Predictive Value of Baseline Neutrophil/Lymphocyte Ratio for T4 Disease in Wall-Penetrating Gastric Cancer

Multimodality therapy has been used in the management of gastric cancer associated with locoregional spread. However, the accurate clinical staging still remains to be established. The neutrophil/lymphocyte ratio (NLR) in the peripheral blood is reported to be an easily assessable prognostic factor in cancer patients. We evaluated the predictive significance of the NLR and other serological parameters in patients with wall-penetrating gastric cancer. Two hundred sixty-two patients who underwent gastric cancer surgery between 2002 and 2005 were identified retrospectively. Wall penetration was defined as wall invasion deeper than the muscularis propria (a parts per thousand yenT2). Blood data were collected from routinely performed blood examinations before treatment and were analyzed with respect to T stage, nodal status, and histological features. A high NLR was defined as less than 3.2 based on ROC curve analysis, and the predictive value of a high NLR for T4 cancer was evaluated. Elevated levels of NLR (P = 0.004) and C-reactive protein (CRP) (P = 0.017) and the decrease in lymphocyte count (Lym, P = 0.032) and serum hemoglobin (Hb, P < 0.001) were correlated with the T stage, but there was no meaningful correlation with either positive nodal status or histological differentiation. With respect to the predictive value for stage T4, an elevated NLR (OR = 2.206, 95% CI = 1.187-4.100; P = 0.012), decrease of Hb (OR = 1.875, 95% CI = 1.005-3.500; P = 0.048), and poorly differentiated histology (OR = 3.134, 95% CI = 1.593-6.167; P = 0.001) were identified as independent predictive factors. Our findings suggest that the preoperative values of the NLR may be reliable for predicting T4 disease.