These conflicting

results emphasize the importance of using modern immunohistochemistry and other relevant techniques in the assessments of intratumoral neutrophils. The baseline NLR has been associated with prognosis in several studies. Yamanaka et al. evaluated prospectively a cohort of 1220 patients with advanced gastric cancer in Japan [38] and established a significant relationship between high NLR (≥2.5) and poor survival in a multivariate model. Shimada et al. evaluated a total of 1028 patients with primary gastric adenocarcinoma who underwent gastrectomy [39]. On multivariate analysis, after adjusting LGK-974 for tumor stage, a high NLR (≥4.0) was an independent risk factor for reduced survival. Jung et al. evaluated 293 patients who had undergone gastrectomy with curative intent [40]. A multivariate analysis

established a significant relationship between high NLR (≥2.0) and poor OS and between high NLR (≥3.0) and poor disease-free survival. In esophageal cancer, Sharaiha et al. performed a single-center retrospective analysis of 295 patients who underwent attempted curative esophagectomy [41]. In multivariable analyses, elevated NLR (≥5.0) was associated with significantly worse disease-free survival and OS. Recently, Selleckchem Alectinib the first study to demonstrate that the pretherapeutic NLR can be used as a predictor of the chemosensitivity to neoadjuvant chemotherapy has been published [42]. The study was a retrospective evaluation of 83 patients undergoing neoadjuvant chemotherapy of cisplatin and 5-FU followed by esophagectomy for advanced esophageal cancer. The NLR was measured before chemotherapy, and the pathologic response to chemotherapy was evaluated. A multivariate analysis revealed that elevated pretreatment NLR (≥2.2) and lymph nodes metastasis were independently associated with poor pathologic DNA ligase responses. Thus, the pathologic response

rate was 21% in patients with an NLR of ≥2.2 compared with 56% in the patients with an NLR < 2.2. The interpretation is that high baseline NLR hinder chemotherapy effect. These findings require larger, prospective, randomized studies for validation. In total, the independent prognostic role of tumor-infiltrating neutrophils is now also demonstrated in gastric cancer and should be elucidated further. Moreover, elevated preoperative NLR predicts poor prognosis following resection. It may be utilized as a simple, reliable prognostic factor for risk stratification and will provide better treatment allocation. However, it has to be mentioned that the cut-off values for NLR differed greatly between studies. It would therefore be relevant for future studies to optimize the NLR cut-off.