T Grenader1, T Waddell2, C Peckitt3, J Oates2, N Starling2, D Cunningham2, J Bridgewater4. 1. Oncology Institute, Shaare Zedek Medical Centre, Jerusalem, Israel. 2. Section of GI and Lymphoma Units, Department of Medicine, The Royal Marsden Hospital, London. 3. Clinical Research and Development, The Royal Marsden NHS Foundation Trust, London. 4. Department of Oncology, UCL Cancer Institute, London, UK j.bridgewater@ucl.ac.uk.
Abstract
BACKGROUND: The REAL-2 trial demonstrated that capecitabine and oxaliplatin were effective alternatives to fluorouracil and cisplatin, respectively, when used in triplet chemotherapy regimens for previously untreated oesophago-gastric cancer. The aim of the current analysis was to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in the REAL-2 cohort. MATERIAL AND METHODS: A post hoc exploratory analysis was carried out on REAL-2 patients with the available absolute neutrophil count and absolute lymphocyte count. A high NLR was defined using a cut-off value of >3.0. The NLR was then correlated with clinical outcomes including overall survival (OS), progression-free survival (PFS) and objective response rate. Survival curves were generated using the Kaplan-Meier method and comparison between groups was carried out using Cox regression. RESULTS: Data were available in 908 of the 1002 REAL-2 participants. Of these, 516 (56.8%) were deemed to have a high NLR. In univariate analysis, high NLR was associated with a hazard ratio (HR) for OS of 1.73 (1.50-2.00), P < 0.001, compared with low NLR, equating to median OS values of 9.1 [95% confidence interval (CI) 8.0-9.6] and 12.7 months (95% CI 10.8-14.4), respectively. The NLR remained highly significant for OS (P < 0.001) in a multivariate model including performance status, age, disease extent, presence of liver metastases and presence of peritoneal metastases. For PFS, high NLR was associated with an HR of 1.63 (1.41-1.87), P < 0.001, compared with low NLR in univariate analysis. No significant interaction was found between NLR status and treatment arm, 13% of all patients with low NLR achieving survival beyond 24 months compared with only 6% of patients with high NLR (P < 0.001). CONCLUSION: Our results confirm that high NLR status had a significant negative prognostic effect in the REAL-2 trial population. Based on the multivariate analysis, this effect was independent of other known prognostic factors.
RCT Entities:
BACKGROUND: The REAL-2 trial demonstrated that capecitabine and oxaliplatin were effective alternatives to fluorouracil and cisplatin, respectively, when used in triplet chemotherapy regimens for previously untreated oesophago-gastric cancer. The aim of the current analysis was to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in the REAL-2 cohort. MATERIAL AND METHODS: A post hoc exploratory analysis was carried out on REAL-2 patients with the available absolute neutrophil count and absolute lymphocyte count. A high NLR was defined using a cut-off value of >3.0. The NLR was then correlated with clinical outcomes including overall survival (OS), progression-free survival (PFS) and objective response rate. Survival curves were generated using the Kaplan-Meier method and comparison between groups was carried out using Cox regression. RESULTS: Data were available in 908 of the 1002 REAL-2 participants. Of these, 516 (56.8%) were deemed to have a high NLR. In univariate analysis, high NLR was associated with a hazard ratio (HR) for OS of 1.73 (1.50-2.00), P < 0.001, compared with low NLR, equating to median OS values of 9.1 [95% confidence interval (CI) 8.0-9.6] and 12.7 months (95% CI 10.8-14.4), respectively. The NLR remained highly significant for OS (P < 0.001) in a multivariate model including performance status, age, disease extent, presence of liver metastases and presence of peritoneal metastases. For PFS, high NLR was associated with an HR of 1.63 (1.41-1.87), P < 0.001, compared with low NLR in univariate analysis. No significant interaction was found between NLR status and treatment arm, 13% of all patients with low NLR achieving survival beyond 24 months compared with only 6% of patients with high NLR (P < 0.001). CONCLUSION: Our results confirm that high NLR status had a significant negative prognostic effect in the REAL-2 trial population. Based on the multivariate analysis, this effect was independent of other known prognostic factors.
Authors: Alicia-Marie Conway; Zena Salih; George Papaxoinis; Kimberly Fletcher; Jamie Weaver; Ana Patrao; Robert Noble; Sofia Stamatopoulou; Vikki Owen-Holt; Wasat Mansoor Journal: Med Oncol Date: 2017-05-12 Impact factor: 3.064
Authors: Emil Ter Veer; L Bengt van Rijssen; Marc G Besselink; Rosa M A Mali; Jordan D Berlin; Stefan Boeck; Franck Bonnetain; Ian Chau; Thierry Conroy; Eric Van Cutsem; Gael Deplanque; Helmut Friess; Bengt Glimelius; David Goldstein; Richard Herrmann; Roberto Labianca; Jean-Luc Van Laethem; Teresa Macarulla; Jonathan H M van der Meer; John P Neoptolemos; Takuji Okusaka; Eileen M O'Reilly; Uwe Pelzer; Philip A Philip; Marcel J van der Poel; Michele Reni; Werner Scheithauer; Jens T Siveke; Chris Verslype; Olivier R Busch; Johanna W Wilmink; Martijn G H van Oijen; Hanneke W M van Laarhoven Journal: Lancet Oncol Date: 2018-03 Impact factor: 41.316