Blood neutrophil-to-lymphocyte ratio is prognostic in gastrointestinal stromal tumor

Daniel R. Perez, Raymond E. Baser, Michael J. Cavnar, Vinod P. Balachandran, Cristina R. Antonescu, William D. Tap, Vivian E. Strong, Murray F. Brennan, Daniel G. Coit, Samuel Singer, Ronald P. DeMatteo

Research output: Contribution to journalArticlepeer-review

70 Scopus citations


Background: The immune system has been shown to play an important role in gastrointestinal stromal tumor (GIST). The neutrophil-to-lymphocyte ratio (NLR) in blood is an easily assessable parameter of systemic inflammatory response. The aim of this study was to determine whether the NLR is prognostic in GIST. Methods: A total of 339 previously untreated patients with primary, localized GIST operated at our institution between 1995 and 2010 were identified from a prospectively collected sarcoma database. NLR was assessed preoperatively. Patients who received adjuvant imatinib treatment were excluded from the analysis (n = 64). Cox regression models were calculated and correlation analyses were performed. Results: On univariate analysis, NLR was associated with recurrence-free survival (RFS) (P = 0.003, hazard ratio 3.3, 95 % confidence interval 1.5-7.4). Patients with a low NLR had a 1- and 5-year RFS of 98 and 91 %, compared with 89 and 76 % in those with a high NLR. The median RFS was not reached. Positive correlations were found between NLR and mitotic rate (Pearson correlation coefficient [r] = 0.15, P = 0.03), and NLR and tumor size (r = 0.36, P = 0.0001). RFS in patients with a GIST >5 cm with low NLR was significantly longer compared to patients with high NLR (P = 0.002). Flow cytometry analysis of freshly obtained GISTs revealed that neutrophils constituted a minimal percentage of intratumoral immune cells. Conclusions: NLR is a surrogate for high-risk tumor features. Elevated blood NLR appears to represent systemic inflammation in patients with high-risk GIST.

Original languageEnglish
Pages (from-to)593-599
Number of pages7
JournalAnnals of Surgical Oncology
Issue number2
StatePublished - Feb 2013

Bibliographical note

Funding Information:
ACKNOWLEDGMENT Supported in part by NIH Grant CA102613, the Geoffrey Beene Cancer Research Center, J. H. L. Pit and Mrs. Pit-van Karnebeek, and the Dutch GIST Foundation, GIST Cancer Research Fund, and Swim Across America (RPD).

ASJC Scopus subject areas

  • Surgery
  • Oncology


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