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Background: The neutrophil-to-lymphocyte ratio (NLR) is a well-known prognostic marker for gastric cancer (GC) patients. However, for GC patients treated with palliative chemotherapy, the prognostic value of NLR remains obscure. Therefore, we evaluated the clinical impact of NLR in GC patients treated with multiple lines of chemotherapy.Methods: We retrospectively evaluated 83 unresectable GC patients who received a series of chemotherapy treatments. NLR in the blood was calculated before the initiation of each line of chemotherapy (before 1st-, 2nd-, and 3rd-line, respectively).Results: Of the 83 patients enrolled, 56 (67%) received 2nd-line chemotherapy and 34 (41%) received 3rd-line treatment. NLR at 1st-line treatment ranged from 0.72 to 48.9 (the median NLR was 3.00). Thus, we used this median NLR value (3.00) as the cut-off for NLR throughout this study. All patients were divided into a NLR-high (> 3.00) or NLR-low group (< 3.00) by NLR values determined at before each line of chemotherapy. The median overall survival (OS) of the NLR-low group was better than that of the NLR-high group throughout 1st- to 3rd-line treatment (1st-line: 18.1 vs. 8.0 months, p = 0.06; 2nd-line: 10.7 vs. 4.5 months, p = 0.0001; 3rd-line: 8.7 vs. 4.7 months, p = 0.003), respectively. Of the 34 patients who received 3rd-line chemotherapy, 24 were treated with nivolumab. Of the 24 patients treated with nivolumab, patients in the NLR-low group showed better OS compared with those in the NLR-high group (8.3 months in NLR-low and 6.6 months in NLR-high, p = 0.06).Conclusions: Estimates of NLR prior to each chemotherapy line may be readily performed in a clinical setting and are useful for predicting outcome in unresectable GC patients, including in patients treated with nivolumab. |
