Preoperative NLR for predicting survival rate after radical resection combined with adjuvant immunotherapy with CIK and postoperative chemotherapy in gastric cancer.

PURPOSE: The purpose of this study is to determine the efficacy of adjuvant immunotherapy with autologous cytokine-induced killer (CIK) for postoperative patients with gastric cancer and to investigate the impacts of the predictors on the efficacy of CIK immunotherapy.

PATIENTS AND METHODS: Ninety-two gastric cancer patients who have accepted radical resection were enrolled. The CIK and control groups were established by 1:1 matching on their baseline. As prognosis indicators, preoperative blood cell counts, the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were analyzed, respectively. Statistical analyses were done using IBM SPSS Statistics ver.19.0.

RESULTS: CIK treatment significantly prolonged disease-free survival (DFS) (p < 0.05) and there was a tendency of longer overall survival (OS) in the CIK group (p = 0.057). Preoperative NLR was an independent prognostic factor for DFS (p < 0.05). When patients were classified into low and high NLR groups using the cutoff value of 2.995, patients in the low NLR group had a better DFS (p < 0.05). Subset analysis showed that CIK immunotherapy significantly prolonged the DFS in the low NLR group (p = 0.017) but not in the high NLR group (p = 0.695) except that it did well clearly within 17 months. Compared to the low NLR group, lymphocyte decreased significantly, neutrophil increased steeply and white blood cell (WBC) elevated subsequently (p < 0.001in all cases) in the high NLR group.

CONCLUSION: Adjuvant immunotherapy with the CIK cells prolongs DFS in postoperative patients with gastric cancer and the preoperative NLR is an independent prognostic factor for DFS. Low NLR predicts significant benefits from the CIK immunotherapy while high NLR forebodes the requirement of more cycles of CIK treatment or other stronger immunotherapy to improve the survival rate of patients.