627P - Predictive value of the neutrophil lymphocyte ratio in peritoneal and/or metastatic disease at staging laparoscopy for gastric and oesophageal aden...

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Oesophageal Cancer
Gastric Cancer
Staging Procedures (clinical staging)
Translational Research
Basic Principles in the Management and Treatment (of cancer)
Presenter Tal Grenader
Citation Annals of Oncology (2014) 25 (suppl_4): iv210-iv253. 10.1093/annonc/mdu334
Authors T. Grenader1, Y. Plotkin2, B. Mohammadi3, K. Dawas4, M. Hashemi4, M. Mughal4, J.A. Bridgewater5
  • 1Cancer Institute, University College London, WC1E 6AA - London/GB
  • 2Internal Medicine, Hadassah University Hospital, Jerusalem/IL
  • 3Upper Gi Services, University College Hospital, London/GB
  • 4Upper Gi Services, University College London, London/GB
  • 5Medical Oncology, UCL Cancer Institute, University College London, UK WC1E 6DD - LONDON/GB



Despite advances in imaging techniques, the accuracy of preoperative radiological staging for potentially operable oesophagogastric cancer is poor; peritoneal and/or metastatic disease have been identified by staging laparoscopy in up to 50% of patients with a negative preoperative imaging. Neutrophil to lymphocyte ratio (NLR) has been recently shown as a prognostic factor in gastric and esophageal cancers. The aim of the current retrospective analysis was to evaluate the association between NLR and the presence of peritoneal or metastatic involvement on staging laparoscopy.


We retrospectively reviewed the medical records of patients with early gastric and lower esophagus adenocarcinoma that were referred for staging laparoscopy to multidisciplinary team in the last two years in University College Hospital, London. Clinical and pathologic data were collected. Complete blood count was performed preceding staging laparoscopy. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count; a high NLR was defined ≥3.28, based on a receiver-operating characteristics (ROC) curve analysis. We evaluated the predictive power of a high NLR for a positive staging laparoscopy.


117 patients were available for analysis. The median age was 66.7 years; 87 (74.4%) were male. 44% of the tumors were located at the GOJ, 18% were oesophageal and 38% were gastric. Most of the tumors were grade III (78%), the rest were grade II (22%). All patients performed a staging laparoscopy, 25 (21.4%) of them were found to have peritoneal or metastatic disease. The NLR ranged from 0.85 to 7.04, with a mean value of 2.7. NLR ≥3.28 was an independent predicting factor for the discovery of peritoneal and/or metastatic disease on staging laparoscopy (OR 3.9, 95%CI: 1.54 – 9.86, p = 0.005). The median value of NLR was significantly higher in patients for whom the laparoscopy had discovered peritoneal or metastatic disease, than in those it had not (3.3 vs. 2.2, p = 0.011).


Our findings suggest that the NLR may be reliable for predicting the presence of peritoneal or metastatic involvement on staging laparoscopy, in patients with early gastric cancer or lower oesophageal cancer and may contribute to the standard pre-operative work-up.


All authors have declared no conflicts of interest.