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Marques AM, Petrucci G, Gregório H, Lobo L, Henriques J, Figueira AC, Vilhena H, Marrinhas C, Queiroga FL. Diagnostic and Prognostic Value of Blood Ratios in Canine Splenic Hemangiosarcoma: A Multicentric Observational Study. Vet Sci 2025; 12:346. [PMID: 40284848 PMCID: PMC12031375 DOI: 10.3390/vetsci12040346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Revised: 03/21/2025] [Accepted: 04/06/2025] [Indexed: 04/29/2025] Open
Abstract
Peripheral complete blood cell count (CBC) and blood ratios, including neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-red blood cell ratio (NRR), and platelet-to-lymphocyte ratio (PLR), have been used in the diagnosis and prognosis of several cancers; however, their relevance in canine splenic hemangiosarcoma (HSA) remains to be investigated. This study investigated whether CBC, NLR, NRR, and PLR could be diagnostic and prognostic biomarkers in dogs with splenic HSA. Analyzing medical records of 154 dogs undergoing splenectomy from 2018 to 2022, we found that dogs diagnosed with splenic HSA (n = 63) had significantly higher neutrophil counts (14.9 ± 9.7 vs. 12.6 ± 9.6; p < 0.001), increased NRR (3.7 ± 2.6 vs. 2.7 ± 3.7; p < 0.001), lower platelet counts (145 ± 111 vs. 270 ± 213; p < 0.001), and reduced PLR (139.4 ± 160.0 vs. 259.9 ± 278.0; p < 0.001) compared to dogs with other splenic lesions. This study also identified a higher risk of relapse and mortality associated with increased NRR (p < 0.001 and p = 0.012, respectively) and an inverse relationship with PLR (p = 0.015 and p = 0.033, respectively), whereas NLR showed no significant association. The multivariate survival analysis identified NRR as an independent prognostic factor for DFI [hazard ratio (1.837); 95% confidence interval (1.147-2.942); p = 0.011], while for OS, the association did not reach statistical significance [hazard ratio (1.510); 95% confidence interval (0.985-2.314); p = 0.059]. These findings highlight the potential of NRR and PLR as biomarkers for assessing diagnosis and prognosis in canine splenic HSA, advocating for further validation in the future.
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Affiliation(s)
- Ana M. Marques
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
| | - Gonçalo Petrucci
- Vasco da Gama Research Centre (CIVG), Department of Veterinary Sciences, Escola Universitária Vasco da Gama (EUVG), Av. José R Sousa Fernandes, 297, 3020-210 Coimbra, Portugal; (G.P.); (A.C.F.); (H.V.); (C.M.)
- OneVet Group, Hospital Veterinário do Porto, Rua Palmeiras 19, 4150-562, Porto, Portugal;
- Animal and Veterinary Research Center (CECAV), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Av da Universidade Técnica, 1300-477 Lisboa, Portugal
- CESPU, Institute for Research and Advanced Training in Health Sciences and Technologies, Avenida Central de Gandra 1317, 4585-116 Gandra, Portugal
| | - Hugo Gregório
- Animal and Veterinary Research Center (CECAV), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Av da Universidade Técnica, 1300-477 Lisboa, Portugal
- CESPU, Institute for Research and Advanced Training in Health Sciences and Technologies, Avenida Central de Gandra 1317, 4585-116 Gandra, Portugal
- AniCura, CHV Porto, Rua Manuel Pinto de Azevedo 118, 4100-320 Porto, Portugal
| | - Luís Lobo
- OneVet Group, Hospital Veterinário do Porto, Rua Palmeiras 19, 4150-562, Porto, Portugal;
- Faculty of Veterinary Medicine, Lusófona, University of Humanities and Technologies, Campo Grande 376, 1749-024 Lisboa, Portugal
- Center for the Study of Animal Sciences (CECA-ICETA), University of Porto, Praça do Coronel Pacheco 15, 4050-453 Porto, Portugal
| | - Joaquim Henriques
- Anicura Atlântico, Hospital Veterinário, Rua Quintino António Gomes 12, 2640-402 Mafra, Portugal;
- iNOVA4Health, IPO-Lisboa, Rua Prof Lima Basto, 1099-023 Lisboa, Portugal
| | - Ana C. Figueira
- Vasco da Gama Research Centre (CIVG), Department of Veterinary Sciences, Escola Universitária Vasco da Gama (EUVG), Av. José R Sousa Fernandes, 297, 3020-210 Coimbra, Portugal; (G.P.); (A.C.F.); (H.V.); (C.M.)
- OneVet Group, Hospital Veterinário Universitário de Coimbra (HUVC), Av. José R Sousa Fernandes, 297, 3020-210 Coimbra, Portugal
| | - Hugo Vilhena
- Vasco da Gama Research Centre (CIVG), Department of Veterinary Sciences, Escola Universitária Vasco da Gama (EUVG), Av. José R Sousa Fernandes, 297, 3020-210 Coimbra, Portugal; (G.P.); (A.C.F.); (H.V.); (C.M.)
- Animal and Veterinary Research Center (CECAV), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Av da Universidade Técnica, 1300-477 Lisboa, Portugal
- Department of Veterinary Clinics, School of Medicine and Biomedical Sciences, ICBAS-UP, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Carla Marrinhas
- Vasco da Gama Research Centre (CIVG), Department of Veterinary Sciences, Escola Universitária Vasco da Gama (EUVG), Av. José R Sousa Fernandes, 297, 3020-210 Coimbra, Portugal; (G.P.); (A.C.F.); (H.V.); (C.M.)
- OneVet Group, Hospital Veterinário do Baixo Vouga, EN1 255, 3750-742 Águeda, Portugal
| | - Felisbina L. Queiroga
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
- Animal and Veterinary Research Center (CECAV), University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), Av da Universidade Técnica, 1300-477 Lisboa, Portugal
- Center for the Study of Animal Sciences (CECA-ICETA), University of Porto, Praça do Coronel Pacheco 15, 4050-453 Porto, Portugal
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Cooper R, Ramaswami D, Thomas J, Nieva J, Hsu R. Assessing platelet-lymphocyte ratio in EGFR-mutated non-small cell lung cancer patients treated with tyrosine kinase inhibitors: An analysis across TKI generations. RESEARCH SQUARE 2024:rs.3.rs-4930668. [PMID: 39483887 PMCID: PMC11527260 DOI: 10.21203/rs.3.rs-4930668/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
Introduction The prognostic utility of laboratory markers in patients with non-small cell lung cancer (NSCLC) harboring EGFR mutations treated with tyrosine kinase inhibitors (TKIs) is an ongoing area of research. The utility of the platelet-lymphocyte ratio (PLR) in patients treated with osimertinib is undetermined. Methods 151 patients treated with EGFR TKIs in Los Angeles were grouped into one of two groups according to generation of TKI. Differences in progression free survival (PFS) by stratification by PLR was determined using Kaplan-Meier analysis. Differences in median change in laboratory markers by generation of TKI was analyzed using Mann-Whitney tests. Cox Hazard Regression was used to perform multivariate analysis. Results Median PFS of those managed with 1st or 2nd generation TKIs was significantly lower in patients with a PLR ≥ 180 (10.5 months) compared to those with PLR < 180 (16.6 months, p = 0.0163). Median PFS was comparable in those treated with osimertinib regardless of PLR. Patients managed with osimertinib had a significant decrease in absolute lymphocyte count (ALC) at 6 weeks and in platelets at 6 weeks and 3 months compared to those managed with 1st or 2nd generation TKIs. Discussion The prognostic value of PLR was more apparent in patients treated with 1st or 2nd generation TKIs compared to those treated with osimertinib. Third generation EGFR TKIs may be more efficacious in treating patients with laboratory findings previously shown to predict poor survival. The significant changes in peripheral cell counts suggest variability tumor microenvironment changes dependent on the generation of TKI received.
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Affiliation(s)
- Ryan Cooper
- University of Southern California Keck School of Medicine
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De Jesus-Morales K, De Jesús-Rojas W, Ramos-Benitez MJ. Neutrophil-to-Lymphocyte Ratio Dynamics From Pre-diagnosis to End-Stage Amyotrophic Lateral Sclerosis (ALS): A Case Study on Association With Progression and Clinical Events. Cureus 2024; 16:e58109. [PMID: 38738022 PMCID: PMC11088800 DOI: 10.7759/cureus.58109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative condition characterized by the progressive degeneration of motor neurons, resulting in muscle weakness and paralysis. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential marker for monitoring disease severity and progression in ALS, yet longitudinal analyses of NLR are limited. Our study conducts an in-depth examination of NLR dynamics from before diagnosis through the disease's progression to its end stage. We analyze the case of a 56-year-old Puerto Rican male with ALS, tracking his NLR over 13 years - six years before and seven years after his diagnosis - alongside assessments of clinical symptoms and lung function. Our findings indicate that NLR values were initially normal but significantly increased with the onset of symptoms. NLR remained elevated above the normal range, with a notable exception during a period of edaravone therapy when levels normalized. The study demonstrates a clear elevation in NLR associated with ALS progression and critical clinical events, such as symptom onset, diagnosis, and the initiation of respiratory support. This research is, to our knowledge, the first to provide a detailed characterization of NLR changes from the pre-diagnostic phase to end-stage ALS, showing its correlation with clinical deterioration, decreased pulmonary function, and key clinical events. Our results contribute to the body of evidence on NLR's role in ALS while enhancing our understanding of ALS's natural progression.
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Affiliation(s)
- Kevin De Jesus-Morales
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico - Medical Sciences Campus, San Juan, PRI
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Kaczmarek K, Małkiewicz B, Gurwin A, Krawczyk WM, Skonieczna-Żydecka K, Lemiński A. Prognostic Value of Postneoadjuvant Chemotherapy Neutrophil-to-Lymphocyte Ratio in Patients undergoing Radical Cystectomy. J Clin Med 2024; 13:1953. [PMID: 38610718 PMCID: PMC11012838 DOI: 10.3390/jcm13071953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Neutrophil-to-lymphocyte ratio (NLR), a widely assessed biomarker in most common diseases, is typically evaluated before treatment initiation. However, data on NLR in the post-treatment setting is limited. Therefore, we assessed the NLR calculated after neoadjuvant chemotherapy (NAC) initiation in patients with bladder cancer (BC). We hypothesised that changes in blood cells after NAC could be a marker of tumour response and long-term survival. Materials and Methods: Our study included 214 patients who underwent NAC followed by radical cystectomy (RC) in two urological departments, wherein post-NAC NLR was used to categorize patients into the low (NLR ≤ 1.75) and high (NLR > 1.75) groups. Results: Logistic regression analysis indicated that a post-NAC NLR ≥ 1.75 is a good biomarker for pathologic response (odds ratio (OR), 0.045; p <0.001), emphasizing its ability to predict patient survival. The HRs for overall survival and cancer-specific survival were 2.387 (p = 0.048) and 2.342 (p < 0.001), respectively. Conclusions: We believe that post-NAC NLR can be used for patient stratification after NAC. Consequently, the post-NAC NLR may serve as a guide for the decision-making process regarding RC versus bladder-preserving strategies.
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Affiliation(s)
- Krystian Kaczmarek
- Department of General and Oncological Urology, Independent Provincial Public Integrated Hospital, Arkońska 4, 71-455 Szczecin, Poland
| | - Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (B.M.)
| | - Adam Gurwin
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (B.M.)
| | - Wiktor Mateusz Krawczyk
- Department of Urology and Urological Oncology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Karolina Skonieczna-Żydecka
- Department of Biochemical Sciences, Pomeranian Medical University, Władysława Broniewskiego 24, 71-460 Szczecin, Poland;
| | - Artur Lemiński
- Department of General and Oncological Urology, Independent Provincial Public Integrated Hospital, Arkońska 4, 71-455 Szczecin, Poland
- Department of Biochemical Sciences, Pomeranian Medical University, Władysława Broniewskiego 24, 71-460 Szczecin, Poland;
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Olgun P, Diker O. Sixth-Week Immune-Nutritional-Inflammatory Biomarkers: Can They Predict Clinical Outcomes in Patients with Advanced Non-Small Cell Lung Cancer Treated with Immune Checkpoint Inhibitors? Curr Oncol 2023; 30:10539-10549. [PMID: 38132403 PMCID: PMC10742278 DOI: 10.3390/curroncol30120769] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND We investigated the relationships between inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Lung Immune Prognostic Index (LIPI), and modified Glasgow prognostic score (mGPS) to determine whether they could predict treatment response to pembrolizumab or nivolumab (immunotherapy) 6 weeks after the start of treatment (post-treatment). METHODS We included all patients with lung cancer treated with immunotherapy. We examined the biomarker trends and explored their associations with progression-free survival (PFS), overall survival (OS), and response rate (RR) at 6 weeks. RESULTS Eighty-three patients were enrolled in the study. The presence of liver metastasis, low post-treatment NLR (<5), low post-treatment PLR (<170), intermediate post-treatment LIPI, and immune-related adverse events were significantly associated with the response. The multivariate analysis revealed that high post-treatment NLRs ≥ 5 (p = 0.004) and PLRs ≥ 170 (p ≤ 0.001) were independent prognostic factors of shorter OS. A good LIPI status was associated with better PFS (p = 0.020) and OS (p = 0.065). Post-treatment mGPS (0-2) was significantly associated with improved PFS (p = 0.009) and OS (p = 0.064). CONCLUSIONS Post-treatment NLR, PLR, LIPI, and mGPS are associated with worse OS and recurrence. These findings should be independently and prospectively validated in further studies.
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Affiliation(s)
- Polat Olgun
- Department of Medical Oncology, Faculty of Medicine, Near East University, 99138 Nicosia, Cyprus;
- Medical Oncology, Dr. Burhan Nalbantoğlu Government Hospital, 99010 Nicosia, Cyprus
| | - Omer Diker
- Department of Medical Oncology, Faculty of Medicine, Near East University, 99138 Nicosia, Cyprus;
- Medical Oncology, Dr. Burhan Nalbantoğlu Government Hospital, 99010 Nicosia, Cyprus
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DuComb EA, Collins CC, Cupak D, Wagner S, Khan FB, Budd RC, Kinsey CM. Endobronchial ultrasound-guided transbronchial needle injection of cisplatin results in dynamic changes in the tumor immune microenvironment. Respir Med Res 2023; 84:100994. [PMID: 37307616 DOI: 10.1016/j.resmer.2023.100994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/14/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
RATIONALE Direct intratumoral delivery of cisplatin via endobronchial ultrasound guided-transbronchial needle injections (EBUS-TBNI) is a novel approach for salvage treatment of advanced stage non-small cell lung cancer (NSCLC). The goal of this study was to evaluate changes in the tumor immune microenvironment during the course of EBUS-TBNI cisplatin therapy. METHODS Under an IRB approved protocol, patients with recurrence after radiation therapy who were not receiving other cytotoxic therapy, were prospectively enrolled, and underwent weekly treatments with EBUS-TBNI with additional biopsies obtained for research. Needle aspiration was performed prior to cisplatin delivery at each procedure. Samples were evaluated by flow cytometry for the presence of immune cell types. RESULTS Three of the six patients responded to the therapy based on RECIST criteria. Compared to the pre-treatment baseline, intratumoral neutrophils increased in 5 of the 6 patients (p = 0.041), with an average increase of 27.1%, but was not associated with response. A lower pre-treatment CD8+/CD4+ ratio at baseline was associated with response (P = 0.01). Responders demonstrated a lower final proportion of PD-1+ CD8+ T cells compared to non-responders (8.6% vs. 62.3%, respectively, P<0.001. Lower doses of intratumoral cisplatin were associated with subsequent increases in CD8+ T cells within the tumor microenvironment (P = 0.008). CONCLUSIONS EBUS-TBNI cisplatin resulted in significant alterations in the tumor immune microenvironment. Further studies are needed to determine if the changes seen here generalize to larger cohorts.
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Affiliation(s)
- Emily A DuComb
- Division of Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington VT, United States
| | - Cheryl C Collins
- Division of Immunobiology, University of Vermont, University of Vermont College of Medicine, Burlington VT, United States
| | - Dolores Cupak
- Division of Immunobiology, University of Vermont, University of Vermont College of Medicine, Burlington VT, United States
| | - Sarah Wagner
- Division of Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington VT, United States
| | - Farrah B Khan
- Division of Hematology and Oncology, University of Vermont College of Medicine, Burlington VT
| | - Ralph C Budd
- Division of Immunobiology, University of Vermont, University of Vermont College of Medicine, Burlington VT, United States
| | - C Matthew Kinsey
- Division of Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington VT, United States.
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Yamada M, Tanaka K, Yamasaki M, Yamashita K, Makino T, Saito T, Takahashi T, Kurokawa Y, Motoori M, Kimura Y, Nakajima K, Eguchi H, Doki Y. Neutrophil-to-lymphocyte ratio after neoadjuvant chemotherapy as an independent prognostic factor in patients with esophageal squamous cell carcinoma. Oncol Lett 2022; 25:58. [PMID: 36644140 PMCID: PMC9827446 DOI: 10.3892/ol.2022.13644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/19/2022] [Indexed: 01/17/2023] Open
Abstract
Studies have shown that neoadjuvant chemotherapy (NAC) followed by surgical resection improves the survival of patients with esophageal squamous cell carcinoma (ESCC), and that the neutrophil-to-lymphocyte ratio (NLR) nay be a prognostic biomarker in various types of cancer. Despite the noTable changes in the tumor and its microenvironment during NAC, it remains unclear how the NLR changes and which values (before or after NAC) best predict prognosis. The present study aimed to analyze changes in the NLR before and after NAC, and to determine which was a better prognostic factor. This study retrospectively analyzed 338 consecutive patients with ESCC who received NAC followed by curative resection. NLRs before (pre-NLR) and after (post-NLR) NAC were calculated, after which the impact of NAC on NLR, overall survival (OS) and recurrence-free survival (RFS), as well as the relationship between hematological toxicities and NLR, was evaluated. Cutoff values for pre- and post-NLR were 3.7 and 2.5, respectively. Patients with high post-NLR had a worse OS (P=0.0001) and 3-year RFS (P=0.03) than those with low post-NLR. Multivariate analysis identified high post-NLR, pN1 and clinical response as independent prognostic factors. In conclusion, post-NLR was revealed as a better prognostic factor than pre-NLR for patients receiving NAC followed by surgical resection.
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Affiliation(s)
- Moyuru Yamada
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan,Correspondence to: Dr Koji Tanaka, Department of Gastroenterological Surgery, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan, E-mail:
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka 558-8558, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University, Suita, Osaka 565-0871, Japan
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Hoshino S, Takeuchi M, Kawakubo H, Kobayashi R, Matsuda S, Irino T, Fukuda K, Nakamura R, Kitagawa Y. Neutrophil-to-lymphocyte ratio change predicts histological response to and oncological outcome of neoadjuvant chemotherapy for esophageal squamous cell carcinoma. Esophagus 2022; 19:426-435. [PMID: 35059908 DOI: 10.1007/s10388-021-00901-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evaluating tumor response to neoadjuvant chemotherapy (NAC) is important to predict survival and to select the optimal strategy for patients with esophageal cancer. The aim of this study is to investigate the relation between neutrophil-to-lymphocyte ratio (NLR) change after NAC and histological response and oncological outcomes in patients with esophageal cancer. METHODS This study enrolled 209 patients who underwent NAC and thoracic esophagectomy for esophageal cancer as the primary treatment between 2000 and 2019 in our department. Several predictors of survival including NLR change, which was calculated as post-NAC NLR/pre-NAC NLR, were investigated. We used classification and regression tree (CART) analysis to determine the optimal cutoff values of NLR change for the prediction of histological response. RESULTS The best cutoff value of NLR change was 0.55 using the CART analysis. Then we divided all patients into two groups; the patients with NLR change below the cutoff were allocated to the NLR reduction group (n = 53), whereas the patients with NLR change above the cutoff were allocated to the no-NLR reduction group (n = 156). NLR change was identified as a significant predictor for histological responder (odds ratio 3.80; 95% confidence interval (CI) 1.69-8.58; p = 0.001) and recurrence-free survival (hazard ratio 0.55; 95% CI 0.33-0.89; p = 0.015) in multivariable analysis. CONCLUSION The present study demonstrated that NLR change is associated with both histological response to and oncological outcomes of NAC for patients with esophageal cancer. NLR change can help not only to predict survival, but also to facilitate personalized multidisciplinary treatment.
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Affiliation(s)
- Shota Hoshino
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Ryota Kobayashi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Akbas A, Koyuncu S, Hacım NA, Dasiran MF, Kasap ZA, Okan I. Can HALP (Hemoglobin, Albumin, Lymphocytes, and Platelets) Score Differentiate Between Malignant and Benign Causes of Acute Mechanic Intestinal Obstruction? Cancer Biother Radiopharm 2021; 37:199-204. [PMID: 34881988 DOI: 10.1089/cbr.2021.0277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Hematological parameters, including albumin and hemoglobin (Hb) levels and lymphocyte counts, are low-cost tests that can be used to determine inflammation and nutritional status. Recent studies have shown that inflammation plays a very important role in the development of carcinogenesis. Materials and Methods: The authors aimed to investigate whether preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score can distinguish between benign and malignant causes in patients who are admitted to hospital and operated due to acute mechanical intestinal obstruction (AMIO). The patients were divided into two groups etiologically. Group 1 included the AMIO cases, which developed from benign causes, while Group II contained the AMIO cases, which developed as a result of malignancy. HALP score was calculated based on the latest preoperative Hb, albumin, lymphocyte, and platelet values of patients. Results: HALP variable was an independent prognostic factor (p < 0.001) in determining malignancy (odds ratio = 0.91; 95% confidence interval [CI] = 0.882-0.930). Based on the results, when a cutoff value <23.94 was used for HALP score in receiver operating characteristic analysis, sensitivity for determining the malignancy was 85%, while specificity was 78% (Area under the curve [AUC] ± standard error = 0.86 ± 0.029; 95% CI = 0.80-0.91; p < 0.001). Conclusions: The HALP score could be a useful parameter for the clinician in distinguishing between AMIO due to benign and malignant origins.
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Affiliation(s)
- Ahmet Akbas
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Serhat Koyuncu
- Department of Emergency Medicine and Gaziosmanpasa University, Tokat, Turkey
| | - Nadir Adnan Hacım
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | | | - Zeliha Aydın Kasap
- Department of Biostatistics and Medical Informatics, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Ismail Okan
- Department of General Surgery, Gaziosmanpasa University, Tokat, Turkey
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Biswas T, Gawdi R, Jindal C, Iyer S, Kang KH, Bajor D, Machtay M, Choi YM, Efird JT. Pretreatment neutrophil-to-lymphocyte ratio as an important prognostic marker in stage III locally advanced non-small cell lung cancer: confirmatory results from the PROCLAIM phase III clinical trial. J Thorac Dis 2021; 13:5617-5626. [PMID: 34795912 PMCID: PMC8575807 DOI: 10.21037/jtd-21-1018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022]
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) is an important pretreatment marker of systemic inflammation and tumor aggressiveness. Increased levels of this ratio have been associated with reduced survival in several observational studies of lung cancer. However, supporting analyses from large clinical trial data are lacking. Methods To validate the prognostic role of NLR, the current study evaluated data from a randomized phase III study (PROCLAIM; clinicaltrial.gov ID: NCT00686959) of patients with stage IIIA/B, unresectable, non-squamous, non-small cell lung cancer (NSCLC), originally comparing combination pemetrexed-cisplatin chemoradiotherapy with etoposide-cisplatin chemoradiotherapy. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for survival were estimated using a Cox proportional hazards model. Models were adjusted for age, race, sex, stage, treatment, and body mass index (BMI). Patients were followed for a median of 24 months. Results Increased NLR levels at baseline were associated with reduced overall (PTrend <0.0001) and progression-free survival (PTrend <0.005). A similar but decreasing linear trend was not observed for lymphocytes count alone. Conclusions These findings provide substantiating evidence that NLR, which is routinely available from standard blood testing of patients diagnosed with NSCLC, is an important inflammation-based prognostic marker for survival among patients with locally advanced disease undergoing chemoradiation. Future research will benefit by assessing the prognostic potential of NLR in the context of genetic mutations and molecular markers.
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Affiliation(s)
- Tithi Biswas
- Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Rohin Gawdi
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Sharanya Iyer
- Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Kylie H Kang
- Department of Radiation Oncology, Washington University School of Medicine and Alvin J. Siteman Comprehensive Cancer Center, St. Louis, MO, USA
| | - David Bajor
- Medical Oncology, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mitchell Machtay
- Department of Radiation Oncology, Penn State University, Hershey, PA, USA
| | | | - Jimmy T Efird
- Cooperative Studies Program Epidemiology Center, Health Services Research and Development, DVAHCS, Durham, NC, USA
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Hashimoto M, Fujita K, Nakayama T, Fujimoto S, Hamaguchi M, Nishimoto M, Kikuchi T, Adomi S, Banno E, De Velasco MA, Saito Y, Shimizu N, Mori Y, Minami T, Nozawa M, Nose K, Yoshimura K, Uemura H. Higher neutrophil-to-lymphocyte ratio after the first cycle of the first-line chemotherapy is associated with poor cancer specific survival of upper urinary tract carcinoma patients. Transl Androl Urol 2021; 10:2838-2847. [PMID: 34430386 PMCID: PMC8350230 DOI: 10.21037/tau-21-185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/19/2021] [Indexed: 01/29/2023] Open
Abstract
Background Inflammatory cytokines and immature myeloid derived suppressor cells (MDSCs), which increase during cancer progression, could lead to a neutrophil increase and lymphocyte reduction. Thus, the neutrophil-lymphocyte ratio (NLR) was used to predict survival of patients suffering from urological cancers including upper urinary tract carcinoma. We further determined whether the NLR during the first cycle of first-line chemotherapy could predict cancer specific survival. Methods We recruited patients with locally advanced or metastatic upper urinary tract urothelial carcinoma (UTUC) who received chemotherapy between January 2014 and July 2019. We investigated the impact of various clinical variables, including age, sex, performance status, and estimated creatinine clearance (CCr), and NLR before and after the first cycle of the first-line chemotherapy on prognosis. Results A total of 41 patients were included in our study. Cancer specific survival of the patients with lower NLR was significantly better than that of the patients with higher NLR measured after the first cycle of the first-line chemotherapy (log-rank test P=0.005, median 29.2 vs. 11.9 months, respectively). Cox proportional regression analysis showed that higher NLR after the first cycle of the first-line chemotherapy was a significant predictor of cancer specific survival. Conclusions The NLR after the first cycle of the first-line chemotherapy could be an indication for patients with locally advanced or metastatic UTUC to maintain their first-line chemotherapy treatment.
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Affiliation(s)
- Mamoru Hashimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazutoshi Fujita
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takahito Nakayama
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Saizo Fujimoto
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Mamoru Hamaguchi
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | | | - Takashi Kikuchi
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Shogo Adomi
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Eri Banno
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Marco A De Velasco
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshitaka Saito
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nobutaka Shimizu
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yasunori Mori
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takafumi Minami
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masahiro Nozawa
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuhiro Nose
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
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Lin YJ, Wei KC, Chen PY, Lim M, Hwang TL. Roles of Neutrophils in Glioma and Brain Metastases. Front Immunol 2021; 12:701383. [PMID: 34484197 PMCID: PMC8411705 DOI: 10.3389/fimmu.2021.701383] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/19/2021] [Indexed: 12/16/2022] Open
Abstract
Neutrophils, which are the most abundant circulating leukocytes in humans, are the first line of defense against bacterial and fungal infections. Recent studies have reported the role and importance of neutrophils in cancers. Glioma and brain metastases are the most common malignant tumors of the brain. The tumor microenvironment (TME) in the brain is complex and unique owing to the brain-blood barrier or brain-tumor barrier, which may prevent drug penetration and decrease the efficacy of immunotherapy. However, there are limited studies on the correlation between brain cancer and neutrophils. This review discusses the origin and functions of neutrophils. Additionally, the current knowledge on the correlation between neutrophil-to-lymphocyte ratio and prognosis of glioma and brain metastases has been summarized. Furthermore, the implications of tumor-associated neutrophil (TAN) phenotypes and the functions of TANs have been discussed. Finally, the potential effects of various treatments on TANs and the ability of neutrophils to function as a nanocarrier of drugs to the brain TME have been summarized. However, further studies are needed to elucidate the complex interactions between neutrophils, other immune cells, and brain tumor cells.
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Affiliation(s)
- Ya-Jui Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Neurosurgery, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pin-Yuan Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Michael Lim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Tsong-Long Hwang
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, and Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Chemical Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
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13
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Chen W, Wang B, Zeng R, Wang T. Development and Validation of a Nomogram for the Estimation of Response to Platinum-Based Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Cancer. Cancer Manag Res 2021; 13:1279-1289. [PMID: 33603473 PMCID: PMC7884956 DOI: 10.2147/cmar.s293268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/16/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Non-response to platinum-based neoadjuvant chemotherapy (non-rNACT) reduces the surgical outcomes of patients with locally advanced cervical cancer (LACC). The development of an accurate preoperative method to predict a patient’s response to NACT (rNACT) could help surgeons to manage therapeutic intervention in a more appropriate manner. Patients and Methods We recruited a total of 341 consecutive patients who underwent platinum-based NACT followed by radical surgery (RS) at the Hubei Cancer Hospital between January 1, 2010 and April 1, 2020. All patients had been diagnosed with stage Ib2-IIa2 cervical cancer in accordance with the 2009 International Federation of Gynecology and Obstetrics (FIGO) classification system. First, we created a training cohort of patients who underwent NACT+RS (n=239) to develop a nomogram. We then validated the performance of the nomogram in a validation cohort of patients who underwent NACT+RS (n=102). Data analysis was conducted from October 1, 2020. First, we determined overall survival (OS) and progression-free survival (PFS) after NACT+RS. Multivariate logistic regression was then used to identify independent risk factors that were associated with the response to rNACT; these were then incorporated into the nomogram. Results The analysis identified several significant differences between the rNACT and non-rNACT groups, including neutrophil–lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR), platelet count, and FIGO stage. The performance of the rNACT nomogram score exhibited a robust C-index of 0.76 (95% confidence interval [CI]: 0.65 to 0.87) in the training cohort and high C-index of 0.71 (95% CI: 0.62 to 0.78) in the validation cohort. Clinical impact curves showed that the nomogram had good predictive ability. Conclusion We successfully established an accurate and optimized nomogram that could be used preoperatively to predict rNACT in patients with LACC. This model can be used to evaluate the risk of an individual patient experiencing rNACT and therefore facilitate the choice of treatment.
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Affiliation(s)
- Wei Chen
- Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology and Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan, Hubei, 430079, People's Republic of China
| | - Bo Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Rong Zeng
- Department of Obstetrics and Gynecology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tiejun Wang
- Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology and Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan, Hubei, 430079, People's Republic of China
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14
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Kim YJ, Kim YS, Shin JW, Osong B, Lee SH. Prediction scoring system based on clinicohematologic parameters for cervical cancer patients undergoing chemoradiation. Int J Gynecol Cancer 2020; 30:1689-1696. [PMID: 32546642 DOI: 10.1136/ijgc-2019-001050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE A scoring system based on clinicohematologic parameters in cervical cancer patients receiving chemoradiation has not been reported to date. The aim of this study was to determine the prognostic value of clinicohematologic parameters in patients with cervical cancer undergoing chemoradiation and to develop a prediction scoring system based on these results. METHODS A total of 107 patients who received definitive chemoradiation for cervical cancer were enrolled in this study. The clinical data and hematologic parameters were retrospectively reviewed, and their prognostic value in predicting survival was analyzed. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) and the changes in these hematologic parameters (ΔNLR, ΔPLR, and ΔLMR) between pre- and post-treatment were calculated to determine the specific value of these parameters for predicting patient survival. RESULTS The median follow-up time was 39.9 (range 2.7-114.6) months. The 3-year overall survival rate and progression-free survival rate were 80.9% (95% CI 72.7 to 90.0) and 53.4% (95% CI 44.1 to 64.8), respectively. The median progression-free survival was 67.5 months and the median overall survival was not reached. According to multivariable analysis, a ΔNLR≥0 was significantly associated with decreased progression-free survival (HR=2.91, 95% CI 1.43 to 5.94) and overall survival (HR=3.13, 95% CI 1.18 to 8.27). In addition, age (age <58.5 years; progression-free survival: HR=2.55, 95% CI 1.38 to 4.70; overall survival: HR=4.49, 95% CI 1.78 to 11.33) and the International Federation of Gynecology and Obstetrics (FIGO) stage (Ⅲ-Ⅳ; progression-free survival: HR=2.49, 95% CI 1.40 to 4.43; overall survival: HR=3.02, 95% CI 1.32 to 6.90) were identified as predictors of poor survival. CONCLUSIONS Both the age and FIGO stage, as clinical parameters, and the ΔNLR, as a hematologic parameter, were independent prognostic factors for survival for cervical cancer patients treated with chemoradiation. Based on these results, we developed a risk score-based classification system for predicting survival.
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Affiliation(s)
- Youn Ji Kim
- Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young Saing Kim
- Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jin Woo Shin
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Biche Osong
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Seok Ho Lee
- Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Republic of Korea
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15
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Biswas T, Kang KH, Gawdi R, Bajor D, Machtay M, Jindal C, Efird JT. Using the Systemic Immune-Inflammation Index (SII) as a Mid-Treatment Marker for Survival among Patients with Stage-III Locally Advanced Non-Small Cell Lung Cancer (NSCLC). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7995. [PMID: 33143164 PMCID: PMC7662688 DOI: 10.3390/ijerph17217995] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
The Systemic Immune-Inflammation Index (SII) is an important marker of immune function, defined as the product of neutrophil-to-lymphocyte ratio (NLR) and platelet count (P). Higher baseline SII levels have been associated with improved survival in various types of cancers, including lung cancer. Data were obtained from PROCLAIM, a randomized phase III trial comparing two different chemotherapy regimens pemetrexed + cisplatin (PEM) vs. etoposide + cisplatin (ETO), in combination with radiotherapy (RT) for the treatment of stage III non-squamous non-small cell lung cancer (NSCLC). We aimed to determine if SII measured at the mid-treatment window for RT (weeks 3-4) is a significant predictor of survival, and if the effect of PEM vs. ETO differs by quartile (Q) level of SII. Hazard-ratios (HR) for survival were estimated using a proportional hazards model, accounting for the underlying correlated structure of the data. A total of 548 patients were included in our analysis. The median age at baseline was 59 years. Patients were followed for a median of 24 months. Adjusting for age, body mass index, sex, race, and chemotherapy regimen, SII was a significant mid-treatment predictor of both overall (adjusted HR (aHR) = 1.6, p < 0.0001; OS) and progression-free (aHR = 1.3, p = 0.0072; PFS) survival. Among patients with mid-RT SII values above the median (6.8), those receiving PEM (vs. ETO) had superior OS (p = 0.0002) and PFS (p = 0.0002). Our secondary analysis suggests that SII is an informative mid-treatment marker of OS and PFS in locally advanced non-squamous NSCLC.
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Affiliation(s)
- Tithi Biswas
- Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Kylie H. Kang
- Department of Radiation Oncology, Washington University School of Medicine and Alvin J. Siteman Comprehensive Cancer Center, St. Louis, MO 63110, USA;
| | - Rohin Gawdi
- Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - David Bajor
- Medical Oncology, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Mitchell Machtay
- Department of Radiation Oncology, Penn State University, Hershey, PA 17033, USA;
| | - Charu Jindal
- Faculty of Science, University of Newcastle, Newcastle 2308, Australia;
| | - Jimmy T. Efird
- Cooperative Studies Program Epidemiology Center, Health Services Research and Development (DVAHCS/Duke Affiliated Center), Durham, NC 27705, USA
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16
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Dynamic evaluation of neutrophil-to-lymphocyte ratio as prognostic factor in stage III non-small cell lung cancer treated with chemoradiotherapy. Clin Transl Oncol 2020; 22:2333-2340. [PMID: 32449125 DOI: 10.1007/s12094-020-02396-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Locally advanced non-small cell lung cancer (LA-NSCLC) is frequently treated with chemoradiotherapy (CRT). Despite the efforts, long-term outcomes are poor, and novel therapies have been introduced to improve results. Biomarkers are needed to detect early treatment failure and plan future follow-up and therapies. Our aim is to evaluate the role of dynamics of neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced NSCLC treated with CRT. METHODS We retrospectively reviewed patients diagnosed with LA-NSCLC receiving definitive CRT at our center from 2010 to 2015. Baseline and post-treatment NLR were collected from our center database. NLR was dichotomized (threshold = 4) and patients were divided into two groups based on the variation from baseline to post-treatment NLR. The prognostic role and association with response were examined with logistic regression and multivariate Cox regression model, respectively. RESULTS Ninety-two patients were included. Our analysis shows that NLR after treatment is associated with response to treatment [OR in the multivariate analysis 4.94 (1.01-24.48); p value = 0.048]. Furthermore, NLR and ECOG are independent prognostic factors for progression-free survival (PFS) and overall survival (OS). Specifically, PFS was 25.79 months for the good prognosis group and 12.09 for the poor prognosis group [HR 2.98 (CI 95% = 1.74-5.10), p < 0.001]; and OS was 42.94 months and 18.86 months, respectively [HR 2.81 (CI 95% = 1.62-4.90), p < 0.001]. CONCLUSION Dynamics of NLR have a prognostic value in stage III NSCLC treated with definitive CRT. Pre- and post-CRT NLR should be evaluated in prospective clinical trials involving consolidation treatment with immunotherapy.
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Peng Y, Wang J, Xiang H, Weng Y, Rong F, Xue Y, Ji K. Prognostic Value of Neutrophil-Lymphocyte Ratio in Cardiogenic Shock: A Cohort Study. Med Sci Monit 2020; 26:e922167. [PMID: 32418983 PMCID: PMC7251960 DOI: 10.12659/msm.922167] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Inflammation plays an important part in the pathogenesis of cardiogenic shock (CGS). Whether the neutrophil-lymphocyte ratio (NLR), an integrated biomarker of inflammation, is associated with the outcome of CGS patients remains unknown. This retrospective cohort study was performed to identify the utility of using NLR among patients with CGS. MATERIAL AND METHODS Data were extracted from the MIMIC database. We applied smooth curve fitting to define the NLR cutoff values. The primary outcome was 30-day mortality. Cox proportional hazards models, subgroup analysis, and receiver operator characteristic (ROC) curve analysis were performed. RESULTS A total of 1470 CGS patients were extracted, among which 801 (54.5%) were men. The mean age of the population was 70.37 years. An inverse U-shaped relationship was observed between NLR and mortality in CGS patients, with the highest risk being at values ranging from 9.4 to 15. For the primary outcome of 30-day mortality, the adjusted HR (95% CI) values of the middle tertile (NLR 9.4-15) and the upper tertile (NLR >15) were 1.47 (1.14, 1.88) and 1.22 (0.94, 1.57) compared with the reference of lower tertile (NLR <9.4). ROC curve analysis showed that NLR had a more sensitive prognostic value in predicting 30-day mortality of CGS than the neutrophil or lymphocyte percentage alone (0.660 vs. 0.540, 0.549). CONCLUSIONS An inverse U-shaped curve was presented between NLR and the mortality of CGS. NLR seemed to be a readily available and independent prognostic biomarker for patients with CGS. The prognostic value of NLR was more sensitive than the neutrophil or lymphocyte percentage alone, but not as good as SOFA or SAPSII score.
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Affiliation(s)
- Yangpei Peng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Jie Wang
- Department of Endocrinology, Affiliated Hospital of Yanbian University, Yanji, Jilin, China (mainland)
| | - Huaqiang Xiang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Yingbei Weng
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Fangning Rong
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Yangjing Xue
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Kangting Ji
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
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Colonic Wall Thickening Reported in Abdominal CT: Does It Always Imply Malignancy? Gastroenterol Res Pract 2020; 2019:2492097. [PMID: 31933628 PMCID: PMC6942854 DOI: 10.1155/2019/2492097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/05/2019] [Accepted: 12/13/2019] [Indexed: 01/15/2023] Open
Abstract
Aim/Background Early diagnosis of patients with colon cancer is one of the most important parameters affecting the survival of patients. In this study, we aimed to examine the effect of the age, hemoglobin (Hb), albumin, neutrophil lymphocyte ratio (NLR), thrombocyte lymphocyte ratio (PLR), and mean platelet values (MPV) on the separation of benign and malignant diseases in patients with suspected colon wall thickness (CWT) observed in abdominal computed tomography (CT) examination. Method The study included 116 patients between the ages of 18 and 95 who had CT examination where the colon wall could be evaluated and who also had colonoscopy. Patients suspected for CWT in CT with difficulties in differential diagnosis were divided into two groups according to colonoscopic-histopathological evaluations. Normal or benign pathological causes were included in the first group, while malignant causes constituted the second group. Whether the two groups differed in terms of CWT, Hb, age, albumin, NLR, PLR, and MPV values was investigated with descriptive statistics. Results One hundred and sixteen patients (74 males, 42 females) with CT examinations and colonoscopic sampling were included in the study. After colonoscopic and histopathological evaluations, there were 64 cases in the first group and 52 in the second group. According to the results of the univariate analysis and multivariate logistic regression, CWT, Hb, NLR, and MPV were identified to be independent variables for determining colon cancer. Conclusion A combined evaluation of Hb, NLR, and MPV values in patients with CWT in abdominal CT examination may contribute to the separation of benign and malignant pathologies.
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Ishibashi Y, Tsujimoto H, Hiraki S, Kouzu K, Tsuchiya S, Itazaki Y, Yaguchi Y, Horiguchi H, Nomura S, Ito N, Shinto E, Kishi Y, Ueno H. Predictive value of immuno-inflammatory and nutritional measures modulated by neoadjuvant chemotherapy on the response of neoadjuvant chemotherapy and long-term outcomes in patients with esophageal cancer. Oncol Lett 2020; 19:487-497. [PMID: 31897162 PMCID: PMC6924116 DOI: 10.3892/ol.2019.11122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/08/2019] [Indexed: 01/08/2023] Open
Abstract
It has been reported that immuno-inflammatory and nutritional parameters are associated with long-term survival in various malignancies. However, little is known regarding the associations between alterations of these parameters during neoadjuvant chemotherapy (NAC) and the response to NAC in patients with esophageal cancer. The present study examined the clinical significance of alterations in these parameters during NAC in terms of the response to NAC and the long-term outcomes in patients with esophageal cancer. Various systemic immuno-inflammatory and nutritional measures including the systemic neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)-to-albumin ratio (CAR) and psoas muscle index (PMI) were examined before and after NAC. Statistical analyses were performed to determine the significance of immuno-inflammatory and nutritional parameters prior to NAC and alterations during NAC regarding the response to NAC and long-term outcomes. The NLR, PMI, neutrophil count and platelet count declined significantly following NAC, whereas no alterations in PLR, CAR, lymphocyte counts, CRP levels and albumin concentration were observed. The decreases in NLR and neutrophil counts following NAC were strongly associated with a favorable overall survival (P=0.006). In conclusion, decreases in NLR and neutrophil counts following NAC were clinically significant predictors of the response to NAC and of survival in esophageal cancer, respectively.
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Affiliation(s)
- Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shuichi Hiraki
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Keita Kouzu
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Satoshi Tsuchiya
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Yoshihisa Yaguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hiroyuki Horiguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Shinsuke Nomura
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Nozomi Ito
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan
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Luo CL, Rong Y, Chen H, Zhang WW, Wu L, Wei D, Wei XQ, Mei LJ, Wang FB. A Logistic Regression Model for Noninvasive Prediction of AFP-Negative Hepatocellular Carcinoma. Technol Cancer Res Treat 2019; 18:1533033819846632. [PMID: 31106685 PMCID: PMC6535757 DOI: 10.1177/1533033819846632] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
α-Fetoprotein is commonly used in the diagnosis of hepatocellular carcinoma. However, the diagnostic significance of α-fetoprotein has been questioned because a number of patients with hepatocellular carcinoma are α-fetoprotein negative. It is therefore necessary to develop novel noninvasive techniques for the early diagnosis of hepatocellular carcinoma, particularly when α-fetoprotein level is low or negative. The current study aimed to evaluate the diagnostic efficiency of hematological parameters to determine which can act as surrogate markers in α-fetoprotein-negative hepatocellular carcinoma. Therefore, a retrospective study was conducted on a training set recruited from Zhongnan Hospital of Wuhan University-including 171 α-fetoprotein-negative patients with hepatocellular carcinoma and 102 healthy individuals. The results show that mean values of mean platelet volume, red blood cell distribution width, mean platelet volume-PC ratio, neutrophils-lymphocytes ratio, and platelet count-lymphocytes ratio were significantly higher in patients with hepatocellular carcinoma in comparison to the healthy individuals. Most of these parameters showed moderate area under the curve in α-fetoprotein-negative patients with hepatocellular carcinoma, but their sensitivities or specificities were not satisfactory enough. So, we built a logistic regression model combining multiple hematological parameters. This model presented better diagnostic efficiency with area under the curve of 0.922, sensitivity of 83.0%, and specificity of 93.1%. In addition, the 4 validation sets from different hospitals were used to validate the model. They all showed good area under the curve with satisfactory sensitivities or specificities. These data indicate that the logistic regression model combining multiple hematological parameters has better diagnostic efficiency, and they might be helpful for the early diagnosis for α-fetoprotein-negative hepatocellular carcinoma.
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Affiliation(s)
- Chang-Liang Luo
- 1 Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Yuan Rong
- 1 Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Hao Chen
- 2 Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Wu-Wen Zhang
- 1 Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Long Wu
- 3 Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Diao Wei
- 4 Department of Blood Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xiu-Qi Wei
- 5 Department of Laboratory Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lie-Jun Mei
- 6 Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Fu-Bing Wang
- 1 Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
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21
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Peripheral monocyte counts predict the clinical outcome for patients with colorectal cancer: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2019; 31:1313-1321. [PMID: 31567616 DOI: 10.1097/meg.0000000000001553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Monocytes originating from bone marrow play a key role in the inflammatory response. Divergent findings regarding the prognostic value of inflammatory factors like absolute monocyte count (AMC) in colorectal cancer (CRC) exist in the current literature. Thus, we sought to perform a systemic meta-analysis to comprehensively estimate whether the peripheral AMC affects the clinical outcome of CRC patients. A comprehensive literature search was performed in PubMed, Web of Science and EMBASE last updated to 23 December 2018, to identify studies reporting the prognostic value of AMC in patients with CRC. Hazard ratios and corresponding 95% confidence intervals (CIs) or P values were used as the effect size estimates for clinical outcomes including overall survival (OS), disease-free survival (DFS), cancer-specific survival (CSS) and progression-free survival (PFS) with the random-effect inverse variance weighted method. The potential heterogeneity was assessed with Q test and I statistics. Subgroup analyses with respect to some clinicopathological parameters were conducted. A total of 16 clinical studies comprising 3826 patients were included for analysis. Pooled analyses revealed that CRC patients with elevated AMC were significantly associated with worse OS (hazard ratio = 1.708, 95% CI: 1.480-1.971, P < 0.001), DFS (hazard ratio = 1.817, 95% CI: 1.289-2.560, P = 0.001), CSS (hazard ratio = 1.551, 95% CI: 1.187-2.027, P = 0.001) and PFS (hazard ratio = 1.487, 95% CI: 1.259-1.756, P < 0.001). In addition, subgroup analyses provided more information and demonstrated the prognostic effect of elevated preoperative AMC in patients with CRC. There were no significant heterogeneity and publication bias. In conclusion, elevated AMC seems to be served as an unfavorable and robust predicative indicator in CRC patients.
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Kim T, Choi H, Oak CH, Jang TW, Jung MH, Kim J. Correlation between stage of small-cell lung cancer and inflammatory factors. Asian Cardiovasc Thorac Ann 2019; 27:554-558. [PMID: 31379186 DOI: 10.1177/0218492319868407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Several biochemical markers are associated with the stage of small-cell lung cancer. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are useful inflammatory markers and related to poor survival. This study aimed to evaluate the correlation between the disease extent of small-cell lung cancer and neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio. Methods The study was performed retrospectively in a single South Korean medical center from 2010 to 2016. Of 217 patients pathologically diagnosed with small-cell lung cancer, 157 were included in the analysis. The correlation between disease extent and neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio was measured by Student’s t test and analysis of variance. Results Neutrophil-to-lymphocyte ratio (limited disease: 2.38 ± 1.53, extensive disease: 3.25 ± 2.20, p = 0.004) and platelet-to-lymphocyte ratio (limited disease: 122.21 ± 63.13, extensive disease: 153.09 ± 98.57, p = 0.026) were highly associated with disease extent. Neutrophil-to-lymphocyte ratio was associated with advanced TNM stage (stage I: 3.53 ± 3.44, stage II: 2.66 ± 0.95, stage III: 2.34 ± 1.49, stage IV: 3.26 ± 2.22, p = 0.049), and platelet-to-lymphocyte ratio was proportional to the TNM stage but there was no statistical significance (stage I: 111.77 ± 30.76, stage II: 110.71 ± 34.04, stage III: 123.42 ± 64.48, stage IV: 154.68, p = 0.105). Conclusions Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were increased in advanced stages of small-cell lung cancer, especially when stage was classified into extensive and limited disease. It is necessary to analyze the effect on survival outcome.
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Affiliation(s)
- Taeyun Kim
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Hyunji Choi
- 2 Department of Laboratory Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Chul-Ho Oak
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Tae-Won Jang
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Mann-Hong Jung
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Jehun Kim
- 1 Department of Pulmonology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
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Xie X, Liu J, Yang H, Chen H, Zhou S, Lin H, Liao Z, Ding Y, Ling L, Wang X. Prognostic Value of Baseline Neutrophil-to-Lymphocyte Ratio in Outcome of Immune Checkpoint Inhibitors. Cancer Invest 2019; 37:265-274. [PMID: 31304800 DOI: 10.1080/07357907.2019.1639057] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Xianhe Xie
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Junjin Liu
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Haitao Yang
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huijuan Chen
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Sijing Zhou
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Heng Lin
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ziyuan Liao
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yin Ding
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Liting Ling
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xuewen Wang
- Department of Chemotherapy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Yılmaz U, Ozdemir O, Batum O, Ermin S. The prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with stage III non-small cell lung cancer treated with concurrent chemoradiotherapy. Indian J Cancer 2019; 55:276-281. [PMID: 30693894 DOI: 10.4103/ijc.ijc_624_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been shown to be prognostic markers in various types of cancers. In this study, we retrospectively investigated the prognostic role of NLR and PLR in stage III non-small cell lung cancer patients (NSCLC) treated with concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS Seventy-nine stage III NSCLC patients treated with definitive CCRT were retrospectively evaluated. All patients received conformal RT with a total dose of 60-66 Gy with CCRT. The optimal cutoff values identified by receiver operating characteristic curve were 155 for PLR and 3.21 for NLR for overall survival (OS) and 142 and 3.21, respectively, for progression-free survival (PFS). RESULTS Median age of the study population was 58 years with 72 (91%) males. Stages IIIA, IIIB, and IIIC were found in 21 (26.6%), 48 (60.8%), and 10 (12.7%) patients, respectively. Patients with a PLR <155 had a significantly longer OS (P = 0.038) compared with patients who had a higher PLR. The NLR and other parameters were not found to be in correlation with OS. In multivariable analysis, the PLR and lymphocyte count were significantly associated with OS (hazard ratio [HR]: 2.29, 95% confidence interval [CI]: 1.29-4.08, P = 0.005 and HR: 2.00, 95% CI: 1.17-3.42, P = 0.011, respectively). The PLR and lymphocyte count were identified as independent prognostic factors of poor PFS (HR: 2.08, 95% CI: 1.17-3.69, P = 0.012 and HR: 1.83, 95% CI: 1.08-3.08, P = 0.024, respectively). CONCLUSION Our results support the prognostic role of pretreatment PLR and lymphocyte count in stage III NSCLC patients treated with concurrent radiotherapy.
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Affiliation(s)
- Ufuk Yılmaz
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ozer Ozdemir
- Department of Pulmonology, Kemalpasa State Hospital, Izmir, Turkey
| | - Ozgur Batum
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Sinem Ermin
- Department of Pulmonology, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey
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Wang Z, Zhan P, Lv Y, Shen K, Wei Y, Liu H, Song Y. Prognostic role of pretreatment neutrophil-to-lymphocyte ratio in non-small cell lung cancer patients treated with systemic therapy: a meta-analysis. Transl Lung Cancer Res 2019; 8:214-226. [PMID: 31367535 DOI: 10.21037/tlcr.2019.06.10] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) is related to prognosis in non-small cell lung cancer (NSCLC). However, no consensus on the relationship of pretreatment NLR and survival outcomes of systemic therapy in NSCLC exists. This meta-analysis investigated the prognostic role of pretreatment NLR during systemic therapy for NSCLC, including chemotherapy, immunotherapy and targeted therapy. Methods PubMed, Web of Science and Cochrane Library databases were systematically searched up to April 09, 2019. Hazard ratios (HRs) with their 95% confidence intervals (CIs) were pooled to investigate the association of pretreatment NLR with progression-free survival (PFS) and overall survival (OS). Results In total, 27 articles with 4,298 participants were selected. The pooled results showed that elevated pretreatment NLR was associated with inferior PFS (HR, 1.45, 95% CI, 1.28-1.66) and OS (HR, 1.63, 95% CI, 1.43-1.84) during systemic therapy. Subgroup analyses according to the treatment strategy suggested that higher pretreatment NLR was significantly associated with shorter survival in all therapies, including chemotherapy (PFS HR, 1.74, 95% CI, 1.39-2.17; OS HR, 1.73, 95% CI, 1.26-2.36), immunotherapy (PFS HR, 1.53, 95% CI, 1.27-1.84; OS HR, 2.50, 95% CI, 1.60-3.89) and targeted therapy (PFS HR, 1.53, 95% CI, 1.04-2.25; OS HR, 1.92, 95% CI, 1.14-3.24). Conclusions Pretreatment NLR is a promising prognostic indicator for NSCLC patients receiving systemic therapy, including chemotherapy, immunotherapy and targeted therapy.
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Affiliation(s)
- Zimu Wang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ping Zhan
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yanling Lv
- Department of Respiratory Medicine, Jinling Clinical Medical College of Nanjing Medical University, Nanjing 210002, China
| | - Kaikai Shen
- Department of Respiratory Medicine, Wannan Medical College, Wuhu 241000, China
| | - Yuqing Wei
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
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Xuan Q, Yang Y, Ji H, Tang S, Zhao J, Shao J, Wang J. Combination of the preoperative albumin to globulin ratio and neutrophil to lymphocyte ratio as a novel prognostic factor in patients with triple negative breast cancer. Cancer Manag Res 2019; 11:5125-5131. [PMID: 31213922 PMCID: PMC6549418 DOI: 10.2147/cmar.s195324] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/09/2019] [Indexed: 01/29/2023] Open
Abstract
Background: The pretreatment albumin to globulin ratio (AGR) and neutrophil to lymphocyte ratio (NLR) were the inflammation-associated factors which were related to the disease-free survival in various malignancies. The aim of this study was to evaluate the clinical significance of the pretreatment AGR combined with NLR for patients with triple negative breast cancer (TNBC). Method: This retrospective study included 286 cases of pathologically diagnosed patients with TNBC. The relationships of AGR and NLR with clinicopathologic characteristics and prognosis were analyzed by Kaplan–Meier and Cox regression methods. Results: An AGR of 1.63 and a NLR of 2.93 were identified as the optimal cut-off points for distinguishing patients with good versus poor prognosis. The area under the receiver operating characteristic curves of combined with AGR and NLR (CO-AN) was increased compared with AGR and NLR individually. Kaplan–Meier analysis showed that low AGR/high NLR was related to poor survival. The prognosis of patients can be predicted well by the CO-AN. Univariate and multivariate analyses revealed that high AGR levels, low NLR levels, and CO-AN<1 were significantly and independently associated with favorable disease-free survival. Conclusions: Our study suggested that AGR and NLR levels can be prognostic biomarkers for disease-free survival in patients with TNBC. The CO-AN may have greater predictive value than AGR and NLR in patients with TNBC.
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Affiliation(s)
- Qijia Xuan
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province 150081, People's Republic of China
| | - Yan Yang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province 150081, People's Republic of China
| | - Hongfei Ji
- Department of Cancer Molecular and Biology, Cancer Institute, Harbin Medical University, Harbin, Heilongjiang Province 150081, People's Republic of China
| | - Shuli Tang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province 150081, People's Republic of China
| | - Juan Zhao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province 150081, People's Republic of China
| | - Jiayue Shao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province 150081, People's Republic of China
| | - Jingxuan Wang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang Province 150081, People's Republic of China
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Szentkereszty M, Komlósi ZI, Szűcs G, Barna G, Tamási L, Losonczy G, Gálffy G. Effect of COPD on Inflammation, Lymphoid Functions and Progression-Free Survival during First-Line Chemotherapy in Advanced Non-small Cell Lung Cancer. Pathol Oncol Res 2019; 26:1117-1128. [PMID: 31090020 PMCID: PMC7242273 DOI: 10.1007/s12253-019-00661-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common comorbidity of non-small cell lung cancer (NSCLC). COPD is characterized by systemic inflammation and lymphocyte dysfunction, mechanisms that are also known to accelerate progression of advanced (IIIB-IV) stage NSCLC. We aimed to find out whether COPD exerts an influence on tumor induced inflammatory and lymphoid responses and progression-free survival (PFS) after first-line treatment in advanced NSCLC. Patients suffering from NSCLC (n = 95), COPD (n = 54), NSCLC+COPD (n = 80) and healthy controls (n = 60) were included. PFS, neutrophil granulocyte and lymphocyte cell counts were recorded. Serum IFNγ, TNFα, VEGF concentrations were measured by using multiplex cytometric bead-based immunoassay. Prevalence of myeloid-derived suppressor cell populations (MDSC-s), and signs of T cell exhaustion were tested by using flow cytometry. Median PFS increased in the NSCLC+COPD group compared to NSCLC patients without COPD (7.4 vs 4.9 months, p < 0.01). NSCLC+COPD patients had 1.7 times (1.2-2.4) more likely to have longer PFS compared to NSCLC patients without COPD (Cox analysis, p < 0.01). Neutrophil cell counts, CRP, IFNγ and TNFα concentrations were all reduced in NSCLC+COPD (all p < 0.05 vs NSCLC). NSCLC+COPD was also associated with reduced serum IL-10 concentration and increased granzyme-B positive CD8 cell counts compared to NSCLC without COPD. The effects of VEGF and MDSC-s on systemic inflammation appeared to be blunted by COPD in patients suffering from advanced NSCLC. Concomitant COPD moderates tumor-induced inflammation and supports some effector lymphoid functions and thereby may be an independent positive predictive factor of longer PFS after first-line therapy in advanced NSCLC.
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Affiliation(s)
- Márton Szentkereszty
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary.,1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Zsolt István Komlósi
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
| | - Gergő Szűcs
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
| | - Gábor Barna
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
| | - György Losonczy
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary.
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
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Integrative diagnosis of cancer by combining CTCs and associated peripheral blood cells in liquid biopsy. Clin Transl Oncol 2018; 21:828-835. [PMID: 30569214 DOI: 10.1007/s12094-018-02004-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022]
Abstract
Circulating tumor cells (CTCs), as cells shed from solid tumor into the vasculature, play a significant role in tumor metastasis. In the peripheral blood, immune cells and stromal cells can interact with CTCs and influence their biological behaviors of survival, proliferation, dissemination, and immune evasion. These peripheral blood cells can evolve synergistically with CTCs to constitute the liquid microenvironment which is essential for tumor progression. Here, we review the mechanisms of peripheral blood cells interacting with CTCs and uncover their effects on both CTCs and tumor metastasis. Then, we introduce the applications of these CTC-associated peripheral blood cells in the clinical setting. Besides, some peripheral blood cell subsets are of additional clinical values to CTCs in cancer diagnosis and prognosis. To improve the clinical utility of CTCs, an integrative analysis of CTCs and associated peripheral blood cells should be advocated for, which could provide a novel insight into tumor biology and offer comprehensive information in cancer diagnosis, prognosis, and therapy efficacy evaluation.
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Dolan RD, Laird BJ, Horgan PG, McMillan DC. The prognostic value of the systemic inflammatory response in randomised clinical trials in cancer: A systematic review. Crit Rev Oncol Hematol 2018; 132:130-137. [DOI: 10.1016/j.critrevonc.2018.09.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/10/2018] [Accepted: 09/29/2018] [Indexed: 12/18/2022] Open
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Phan TT, Ho TT, Nguyen HT, Nguyen HT, Tran TB, Nguyen ST. The prognostic impact of neutrophil to lymphocyte ratio in advanced non-small cell lung cancer patients treated with EGFR TKI. Int J Gen Med 2018; 11:423-430. [PMID: 30510441 PMCID: PMC6250106 DOI: 10.2147/ijgm.s174605] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose To identify and clarify the roles of inflammatory markers in prognosis for advanced non-small cell lung cancer (NSCLC) patients treated with EGFR tyrosine kinase inhibitor (TKI). Patients and methods One hundred and twelve adenocarcinoma, clinical stage IV, NSCLC patients with either EGFR exon 19 deletion (E19del) or EGFR exon 21 L858R substitution mutation (L858R) were selected for this study. The blood cell count at different stages of treatment was used to calculate the inflammatory markers. The Kaplan–Meier statistics and Cox regression model were used to test the differences of progression-free survival (PFS) between groups by the optimal cutoff point of biomarkers. Results The median values of white blood cell (WBC), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) and platelet to lymphocyte ratio (PLR) in NSCLC patients tended to be reduced after 3 months treated with EGFR TKI and increased conversely when the disease develops progression (P<0.001). With an optimal cutoff point of 2.96, NLR is the best prognostic marker in prediction of clinical response among the investigated markers (area under the curve [AUC]=0.873, 95% CI: 0.821–0.926, P<0.001), and it is an independent predictive marker (OR=3.52, 95% CI: 1.42–8.71, P<0.001). With optimal cutoff point of 0.38, MLR is also a predictive marker in response evaluation (AUC=0.762, 95% CI: 0.691–0.832). Univariate analyses have shown that the larger tumor size (>3cm) and the high level of pretreatment NLR were associated with the shortening of PFS (HR=2.24, 95% CI: 1.04–4.83, P=0.039 and HR=2.67, 95% CI: 1.41–5.03, P=0.006, respectively). Multivariate analysis has shown that the elevated NLR is an independent prognostic marker for worse PFS of NSCLC patients treated with EGFR TKI (HR=2.15, 95% CI: 1.15–3.99, P=0.016). Conclusion NLR and MLR are valuable markers in response evaluation for NSCLC patients treated with EGFR TKI. The elevated NLR is also an independent prognostic factor for worse survival.
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Affiliation(s)
- Thang Thanh Phan
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam,
| | - Toan Trong Ho
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam,
| | - Hue Thi Nguyen
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam,
| | - Hang Thuy Nguyen
- Pathology Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Thu Bich Tran
- Faculty of Biology and Biotechnology, University of Science, VNU-HCM, Ho Chi Minh City, Vietnam
| | - Son Truong Nguyen
- Laboratory D Unit, Clinical Cancer Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam,
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31
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Aguiar-Bujanda D, Dueñas-Comino A, Saura-Grau S, Ros-Sanjuan L, Blanco-Sanchez MJ, Hernandez-Sosa M, Mori-De Santiago M, Galvan-Ruiz S, Lorenzo-Barreto JE, Vargas-Prado AM, Bohn-Sarmiento U. Neutrophil to Lymphocyte Ratio as a Prognostic Factor in European Patients with Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer Treated with Tyrosine Kinase Inhibitors. Oncol Res Treat 2018; 41:755-761. [PMID: 30419558 DOI: 10.1159/000492344] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/23/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND A high neutrophil to lymphocyte ratio (NLR) has been associated with adverse outcomes in non-small cell lung cancer (NSCLC). However, information on epidermal growth factor receptor (EGFR)-mutant advanced NSCLC is scarce, and most of the studies published have been conducted in Asian populations. We aimed to assess the influence of pretreatment NLR on progression-free survival (PFS) and overall survival (OS) in Western European patients treated with EGFR tyrosine kinase inhibitors (TKIs). METHODS A retrospective evaluation of 41 patients with EGFR-mutant advanced NSCLC treated with EGFR TKIs between June 2010 and May 2016 was carried out. The association between several prognostic factors including pretreatment NLR and survival was analyzed. RESULTS Median PFS and OS were 10.58 and 20.84 months, respectively. OS for patients with a high NLR was 7.4 months, compared to 24.6 months for patients with a low NLR (p = 0.0122). In multivariate analysis, poor performance status (ECOG PS ≥ 2) and presence of ≥ 3 metastatic locations were identified as significant independent prognostic factors for worse PFS. For OS, unfavorable prognostic factors were a high NLR and central nervous system metastasis at diagnosis. CONCLUSION Pretreatment NLR is an independent prognostic factor for OS in Western European patients with EGFR-mutant NSCLC treated with EGFR TKIs.
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Ding PN, Roberts TL, Chua W, Becker TM, Descallar J, Yip PY, Bray V. Clinical outcomes in patients with advanced epidermal growth factor receptor-mutated non-small-cell lung cancer in South Western Sydney Local Health District. Intern Med J 2018; 47:1405-1411. [PMID: 28742280 DOI: 10.1111/imj.13555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/29/2017] [Accepted: 07/17/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) is a subgroup of oncogene addicted lung cancer that predicts response to tyrosine kinase inhibitors (TKI). However, there is variability in response and survival outcomes in patients with EGFR mutation treated with TKI. AIM To describe clinical characteristics, treatment patterns and factors influencing outcomes in patients with EGFR-mutated NSCLC in South Western Sydney Local Health District. METHODS Retrospective review of patients with EGFR-mutated NSCLC diagnosed between January 2010 and June 2016. RESULTS A total of 85 EGFR-mutated NSCLC patients was identified; 80 (94%) received first-line treatment with EGFR-TKI. The median follow-up was 10.7 months with a median duration of treatment of 9 months. On disease progression (n = 44), 37% had best supportive care only, 30% received chemotherapy, 23% participated in clinical trials, 7% continued on a first generation EGFR-TKI and 3% received afatinib. Overall response rate to first-line EGFR-TKI was 66%. Median progression-free survival (PFS) was 10.7 months (range 2.7-55.9 months) and median overall survival (OS) was 23 months (range 0.4-35.8 months). Multivariate Cox regression analysis showed that patients with lower disease burden (<4 sites) had longer PFS (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.18-0.72, P = 0.004) but not OS. Good performance status predicts longer OS (HR 0.33, CI 0.14-0.77, P = 0.01). Lower (<5) pre-treatment neutrophil-to-lymphocyte ratio (NLR) was associated with better PFS (HR 0.40, 95% CI 0.18-0.87, P = 0.02) and OS (HR 0.43, 95% CI 0.19-0.94, P = 0.04). There were no survival differences when patients were stratified by age, baseline albumin level and types of EGFR mutation. CONCLUSION Results from this community-based cohort confirm known prognostic factors in patients with EGFR-mutated NSCLC receiving TKI and suggest the negative influence of a heightened host systemic inflammatory response on patient outcomes.
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Affiliation(s)
- Pei N Ding
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,Medical Oncology Department, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Tara L Roberts
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Wei Chua
- Medical Oncology Department, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Therese M Becker
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Po Y Yip
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Victoria Bray
- Medical Oncology Department, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Zer A, Sung MR, Walia P, Khoja L, Maganti M, Labbe C, Shepherd FA, Bradbury PA, Feld R, Liu G, Iazzi M, Zawisza D, Nouriany N, Leighl NB. Correlation of Neutrophil to Lymphocyte Ratio and Absolute Neutrophil Count With Outcomes With PD-1 Axis Inhibitors in Patients With Advanced Non-Small-Cell Lung Cancer. Clin Lung Cancer 2018; 19:426-434.e1. [PMID: 29803574 DOI: 10.1016/j.cllc.2018.04.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 03/14/2018] [Accepted: 04/24/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Programmed death-1 (PD-1) axis inhibitors have become standard therapy in advanced non-small-cell lung cancer (NSCLC). Response might be delayed and pseudo-progression occasionally occurs in patients who eventually benefit from treatment. Additional markers beyond programmed death ligand 1 (PD-L1) expression are needed to assist in patient selection, response evaluation, and treatment decisions. MATERIALS AND METHODS The relationship between prospectively collected clinical outcomes (response, disease control rate [DCR], treatment duration, overall survival) and hematologic parameters (neutrophil to lymphocyte ratio [NLR], absolute neutrophil count [ANC], and platelet to lymphocyte ratio [PLR]) was explored retrospectively in advanced NSCLC patients treated with PD-1 axis inhibitors at a major cancer center from May 2013 to August 2016. Hematologic parameters at baseline and during treatment (week 2 or 3 and week 8) were included. RESULTS Of 88 patients treated with PD-1 axis inhibitors, 22 (25%) experienced partial response. Baseline NLR ≤4 was associated with superior DCR (74% vs. 50%; P = .025), treatment duration (P = .037), time to progression (P = .053), and overall survival (P = .019), with no differential association according to PD-L1 tumor expression. Lower NLR and ANC during treatment were also associated with response to treatment (P = .025 and P = .017, respectively), and treatment duration (P = .036 and P = .008). No association was found between baseline PLR and DCR, response, treatment duration, nor overall survival. CONCLUSION Baseline NLR ≤4 and lower NLR and ANC during treatment might correlate with disease control and treatment response and should be explored further as potential predictors of treatment benefit in larger studies.
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Affiliation(s)
- Alona Zer
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mike R Sung
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Preet Walia
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Leila Khoja
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Manjula Maganti
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Catherine Labbe
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Penelope A Bradbury
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ronald Feld
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Melissa Iazzi
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Dianne Zawisza
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nazanin Nouriany
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
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Suh KJ, Kim SH, Kim YJ, Kim M, Keam B, Kim TM, Kim DW, Heo DS, Lee JS. Post-treatment neutrophil-to-lymphocyte ratio at week 6 is prognostic in patients with advanced non-small cell lung cancers treated with anti-PD-1 antibody. Cancer Immunol Immunother 2018; 67:459-470. [PMID: 29204702 PMCID: PMC11028357 DOI: 10.1007/s00262-017-2092-x] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 11/08/2017] [Indexed: 01/04/2023]
Abstract
We investigated inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) that may predict the response to anti-PD-1 (programmed cell death protein 1) antibody therapy. Data from 54 patients with non-small cell lung cancer (NSCLC) treated with anti-PD-1 antibodies were retrospectively analyzed. The NLR was assessed at baseline and 6 weeks after the start of treatment (post-treatment). Eighteen of 54 patients (33.3%) had objective responses to treatment. Older age, absence of brain metastasis, low post-treatment NLR (< 5), and immune-related adverse events were significantly associated with response. Patients with a high post-treatment NLR (≥ 5) had significantly shorter progression-free survival (PFS) than those with a low post-treatment NLR (median, 1.3 vs. 6.1 months, p < 0.001). Multivariate analysis demonstrated that high post-treatment NLR [hazard ratio (HR) 15.1, 95% confidence interval (CI) 1.5-50.1, p < 0.001], liver metastasis (HR 4.9, 95% CI 1.9-12.4, p = 0.001), and brain metastasis (HR 3.2, 95% CI 1.3-8.2, p = 0.013) were independent prognostic factors of shorter PFS. Overall survival (OS) was significantly different in patients with high and low post-treatment NLRs (median, 2.1 vs. 14.0 months, p < 0.001). A high post-treatment NLR remained an independent prognostic factor for OS in multivariate analysis (HR 3.9, 95% CI 1.6-9.2, p = 0.003). The NLR at 6 weeks after treatment initiation was a prognostic marker in patients with advanced NSCLC treated with anti-PD-1 antibody. Further studies are warranted to evaluate the role of the 6-week NLR as a predictor in anti-PD-1 antibody treatment.
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Affiliation(s)
- Koung Jin Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-Gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-Gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-Gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Jong Seok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 beon-gil, Bundang-Gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.
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Prognostic significance of neutrophil-lymphocyteratio/platelet-lymphocyteratioin lung cancers: a meta-analysis. Oncotarget 2018; 7:76769-76778. [PMID: 27732958 PMCID: PMC5363548 DOI: 10.18632/oncotarget.12526] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/10/2016] [Indexed: 01/29/2023] Open
Abstract
Setting For now, hematological markers of inflammatory response have emerged as prognostic factors for patients with cancer. Many articles have confirm that neutrophil to lymphocyte ratio(NLR) and platelet–lymphocyte ratio (PLR) are relate with poor prognosis in various types of tumors. Objective To investigate the association between NLR/PLR and progression free survival (PFS), overall survival (OS) and clinicopathologic parameters in lung cancer patients. Design We performed relevant searches in PubMed database, Google Scholar, Springer Link. We included retrospective cohort studies that reported hazard ratios with 95% confidence intervals for the NLR or PLR and PFS or OS. Results Both high NLR (P < 0.00001) and high PLR (P = 0.01) were significantly predictive of poorer OS. It also demonstrated that elevated NLR predicted poorer PFS (P = 0.0002). High NLR was significantly associated with deeper Invasive of tumor, (P = 0.006) extensive lymph nodetastasis(N2–3) (P = 0.01), poor differentiation (P = 0.0002) and vascular invasion(P = 0.002). There was no evidence of publication bias. Subgroup analysis indicated that little evidence of heterogeneity. However, PLR has no prognostic significance for SCLC. Conclusions We provides further evidence in support of elevated NLR and PLR were predictors of poor OS and PFS in patients with lung cancer. Given this, NLR and PLR may be markers to report treatment outcomes.
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Araki O, Matsumura Y, Inoue T, Karube Y, Maeda S, Kobayashi S, Chida M. Association of Perioperative Redox Balance on Long-Term Outcome in Patients Undergoing Lung Resection. Ann Thorac Cardiovasc Surg 2018; 24:13-18. [PMID: 29129842 PMCID: PMC5833135 DOI: 10.5761/atcs.oa.17-00127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/24/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE We examined whether redox balance during the perioperative period is associated with long-term survival of patients after undergoing lung resection. METHODS Patients who underwent surgery for lung cancer from January to June 2013 at our institution were investigated. Serum was collected during the operation, and on postoperative day (POD) 3 and 7, and the levels of derivatives of reactive oxygen metabolites (d-ROMs) and biologic antioxidant potential (BAP) were measured. RESULTS In all, 21 patients (69 ± 7 years old) were enrolled, of whom 9 underwent video-assisted thoracoscopic surgery. Comorbidities in the patients included chronic obstructive pulmonary disease in eight and idiopathic pulmonary fibrosis in five. d-ROM values on POD 3 and 7 were significantly increased as compared to those obtained during the operation (p <0.001), whereas BAP did not change after surgery. Patients with a value below a d-ROM cutoff value of 327 during the operation showed significantly superior 3-year overall survival as compared to those with a value above the cutoff (87.5% vs. 20.0%, p <0.001). CONCLUSION In the present patients, surgical stress caused an increase in d-ROM during the postoperative course. The d-ROM value obtained during the operation was correlated with long-term survival following resection for lung cancer.
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Affiliation(s)
- Osamu Araki
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yuji Matsumura
- Department of Cardiothoracic Surgery, Dokkyo Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Takashi Inoue
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yoko Karube
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Sumiko Maeda
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Satoru Kobayashi
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
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Kiriu T, Yamamoto M, Nagano T, Hazama D, Sekiya R, Katsurada M, Tamura D, Tachihara M, Kobayashi K, Nishimura Y. The time-series behavior of neutrophil-to-lymphocyte ratio is useful as a predictive marker in non-small cell lung cancer. PLoS One 2018; 13:e0193018. [PMID: 29447258 PMCID: PMC5814002 DOI: 10.1371/journal.pone.0193018] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/02/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Nivolumab improves the survival of advanced non-small cell lung cancer (NSCLC), but a significant number of patients still fail to benefit from this treatment. In this study, we evaluated the efficacy of the time-series behavior of neutrophil-to-lymphocyte ratio (NLR) in a complete blood count from advanced NSCLC patients as a predictive marker of the anticancer effect of nivolumab. METHODS We performed a retrospective review of medical records and collected data on patients with advanced NSCLC treated with nivolumab as second- and further-line treatments from December 2015 to March 2017. The NLRs were calculated before each treatment cycle for four cycles. These parameters were tested for its association with the overall survival (OS), progression-free survival (PFS) and time to treatment failure (TTF). RESULTS Nineteen patients were treated with nivolumab. Stratified by the response to nivolumab, the median OS was 2.8 months in progressive disease (PD) and 14.0 months in non-PD (p = 0.002). Before discontinuation of PD or toxicity, an NLR is rising from baseline in 5 out of 7 patients with PD and all of 4 patients with discontinuation due to toxicity. Patients with an >30% increase in NLR were associated with a significantly shorter TTF compared with those with stable or decrease in NLR both after first cycle (p = 0.014) and second cycle (p < 0.001). CONCLUSIONS The NLR is suggested to be useful not only as a prognostic marker but also as a predictive marker for treatment with nivolumab. Further prospective study is warranted to develop a predictive algorithm to detect PD cases as early as possible by focusing the time-series behavior of NLR.
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Affiliation(s)
- Tatsunori Kiriu
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masatsugu Yamamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- * E-mail:
| | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Hazama
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Reina Sekiya
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Katsurada
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Tamura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuyuki Kobayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Ozyurek BA, Ozdemirel TS, Ozden SB, Erdoğan Y, Ozmen O, Kaplan B, Kaplan T. Does advanced lung inflammation index (ALI) have prognostic significance in metastatic non-small cell lung cancer? CLINICAL RESPIRATORY JOURNAL 2018; 12:2013-2019. [PMID: 29356383 DOI: 10.1111/crj.12768] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/11/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lung cancer is the most commonly diagnosed and death-related cancer type and is more frequent in males. Non-small-cell lung cancer (NSCLC) accounts for about 85% of all case. In this study, it was aimed to research the relationship between advanced lung inflammation index (ALI) and the primary mass maximum standardized uptake value (SUVmax) and C-reactive protein (CRP) at initial diagnosis and the prognostic value of ALI in determining the survival in metastatic NSCLC. METHODS A total of 112 patients diagnosed as stage 4 non-small-lung cancer in our hospital between January 2006 and December 2013 were included in this study. ALI was calculated as body mass index (BMI) × serum albumin/neutrophil-to-lymphocyte ratio (NLR). The patients were divided into two groups as ALI < 18 (high inflammation) and ALI ≥ 18 (low inflammation). The log-rank test and Cox proportional hazard model were used to identify predictors of mortality. RESULTS Evaluation was made of 94 male and 18 female patients with a mean age of 59.7 ± 9.9 years. A statistically significant negative relationship was determined between ALI and CRP values (P < .001), but no relationship was found between ALI and SUVmax values (P = .436). The median survival time in patients with ALI < 18 was 12 months and, in those with ALI ≥ 18, it was 16 months (P = .095). CONCLUSION ALI is an easily calculated indicator of inflammation in lung cancer patients. Values <18 can be considered to predict a poor prognosis.
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Affiliation(s)
- Berna Akinci Ozyurek
- Chest Diseases Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Tugce Sahin Ozdemirel
- Chest Diseases Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Sertac Buyukyaylaci Ozden
- Chest Diseases Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Yurdanur Erdoğan
- Chest Diseases Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Ozlem Ozmen
- Nuclear Medicine Clinic, Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - Bekir Kaplan
- Bloomberg School of Public Health, Johns Hopkins University, Maryland
| | - Tugba Kaplan
- Chest Diseases, Ulus State Hospital, Ankara, Turkey
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Teo M, Sharial MSNM, McDonnell F, Conlon KC, Ridgway PF, McDermott RS. Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Advanced Pancreatic Ductal Adenocarcinoma: Impact of Baseline Fluctuation and Changes during Chemotherapy. TUMORI JOURNAL 2018; 99:516-22. [DOI: 10.1177/030089161309900413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Aims and background Inflammation has been implicated in carcinogenesis and progression of pancreatic cancer. The neutrophil-to-lymphocyte ratio is an index of systemic inflammation. We examined the prognostic role of the neutrophil-to-lymphocyte ratio at baseline and the significance of intrapersonal variability of the ratio before and during chemotherapy. Methods and study design Advanced pancreatic adenocarcinoma patients who had received chemotherapy were included. Baseline clinical and biochemical parameters, including the neutrophil-to-lymphocyte ratio, were extracted and analyzed. The neutrophil-to-lymphocyte ratio threshold was determined via recursive partitioning and assessed at diagnosis, prior to chemotherapy and during treatment. Overall survival was estimated via the Kaplan-Meier method and compared between groups with the logrank test. Results Between 2005 and 2011, 85 patients with locally advanced (n = 38) and metastatic disease were identified: 68% with a neutrophil-to-lymphocyte ratio >3 had shorter median overall survival than patients with a neutrophil-to-lymphocyte ratio <3 (3.4 vs 9.4 months, P = 0.001). Pretreatment, 35% of repeat neutrophil-to-lymphocyte ratios crossed the threshold of 3. A persistently elevated neutrophil-to-lymphocyte ratio >3 suggested a worse overall survival than in patients with a decreasing, increasing or persistently low neutrophil-to-lymphocyte ratio (1.9 vs 8.2, 12.3 and 11.7 months, respectively, P <0.001). Twenty-three percent of patients had a >50% decrease in neutrophil-to-lymphocyte ratio following 4 weeks of chemotherapy, with a trend towards improvement in overall survival (12.5 vs 5.0 mo, P = 0.068). Conclusions The baseline neutrophil-to-lymphocyte ratio is a validated marker for a poor prognosis. Multiple assessments of the pre-treatment neutrophil-to-lymphocyte ratio might be required. Reduction in the neutrophil-to-lymphocyte ratio during chemotherapy may be associated with improved survival.
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Affiliation(s)
- MinYuen Teo
- Department of Medical Oncology, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
| | | | - Felicity McDonnell
- Pharmacy Department, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
| | - Kevin C Conlon
- Professorial Surgical Unit and Department of Upper Gastrointestinal & Hepato-Pancreato-Biliary Surgery, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
| | - Paul F Ridgway
- Professorial Surgical Unit and Department of Upper Gastrointestinal & Hepato-Pancreato-Biliary Surgery, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
| | - Ray S McDermott
- Department of Medical Oncology, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
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Gao Y, Wang WJ, Zhi Q, Shen M, Jiang M, Bian X, Gong FR, Zhou C, Lian L, Wu MY, Feng J, Tao M, Li W. Neutrophil/lymphocyte ratio is a more sensitive systemic inflammatory response biomarker than platelet/lymphocyte ratio in the prognosis evaluation of unresectable pancreatic cancer. Oncotarget 2017; 8:88835-88844. [PMID: 29179480 PMCID: PMC5687650 DOI: 10.18632/oncotarget.21340] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/26/2017] [Indexed: 12/23/2022] Open
Abstract
Multiple cancers arise from sites of infection, chronic irritation, and inflammation. It has been widely accepted that pancreatic cancer is an inflammation-driven cancer. In this study, we investigated the application value of systemic inflammatory markers, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), in the prediction of chemotherapy response and prognosis in patients with late pancreatic cancer. 122 patients with inoperable pancreatic cancers were included and separated into two groups according to median values of NLR or PLR (NLR low:<3.81 or NLR high:≥3.81, and PLR low:<142.14 or PLR high≥142.14, respectively). Baseline NLR and PLR levels were significantly higher in pancreatic cancer patients compared with the healthy subjects. Neither of the baseline NLR or PLR levels could predict outcomes. Patients with low baseline level of NLR, but not PLR, had better responses to chemotherapy. Changes in NLR, but not PLR levels, were associated with the therapeutic efficacy. Patients who stayed in or dropped into the low NLR level subgroup after first-line chemotherapy had better responses, comparing to those stayed in or jumped into the high NLR level group. No similar results could be observed when the PLR level was investigated. Therefore, NLR is a more sensitive biomarker than PLR in the prediction of chemotherapy response of patients.
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Affiliation(s)
- Yuan Gao
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wen-Jie Wang
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiaoming Zhi
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meng Shen
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Jiang
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaojie Bian
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fei-Ran Gong
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chong Zhou
- Department of Radiation Oncology, Xuzhou Central Hospital, Xuzhou, China
| | - Lian Lian
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Oncology, Suzhou Xiangcheng People's Hospital, Suzhou, China
| | - Meng-Yao Wu
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Feng
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Tao
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.,PREMED Key Laboratory for Precision Medicine, Soochow University, Suzhou, China
| | - Wei Li
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China.,PREMED Key Laboratory for Precision Medicine, Soochow University, Suzhou, China.,Center for Systems Biology, Soochow University, Suzhou, China
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Rejec A, Butinar J, Gawor J, Petelin M. Evaluation of Complete Blood Count Indices (NLR, PLR, MPV/PLT, and PLCRi) in Healthy Dogs, Dogs With Periodontitis, and Dogs With Oropharyngeal Tumors as Potential Biomarkers of Systemic Inflammatory Response. J Vet Dent 2017; 34:231-240. [PMID: 28936913 DOI: 10.1177/0898756417731775] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of the study was to retrospectively assess complete blood count (CBC) indices of dogs with periodontitis (PD; n = 73) and dogs with oropharyngeal tumors (OT; n = 92) in comparison to CBC indices of healthy dogs (HD; n = 71). Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, mean platelet volume to platelet ratio, and platelet large cell ratio index (PLCRi) were evaluated as biomarkers of systemic inflammatory response provoked by PD and OT. Results of multivariable polytomous logistic regression analysis indicated no significant associations between CBC indices and PD. Both NLR and PLCRi were significantly higher in dogs with OT when compared to HD and dogs with PD and could, therefore, indicate a tumor-associated systemic inflammatory response. Additional studies of CBC indices, along with other biomarkers of systemic inflammatory response, are recommended to validate them as reliable indicators of clinical disease activity.
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Affiliation(s)
- Ana Rejec
- 1 Animal Hospital Postojna, Postojna, Slovenia
| | | | | | - Milan Petelin
- 3 Department of Oral Medicine and Periodontology, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
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Yu Y, Qian L, Cui J. Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: A meta-analysis of 7,219 patients. Mol Clin Oncol 2017; 7:498-506. [PMID: 28811903 DOI: 10.3892/mco.2017.1342] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022] Open
Abstract
Current evidence suggests that the neutrophil-to-lymphocyte ratio (NLR) may be a biomarker for poor prognosis in lung cancer, although this association remains controversial. Therefore, a meta-analysis was performed to evaluate the association between NLR and lung cancer outcome. A systematic literature search was performed through the PubMed, Embase and Cochrane Library databases (until July 30, 2016), to identify studies evaluating the association between NLR and overall survival (OS) and/or progression-free survival (PFS) among patients with lung cancer. Based on the results of this search, data from 18 studies involving 7,219 patients with lung cancer were evaluated. The pooled hazard ratio (HR) suggested that elevated pretreatment NLR predicted poor OS [HR=1.46, 95% confidence interval (CI): 1.30-1.64] and poor PFS (HR=1.42, 95% CI: 1.15-1.75) among patients with lung cancer. Subgroup analysis revealed that the prognostic value of NLR for predicting poor OS increased among patients who underwent surgery (HR=1.50, 95% CI: 1.21-1.84) or patients with early-stage disease (HR=1.64, 95% CI: 1.37-1.97). An NLR cut-off value of ≥4 significantly predicted poor OS (HR=1.56, 95% CI: 1.31-1.85) and PFS (HR=1.54, 95% CI: 1.13-1.82), particularly in the cases of small-cell lung cancer. Thus, the results of the present meta-analysis suggested that an elevated pretreatment NLR (e.g., ≥4) may be considered as a biomarker for poor prognosis in patients with lung cancer.
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Affiliation(s)
- Yu Yu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Lei Qian
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jiuwei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Significance of neutrophil-to-lymphocyte ratio in Western advanced EGFR-mutated non-small cell lung cancer receiving a targeted therapy. TUMORI JOURNAL 2017; 103:443-448. [PMID: 28731495 DOI: 10.5301/tj.5000632] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Lung cancer is one of the leading causes of cancer-related death worldwide and, although targeted therapy with tyrosine kinase inhibitors has dramatically improved the rates of response and survival in advanced EGFR-mutated adenocarcinoma, the overall outcome remains unsatisfactory. Therefore, new prognostic factors, preferably simple, inexpensive, and easy to reproduce on a large scale, are needed. We performed a retrospective analysis of our database including 63 western Caucasian patients with advanced EGFR-mutated lung adenocarcinoma and receiving gefitinib, erlotinib, or afatinib as first- or second-line therapy. Several studies demonstrated a strong link between elevated neutrophil-to-lymphocyte ratio (NLR) and poor prognosis both in early and advanced stages of non-small-cell lung cancer (NSCLC). METHODS From January 2011 to December 2015, 63 consecutive elegible patients with advanced EGFR-mutated NSCLC were included in this analysis from 5 institutions. The NLR was derived from the absolute neutrophil and the absolute lymphocyte counts of a full blood count and the cutoff value was determined according to the mean NLR level. RESULTS Despite the small sample analyzed, we found that NLR has a prognostic role for progression-free survival (PFS) and overall survival (OS), reaching a statistically significant difference with a better PFS and OS in the lower NLR group. CONCLUSIONS Pretreatment NLR seems to represent a reliable, simple, and easy to reproduce laboratory tool to predict outcome and response to cancer therapies in this setting of Western Caucasian patients with EGFR-mutated NSCLC.
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Kang KH, Efird JT, Sharma N, Yang M, Dowlati A, Linden P, Machtay M, Biswas T. Prognostic potential of neutrophil-to-lymphocyte ratio and lymphocyte nadir in stage III non-small-cell lung cancer. Future Oncol 2017; 13:1405-1414. [PMID: 28685599 DOI: 10.2217/fon-2017-0045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AIM Studies have shown increased pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to be predictive of survival in various cancers. Our aim was to evaluate the prognostic role of such inflammatory markers in non-small-cell lung cancer (NSCLC). METHODS One hundred and sixty-three patients with stage III NSCLC who received definitive treatment were included. Survival analysis was performed using Kaplan-Meier method. Hazard ratios for overall and recurrence-free survival were estimated using Cox proportional hazards model. RESULTS Both neutrophil-to-lymphocyte >Q75 (4.5) and lymphocyte nadir values <Q25 (0.25) and their unified values were associated with 90% increased overall mortality risk (p = 0.040) and a nonsignificant 50% decreased recurrence-free survival risk. CONCLUSION Our exploratory analysis showed markers of systemic inflammation predicted survival outcomes in advanced NSCLC. Future prospective data analyses are needed to confirm this potential.
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Affiliation(s)
- Kylie H Kang
- School of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, USA
| | - Jimmy T Efird
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Neelesh Sharma
- University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, USA
| | - Michael Yang
- University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, USA
| | - Afshin Dowlati
- University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, USA
| | - Philip Linden
- University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, USA
| | - Mitchell Machtay
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, USA
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, USA
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Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, Wang Q, Yang W. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev 2017; 58:1-13. [PMID: 28602879 DOI: 10.1016/j.ctrv.2017.05.005] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/15/2017] [Accepted: 05/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) is crucial for the incidence and mortality of various tumors. However, little is known on NLR and its association with prognosis in advanced tumors. Here we performed a meta-analysis to establish the prognostic significance of pretreatment blood NLR for advanced tumors. METHODS A systematic literature search through April 2016 was performed to evaluate the association between pretreatment blood NLR and overall survival (OS) or progression-free survival (PFS) in patients with advanced tumors. Data were extracted from studies reporting hazard ratios (HRs) and 95% confidence interval (CI) and pooled using the Mantel-Haenszel random-effect model. RESULTS Sixty-six studies with a total of 24536 individuals were included in the meta-analysis. Pooled analyses revealed that elevated pretreatment NLR was associated with worse OS (HR 1.70, 95% CI 1.57-1.84, P<0.001) and PFS (HR 1.61, 95% CI 1.42-1.82, P<0.001) in advanced tumors. Subgroup analysis stratified by tumor type demonstrated that pancreatic cancer patients with high pretreatment NLR had the worst OS (HR 1.94, 95% CI 1.55-2.54, P<0.001) and colorectal cancer with the worst PFS (HR 1.74, 95% CI 1.04-2.90, P<0.001). When stratified by cut-off value for NLR, we found that cut-off value being five indicated the worst PFS (HR 2.23, 95% CI 1.54-3.23, P=0.019). CONCLUSIONS Overall, high pretreatment blood NLR could be an adverse prognostic indicator for advanced tumor. Large-scale prospective studies investigating its survival outcomes in specific cancer type are strongly advocated.
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Affiliation(s)
- Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Lu Shi
- Transplantation Biology Research Division, State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Bo Wang
- Department of Biological Medicine, Changjiang Polytechnic, Wuhan, Hubei Province, China
| | - Jizhen Yang
- Department of Medical Ultrasonic, Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Zhihong Xiao
- Department of Orthopaedics, Pu Ai Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| | - Peixin Du
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingming Wang
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Yang
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Akinci Ozyurek B, Sahin Ozdemirel T, Buyukyaylaci Ozden S, Erdogan Y, Kaplan B, Kaplan T. Prognostic Value of the Neutrophil to Lymphocyte Ratio (NLR)
in Lung Cancer Cases. Asian Pac J Cancer Prev 2017; 18:1417-1421. [PMID: 28612596 PMCID: PMC5555556 DOI: 10.22034/apjcp.2017.18.5.1417] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Haemogram assessment is a cheap and easy method which can be readily performed for almost all patients. Leucocyte, neutrophil and lymphocyte counts and the neutrophil to lymphocyte ratio (NLR) are markers of systemic inflammation. We here aimed to evaluate haemogram parameters of our patients with lung cancer according to the pathologic diagnosis of small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Materials and Methods: The study included 386 patients diagnosed with lung cancer in our hospital between January 2006 and January 2014. A retrospective examination was made of the data from the patient records and the hospital information. NLR values were categorised into two groups: <3 and ≥3. Results: Median survival time in patients aged <65 years was 28.7 months and in those aged ≥65 years, it was 18.4 months (p<0.001). The median survival time was 20.2 months in NSCLC and 13.0 months in SCLC patients (p<0.001). In NSCLC cases with NLR<3 the median survival time (31.1 months) was longer than that of patients with NLR≥3 (18 months) (p=0.003). In SCLC patients, no relationship could be found between NLR and median survival time (p=0.408). With every 1 unit increase in lymphocyte count a 5.5% decrease in risk of periodic death ((1/0.947)x100=5.5%) was noted. Conclusion: The results of this study demonstrated that lymphocyte count, neutrophil count, Hb, Htc, and NLR are useful in determining prognosis in lung cancer (LC) patients and NLR could be more significant in determining the prognosis in NSCLC than in SCLC cases.
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Affiliation(s)
- Berna Akinci Ozyurek
- Ataturk Chest Diseases And Chest Surgery Education And Research Hospital, Chest Diseases Clinic, Ankara, Turkey.
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Association of Postoperative Nausea and Vomiting Incidence With Neutrophil-Lymphocyte Ratio in Ambulatory Maxillofacial Surgery. J Oral Maxillofac Surg 2017; 75:1367-1371. [PMID: 28137634 DOI: 10.1016/j.joms.2016.12.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/09/2016] [Accepted: 12/20/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) constitutes an important factor in ambulatory surgery. The mechanisms of the antiemetic action of potent anti-inflammatory corticosteroids, which are used extensively for the treatment of PONV, as well as the association between PONV and inflammation, have not been investigated sufficiently. We aimed to establish the association between the neutrophil-lymphocyte ratio (NLR) and postoperative antiemetic administration, as well as to investigate whether the NLR would be a biomarker for PONV. MATERIALS AND METHODS The anesthesia records of American Society of Anesthesiologists (ASA) physical status I or II patients who underwent ambulatory routine oral surgery under general anesthesia were evaluated after we obtained ethical approval from the faculty ethics committee. A 5-point scale was used to score PONV. Metoclopramide (Metpamid, Istanbul, Turkey) was used as the first choice in patients who had a PONV scale score of 1 or higher. Data regarding metoclopramide administration during extubation and discharge periods were analyzed. Sixty-four patients were randomized and enrolled in the study with an NLR less than 2 (group I, n = 37) or an NLR greater than 2 (group II, n = 27), and metoclopramide administration was evaluated in each case. The association between the NLR and metoclopramide administration was analyzed statistically by a descriptive statistical method in detecting frequencies; the χ2 test was used in comparison of the groups and the t test in independent groups. RESULTS The metoclopramide administration frequency for PONV was 5.4% in group I and 96.3% in group II. The metoclopramide administration frequency in group II was statistically higher than that in group I (P < .001). CONCLUSIONS We are of the opinion that the NLR can be easily calculated with data obtained from the complete blood count and could be a marker for PONV. Antiemetic prophylaxis could be given after evaluation of the NLR. However, we suggest that this result should be supported with further prospective studies using larger series.
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Wang Q, Liu H, Sun S, Cheng Z, Zhang Y, Sun X, Wang Z, Wang S. Neutrophil-to-lymphocyte ratio is effective prognostic indicator for post-amputation patients with critical limb ischemia. Saudi Med J 2017; 38:24-29. [PMID: 28042626 PMCID: PMC5278060 DOI: 10.15537/smj.2017.1.15936] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/20/2016] [Indexed: 12/15/2022] Open
Abstract
To confirm whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are indicators for the prognosis of post-amputation patients with critical limb ischemia (CLI). Methods: In this retrospective observational study a total 270 post-amputation patients with CLI were included between January 2010 and December 2014 in the First Hospital of Jilin University, Changchun, China. The neutrophil and lymphocyte counts were recorded before amputations. Neutrophil-to-lymphocyte ratio was calculated and NLR ≥8.08 was defined as elevated. Logistic regression analysis was conducted to test the prognostic value. Results: According to the statistical analysis, it was indicated that NLR ≥8.08 (odds ratio [OR]: 26.228, 95% confidence interval [CI]: 5.801-118.583, p less than 0.001), PLR ≥237.14 (OR: 3.464, 95% CI: 1.289-9.308, p=0.014) and coronary heart disease (OR: 2.739, 95% CI: 1.060-7.082, p=0.038) were the independent prognostic indicators for the patients. Conclusion: Neutrophil-to-lymphocyte ratio, PLR, and coronary heart disease are independent prognostic indicators for post-amputation patients with CLI.
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Affiliation(s)
- Qi Wang
- Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, China. E-mail.
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A retrospective evaluation of associations between chronic obstructive pulmonary disease, smoking, and efficacy of chemotherapy and selected laboratory parameters in patients with advanced non-small cell lung cancer. Contemp Oncol (Pozn) 2016; 20:407-413. [PMID: 28373824 PMCID: PMC5371709 DOI: 10.5114/wo.2016.64605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/22/2016] [Indexed: 11/25/2022] Open
Abstract
Aim of the study To was to determine the impact of chronic obstructive pulmonary disease (COPD) and active smoking on the efficacy of chemotherapy and complete blood count (CBC) in patients with non-small cell lung cancer (NSCLC). Material and methods The retrospective evaluation included 50 patients with stage IIIB–IV NSCLC, who started cisplatin-based chemotherapy. Peripheral blood CBC values were collected for testing before chemotherapy and after the first and third cycles. Results COPD was diagnosed in 49% of patients, while 42% of those enrolled were current smokers. Current smoking (p = 0.92) and COPD (p = 0.91) status did not affect the response to treatment. The non-COPD population presented a significantly higher pretreatment absolute lymphocyte count (ALC) than the COPD population (2.31 vs. 1.81 × 109/l; p = 0.0374). Also, only the non-COPD group demonstrated an elevated absolute monocyte count (AMC) following the first and third cycles of chemotherapy (p = 0.004). In current smokers, pretreatment values for white blood cells (WBC), absolute neutrophil count (ANC), and platelets (PLT) were higher than in the ex-smoker population (WBC 9.94 vs. 8.7 (× 109/l); p = 0.01; ANC 6.47 vs. 5.61 (× 109/l); p = 0.037; PLT 316 vs. 266 (× 109/l); p = 0.049). Ex-smokers demonstrated AMC level elevation after the first cycle of chemotherapy and PLT level elevation after the third cycle, while current smokers also demonstrated an early decrease in LMR. Conclusions COPD and smoking induce chronic systemic inflammation and oxidative stress, which influence the results of standard laboratory tests, but do not change the response rate of lung cancer on chemotherapy.
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50
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Onal C, Guler OC, Yildirim BA. Prognostic Use of Pretreatment Hematologic Parameters in Patients Receiving Definitive Chemoradiotherapy for Cervical Cancer. Int J Gynecol Cancer 2016; 26:1169-75. [PMID: 27206286 DOI: 10.1097/igc.0000000000000741] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES The aim of this work was to evaluate the prognostic role of pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in recipients of definitive chemoradiotherapy (ChRT) for cervical cancer. METHODS In 235 patients given definitive ChRT for histologically confirmed cervical cancer, clinical data and pretreatment complete blood cell counts were analyzed. Prognostic and therapeutic ramifications of NLR and PLR were assessed. RESULTS Median pretreatment NLR and PLR were 3.03 (range, 1.04-13.03) and 133.02 (range, 36.3-518.16), respectively. Both NLR and PLR correlated significantly with tumor size, lymph node metastasis, and treatment response. In addition to NLR and PLR, tumor stage, size, and nodal metastasis were identified by univariate analysis as significant predictors of overall survival (OS) and progression-free survival (PFS). By multivariate analysis, independent predictors of OS and PFS were NLR (OS: hazard ratio [HR], 3.322; 95% confidence interval [CI], 1.905-5.790; PFS: HR, 3.579; 95% CI, 2.106-6.082; both P < 0.001) and lymph node metastasis (OS: HR, 2.620; 95% CI, 1.706-4.023; PFS: HR, 2.989; 95% CI, 1.918-4.378; both P < 0.001), although patients' age (HR, 1.019; 95% CI, 1.003-1.035; P = 0.02) was also significantly predictive of OS. CONCLUSIONS Pretreatment NLR and PLR were associated with larger tumors, lymph node metastasis, and poorer therapeutic responses to definitive ChRT. By multivariate analysis, pretreatment NLR and lymph node metastasis were found independently predictive of OS and PFS, whereas patients' age was significantly predictive of OS only. In patients with advanced cervical cancer, NLR is a potential biomarker, serving to guide systemic therapy and predict treatment outcomes.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
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