Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratioin predicting survival for patients with stage Ⅰ-Ⅱgastric cancer

Background：The preoperative neutrophil-to-lymphocyte ratio（NLR） and the platelet-to-lymphocyte ratio（PLR） are associated with poor prognosis of gastric cancer.We aimed to determine whether the combination of NLR and PLR（NLR-PLR） could better predict survival of patients after curative resection for stage Ⅰ-Ⅱ gastric cancer.Methods：We collected data from the medical records of patients with stage Ⅰ-Ⅱ gastric cancer undergoing curative resection between December 2000 and November 2012 at the Sun Yat-sen Cancer Center.The preoperative NLRPLR was calculated as follows：patients with both elevated NLR（≥2.1） and PLR（≥ 120） were given a score of 2,and patients with only one or neither were given a score of 1 or 0,respectively.Results：Kaplan-Meier analysis and log-rank tests revealed significant differences in overall survival（OS） among patients with NLR-PLR scores of 0,1 and 2（P 〈 0.001）.Multivariate analysis showed that OS was independently associated with the NLR-PLR score[hazard ratio（HR） = 1.51,95%confidence interval（CI） 1.02-2.24,P = 0.039]and TNM stage（HR = 1.36,95%CI 1.01-1.83,P= 0.041）.However,other systemic inflammation-based prognostic scores,including the modified Glasgow prognostic score,the prognostic nutritional index,and the combination of platelet count and NLR,were not.In TNM stage-stratified analysis,the prognostic significance of NLR-PLR was maintained in patients with stage Ⅰ（P 〈 0.001） and stage Ⅱ cancers（P= 0.022）.In addition,the area under the receiver operating characteristic curve for the NLR-PLR score was higher than those of other systemic inflammation-based prognostic scores（P = 0.001）.Conclusion：The preoperative NLR-PLR score is a useful predictor of postoperative survival in the patients with stage l-ll gastric cancer and may help identify high-risk patients for rational therapy and timely follow-up.