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Monocyte to lymphocyte ratio predicts survival in patients with advanced gastric cancer undergoing neoadjuvant chemotherapy

Authors Chen L, Hao Y, Zhu LH, Li S, Zuo YJ, Zhang YX, Song HJ, Xue YW

Received 21 April 2017

Accepted for publication 22 June 2017

Published 10 August 2017 Volume 2017:10 Pages 4007—4016


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Dr Ingrid Espinoza

Li Chen,1,* Ying Hao,2,* Lihua Zhu,3 Sen Li,1 Yanjiao Zuo,1 Yuxin Zhang,4 Hongjiang Song,1 Yingwei Xue1

1Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang, China; 2Department of Internal Oncology, Harbin The First Hospital, Harbin, Heilongjiang, China; 3Department of Pathogen Biology, School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, Hebei, China; 4Department of General Surgery, Mudanjiang First People’s Hospital, Mudanjiang, Heilongjiang, China

*These authors contributed equally to this work

Background: Currently, precise predictors in gastric cancer patients undergoing neoadjuvant chemotherapy are lacking. The study aims to investigate the prognostic value of the monocyte to lymphocyte ratio (MLR) in patients with advanced gastric cancer receiving S-1 plus oxaliplatin (SOX) or oxaliplatin and capecitabine (XELOX) neoadjuvant chemotherapy regimen.
Methods: The data from Harbin Medical University Cancer Hospital from August 2008 to September 2015 were retrospectively collected. Ninety-one patients with advanced gastric cancer treated with neoadjuvant chemotherapy were included. The blood samples were collected before neoadjuvant chemotherapy. The MLR was divided into two groups: Low-MLR <0.27 group and high-MLR ≥0.27 group. Survival curves were performed using the Kaplan–Meier method and compared using the log-rank test. Univariate and multivariate Cox proportional hazards regression model were evaluated to determine independent prognostic factors.
Results: The univariate analysis showed that median disease free survival (DFS) and overall survival (OS) for all patients were better in low-MLR value group than high-MLR value group (median DFS 26.80 and 23.73 months, P=0.653, respectively; median OS 27.93 and 26.87 months, P=0.807, respectively). Multivariate analysis showed that MLR level was not an independent prognostic factor of DFS and OS. Nevertheless, median DFS and OS for all patients were better for patients with low monocyte values compared to those with high monocyte values (median DFS 30.23 and 21.03 months, P=0.645, respectively; median OS 37.97 and 25.83 months, P=0.509, respectively); in patients with high lymphocyte values compared with low lymphocyte values median DFS was 26.87 and 21.03 months, (P=0.624) respectively; median OS was 27.93 and 26.37 months, (P=0.584) respectively. However, the patients with low level MLR had better 5-year DFS and OS rates.
Conclusion: MLR may be used as a convenient and cheap prognostic marker in patients with advanced gastric cancer undergoing neoadjuvant chemotherapy with SOX or XELOX. Low level MLR as a prognostic marker may help doctors in terms of efficient measures to treat gastric cancer.

Keywords: neoadjuvant chemotherapy, advanced gastric cancer, monocyte to lymphocyte ratio (MLR), disease free survival, overall survival

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