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. 2018 May 2;18(1):515.
doi: 10.1186/s12885-018-4414-6.

Combined neutrophil/platelet/lymphocyte/differentiation score predicts chemosensitivity in advanced gastric cancer

Zhenhua Huang  1 , Yantan Liu  1 , Chen Yang  1 , Xiaoyin Li  1 , Changqie Pan  1 , Jinjun Rao  2 , Nailin Li  3 , Wangjun Liao  1 , Li Lin  4
Affiliations

Combined neutrophil/platelet/lymphocyte/differentiation score predicts chemosensitivity in advanced gastric cancer

Zhenhua Huang et al. BMC Cancer. .

Abstract

Background: Gastric cancer is common in developing regions, and we hope to find out an economical but practical prognostic indicator. It was reported that pre-treatment peripheral neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as well as differentiation status, were associated with cancer progression. Hence, we introduced a novel combined Neutrophil/platelet/lymphocyte/differentiation Score (cNPLDS) to improve the prediction value of palliative chemotherapeutic response in advanced gastric cancer.

Methods: According to statistical sample size estimation, 136 primary diagnosed unresectable advanced ptaients were included for a retrospective study. The follow-up end-point was progression free survival (PFS) during the first-line palliative chemotherapy. Differentiation stratified patients into well, medium and poor groups by score 1 to 3, while patients with neither elevated NLR and PLR, only one elevated, or both elevated were of the combined NLR-PLR score (cNPS) 1 to 3, respectively. The cNPLDS was calculated by multiplying the tumor differentiation score and cNPS.

Results: Determined by the receiver operating characteristic (ROC) curve, the optimal cut-off points for NLR and PLR were 3.04 and 223. Through univariate analysis and survival analysis, poor differentiation, high NLR, high PLR, high cNPS, and high cNPLDS respectively indicated inferior PFS during the first-line palliative chemotherapy. Patients were furhter classified into low to high risk groups by cNPLDS. Groups of elevated NLR, PLR, cNPS, and cNPLDS showed lower disease control rate. Compared to other parameters, cNPLDS significantly improved the accuracy in predicing the first-progression.

Conclusions: This study indicates that the novel parameter cNPLDS is superior to NLR or PLR alone, or even cNPS, in predicting the first-line chemosensitivity in advanced gastric cancer.

Keywords: Chemosensitivity; Gastric cancer; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio; Tumor differentiation.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Nanfang Hospital Ethics Review Board.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Parameter definitions. a Progression-free survival during the first-line chemotherapy (1st PFS) curve for all the 136 patients included in this study. b Correlation analysis between NLR and PLR. c ROC curve for NLR and PLR to determine the cut-off values at the median 1st PFS. d Schematic figures of cNPLDS and risk classifications
Fig. 2
Fig. 2
PFS analysis by Kaplan-Meier curves. Kaplan-Meier curves for 1st PFS in patients categorized by (a) histological differentiation, (b) NLR level, (c) PLR level (d) cNPS and (e) cNPLDS
Fig. 3
Fig. 3
Comparing prognostic prediction priority using ROC curves. ROC curves for histological differentiation, NLR, PLR, cNPS and cNPLDS at (a) the median and (b) the third-quarter of 1st PFS
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