Elevated preoperative neutrophil-to-lymphocyte ratio can predict poor survival in early stage gastric cancer patients receiving radical gastrectomy: The Fujian prospective investigation of cancer (FIESTA) study

Aims: This cohort study was conducted to evaluate the prognostic impact of blood-routine parameters before radical gastrectomy on gastric cancer mortality.Methods: Total 3012 patients with gastric cancer were consecutively enrolled from a mono-center between 2000 and 2010, and the latest follow-up was completed in 2015.Results: The median follow-up time was 44.05 months.Finally, 1331 out of 3012 gastric cancer patients died from gastric cancer.Per standard deviation increment in neutrophil (hazard ratio or HR=1.08,P<0.001), white blood cell count (HR=1.07,P=0.001), neutrophil-to-lymphocyte ratio or NLR (HR=1.08,P<0.001) and platelet-to-lymphocyte ratio (HR=1.08,P<0.001) was significantly associated with an increased risk of gastric cancer mortality, while that in lymphocyte (HR=0.69,P<0.001), hemoglobin (HR=0.82,P<0.001) and lymphocyte-to-monocyte ratio (HR=0.68,P<0.001) was associated with a reduced risk.Survival tree analysis indicated that in patients with TNM stage I/II, the contrasts of NLR>2.61 with ≤2.61 and NLR>1.87 with ≤1.87 were respectively associated with a 5.21-fold (P=0.004) and 2.36-fold (P=0.001)increased risk of gastric cancer mortality.The effect-size magnitude of NLR was further potentiated in patients with invasion depth T1/T2 (HR=1.73,P=0.001), regional lymph node metastasis N0 (HR=1.60,P<0.001), TNM stage I/II (HR=1.36,P=0.009) and tumor size ≤ 4.5 cm (HR=1.17,P<0.001).Conclusions: Our findings consolidated the prognostic impact of preoperative NLR on gastric mortality, and demonstrated that elevated preoperative NLR was a robust indicator of poor survival in patients at early stage.