S, Pikarsky E, Karin M. Cancer and inflammation: promise for biologic therapy. J Immunother. 2010;33:335-51.

3. Ostrand-Rosenberg S, Sinha P. Myeloid-derived suppressor cells: linking inflammation and cancer. J Immunol. 2009;182:4499-506.

4. Jarnicki A, Putoczki T, Ernst M. Stat3: linking inflammation to epithelial cancer - more than a “gut” feeling? Cell Div. 2010;5:14.

5. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860-7.

6. Guthrie GJ, Charles KA, Roxburgh CS, et al. The systemic inflammation- based neutrophil–lymphocyte ratio: Experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88:218-30.

7. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6:149-63.

8. Kao SC, Pavlakis N, Harvie R, et al. High blood neutrophil-tolymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res. 2010;16:5805-13.

9. Chua W, Charles KA, Baracos VE, et al. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 2011;104:1288-95.

10. Stotz M, Gerger A, Eisner F, et al. Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer. Br J Cancer. 2013;109:416-21.

11. Meniawy TM, Creaney J, Lake RA, et al. Existing models, but not neutrophil-to-lymphocyte ratio, are prognostic in malignant mesothelioma. Br J Cancer 2013;109:1813-20.

12. Stotz M, Gerger A, Eisner F, et al. The combined use of the neutrophil-lymphocyte ratio and C-reactive protein level as prognostic predictors in adult patients with soft tissue sarcoma. Br J Cancer. 2013;109:416-21.

13. Chua W, Charles KA, Baracos VE, et al. Neutrophil/lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Br J Cancer. 2011;104:1288-95.

14. Hung HY, Chen JS, Yeh CY, et al. Effect of preoperative neutrophil- lymphocyte ratio on the surgical outcomes of stage II colon cancer patients who do not receive adjuvant chemotherapy. Int J Colorectal Dis. 2011;26:1059-65.

15. Sarraf KM, Belcher E, Raevsky E, et al. Neutrophil/lymphocyte ratio and its association with survival after complete resection in nonsmall cell lung cancer. J Thorac Cardiovasc Surg. 2009;137:425-8.

16. Wang DS, Luo HY, Qiu MZ, et al. Comparison of the prognostic values of various inflammation based factors in patients with pancreatic cancer. Med Oncol. 2012;29:3092-100.

17. Garcea G, Ladwa N, Neal CP, et al. Preoperative neutrophil-tolymphocyte ratio (NLR) is associated with reduced disease-free survival following curative resection of pancreatic adenocarcinoma. World J Surg. 2011;35:868-72.

18. Jin H, Zhang G, Liu X et al, Blood neutrophil-lymphocyte ratio predicts survival for stages III-IV gastric cancer treated with neoadjuvant chemotherapy. World J Surg Oncol. 2013;11:112-22.

19. Mohri Y, Tanaka K, Ohi M, et al. Prognostic significance of hostand tumor-related factors in patients with gastric cancer. World J Surg. 2010;34:285-90.

20. Sharaiha RZ, Halazun KJ, Mirza F, et al. Elevated preoperative neutrophil: lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol. 2011;18:3362-9.

21. Tomita M, Shimizu T, Ayabe T, et al. Preoperative neutrophil to lymphocyte ratio as a prognostic predictor after curative resection for non-small cell lung cancer. Anticancer Res. 2011;31:2995-8.

22. Sarraf K, Belche E, Raevsky E, et al. Neutrophil/lymphocyte ratio and its association with survival after complete resection in nonsmall cell lung cancer. J Thorac Cardiovasc Surg. 2009;137:425-8.

23. Azab B, Shah N, Radbel J, et al. Pretreatment neutrophil/lymphocyte ratio is superior to platelet/lymphocyte ratio as a predictor of long-term mortality in breast cancer patient. Med Oncol. 2013;30:432-9.

24. Templeton AJ, McNamara MG, Seruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106:124-30.

25. Wang X, Zhang G, Jiang X, et al. Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: a meta-analysis of observational studies. Atherosclerosis. 2014;234:206-13.

26. Vaughan-Shaw PG, Rees JR, King AT. Neutrophil lymphocyte ratio in outcome prediction after emergency abdominal surgery in the elderly. Int J Surg. 2012;10:157-62.

27. Ouellete JR, Small DG, Termuhlen PM. Evaluation of Charlson-Age comorbidity index as predictor of morbidity and mortality in patients with colorectal carcinoma. J Gastrointest Surg. 2004;8:1061-7.

28. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.

29. Bhatti I, Peacock O, Lloyd G, et al. Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil-lymphocyte versus platelet-lymphocyte ratio. Am J Surg. 2010;200:197-203.

30. Nakamura T, Matsumine A, Matsubara T, et al. The combined use of the neutrophil-lymphocyte ratio and C-reactive protein levels as prognostic predictors in adult patients with soft tissue sarcoma. J Surg Oncol. 2013;108:481-5.

31. Kim HS, Han KH, Chung HH, et al. Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: a casematched comparison. Eur J Surg Oncol. 2010;36:691-8.

32. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539-45.

33. Chua TC, Chong CH, Liauw W, et al. Inflammatory markers in blood and serum tumor markers predict survival in patients with epithelial appendiceal neoplasms undergoing surgical cytoreduction and intraperitoneal chemotherapy. Ann Surg. 2012;256:342-9.

34. Proctor MJ, Morrison DS, Talwar D, et al. A comparison of inflammation- based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer. 2011;47:2633-41.

35. Hashimoto T, Ohno Y, Nakashima J, et al. Clinical significance of preoperative peripheral blood neutrophil count in patients with non-metastatic upper urinary tract carcinoma. World J Urol. 2012;88:1-6.

36. Azab B, Bhatt V, Phookan J, et al. Usefulness of the neutrophil-tolymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol. 2012;19:217-24.

37. Halazun K, Hardy M, Rana A, et al. Negative Impact of neutrophil- lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Ann Surg. 2009;250:141-51.

38. Jung M, Park J, Jeong O, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts poor survival following resection in late stage gastric cancer. J Surg Oncol. 2011;104:504-10.

39. Kusumanto Y, Dam W, Hospers G, et al. Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor. Angiogenesis. 2003;6:283-7.

40. Gomez D, Farid S, Malik H, et al. Preoperative neutrophil-tolymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma. World J Surg. 2008;32:1757-62.

41. Walsh S, Cook E, Goulder F, et al. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91:181-4.

42. Ali A, McMillan D, Matalka I, et al. Tumour T-lymphocyte subset infiltration and tumour recurrence following curative resection for colorectal cancer. Eur J Surg Oncol. 2004;30:292-5.

43. Mlecnik B, Tosolini M, Kirilovsky A, et al. Histopathologic-based prognostic factors of colorectal cancers are associated with the state of the local immune reaction. J Clin Oncol. 2011;29:610-18.

44. Mallappa S, Sinha A, Gupta S, et al. Preoperative neutrophil lymphocyte ratio greater than five is a prognostic factor for recurrent colorectal cancer. Colorectal Dis. 2013;15:323-8.

45. Ubukata H, Motohashi G, Tabuchi T, et al. Evaluations of interferon-γ/interleukin-4 ratio and neutrophil/lymphocyte ratio as prognostic indicators in gastric cancer patients. J Surg Oncol. 2010;102:742-7.

46. Hirashima M, Higuchi S, Sakamoto K, et al. The ratio of neutrophils to lymphocytes and the phenotypes of neutrophils in patients with early gastric cancer. J Cancer Res Clin Oncol. 2010;124;329-34.

47. Chua T, Chong C, Liauw W, et al. Inflammatory markers in blood and serum tumor markers predict survival in patients with epithelial appendiceal neoplasms undergoing surgical cytoreduction and intraperitoneal chemotherapy. Ann Surg. 2012;256:342-9.

48. Balkwilltaoglu M, Bilici A, Seker M, et al. The association of pretreatment peripheral blood markers with survival in patients with pancreatic cancer. Hepatogastroenterology. 2010;57:640-5.

49. Dumitrascu T, Chirita D, Ionescu M, et al. Resection for hilar cholangiocarcinoma: analysis of prognosis factors and the impact of systemic inflammation on long-term outcome. J Gastrointest Surg. 2013;17:913-24.