Prognostic significance of neutrophil to lymphocyte ratio in patients with gallbladder carcinoma

Abstract

Background: Numerous literature suggest that the preoperative neutrophil to lymphocyte ratio (NLR) is correlated to the prognosis of various cancers. However, the prognostic significance of NLR in gallbladder carcinoma (GBC) remains to be determined.

Methods: Data from 316 GBC patients with surgical treatment were reviewed retrospectively. A receiver operating characteristic (ROC) curve was performed to determine an optimal cut-off value for NLR. The Kaplan-Meier method and Cox regression proportional hazard model were performed to evaluate prognostic factors.

Results: The optimal cut-off point for NLR was 2.61 according to the ROC curve. According to the univariable analysis, NLR, differentiation and TNM stage were associated with GBC prognosis. GBC patients with NLR > 2.61 have worsened 5-year overall survival (OS) compared to patients with NLR ≤ 2.61 (P < 0.001). Multiple analyses indicated that NLR (hazard ratio (HR) 1.65; 95 percent confidence interval (95% CI) 1.25-2.17), differentiation (HR 1.25; 95% CI 0.97-1.62) and TNM stage (HR 3.79; 95% CI 2.09-6.87) were independent prognostic factors for GBC. GBC patients in stage III/IV, NLR > 2.61 exhibited worse OS compared to patients with NLR ≤ 2.61 (P < 0.05). A prognostic evaluation model based on the independent prognostic factors was established.

Conclusion: NLR is associated with GBC prognosis and is a potential prognostic marker for GBC, not only preoperatively but also postoperatively.

Figure 1

A ROC curve to identify the optimal cut-off value of NLR. The area under the curve was 0.637 (95% confidence interval: 0.556–0.718). The appropriate cut-off point for NLR was 2.61 with the highest sum of a sensitivity (71.3%) and a specificity (56.5%). ROC: receiver operating characteristic; NLR: nuetrophil to lymphocyte ratio; GBC: primary gallbladder carcinoma

Figure 2

The survival curve of OS stratified by NLR in GBC patients. The OS of GBC patients with NLR > 2.61 is worse significantly than those with NLR ≤ 2.61 (the time of the median OS: 8 ± 0.53 vs. 14 ± 2.43 month, P < 0.001). OS: overall survival; NLR: neutrophil to lymphocyte ratio; GBC: primary gallbladder carcinoma

Figure 3

The results of multiple analysis about the prognostic factors for GBC patients. NLR, differentiation, and TNM stage were the independent prognostic factors for gallbladder cancer. NLR: neutrophil to lymphocyte ratio; GBC: primary gallbladder carcinoma

Figure 4

The prognostic significance of the TNM stage stratified by NLR for GBC patients. a and b: for GBC patients in stage I and II, there was no statistical significance in overall survival between NLR ≤ 2.61 and NLR > 2.61 (a: P = 0.564, b: P = 0.379). c and d: for GBC patients in stage III and IV, the overall survival with NLR ≤ 2.61 is superior to those with NLR > 2.61 (c: P = 0.003, d: P = 0.008). NLR: neutrophil to lymphocyte ratio; GBC: primary gallbladder carcinoma

Figure 5

The frequency distribution of the GBC patients with different score. The frequency of GBC patients scored as 0, 1, 2, and 3 was 12, 62, 135, and 107, respectively. GBC: primary gallbladder carcinoma

Figure 6

The prognostic implication of the model for GBC patients. The survival analysis indicated that the higher the scores, the worse the prognosis (score 0 venous score 1: P < 0.001; score 1 venous score 2: P < 0.001; score 2 venous score 3: P = 0.043). The time of the median OS for the four groups were 77, 21 ± 5.86, 8 ± 0.97, and 7 ± 0.56 months, respectively. GBC: primary gallbladder carcinoma