Zhao YZ, Han JQ, Zhao XR, Wang ZY, He KY, Duan YS, Lu HX. Predictive value of neutrophil-to-lymphocyte ratio combined with carcinoembryonic antigen in postoperative adjuvant chemotherapy after gastric cancer surgery. World J Gastrointest Oncol 2025; 17(7): 107399 [DOI: 10.4251/wjgo.v17.i7.107399]
Corresponding Author of This Article
Hong-Xia Lu, Chief Physician, Full Professor, Head, Department of Gastroenterology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, No. 3 Zhigong New Street, Xinghualing District, Taiyuan 030013, Shanxi Province, China. luhongxia@sxmu.edu.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jul 15, 2025; 17(7): 107399 Published online Jul 15, 2025. doi: 10.4251/wjgo.v17.i7.107399
Predictive value of neutrophil-to-lymphocyte ratio combined with carcinoembryonic antigen in postoperative adjuvant chemotherapy after gastric cancer surgery
Yuan-Zheng Zhao, Jia-Qi Han, Kai-Yu He, Department of Clinical Medicine, Fenyang College Shanxi Medical University, Lüliang 030500, Shanxi Province, China
Xin-Ran Zhao, Department of Optometry and Ophthalmology, Fenyang College Shanxi Medical University, Lüliang 030500, Shanxi Province, China
Zi-Yuan Wang, Department of Medical Laboratory, Fenyang College Shanxi Medical University, Lüliang 030500, Shanxi Province, China
Yong-Sheng Duan, Department of Medical Imaging, Fenyang College Shanxi Medical University, Lüliang 030500, Shanxi Province, China
Hong-Xia Lu, Department of Gastroenterology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, Shanxi Province, China
Author contributions: Lu HX provided research ideas and resources; Zhao YZ collected data and wrote the article and completed the visualization of the research; Han JQ, Zhao XR, Wang ZY, He KY, and Duan YS collected data. All authors have read and approve the final manuscript.
Institutional review board statement: The research was examined and approved by the Ethics Committee of Shanxi Cancer Hospital (Ethics number: KY 2024131).
Informed consent statement: Due to the retrospective observational nature of this study, there was no intervention in the patient's diagnosis and treatment process. Therefore, the Ethics Committee of Shanxi Province approved the waiver of the formal consent that patients provided prior to hospitalization.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All data from this study can be obtained by email from the corresponding author or first author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Xia Lu, Chief Physician, Full Professor, Head, Department of Gastroenterology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, No. 3 Zhigong New Street, Xinghualing District, Taiyuan 030013, Shanxi Province, China. luhongxia@sxmu.edu.cn
Received: March 23, 2025 Revised: April 22, 2025 Accepted: June 12, 2025 Published online: July 15, 2025 Processing time: 114 Days and 3.4 Hours
Abstract
BACKGROUND
Gastric cancer (GC) is an aggressive malignancy of the gastrointestinal tract characterized by high recurrence rates following radical gastrectomy. To enhance treatment efficacy, reduce recurrence, and improve patient survival, adjuvant chemotherapy is commonly administered based on established postoperative guidelines. Despite advancements in chemotherapy delivery, the overall response rate remains below 50%, primarily due to the lack of targeted therapies tailored to specific patient populations.
AIM
To explore sensitive biomarkers to assess the efficacy of postoperative adjuvant chemotherapy in appropriate patient subgroups.
METHODS
This study retrospectively analyzed 1628 patients who underwent radical gastrectomy for GC at our hospital in 2017 and 2018, with a subsequent five-year follow-up. Patients were divided based on whether they received postoperative adjuvant chemotherapy. The study aimed to determine optimal cutoff values for various biomarkers-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 199, CA724, and CA242-using receiver operating characteristic (ROC) curves. Based on the optimal ROC cut-off, a novel combined metric, NLR-CEA, was developed to assess the efficacy of adjuvant chemotherapy following GC surgery.
RESULTS
Cox subgroup analysis demonstrated that postoperative adjuvant chemotherapy significantly improved overall survival in the NLR-CEA_Low group with a rate of 0.41 (0.26-0.63). In the NLR-CEA_Middle group, the protective effect was observed at 0.69 (0.54-0.87), while in the NLR-CEA_High group, it was 0.73 (0.53-0.99). Notably, a 32% difference in the efficacy of chemotherapy was observed between the NLR-CEA_Low and NLR-CEA_High groups.
CONCLUSION
NLR-CEA is an effective biomarker for evaluating the efficacy of postoperative adjuvant chemotherapy in GC. Patients with NLR-CEA_Low exhibit significantly better responses to chemotherapy compared to those with NLR-CEA_High.
Core Tip: This investigation conducted a retrospective analysis on a cohort of gastric cancer patients, revealing a 32% disparity in therapeutic efficacy of postoperative adjuvant chemotherapy across distinct neutrophil-to-lymphocyte ratio (NLR)-carcinoembryonic antigen (CEA) stratification groups. Utilizing a stratified approach based on adjuvant chemotherapy administration status, we performed covariate-adjusted Cox proportional hazards regression analyses to evaluate comparative therapeutic outcomes among NLR-based, CEA-based, and combined NLR-CEA stratification models. The findings demonstrate significantly greater differential therapeutic benefits in the combined NLR-CEA stratification group compared to isolated NLR or CEA parameter stratification, suggesting synergistic prognostic value of this composite biomarker approach.
