The pre-operative neutrophil-lymphocyte ratio predicts overall and disease-free survival following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with pseudomxyoma peritonei of appendiceal origin

Int J Hyperthermia. 2018 Aug;34(5):559-563. doi: 10.1080/02656736.2017.1384073. Epub 2017 Oct 24.


Aim: The neutrophil-lymphocyte ratio (NLR) and other inflammation-based scores have been used as a prognostic tool to predict survival in solid tumours including pseudomyxoma peritonei (PMP). The aim was to evaluate the prognostic value of this marker and risk stratify PMP patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods: Retrospective analysis was conducted of a prospectively collected database of patients with PMP who underwent CRS and HIPEC between 1994 and 2015. The NLR was calculated by dividing the pre-operative neutrophil count by lymphocyte count. Predicted overall survival (OS) and disease-free interval (DFI) were calculated using a Kaplan-Meier survival model.

Results: The study included 699 patients, stratified into four groups as defined by their NLR. Group A: 200 (28.6%) patients (NLR = 0.10-2.00), Group B: 160 (22.8%) patients (NLR = 2.10-2.78), Group C: 184 (26.3%) patients (NLR = 2.79-4.31) and Group D: 155 (22.2%) patients (NLR ≥ 4.32). The median follow-up for this cohort was 36 months. The predicted DFI was 132.2, 113.1, 84.4 and 47.9 months and the OS was 141.1, 117.6, 88.7 and 51.2 months for Groups A, B, C and D, respectively. As the NLR increases, there is a reduction in long-term survival.

Conclusion: The pre-operative NLR is cost effective and has equivalent prognostic value to pre-operative tumour markers for patients with PMP treated with CRS and HIPEC. The NLR is a reliable tool that may have a role in predicting outcomes following CRS and HIPEC for patients with PMP of appendiceal origin.

Keywords: Appendix; lymphocyte; neutrophil; pseudomyxoma; ratio; survival.

MeSH terms

  • Aged
  • Appendiceal Neoplasms / drug therapy*
  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / surgery*
  • Cytoreduction Surgical Procedures / methods*
  • Disease-Free Survival
  • Female
  • Humans
  • Hyperthermia, Induced / methods*
  • Lymphocytes / metabolism*
  • Male
  • Middle Aged
  • Neutrophils / metabolism*
  • Prognosis
  • Pseudomyxoma Peritonei / drug therapy*
  • Pseudomyxoma Peritonei / mortality
  • Pseudomyxoma Peritonei / pathology
  • Pseudomyxoma Peritonei / surgery*
  • Survival Analysis
  • Treatment Outcome