You are here

Prognostic value of neutrophil to lymphocyte ratio in advanced oesophago-gastric cancer: exploratory analysis of the REAL-2 trial

Grenader T, Waddell T, Peckitt C, Oates J, Starling N, Cunningham D, Bridgewater J.

Ann Oncol. 2016 Jan 19 [Epub ahead of print]



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 neutrophil to lymphocyte ratio (NLR) in the REAL-2 cohort.


A post-hoc exploratory analysis was performed on REAL-2 patients with available absolute neutrophil count and absolute lymphocyte count. A high NLR, defined using a cut-off value of >3.0. NLR, was then correlated with clinical outcomes including overall survival (OS), progression-free survival (PFS) and objective response rate (ORR). Survival curves were generated using the Kaplan-Meier method and comparison between groups was performed using cox regression.


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 for OS of 1.73 (1.50 - 2.00), p<0.001, compared to low NLR, equating to median OS values of 9.1 (95% CI 8.0 to 9.6) and 12.7 months (95% CI 10.8 to 14.4) respectively. NLR remained highly significant for OS (p<0.001) in a multi-variate model including PS, age, disease extent, presence of liver metastases, and presence of peritoneal metastases.For PFS, high NLR was associated with a hazard ratio of 1.63 (1.41 - 1.87), p<0.001, compared to 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 to only 6% of patients with high NLR (p<0.001).


Our results confirm that high NLR status had a significant negative prognostic effect in the REAL-2 trial population. Based on the multi-variate analysis, this effect was independent of other known prognostic factors.

©PubMed Central

Search this site

Search form

ECCO2017 symposium webcast: Treatment evolution in advanced GI malignancies

Welcome and introduction - Florian Lordick


Subscribe to our E-Alert to keep up to date with the new items in the Resource Centre

Featured Content

New Book Content

This online Resource Centre has been sponsored by Lilly Oncology

Note that Lilly Oncology has no editorial control over the content of this Resource Centre. The Resource Centre and all content therein has been subject to an independent editorial review.