The neutrophil-lymphocyte ratio (NLR) and the prognostic nutritional index (PNI) are markers of systemic inflammation known to be useful prognostic indicators in the malignancy. However, no direct evidence has yet defined the influence of inflammation on the tumor microenvironment.
A total of 288 patients who underwent curative surgery for gastric cancer were included. Preoperative peripheral blood samples were used to analyze NLR and PNI. The optimal cut-off levels for NLR and PNI were defined using receiver operating characteristic curve analysis for survival (NLR = 2.7, PNI = 47.7). The densities of specific immune cells [CD3(+), CD4(+), CD8(+)] within the tumor microenvironment were measured in tumor microarrays by immunohistochemical analysis.
There were 235 patients (81.6%) in low NLR and 53 patients (18.4%) in high NLR. Low PNI was identified in 117 patients (40.6%) and high PNI is in 171 patients (59.4%). CD3(+) and CD8(+) immune cell density were not associated with NLR and PNI. However, in high NLR group, CD4(+) immune cell density was significantly decreased compared to low NLR group (P
In summary, NLR and PNI are associated with the density of CD4(+) immune cells in the tumor microenvironment, which leads to its prognostic values of systemic inflammation in gastric cancer.
Clinical trial identification
It is not clinical trial
Legal entity responsible for the study
Jin Won Kim
Seoul National University Bundang Hospital
All authors have declared no conflicts of interest.