266P - Elevation of neutrophil-to-lymphocyte ratio before first-line chemotherapy predicts a poor prognosis of second line chemotherapy in gastric cancer

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Anticancer Agents
Gastric Cancer
Presenter Dai Inoue
Citation Annals of Oncology (2016) 27 (suppl_9): ix68-ix85. 10.1093/annonc/mdw582
Authors D. Inoue1, A. Nakazono1, F. Hatao2, K. Imamura2, S. Namiki1
  • 1Depaetment Of Gastroenterology, Tokyo Metropolitan Tama Medical Center, 183-8524 - Tokyo/JP
  • 2Department Of Surgery, Tokyo Metropolitan Tama Medical Center, 183-8524 - Tokyo/JP



Previous studies have shown a high-level of evidence which supports the use of second-line chemotherapy in patients with gastric cancer, but not enough prognostic factors have been established. Recent studies suggested that the neutrophil-to-lymphocyte ratio (NLR) was closely associated with cancer patient prognosis. The aim of our study is to examine the prognostic value of NLR in patients with gastric cancer, especially focusing on the relationship between NLR and the efficacy of second-line chemotherapy.


This is a retrospective study, and the clinicopathological findings before the initiation of chemotherapy were analyzed. Selection criteria was as follows; patients who 1) received paclitaxel or irinotecan as a second-line chemotherapy in our hospital between January 2010 and June 2015, 2) had histologically confirmed unresectable gastric adenocarcinoma, 3) followed- up until death or for 180 days or longer. The primary endpoint was overall survival of second-line chemotherapy. NLR level of 3.0 was selected as cut-off value for validation. Kaplan-Meier survival plots were generated based on NLR level and the curves compared by using the log-rank test. The relationship between each baseline variable and long-term survival was investigated by univariate and multivariate Cox regression analyses.


There were 86 patients who met the selection criteria. In second line chemotherapy, the median OS was 9.9 months (95% CI, 6.0-13.8) in normal NLR patients as compared with 5.5 months (95% CI, 5.0-5.9) in elevated NLR patients (P = 0.002). On the other hand, there were no statistically significant difference in first line, the median OS was 18.9 months (95% CI, 15.1-22.8) in normal NLR patients as compared with 14.6 months (95% CI, 11.2-18.0) in elevated NLR patients (P = 0.157). The univariate and multivariate Cox regression analysis revealed that NLR was an independent predictive marker for second-line chemotherapy.


The second-line chemotherapy may not be benefit if elevation of NLR was seen before the initiation of the first-line chemotherapy in patients with advanced gastric cancer.

Clinical trial indentification

Legal entity responsible for the study

Tokyo Metropolitan Tama Medical Center


Tokyo Metropolitan Tama Medical Center


All authors have declared no conflicts of interest.