Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2017; 23(47): 8376-8386
Published online Dec 21, 2017. doi: 10.3748/wjg.v23.i47.8376
Nomogram based on tumor-associated neutrophil-to-lymphocyte ratio to predict survival of patients with gastric neuroendocrine neoplasms
Long-Long Cao, Jun Lu, Jian-Xian Lin, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Qi-Yue Chen, Mi Lin, Ru-Hong Tu, Chang-Ming Huang
Long-Long Cao, Jun Lu, Jian-Xian Lin, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Qi-Yue Chen, Mi Lin, Ru-Hong Tu, Chang-Ming Huang, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Cao LL, Lu J, Lin JX and Huang CM conceived the study, analyzed the data, and drafted the manuscript; Zheng CH helped critically revise the manuscript for important intellectual content; Li P, Xie JW, Wang JB, Chen QY, Lin M and Tu RH helped collect the data and designed the study; All authors read and approved the final manuscript.
Supported by National Key Clinical Specialty Discipline Construction Program of China, No. [2012] 649.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Fujian Medical University Union Hospital.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest associated with the publication of this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Chang-Ming Huang, Professor, Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China. hcmlr2002@163.com
Telephone: +86-591-83363366 Fax: +86-591-83320319
Received: March 10, 2017
Peer-review started: March 11, 2017
First decision: May 9, 2017
Revised: June 3, 2017
Accepted: July 4, 2017
Article in press: July 4, 2017
Published online: December 21, 2017
Processing time: 285 Days and 2.9 Hours
Abstract
AIM

To assess the predictive value of the tumor-associated neutrophil-to-lymphocyte ratio in terms of the clinical outcomes of patients with gastric neuroendocrine neoplasms after radical surgery.

METHODS

Data were retrospectively collected from 142 patients who were diagnosed with gastric neuroendocrine neoplasms and who underwent radical gastrectomy at our department from March 2006 to March 2015. These data were retrospectively analyzed, and a receiver operating characteristic curve analysis was used to identify the optimal value of the tumor-associated neutrophil-to-lymphocyte ratio. Univariate and multivariate survival analyses were used to identify prognostic factors. A nomogram was then applied to predict clinical outcomes after surgery.

RESULTS

The tumor-associated neutrophil-to-lymphocyte ratio was significantly associated with tumor recurrence, especially with liver metastasis and lymph node metastasis (P < 0.05 for both), but not with clinical characteristics (P > 0.05 for all). A multivariate Cox regression analysis identified the tumor-associated neutrophil-to-lymphocyte ratio as an independent prognostic factor for recurrence-free survival and overall survival (P < 0.05 for both). The concordance index of the nomograms, which included the tumor-associated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio, was 0.788 (0.759) for recurrence-free survival (overall survival) and was higher than the concordance index of the traditional TNM staging system [0.672 (0.663)].

CONCLUSION

The tumor-associated neutrophil-to-lymphocyte ratio is an independent prognostic factor in patients with gastric neuroendocrine neoplasms. Nomograms that include the tumor-associated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio have a superior ability to predict clinical outcomes of postoperative patients.

Keywords: Gastric neuroendocrine neoplasms; Tumor-associated neutrophil-to-lymphocyte ratio; Tumor recurrence; Prognosis

Core tip: The study aimed to assess the predictive value of the tumor-associated neutrophil-to-lymphocyte ratio in terms of the clinical outcomes of 142 patients diagnosed with gastric neuroendocrine neoplasms. We demonstrated that the tumor-associated neutrophil-to-lymphocyte ratio was significantly correlated with tumor recurrence, especially with liver and lymph node metastasis. Moreover, the tumor-associated neutrophil-to-lymphocyte ratio was found to be an independent predictor of recurrence-free survival and overall survival, and combining it with the Ki-67 index and lymph node ratio could improve prognosis prediction in patients with gastric neuroendocrine neoplasms, as could applying the traditional TNM staging system.