Neutrophil/Lymphocyte Ratio predicts resection margin status and lymphovascular invasion in patients with resectable oesophageal and gastric adenocarcinomas who received neoadjuvant FLOT.


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Danny Ulahannan1,Danny Ulahannan1,Konstantinos Kamposioras2,Jessica Tay3,George Papaxoinis4,Jeremy Hayden1,Dan Swinson1,Jonathan Wadsley3,Usman Ahmad5,Simon Brown6,Sohail Mughal6,Jo Dent7,Elizabeth Appleton7,Rajarshi Roy8,Ornella Belvedere9,Kim Last9,Mohan Hingorani1,Matt Seymour1
1Leeds Teaching Hospital,2Christie Hospital,3Weston Park cancer centre, Sheffield,4Agios Savvas Anticancer hospital, Athens, Greece,5Mid Yorkshire hospital NHS trust,6Bradford Teaching hospital,7Calderdale and Huddersfield NHS trust,8Hull University teaching hospital,9York teaching hospital



Increased neutrophil/lymphocyte ratio (NLR) has been correlated with worse outcome and survival in different malignancies. In this research, we aimed to compare the prognostic significance of NLR in patients with oesophagogastric adenocarcinoma who received neoadjuvant FLOT followed by radical resection. 



62 patients following neoadjuvant FLOT between October 2017 and February 2019 in the Yorkshire and Humber region were included in the analysis. The correlation of NLR with clinical data including clinical stage, Mandard regression grade, resection margins (R), lymphovascular invasion (LVI) was evaluated. Mann Whitney non parametric test was used to compare continuous variables.


Baseline pre-chemotherapy bloods were analysed. Median blood neutrophil levels were 5.1/nL (range, 2.1-15.0), and median lymphocyte levels 1.5/nL (range, 0.2-3.2). Median NLR was 3.4 (range, 0.8-18.5).  Median NLR levels were 2.6 (range, 1.7-18.2) in patients who achieved Mandard pathological regression grade 1-2 and 4.0 (range, 0.8-18.5) in grade 3-5 (p=0.674). Median NLR was 3.8 (range, 0.8-18.2) in patients who had R0 resection and 7.0 (range, 3.0-10.7) in those with R1 resection (p=0.012). Also, median NLR was 3.1 (range, 0.8-13.3) in patients who had tumours without LVI and median NLR was 6.8 (range, 1.9-18.2) in patients with LVI (p=0.027). Predictive accuracy (ROC AUC) of NLR for Resection margin was 0.743 (95%CI, 0.587-0.900) and for LVI was 0.719 (95%CI, 0.576-0.862).


The results suggest that the elevated pre-chemotherapy NLR predicts involved resection margins and lymphovascular invasion in patients with distal oesophageal, GOJ and gastric cancers. These preliminary results will need to be validated in a bigger cohort and correlation with survival data will follow.