Blood neutrophil-to-lymphocyte ratio is prognostic in gastrointestinal stromal tumor Journal Article


Authors: Perez, D. R.; Baser, R. E.; Cavnar, M. J.; Balachandran, V. P.; Antonescu, C. R.; Tap, W. D.; Strong, V. E.; Brennan, M. F.; Coit, D. G.; Singer, S.; DeMatteo, R. P.
Article Title: Blood neutrophil-to-lymphocyte ratio is prognostic in gastrointestinal stromal tumor
Abstract: Background: The immune system has been shown to play an important role in gastrointestinal stromal tumor (GIST). The neutrophil-to-lymphocyte ratio (NLR) in blood is an easily assessable parameter of systemic inflammatory response. The aim of this study was to determine whether the NLR is prognostic in GIST. Methods: A total of 339 previously untreated patients with primary, localized GIST operated at our institution between 1995 and 2010 were identified from a prospectively collected sarcoma database. NLR was assessed preoperatively. Patients who received adjuvant imatinib treatment were excluded from the analysis (n = 64). Cox regression models were calculated and correlation analyses were performed. Results: On univariate analysis, NLR was associated with recurrence-free survival (RFS) (P = 0.003, hazard ratio 3.3, 95 % confidence interval 1.5-7.4). Patients with a low NLR had a 1- and 5-year RFS of 98 and 91 %, compared with 89 and 76 % in those with a high NLR. The median RFS was not reached. Positive correlations were found between NLR and mitotic rate (Pearson correlation coefficient [r] = 0.15, P = 0.03), and NLR and tumor size (r = 0.36, P = 0.0001). RFS in patients with a GIST >5 cm with low NLR was significantly longer compared to patients with high NLR (P = 0.002). Flow cytometry analysis of freshly obtained GISTs revealed that neutrophils constituted a minimal percentage of intratumoral immune cells. Conclusions: NLR is a surrogate for high-risk tumor features. Elevated blood NLR appears to represent systemic inflammation in patients with high-risk GIST. © 2012 Society of Surgical Oncology.
Keywords: adult; aged; major clinical study; cancer risk; flow cytometry; nuclear magnetic resonance imaging; gastrointestinal stromal tumor; imatinib; computer assisted tomography; tumor volume; neutrophil; thorax radiography; small intestine; lymphocyte; immunocompetent cell; stomach; rectum; recurrence free survival; cancer prognosis
Journal Title: Annals of Surgical Oncology
Volume: 20
Issue: 2
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2013-02-01
Start Page: 593
End Page: 599
Language: English
DOI: 10.1245/s10434-012-2682-y
PROVIDER: scopus
PMCID: PMC3700425
PUBMED: 23054118
DOI/URL:
Notes: --- - Cited By (since 1996):1 - "Export Date: 19 July 2013" - "CODEN: ASONF" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Raymond E Baser
    65 Baser
  2. Murray F Brennan
    759 Brennan
  3. Ronald P DeMatteo
    597 DeMatteo
  4. Cristina R Antonescu
    606 Antonescu
  5. Daniel Perez
    7 Perez
  6. Michael Joseph Cavnar
    26 Cavnar
  7. Samuel Singer
    225 Singer
  8. Vivian Strong
    144 Strong
  9. Daniel Coit
    415 Coit
  10. William Douglas Tap
    122 Tap