THE RELATIONSHIP BETWEEN PERIPHERAL BLOOD COUNT AND PROGNOSIS IN PATIENTS WITH GASTRIC CANCER

Abstract

Objective: Like in many types of cancer, predicting the course of the illness at the moment of diagnosis has an important place in determining the treatment strategy. Recently, there have been a great number of studies which indicate that there may be a relationship between total blood count parameters and cancers in terms of prognosis. In our study, we assessed the relationship between survival and the patients’ neutrophil-lymphocyte ratio (NLR), thrombocyte-lymphocyte ratio (PLR) and red blood distribution width (RDW) values at the moment of diagnosis. Material and Method: Patients (n=201) of gastric cancer who were recently diagnosed at Ondokuz Mayıs University, Faculty of Medicine, Medical Oncology clinic between the dates January 2006 and September 2014 and who were treated and followed up at our center were included in the study. They were divided into two groups as Group A (n=122) consisting of stage 1-2-3 patients and Group B (n=79) consisting of stage 4 patients. The relationship of survival between NLR, PLR and RDW and the groups was assessed with life analysis. For these parameters, cut-off values were found by using ROC analysis. Results: When the relationship between the parameters and the survival of the patients with gastric cancer was examined, it was statistically shown that with the increase in NLR, longevity significantly decreased and thus prognosis became worse (p<0.05). No significant relationship was found between PLR and RDW and the patients’ sruvival. Conclusion: There is a statistical relationship between NLR at the moment of diagnosis in gastric cancer and prognosis and survival. Rates of survival decrease as this rate increases and the prognosis becomes worse.

Keywords

• Gastric cancer,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,red cell distribution width

MİDE KANSERİ HASTALARINDA PERİFERİK KAN SAYIMI İLE PROGNOZ ARASINDAKİ İLİŞKİ

Abstract

Amaç: Birçok kanserde olduğu gibi mide kanserinde de hastalığın seyrini tanı anında öngörmek tedavi stratejisini belirlemede önemli yer tutmaktadır. Son yıllarda tam kan sayımı parametreleriyle kanserler arasında prognoz açısından ilişki olabileceği konusunda birçok çalışma yapılmıştır. Çalışmamızda hastaların tanı anındaki nötrofil-lenfosit oranı (NLR), trombosit-lenfosit oranı (PLR) ve eritrosit dağılım aralığı (RDW) değerlerinin sağkalım ile olan ilişkisini değerlendirdik. Gereç ve Yöntem: Çalışmaya Ondokuz Mayıs Üniversitesi Tıp Fakültesi Tıbbı Onkoloji kliniğinde Ocak 2006 ile Eylül 2014 tarihleri arasında yeni tanı almış, tedavi ve takipleri merkezimizde yapılan mide kanseri hastaları dahil edildi. Çalışmaya 201 hasta alınmış olup, evre 1-2-3 olanlar Grup A (n=122) ve evre 4 olanlar Grup B (n=79) olmak üzere 2 gruba ayrıldı. Gruplar ile NLR, PLR ve RDW arasındaki sağ kalım ilişkisi yaşam analizi ile değerlendirildi. Bu parametreler için ROC analizi kullanılarak cut-off değerleri bulundu. Bulgular: Çalışmada bahsedilen parametreler ile mide kanseri hastalarının sağkalımları arasındaki ilişki incelendiğinde; NLR’nin artmasıyla yaşam sürelerinin anlamlı ölçüde kısaldığı ve dolayısıyla prognozun daha kötü olduğu istatistiksel olarak gösterildi (p<0,05). PLR ve RDW ile hastaların sağkalımları arasında anlamlı ilişki yoktu. Sonuç: Mide kanserinde tanı anındaki NLR ile prognoz ve sağkalım arasında istatistiksel olarak ilişki olup, bu oran arttıkça sağkalım oranları azalmakta ve prognoz daha kötü olmaktadır.

Keywords

• Mide kanseri,nötrofil-lenfosit oranı,trombosit-lenfosit oranı,eritrosit dağılım aralığı

References

1. 1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359-86.
2. 2. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet 2001;357(9255):539-545.
3. 3. Ikeda M, Furukawa H, Imamura H, Shimizu J, Ishida H, Masutani S, et al. Poor prognosis associated with thrombocytosis in patients with gastric cancer. Ann Surg Oncol 2002;9(3):287-91.
4. 4. An X, Ding PR, Li YH, Wang FH, Shi YX, Wang ZQ, et al. Elevated neutrophil to lymphocyte ratio predicts survival in advanced pancreatic cancer. Biomarkers 2010;15(6):516-22.
5. 5. Cihan YB, Ozturk A, Mutlu H. Relationship between prognosis and neutrophil: lymphocyte and platelet: lymphocyte ratios in patients with malignant pleural mesotheliomas. Asian Pac J Cancer Prev 2014;15(5):2061-7.
6. 6. Baron JA, Sandler RS. Nonsteroidal anti-inflammatory drugs and cancer prevention. Annu Rev Med 2000;51(1):511-23.
7. 7. García-Rodríguez LA, Huerta-Alvarez C. Reduced risk of colorectal cancer among long-term users of aspirin and nonaspirin nonsteroidal antiinflammatory drugs. Epidemiology 2001;12(1):88-93.
8. 8. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol 2010; 6(1):149-63.

9. 9. Cho H, Hur HW, Kim SW, Kim SH, Kim JH, Kim YT, et al. Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 2009;58(1):15-23.
10. 10. Blake-Mortimer JS, Sephton SE, Carlson RW, Stites D, Spiegel D. Cytotoxic T lymphocyte count and survival time in women with metastatic breast cancer. Breast J 2004;10(3):195-9.
11. 11. Fumagalli LA, Vinke J, Hoff W, Ypma E, Brivio F, Nespoli A. Lymphocyte counts independently predict overall survival in advanced cancer patients: a biomarker for IL-2 immunotherapy. J Immunother 2003;26(5):394-402.
12. 12. Bruckner HW, Lavin PT, Plaxe SC, Storch JA, Livstone EM. Absolute granulocyte, lymphocyte, and monocyte counts: useful determinants of prognosis for patients with metastatic cancer of the stomach. JAMA 1982;247(7):10046.
13. 13. Di Carlo E, Forni G, Musiani P. Neutrophils in the antitumoral immune response. Chem Immunol Allergy 2003;83:182-203.
14. 14. McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care 2009;12.3:223-6.
15. 15. Kemal Y, Yucel I, Ekiz K, Demirag G, Yilmaz B, Teker F, et al. Elevated serum neutrophil to lymphocyte and platelet to lymphocyte ratios could be useful in lung cancer diagnosis. Asian Pac J Cancer Prev 2014;15(6):2651-4.
16. 16. Lee S, Oh SY, Kim SH, Lee JH, Kim MC, Kim KH, et al. Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer 2013;13(1):350.
17. 17. Kim EY, Lee JW, Yoo HM, Park CH, Song KY. The plateletto-lymphocyte ratio versus neutrophil-to-lymphocyte ratio: which is better as a prognostic factor in gastric cancer? Ann Surg Oncol 2015;22(13):4363-70.
18. 18. Benoy I, Salgado R, Colpaert C, Weytjens R, Vermeulen PB, Dirix LY. Serum interleukin 6, plasma VEGF, serum VEGF, and VEGF platelet load in breast cancer patients. Clin Breast Cancer 2002;2(4):311-5.
19. 19. Shariat SF, Andrews B, Kattan MW, Kim J, Wheeler TM, Slawin KM. Plasma levels of interleukin-6 and its soluble receptor are associated with prostate cancer progression and metastasis. Urology 2001;58(6):1008-15.
20. 20. Wu CW, Wang SR, Chao MF, Wu TC, Lui WY, P’eng FK, et al. Serum interleukin-6 levels reflect disease status of gastric cancer. Am J Gastroenterol 1996;91(7):1417-22. 21. Hsu HC, Lee YM, Tsai WH, Jiang ML, Ho CH, Ho CK, et al. Circulating levels of thrombopoietic and inflammatory cytokines in patients with acute myeloblastic leukemia and myelodysplastic syndrome. Oncology 2002;63(1):64-9.
21. 22. Folman CC, Ooms M, Kuenen B, de Jong SM, Vet RJ, de Haas M, et al. The role of thrombopoietin in post-operative thrombocytosis. Br J Haematol 2001;114(1):126-33.
22. 23. Kim EY, Lee JW, Yoo HM, Park CH, Song KY. The plateletto-lymphocyte ratio versus neutrophil-to-lymphocyte ratio: which is better as a prognostic factor in gastric cancer? Ann Surg Oncol 2015;22(13):4363-4370.
23. 24. Jiang N, Deng JY, Liu Y, Ke B, Liu HG, Liang H. The role of preoperative neutrophil-lymphocyte and plateletlymphocyte ratio in patients after radical resection for gastric cancer. Biomarkers 2014;19(6):444-51.
24. 25. Ay S, Eryilmaz MA, Aksoy N, Okus A, Unlu Y, Sevinc B. Is early detection of colon cancer possible with red blood cell distribution width? Asian Pac J Cancer Prev 2014;16(2):753756.
25. 26. Kemal Y, Demirag G, Baş B, Önem S, Teker F, Yücel İ. The value of red blood cell distribution width in endometrial cancer. Clin Chem Lab Med 2015; 53(5), 823-7.