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Wazib S, Quasimi H, Bhagat S, Alam A, Ealhi AA, Sharma S, Khan GA, Alam I. The Correlation Between Neutrophil Elastase and Neutrophil-Lymphocyte Ratio in Endothelial Dysfunction of Preeclampsia. Cureus 2024; 16:e67312. [PMID: 39301340 PMCID: PMC11412614 DOI: 10.7759/cureus.67312] [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: 08/19/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Preeclampsia (PE) is a serious inflammatory process that is unique to pregnancy, occurring at or after the 20th week of pregnancy, and leading to maternal and neonatal illness and systemic disruptions. Placental hypoxia leads to increased levels of cytokines and inflammatory syncytiotrophoblast microvillus membrane microparticles (STBM) which activates neutrophils leading to oxidative stress and endothelial dysfunction in preeclampsia. The mechanisms that cause PE in people remain unknown. To understand the pathophysiology of PE, numerous theories have been given. There is currently no proven treatment or early detecting marker for PE available so far. METHODS The present study includes 40 patients (20 controls and 20 PE patients) aged 20-45 years hospitalized at the Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR) and Hakeem Abdul Hameed Centenary (HAHC) Hospital, Jamia Hamdard, New Delhi. Nitric oxide (NO), neutrophil elastase (NE), and the neutrophil-to-lymphocyte ratio were measured. The blood and biochemical parameters in PE patients were also analyzed. RESULTS The neutrophil-to-lymphocyte ratio (NLR) was significantly increased in PE patients as compared to healthy pregnant. All the biochemical and hemodynamic parameters were assessed. The serum NO concentrations were lower in PE patients and endothelial dysfunction markers (NE and von Willebrand factor {vWF}) were markedly increased in PE patients. The difference was statistically significant with a p-value <0.05. CONCLUSIONS NLR is greatly increased in PE patients. An increase in NLR in PE patients occurs due to an increase in inflammatory markers and endothelial damage. Hence, the NLR could act as a novel diagnostic biomarker for depicting PE progression.
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Affiliation(s)
- Sheema Wazib
- Physiology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, IND
| | - Huma Quasimi
- Physiology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, IND
| | - Saumya Bhagat
- Internal Medicine, Division of Bone and Mineral Diseases, Washington University School of Medicine, St. Louis, UMI
| | - Ayaan Alam
- Physiology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, IND
| | - Arifa A Ealhi
- Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, IND
| | - Sumedha Sharma
- Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, IND
| | - Gausal Azam Khan
- Clinical Nutrition, College of Applied Medical Sciences, King Faisal University, Alhasa, SAU
| | - Iqbal Alam
- Physiology, Hamdard Institute of Medical Sciences and Research (HIMSR), New Delhi, IND
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Pan Z, Wang Y, Li S, Cai H, Guan G. The prognostic role of the change in albumin-derived neutrophil-to-lymphocyte ratio during neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. BIOMOLECULES & BIOMEDICINE 2024; 24:612-624. [PMID: 38041687 PMCID: PMC11088900 DOI: 10.17305/bb.2023.9787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/12/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Abstract
The prognosis of patients with locally advanced rectal cancer (LARC) has improved with the adoption of a multidisciplinary treatment approach combining neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME). Developing real-time, sensitive biomarkers to monitor systemic changes during nCRT is of paramount importance. Although the association between albumin-derived neutrophil-to-lymphocyte ratio (Alb-dNLR) and prognosis in various cancers is established, its prognostic value in LARC patients undergoing nCRT is not well-studied. This study enrolled a cohort of 618 LARC patients, stratifying them into two groups according to their change in Alb-dNLR (∆Alb-dNLR) values, using an optimal cut-off point: a low ∆Alb-dNLR group (≤ 0.90) and a high ∆Alb-dNLR group (> 0.90). The prognostic significance of ∆Alb-dNLR was evaluated using a Cox proportional hazards model. The 5-year overall survival (OS) rates were 75.2% in the low ∆Alb-dNLR group (≤ 0.90) and 85.9% in the high ∆Alb-dNLR group (>0.90) (P < 0.001). The 5-year disease-free survival (DFS) rates were 71.2% and 80.6%, respectively (P = 0.016). Multivariate analyses demonstrated that both ∆Alb-dNLR and pre-Alb-dNLR were independent prognostic factors for OS (P ≤ 0.001), while ∆Alb-dNLR was demonstrated as an independent prognostic factor for DFS (P = 0.016). A predictive nomogram, incorporating the ∆Alb-dNLR subgroup, demonstrated enhanced performance (concordance index [C-index] of 0.720 for OS and 0.690 for DFS) compared to the pre-treatment Alb-dNLR subgroup (C-index of 0.700 for OS and of 0.680 for DFS). Therefore, ∆Alb-dNLR shows significant potential as a usable and prognostic biomarker for predicting OS and DFS in LARC patients undergoing nCRT.
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Affiliation(s)
- Zhen Pan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ye Wang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shoufeng Li
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huajun Cai
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guoxian Guan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fuzhou, China
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Sharma D, Gajjar D, Seshadri S. Understanding the role of gut microfloral bifidobacterium in cancer and its potential therapeutic applications. MICROBIOME RESEARCH REPORTS 2023; 3:3. [PMID: 38455077 PMCID: PMC10917622 DOI: 10.20517/mrr.2023.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/28/2023] [Accepted: 10/30/2023] [Indexed: 03/09/2024]
Abstract
Gut microbiota research has gained a tremendous amount of attention from the scientific community because of its contribution to gut homeostasis, human health, and various pathophysiological conditions. The early colonizer of the human gut, i.e., bifidobacteria, has emerged as an efficient probiotic in various diseased conditions, including cancer. This review explores the pros and cons of Bifidobacterium in various malignancies and various therapeutic strategies. We have illustrated the controversial role of bifidobacteria participating in various malignancies as well as described the current knowledge regarding its use in anticancer therapies. Ultimately, this article also addresses the need for further extensive research in elucidating the mechanism of how bifidobacteria is involved and is indirectly affecting the tumor microenvironment. Exhaustive and large-scale research is also required to solve the controversial questions regarding the involvement of bifidobacteria in cancer research.
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Affiliation(s)
| | | | - Sriram Seshadri
- Institute of Science, Nirma University, 382481 Ahmedabad, Gujarat, India
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Çelik M, Işik C, Arikan E, Kurtboğan M, Boz M. Mean platelet volume and neutrophil/lymphocyte ratio in adolescent idiopathic scoliosis: can they be predictive value in diagnosis? Acta Orthop Belg 2023; 89:393-398. [PMID: 37935220 DOI: 10.52628/89.3.10621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
In our study, we evaluated whether mean platelet volume (MPV) and neutrophil lymphocyte ratio (NLR) are predictive values in the diagnosis of Adolescent Idiopathic Scoliosis in patients diagnosed with scoliosis in our clinic. Approximately 15000 patients who applied to our spine outpatient clinic with the suspicion of scoliosis between 2011 and 2018 were reviewed retrospectively. 292 patients were included in the study. The patients were divided into 3 groups. Group 1; control group group 2; group with the possibility of developing scoliosis under follow-upand group 3; the patient group diagnosed with scoliosis. Spinal curvature degrees of the patients were measured using the Cobb method. The MPV and NLR values of the patients were compared with the degree of curvature measured by the cobb method. NLR was 2.17 ± 2.10 K/ul in Group 1, 2.42 ± 1.76 K/ul in Group 2, and 2.72 ± 3.91 K/ul in Group 3. Although the NLR of the 3rd group was higher than the other 2 groups, it was not statistically significant. (p > 0.05). MPV was 7.90 ± 1.07 fL in Group 1, 7.95 ±1.39 fL in Group 2, 8.33 ± 1.37 fL in Group 3.MPV was higher in Group 3 and was found to be statistically significant (p=0.024). After adjusting for the effects of gender and age variables on the groups, the difference in MPV between groups became more significant (p=0.017) . While there was no statistically significant difference between the groups in terms of NLR, it was observed that MPV was statistically significantly higher in patients with AIS.Could this relationship be a promising inflammatory marker for AIS? We think that this question should be answered by studies involving larger patient and control groups.
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Zhou Q, Deng G, Wang Z, Dai G. Preoperative lung immune prognostic index predicts survival in patients with pancreatic cancer undergoing radical resection. Front Surg 2023; 9:1002075. [PMID: 36684178 PMCID: PMC9852768 DOI: 10.3389/fsurg.2022.1002075] [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] [Received: 07/24/2022] [Accepted: 12/05/2022] [Indexed: 01/08/2023] Open
Abstract
Background Lung immune prognostic index (LIPI), a combination of derived neutrophil-to-lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH), is currently attracting considerable interest as a potential prognostic indicator in many malignancies. Our study aimed to investigate the prognostic value of preoperative LIPI in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing radical resection. Methods We retrospectively reviewed PDAC patients treated with radical resection from February 2019 to April 2021 at Chinese People's Liberation Army (PLA) general hospital. Based on the cut-off value of dNLR and LDH identified by X-tile, patients were divided into LIPI good and LIPI intermediate/poor group. Kaplan-Meier curve and log-rank test were used to compare the recurrence-free survival (RFS) and overall survival (OS) of the two groups. Univariate and multivariate Cox regression was used to identify the independent prognostic value of LIPI. Subgroup analysis was performed to identify specific population benefited from radical resection. Results A total of 205 patients were included and the median RFS and OS was 10.8 and 24.3 months, respectively. Preoperative LIPI intermediate/poor was related to worse RFS and OS (p < 0.05). Preoperative LIPI intermediate/poor, vascular invasion and no adjuvant chemotherapy were indicators of poor OS. Patients with LIPI intermediate/poor had worse OS especially among females and those with adjuvant chemotherapy (p < 0.05). Adjuvant chemotherapy related to better RFS and OS in patients with LIPI good (p < 0.05). Conclusions Preoperative LIPI intermediate/poor can be an indicator of poor prognosis in patients with PDAC undergoing radical resection. LIPI good could be an effective marker of benefit from adjuvant chemotherapy. Larger studies are warranted for further validation.
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Affiliation(s)
- Qian Zhou
- Department of Oncology, Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Department of Medical Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guochao Deng
- School of Medicine, Nankai University, Tianjin, China,Department of Medical Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhikuan Wang
- Department of Medical Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China,Correspondence: Zhikuan Wang Guanghai Dai
| | - Guanghai Dai
- Department of Oncology, Medical School of Chinese People’s Liberation Army (PLA), Beijing, China,Department of Medical Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China,Correspondence: Zhikuan Wang Guanghai Dai
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Gut Microbial Profile in Patients with Pancreatic Cancer. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm-122386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Pancreatic cancer is a lethal tumor with a poor prognosis. The connection between pancreatic cancer and gut microbiota is less reported. Objectives: This study analyzed microbial characteristics in patients with pancreatic cancer from the tropical area of China and explored the potential impact of the characteristic microflora on pancreatic cancer. Methods: Stool samples and blood test indices of participants were collected in Hainan, China. Metagenomic sequencing was used to analyze the gut microbiota characteristics. The R corrplot package was used to analyze the correlation between gut microbiota and blood test indices. Results: The microbial community in pancreatic cancer were clustered together and significantly separated from controls. The Simpson index was increased significantly in pancreatic cancer compared to controls. The abundances of butyrate-producing bacteria (Anaerostipes hadrus, Lachnoclostridium phocaeense, and Romboutsia ilealis), Bifidobacteria, and [Eubacterium] eligens were significantly decreased, while Fusobacterium, Enterobacter, and Enterococcus were significantly increased in pancreatic cancer. Prevotella copri may have a vital role in the bacterial interaction network. Pathways connected to metabolism, environment (bacterial secretion system), genetic information (protein export and ribosome), and human diseases (infectious diseases and drug resistance) were increased in the pancreatic cancer group. Butyrate-producing bacteria (butyrate-producing bacterium SS3/4, A. hadrus, R. intestinalis, and Faecalibacterium prausnitzii) and Bifidobacteria were significantly negatively correlated with the neutrophil-to-lymphocyte ratio. Conclusions: The gut microbiome was distinct in patients with pancreatic cancer from the tropical area of China. Changes in intestinal flora abundance and metabolic pathways may play an essential role in the occurrence and development of pancreatic cancer.
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Ziccardi C, Cohn LA, Janacek B, Gross J, Nafe L, Grobman M. Etiology and outcome of extreme neutrophilic leukocytosis: A multi-institutional retrospective study of 269 dogs. J Vet Intern Med 2022; 36:541-548. [PMID: 35043992 PMCID: PMC8965212 DOI: 10.1111/jvim.16344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022] Open
Abstract
Background The magnitude of diagnostic abnormalities can influence the perception of clinical outcome. Extreme neutrophilic leukocytosis (ENL) is an uncommon finding caused by markedly increased granulopoiesis. A lack of recent, large‐scale studies limits our understanding of the importance, causation, and prognosis associated with ENL in dogs. Hypothesis/Objectives Describe disease categories (DC) identified in dogs with ENL and identify variables associated with survival. We hypothesized that factors including fever, segmented and band neutrophil counts, and DC would be negatively associated with survival. Animals Two‐hundred sixty‐nine dogs with ENL (segmented neutrophils ≥50 × 103 cells/μL) presented to the veterinary teaching hospitals at Auburn University (n = 164), the University of Missouri (n = 81), and Oklahoma State University (n = 24) between January 1, 2009 and December 31, 2019. Methods Retrospective study. Demographic data and outcome variables including temperature, CBC findings, DC, duration of hospitalization (DOH) and outcome were acquired from the medical record. Statistical analyses included chi‐squared and Kruskal‐Wallis tests, and Pearson product moment correlations with a P < .05 significance level. Results Mortality was 41%. Survival differed with DC (P = .002). Mortality was higher (P < .05) in dogs with neoplasia (56.2%) vs immune‐mediated disease (20.5%) or tissue damage/necrosis (19%). Weight (P = .001, r = −0.14) and total neutrophil count (P = .04, r = −0.02) were weakly negatively associated with survival whereas DOH was weakly positively associated with survival (P = .03, r = 0.14). Conclusions and Clinical Importance Mortality in dogs with ENL is high but differed according to DC. Only weak correlations between clinical or clinicopathologic variables and mortality were identified. Extreme neutrophilic leukocytosis should be interpreted in conjunction with the underlying disease process, and not broadly used to predict clinical outcome.
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Affiliation(s)
- Christianna Ziccardi
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Leah A Cohn
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
| | - Blakeley Janacek
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
| | - Jacklyn Gross
- Department of Veterinary Clinical Sciences, Oklahoma State University College of Veterinary Medicine, Stillwater, Oklahoma, USA
| | - Laura Nafe
- Department of Veterinary Clinical Sciences, Oklahoma State University College of Veterinary Medicine, Stillwater, Oklahoma, USA
| | - Megan Grobman
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA.,Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
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Abe T, Oshikiri T, Goto H, Kato T, Horikawa M, Sawada R, Harada H, Urakawa N, Hasegawa H, Kanaji S, Yamashita K, Matsuda T, Kakeji Y. Albumin-Derived NLR Score is a Novel Prognostic Marker for Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2021; 29:2663-2671. [PMID: 34807322 DOI: 10.1245/s10434-021-11012-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multidisciplinary treatment for esophageal squamous cell carcinoma (ESCC) has improved outcomes, but the prognosis for ESCC remains poor. Nutritional and inflammatory indicators are reported to be associated with cancer prognosis. The combination of albumin and the derived neutrophil-to-lymphocyte ratio (Alb-dNLR) score was established to measure the immune system and nutritional status. The authors hypothesized that the Alb-dNLR score could be a new reliable prognostic factor for ESCC patients. METHODS The study evaluated 269 patients who underwent esophagectomy between April 2010 and March 2018, including 185 patients who received neoadjuvant chemotherapy. The Alb-dNLR score was calculated using serum albumin and the dNLR. The dNLR was calculated as neutrophils to (leukocyte-neutrophil count). The cutoff values of the albumin and dNLR for overall survival (OS) were determined using the receiver operating characteristic curve. Patients were divided into "high" and "low" groups according to the Alb-dNLR score. RESULTS A high Alb-dNLR score was found in 61 cases (22.7%). The 5-year OS was 34% in the high Alb-dNLR group and 66.2% in the low Alb-dNLR group (p < 0.0001). The 5-year cause-specific survival (CSS) was 51.5% in the high Alb-dNLR group and 74.7% in the low Alb-dNLR group (p < 0.0001). Multivariate analyses demonstrated that the Alb-dNLR score was an independent prognostic factor for OS (hazard ratio [HR], 2.198; 95% confidence interval [CI], 1.460-3.263; p = 0.0002) and CSS (HR, 1.733; 95% CI, 1.035-2.835; p = 0.0371). CONCLUSIONS The Alb-dNLR score is an extremely useful, easy-to-use parameter to predict OS and CSS for ESCC patients.
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Affiliation(s)
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
| | - Hironobu Goto
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takashi Kato
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Manabu Horikawa
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Ryuichiro Sawada
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hitoshi Harada
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Naoki Urakawa
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | | | - Takeru Matsuda
- Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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Mohindroo C, Hasanov M, Rogers JE, Dong W, Prakash LR, Baydogan S, Mizrahi JD, Overman MJ, Varadhachary GR, Wolff RA, Javle MM, Fogelman DR, Lotze MT, Kim MP, Katz MHG, Pant S, Tzeng CWD, McAllister F. Antibiotic use influences outcomes in advanced pancreatic adenocarcinoma patients. Cancer Med 2021; 10:5041-5050. [PMID: 34250759 PMCID: PMC8335807 DOI: 10.1002/cam4.3870] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/14/2020] [Accepted: 12/31/2020] [Indexed: 12/21/2022] Open
Abstract
Recent studies defined a potentially important role of the microbiome in modulating pancreatic ductal adenocarcinoma (PDAC) and responses to therapies. We hypothesized that antibiotic usage may predict outcomes in patients with PDAC. We retrospectively analyzed clinical data of patients with resectable or metastatic PDAC seen at MD Anderson Cancer from 2003 to 2017. Demographic, chemotherapy regimen and antibiotic use, duration, type, and reason for indication were recorded. A total of 580 patients with PDAC were studied, 342 resected and 238 metastatic patients, selected retrospectively from our database. Antibiotic use, for longer than 48 hrs, was detected in 209 resected patients (61%) and 195 metastatic ones (62%). On resectable patients, we did not find differences in overall survival (OS) or progression‐free survival (PFS), based on antibiotic intake. However, in the metastatic cohort, antibiotic consumption was associated with a significantly longer OS (13.3 months vs. 9.0 months, HR 0.48, 95% CI 0.34–0.7, p = 0.0001) and PFS (4.4 months vs. 2 months, HR 0.48, 95% CI 0.34–0.68, p = <0.0001). In multivariate analysis, the impact of ATB remained significant for PFS (HR 0.59, p = 0.005) and borderline statistically significant for OS (HR 0.69, p = 0.06). When we analyzed by chemotherapy regimen, we found that patients who received gemcitabine‐based chemotherapy as first‐line therapy (n = 118) had significantly prolonged OS (HR 0.4, p 0.0013) and PFS (HR 0.55, p 0.02) if they received antibiotics, while those receiving 5FU‐based chemotherapy (n = 98) had only prolonged PFS (HR 0.54, p = 0.03). Antibiotics‐associated modulation of the microbiome is associated with better outcomes in patients with metastatic PDAC. We have analyzed the effect of antibiotics’ intake on two cohorts of patients with pancreatic adenocarcinoma, resectable, and metastatic. We have found that on the metastatic cohort, antibiotics use was significantly associated with better outcomes, particularly, on patients that received gemcitabine based‐chemotherapy as the first line.
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Affiliation(s)
- Chirayu Mohindroo
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Merve Hasanov
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jane E Rogers
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wenli Dong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laura R Prakash
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Seyda Baydogan
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan D Mizrahi
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gauri R Varadhachary
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Milind M Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David R Fogelman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael T Lotze
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael P Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shubham Pant
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Investigation Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Florencia McAllister
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Ueberroth BE, Khan A, Zhang KJ, Philip PA. Differences in Baseline Characteristics and White Blood Cell Ratios Between Racial Groups in Patients with Pancreatic Adenocarcinoma. J Gastrointest Cancer 2021; 52:160-168. [PMID: 32077005 DOI: 10.1007/s12029-020-00378-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Pancreatic adenocarcinoma remains a malignancy with poor prognosis. Black patients experience poorer overall survival compared with other races. Recent studies have elucidated certain prognostic factors at the time of diagnosis of pancreatic cancer which have largely not been studied for differences between racial groups. We present a study examining differences in blood levels between Black and non-Black patients and their effects on overall survival. METHODS This is a retrospective cohort study. One hundred sixty-three patients were confirmed to carry a tissue diagnosis of pancreatic adenocarcinoma and included in analysis; 27 of the patients were self-identified as "Black"; 136 were analyzed together as "Non-Black" with the majority identifying as "White". Various blood markers were drawn at the time of diagnosis. Kaplan-Meier and multivariable Cox regression models were used to examine differences in these factors between Black and non-Black patients, as well as their effect on overall survival. RESULTS Black patients were younger at diagnosis (p = 0.001) and were more likely to experience significant weight loss leading up to diagnosis (p = 0.009); Black patients also had a lower neutrophil-to-lymphocyte ratio (NLR) (p = 0.001) and higher lymphocyte-to-monocyte ratio (LMR) (p = 0.001) at diagnosis. In multivariable analysis, an NLR > 3.5 had a significantly negative impact on overall survival (p = 0.002), as did the presence of metastatic disease (p < 0.001). CONCLUSION Black patients demonstrated a "favorable" white blood cell profile (higher LMR, lower NLR) compared with non-Black patients. This may suggest that the immune response in pancreatic adenocarcinoma is not what is driving disparately poor outcomes in Black patients. Further study is warranted to ascertain the role of immune response in pancreatic adenocarcinoma, the prognostic use of these measurements at diagnosis, and possible other factors, such as genetics, which may better explain poorer outcomes in Black patients.
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Affiliation(s)
- Benjamin E Ueberroth
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA.
- Department of Internal Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Adnan Khan
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
- Department of Internal Medicine, Kaiser Permanente, 3801 Howe St, Oakland, CA, 94611, USA
| | - Kevin J Zhang
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
- Department of Internal Medicine, Indiana University, 1120 W Michigan St, Indianapolis, IN, 46202, USA
| | - Philip A Philip
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
- Barbara Ann Karmanos Cancer Institute, 4100 John R St, Detroit, MI, 48201, USA
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Colloca GA, Venturino A, Guarneri D. Systemic Inflammation Scores Predict the Activity of First-Line Chemotherapy in Patients with Metastatic Pancreatic Adenocarcinoma. Cancer Invest 2021; 39:55-61. [PMID: 33353411 DOI: 10.1080/07357907.2020.1863419] [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: 05/01/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Systemic inflammation response (SIR)-related variables are controversial as predictive variables. METHODS Patients with metastatic pancreatic adenocarcinoma (mPDAC) receiving chemotherapy were identified, three SIR-related variables and the relationships between each of them with overall survival (OS) were analysed. RESULTS Of 129 patients receiving chemotherapy, 97 had metastases. A significant relationship between SIR and OS has been documented. Each of the SIR-related variables retained its independent prognostic role after multivariate analysis, whereas tri-linear peripheric blood-cell score (TRIS) appeared as the most reliable predictive parameter. CONCLUSIONS Among patients with mPDAC receiving chemotherapy, SIR is prognostic and could predict the effectiveness of chemotherapy.
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12
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Mady M, Prasai K, Tella SH, Yadav S, Hallemeier CL, Rakshit S, Roberts L, Borad M, Mahipal A. Neutrophil to lymphocyte ratio as a prognostic marker in metastatic gallbladder cancer. HPB (Oxford) 2020; 22:1490-1495. [PMID: 32122786 DOI: 10.1016/j.hpb.2020.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) has been used as an inflammation based prognostic marker for various malignancies. This study evaluated the association between NLR and overall survival (OS) in patients with metastatic gallbladder cancer (GBC) METHODS: An optimal cut off point for NLR was identified by plotting spline-based hazard ratio curves to identify a threshold effect and patients were divided into two groups, ≥5 or <5. Kaplan-Meier curves were plotted for NLR≥5 and NLR<5 and OS between the two groups. RESULTS Of the 231 patients included, 138 (60%) had NLR <5 and 93 (40%) had NLR ≥5. There were no significant differences noted in gender, race, and administration of chemotherapy between the two groups. On univariable analysis, patients with NLR ≥5 had a significantly poor OS compared to those with NLR <5 (Median OS: 3.6 vs 8.7 months, p < 0.001). On multivariable analysis, adjusting for age, performance status, albumin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, platelet count and no administration of chemotherapy, NLR of ≥5 was associated with a worse OS compared to NLR <5 (HR: 1.70, 95%CI:1.20-2.39, p < 0.05). CONCLUSION The current study demonstrates that NLR ≥5 is an independent predictor of poor prognosis in patients with metastatic GBC.
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Affiliation(s)
- Mohamed Mady
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Sri H Tella
- Department of Internal Medicine, University of South Carolina, Columbia, USA
| | | | | | - Sagar Rakshit
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Lewis Roberts
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Mitesh Borad
- Department of Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN, USA.
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Barth DA, Brenner C, Riedl JM, Prinz F, Klocker EV, Schlick K, Kornprat P, Lackner K, Stöger H, Stotz M, Gerger A, Pichler M. External validation of the prognostic relevance of the advanced lung cancer inflammation index (ALI) in pancreatic cancer patients. Cancer Med 2020; 9:5473-5479. [PMID: 32537935 PMCID: PMC7402815 DOI: 10.1002/cam4.3233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/11/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The advanced lung cancer inflammation index (ALI) was first introduced for prognosis prediction in lung cancer patients and since then evaluated in several other malignancies. However, in pancreatic cancer (PC) the ALI and its prognostic utility were only investigated in a comparably small and specific cohort of locally advanced PC patients treated with chemoradiotherapy. METHODS In our single-center cohort study, we included 429 patients with histologically verified PC who were treated between 2003 and 2015 at our academic institution. The ALI was defined as body mass index (BMI; kg/m2 ) × serum albumin levels (g/dL)/neutrophil-lymphocyte ratio (NLR) and we defined the optimal cutoff for biomarker dichotomization by ROC-analysis. Kaplan-Meier method as well as uni- and multivariate Cox regression Hazard proportional models were implemented to assess the prognostic potential of ALI in PC patients. We considered cancer-specific survival (CSS) as the primary endpoint of the study. RESULTS The ALI showed a significant negative correlation with CA19-9 levels and C-reactive protein levels whereas we found an association with localized tumor stage and better performance status (P < .05 for all mentioned variables). As opposed to patients with a high ALI, decreased ALI was significantly associated with shorter CSS (HR = 0.606, 95% CI: 0.471-0.779, P = .001). Multivariate analysis demonstrated tumor grade, tumor stage, chemotherapy, C-reactive protein levels, and CA19-9 levels to independently predict for CSS (all P < .05). In contrast the ALI failed to independently predict for CSS in the performed multivariate models (HR = 0.878, 95% CI: 0.643-1.198, P = .411). CONCLUSION In this large cohort of PC patients, the ALI did not complement existing clinicopathological factors for outcome determination.
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Affiliation(s)
- Dominik Andreas Barth
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Carina Brenner
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Jakob Michael Riedl
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Felix Prinz
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Eva Valentina Klocker
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical OncologyHemostaseology, Rheumatology and Infectious DiseasesLaboratory for Immunological and Molecular Cancer ResearchOncologic CenterParacelsus Medical University SalzburgSalzburgAustria
| | - Peter Kornprat
- Division of General SurgeryDepartment of SurgeryMedical University of GrazGrazAustria
| | | | - Herbert Stöger
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Michael Stotz
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
| | - Armin Gerger
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Center for Biomarker Research in MedicineGrazAustria
| | - Martin Pichler
- Division of Clinical OncologyDepartment of MedicineComprehensive Cancer Center GrazMedical University of GrazGrazAustria
- Department of Experimental TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
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Caputo D, Coppola A, Cascone C, Angeletti S, Ciccozzi M, La Vaccara V, Coppola R. Preoperative systemic inflammatory biomarkers and postoperative day 1 drain amylase value predict grade C pancreatic fistula after pancreaticoduodenectomy. Ann Med Surg (Lond) 2020; 57:56-61. [PMID: 32714527 PMCID: PMC7374182 DOI: 10.1016/j.amsu.2020.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 12/19/2022] Open
Abstract
Background Postoperative day 1-drains amylase (POD1-DA) values are commonly used to predict the risk of pancreatic fistula (PF) after pancreaticoduodenectomy (PD). Perioperative inflammatory biomarkers have been associated to higher risk of complications in different oncological surgeries. Aim of this study was to investigate the utility of the combination of preoperative inflammatory biomarkers (PIBs) with POD1-DA levels in predicting grade C PF. Materials and methods From a prospective collected database of 317 consecutive pancreaticoduodenectomies, data regarding POD1-DA levels and PIBs as neutrophil-to-lymphocyte ratio (NRL), derived neutrophil-to-lymphocyte ratio (dNRL), platelet-to-lymphocyte ratio (PLR) were analyzed in 227 cases. P-values <0.05 were considered statistically significant. Receiver operating characteristic (ROC) curves defined the optimal thresholds for biomarkers and drains amylase values and their accuracy to predict PF. Furthermore, the Positive Predictive Value (PPV) was computed to evaluate the probability to develop PF combining PIBs and drains amylase values. Combination of drains amylase and different PIBs cut-offs were used to evaluate the risk of grade C PF. Results A POD1-DA level of 351 U/L significantly predicted PF (sensitivity 82.7%, specificity 76%, AUC 0.836; p < 0.001) with a PPV of 76.5% and a NPV of 82.6%. POD1-DA levels ≥807 U/L significantly predicted grade C PF (sensitivity 72.7%, specificity 64.4%, AUC 0.676; p = 0.004) with a PPV of 17.8% and a NPV of 95.6%. Notably, this last PPV increased from 17.8% to 89% when PIBs, at different cut-offs, were combined with POD1-DA at the value ≥ 807 U/L. Conclusion PIBs significantly improve POD1-DA ability in predicting grade C PF after PD.
Grade C pancreatic fistula is a major complication after pancreaticoduodenectomy. Postoperative day 1-drain amylase levels is a reliable predictor of pancreatic fistula. Systemic inflammatory biomarkers and postoperative day 1-drain amylase levels may predict grade C pancreatic fistula.
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Affiliation(s)
- Damiano Caputo
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Alessandro Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Chiara Cascone
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
- Corresponding author. Department of Surgery, University Campus Bio-Medico di Roma Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistic and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Roberto Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
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15
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Klocker EV, Barth DA, Riedl JM, Prinz F, Szkandera J, Schlick K, Kornprat P, Lackner K, Lindenmann J, Stöger H, Stotz M, Gerger A, Pichler M. Decreased Activity of Circulating Butyrylcholinesterase in Blood Is an Independent Prognostic Marker in Pancreatic Cancer Patients. Cancers (Basel) 2020; 12:cancers12051154. [PMID: 32375339 PMCID: PMC7281496 DOI: 10.3390/cancers12051154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction: The activity of butyrylcholinesterase (BChE) in blood reflects liver function and has recently been associated with systemic inflammatory response and tumor cachexia. As these conditions have been previously linked with pancreatic cancer (PC), the purpose of the present study was to evaluate the prognostic impact of plasma BChE in PC. Methods: Data from 574 consecutive PC patients, treated between 2004 and 2018 at a single academic center, was evaluated. The primary endpoint was cancer-specific survival (CSS), analyzed by Kaplan–Meier curve, and both univariate and multivariate Cox proportional models. Results: BChE activity negatively correlated with other liver parameters (bilirubin, gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and C-reactive protein (CRP)), and positively correlated with albumin levels, respectively (p < 0.01). In univariate analysis, a low plasma BChE activity was a factor of poor CSS (hazard ratio: 1.4, 95% confidence interval: 1.129–1.754, p = 0.002). In multivariate analysis, tumor stage, tumor grade, administration of chemotherapy, bilirubin levels and a low BChE activity (hazard ratio: 1.42, 95% confidence interval: 1.10–1.82; p = 0.006) were identified as independent prognostic factors. Conclusion: Decreased activity of BChE in blood plasma predicts shorter survival time in PC patients. Therefore, BChE might be helpful in additional stratification of patients into different prognostic risk groups.
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Affiliation(s)
- Eva Valentina Klocker
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Dominik Andreas Barth
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
- Research Unit “Non-coding RNAs and Genome Editing in Cancer”, Medical University of Graz, 8010 Graz, Austria
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jakob Michael Riedl
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Felix Prinz
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
| | - Peter Kornprat
- Division of General Surgery, Department of Surgery, Medical University of Graz, 8010 Graz, Austria;
| | - Karoline Lackner
- Institute of Pathology, Medical University of Graz, 8036 Graz, Austria;
| | - Jörg Lindenmann
- Division of Thoracic Surgery, Department of Surgery, Medical University of Graz, 8010 Graz, Austria;
| | - Herbert Stöger
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, 8010 Graz, Austria; (E.V.K.); (D.A.B.); (J.M.R.); (F.P.); (J.S.); (H.S.); (M.S.); (A.G.)
- Research Unit “Non-coding RNAs and Genome Editing in Cancer”, Medical University of Graz, 8010 Graz, Austria
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +43316-385-30196; Fax: +43316-385-13355
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Predictive role of neutrophil-to-lymphocyte ratio in preeclampsia: A meta-analysis including 3982 patients. Pregnancy Hypertens 2020; 20:111-118. [DOI: 10.1016/j.preghy.2020.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/25/2020] [Accepted: 03/20/2020] [Indexed: 01/08/2023]
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Colloca GA, Venturino A, Guarneri D. Neutrophil count kinetics during the first cycle of chemotherapy predicts the outcome of patients with locally advanced or metastatic pancreatic cancer. Asia Pac J Clin Oncol 2020; 16:247-253. [PMID: 32129930 DOI: 10.1111/ajco.13325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 01/28/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Neutrophil count reduction after chemotherapy has been related with longer survival of patients with metastatic pancreatic adenocarcinoma, but there is not a standardized measurement for this phenomenon. METHODS Some parameters related to the change in neutrophil count between the first and the second cycle of chemotherapy or between the baseline count and the nadir have been evaluated among patients with advanced pancreatic cancer at a single institution. A Cox regression model was built which included, in addition to the common prognostic variables, some variables related to the change of the neutrophil count after chemotherapy. RESULTS One hundred patients were selected. Two neutrophil kinetics related variables predicted overall survival independently, such as the neutrophil count growth rate (hazard ratio [HR] = 1.245; confidence intervals [CIs], 1.077-1.440) and the chemotherapy-induced neutropenia after one cycle (HR = 0.499; CIs, 0.269-0.927). CONCLUSION The kinetics of neutrophil count after chemotherapy is an early and independent prognostic factor, which appears to be simple to measure at the start of the second cycle of chemotherapy by means of the neutrophil count growth rate.
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18
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Li X, Li S, Liu L, Hong J, Zhao T, Gao C. Effect of Perioperative CEA and CA24-2 on Prognosis of Early Resectable Pancreatic Ductal Adenocarcinoma. J Cancer 2020; 11:9-15. [PMID: 31892968 PMCID: PMC6930410 DOI: 10.7150/jca.33767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
Patients with resectable pancreatic ductal adenocarcinoma (PDAC) show differential prognosis after radical resection. Currently, cancer grading and surgical criteria depend heavily on imaging and anatomical diagnosis. It's essential to set up a model with reliable prognostic factors during the perioperative period to assess prognosis in PDAC patients. In this study, 103 patients diagnosed with PDAC who underwent radical resection were recruited. The predictive value of preoperative carcinoembryonic antigen (CEA), postoperative CA24-2 and the combination of two for overall survival (OS) were evaluated. Both pre-CEA and post-CA24-2 were found to be independent prognostic factors for OS according to multivariate analyses. Kaplan-Meier analysis revealed that CEA and CA24-2 as well as the combination of two were correlated with poor OS. In addition, patients with both markers elevated have worse prognosis than patients with either pre-CEA or post-CA24-2 elevated. Thus, we concluded that the combination of CEA and CA24-2 can be used as a prognostic factor for stage I and II resectable PDAC patients.
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Affiliation(s)
- Xiaojie Li
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China, 300060
| | - Shengnan Li
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China, 300060
| | - Lili Liu
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China, 300060
| | - Jiahui Hong
- Department of Nutrition and Food Hygiene, School of Public Health, Tianjin Medical University, Tianjin, China, 300060
| | - Tiansuo Zhao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China, 300060
| | - Chuntao Gao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China, 300060
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C-Reactive Protein and Neutrophil/Lymphocytes Ratio: Prognostic Indicator for Doubling overall survival Prediction in Pancreatic Cancer Patients. J Clin Med 2019; 8:jcm8111791. [PMID: 31717722 PMCID: PMC6912559 DOI: 10.3390/jcm8111791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Despite modern chemotherapy regimens, survival of patients with locally advanced/metastatic pancreatic cancer remains dismal. Long-term survivors are rare and there are no prognostic scores to identify patients benefitting most from chemotherapy. Methods: This retrospective study includes 240 patients with pancreatic cancer who were treated in a primary palliative setting between the years 2007 to 2016 in a single academic institution. Survival rates were analyzed using the Kaplan–Meier method. Prognostic models including laboratory and clinical parameters were calculated using Cox proportional models in univariate and multivariate analyses. Results: Median age at diagnosis was 67 years (range 29–90 years), 52% were female and a majority had an ECOG performance status of 0 or 1. Locally advanced pancreatic cancer was diagnosed in 23.3% (n = 56) and primary metastatic disease in 76.7% (n = 184) of all patients. Median overall survival of the whole study cohort was 8.3 months. Investigating potential risk factors like patient characteristics, tumor marker or inflammatory markers, multivariate survival analysis found CRP (c-reactive protein) and NLR (neutrophil to lymphocyte ratio) elevation before the start of palliative chemotherapy to be independent negative prognostic factors for OS (overall survival) (p < 0.001 and p < 0.01). Grouping patients with no risk factor versus patients with one or two of the above mentioned two risk factors, we found a median OS of 16.8 months and 9.4 months (p < 0.001) respectively. By combining these two factors, we were also able to identify pancreatic cancer patients that were more likely to receive any post first line therapy. These two risk factors are predictive for improved survival independent of disease stage (III or IV) and applied chemotherapy agents in first line. Conclusion: By combining these two factors, CRP and NLR, to create a score for OS, we propose a simple, new prognostic tool for OS prediction in pancreatic cancer.
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20
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Liu F, Luo H, Zhu Z, Zhu P, Huang J. Prognostic significance of peripheral blood-derived neutrophil/lymphocyte ratio in patients with digestive cancer. J Cell Physiol 2019; 234:22775-22786. [PMID: 31140613 DOI: 10.1002/jcp.28842] [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] [Received: 12/11/2018] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 12/12/2022]
Abstract
Accumulating studies reported the clinical value of derived neutrophil/lymphocyte ratio (dNLR) regarding the prediction of survival outcomes in digestive cancers, however, the prognostic significances of dNLR in these cancers were inconsistent. This study was carried out to clarify the relationship between circulating dNLR and prognosis in gastrointestinal (GI) cancers. Eligible publications were collected and extracted by searching Pubmed, Embase, Web of Science, and Google Scholar up to November 21, 2018. The prognostic impact of dNLR in subjects with GI cancers was assessed with the overall hazard ratios (HRs). A total of 26 studies with up to 13,945 participants were recruited. Our findings showed that peripheral blood dNLR before treatment could be a useful prognostic predictor in digestive cancers, an elevated dNLR indicated a shorter overall survival (OS) in GI tumors (HR, 1.44; 95% confidence interval [CI], 1.36-1.51). Furthermore, its significant prognostic value for OS was also confirmed in subgroup analyses stratified by disease type, publication year, type of research, detection method, geographic location, cut-off value, treatment, analysis type, follow-up time and disease stage. In addition, high dNLR was significantly associated with worse cancer-specific survival (HR, 1.25; 95% CI, 1.04-1.47) and inferior event-free survival (HR, 1.22; 95% CI, 1.11-1.33) in patients with digestive cancers. Our study showed elevated peripheral blood dNLR may indicate unfavorable outcomes in digestive cancer.
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Affiliation(s)
- Fangteng Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China
| | - Hongliang Luo
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China
| | - Zhengming Zhu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China
| | - Peiqian Zhu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China
| | - Jun Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P. R. China
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Rho SY, Hwang HK, Chong JU, Yoon DS, Lee WJ, Kang CM. Association of preoperative total lymphocyte count with prognosis in resected left-sided pancreatic cancer. ANZ J Surg 2019; 89:503-508. [PMID: 30836428 DOI: 10.1111/ans.15030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/22/2018] [Accepted: 11/24/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Immunologic factors such as neutrophil-lymphocyte ratio and platelet-lymphocyte ratio play an important role in predicting the oncologic outcome of patients in pancreatic ductal adenocarcinoma (PDAC). It is hypothesized that host immunity represented by total lymphocyte count at diagnostic stage would influence oncologic outcome in left-sided PDAC. METHODS Between January 1992 and August 2017, total of 112 patients who underwent distal pancreatectomy for left-sided PDAC were included and analysed. RESULTS At the time of the diagnosis, total lymphocyte count at diagnosis of left-sided PDAC was 1.8 ± 0.7 103 /μL (mean value ± standard deviation). Among different cut-off values, 1.7 showed most powerful significant differences in long-term oncologic outcomes. The patients with preoperative lymphocyte count (≤1.7) was associated with early recurrence (median 8.4 months versus 18.1 months, P = 0.011) and shorter survival (median 18.6 months versus 35.9 months, P = 0.028). Patients with preoperative total lymphocyte count over 1.7 showed higher white blood cell count (P < 0.001), platelet count (P = 0.039), neutrophil count (P = 0.004) and monocyte count (P = 0.001). However, more interestingly, neutrophil-lymphocyte ratio (P < 0.001) and platelet-lymphocyte ratio (P < 0.001) were found to be significantly higher in those with total lymphocyte count less than 1.7. Lymphocyte to monocyte ratio was inversely related to preoperative total lymphocyte count (P < 0.001). Only age was identified to be significantly different (P = 0.007). However, other clinicopathological parameters generally known to be related to tumour aggressiveness, were not different between two groups. CONCLUSION In conclusion, preoperative total lymphocyte at diagnostic stage is simple, and good prognostic factor in left-sided pancreatic cancer.
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Affiliation(s)
- Seoung Yoon Rho
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Ho Kyoung Hwang
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Jae Uk Chong
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Dong Sup Yoon
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Woo Jung Lee
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
| | - Chang Moo Kang
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
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22
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Song S, Chen H, Dong W, Zhou H. The prognostic value of preoperative derived neutrophil-to-lymphocyte ratio in patients undergoing total laryngectomy with laryngeal carcinoma. Acta Otolaryngol 2019; 139:294-298. [PMID: 30882257 DOI: 10.1080/00016489.2019.1566780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Emerging evidence indicate that inflammation plays a crucial role in carcinogenesis and tumor progression. Inflammatory response biomarkers are recognized as promising prognostic factors in laryngeal squamous cell carcinoma (LSCC). OBJECTIVE To evaluate the prognostic significance of preoperative derived neutrophil-to-lymphocyte ratio (dNLR) in patients with total laryngectomy. METHODS This was a retrospective analysis of 137 patients with LSCC who received total laryngectomy from January 2009 to December 2015. The preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and dNLR were calculated. Receiver-operating characteristic (ROC) curve was used to determine the cut-off values of these parameters. Univariate analysis and multivariate Cox regression model were used to evaluate the association between these parameters and recurrence-free survival (RFS) and overall survival (OS). RESULTS The optimal critical value of dNLR was 1.85, by which cases were divided into high dNLR group (dNLR ≥ 1.85) and low dNLR group (dNLR < 1.85). The elevated dNLR was significantly associated with decreased RFS (HR 2.72, 95% CI 1.56-4.75, p = .000) and remained significant in multivariate analysis (p = .034). However, we did not find any significant correlation between dNLR and OS. CONCLUSIONS An elevated preoperative dNLR may be an independent prognostic biomarker for RFS in patients undergoing total laryngectomy with LSCC.
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Affiliation(s)
- Shenghua Song
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Huijun Chen
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Weida Dong
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Han Zhou
- Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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23
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Park JS, Kim HM, Jeung HC, Kang SA. Association between early nutritional risk and overall survival in patients with advanced pancreatic cancer: A single-center retrospective study. Clin Nutr ESPEN 2019; 30:94-99. [PMID: 30904235 DOI: 10.1016/j.clnesp.2019.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/14/2018] [Accepted: 01/31/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS We investigated the predictors of overall survival (OS) among Korean patients with advanced pancreatic cancer (PC) according to their baseline nutritional status. METHODS We retrospectively reviewed the data of 412 inpatients with PC between January 2007 and February 2015 at the Department of Oncology of the Gangnam Severance Hospital, Korea. Data on demographic and clinical parameters were collected from electronic medical records, and OS was estimated using the Kaplan-Meier method. Stepwise Cox regression analysis was used to determine the factors associated with survival. Patients with a Nutritional Risk Screening (NRS) 2002 score <3 were classified as "no-risk; " those with a score of 3 were classified as "moderate-risk; " and those with a score of ≥4 were classified as "high-risk." RESULTS Following nutritional screening at baseline, 194 patients (47.1%, mean age 61.8 ± 9.9 years) were classified as the "no risk" group; 81 patients (19.7%, mean age 65.4 ± 10.8 years), as the "moderate risk" group; and 137 patients (33.3%, mean age 67.8 ± 12.0 years), as the "high risk" group. Predictors of survival were NRS 2002 score (hazard ratio [HR] = 1.238; 95% confidence interval [CI] = 1.143-1.341), percentage of lymphocytes (HR = 0.973; 95% CI = 0.962-0.984), C-reactive protein level (HR = 1.003; 95% CI = 1.001-1.006), carcinoembryonic antigen level (HR = 1.000; 95% CI = 1.000-1.000), and carbohydrate antigen 19-9 level (HR = 1.000; 95% CI = 1.000-1.000). Kaplan-Meier survival analysis showed significant differences in the median OS among the NRS 2002 groups: "no risk" group: 12.3 ± 0.4 months (95% CI: 11.47-13.13 months); "moderate risk" group: 6.5 ± 0.9 months (95% CI: 4.78-8.17 months); and "high risk" group: 5.5 ± 0.6 months (95% CI: 4.31-6.69 months). CONCLUSIONS A good baseline nutritional status was associated with OS among Korean patients with advanced PC. An improvement in the nutritional status of patients with advanced PC through baseline nutritional interventions is therefore necessary to prolong OS.
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Affiliation(s)
- Joung Soon Park
- Department of Clinical Nutrition, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Hyung-Mi Kim
- Department of Clinical Nutrition, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Hei-Cheul Jeung
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Soon Ah Kang
- Department of Converting Technology, Graduated of Venture, Hoseo University, Seoul, Republic of Korea.
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24
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Zou J, Li Q, Kou F, Zhu Y, Lu M, Li J, Lu Z, Shen L. Prognostic value of inflammation-based markers in advanced or metastatic neuroendocrine tumours. ACTA ACUST UNITED AC 2019; 26:e30-e38. [PMID: 30853807 DOI: 10.3747/co.26.4135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background The role of systemic inflammation-based markers remains uncertain in advanced or metastatic neuroendocrine tumours (nets). Methods Systemic inflammatory factors, such as levels of circulating white blood cells and other blood components, were combined to yield inflammation-based prognostic scores [high-sensitivity inflammation-based Glasgow prognostic score (hsgps), neutrophil:lymphocyte ratio (nlr), platelet:lymphocyte ratio (plr), high-sensitivity inflammation-based prognostic index (hspi), and prognostic nutritional index (pni)], whose individual values as prognostic markers were retrospectively determined. Univariate and multivariate analyses were used to examine the association of inflammatory markers with overall survival (os). Results The study included 135 patients. Univariate analysis revealed that elevated white blood cell count, elevated neutrophil count, low serum albumin, elevated high-sensitivity C-reactive protein, and elevated hspi, hsgps, and nlr scores were significantly associated with worse os. Multivariate analyses demonstrated that, apart from pathology grade and original site of the tumour, elevated hspi (p = 0.004) was an independent prognostic factor for worse os. Conclusions In the present study, elevated pretreatment hspi was observed to be an independent predictor of shorter os in patients with inoperable advanced or metastatic net. The hspi might thus provide additional guidance for therapeutic decision-making in such patients.
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Affiliation(s)
- J Zou
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - Q Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - F Kou
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - Y Zhu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - M Lu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - J Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - Z Lu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - L Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Peking University Cancer Hospital and Institute, Beijing, P.R.C
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25
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Wu YY, Qin YY, Qin JQ, Zhang X, Lin FQ. Diagnostic value of derived neutrophil-to-lymphocyte ratio in patients with ovarian cancer. J Clin Lab Anal 2019; 33:e22833. [PMID: 30666724 PMCID: PMC6528614 DOI: 10.1002/jcla.22833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/26/2022] Open
Abstract
Background Inflammation plays an important role in the occurrence and development of cancer. Numerous studies have used the derived neutrophil‐to‐lymphocyte ratio (dNLR) to evaluate prognosis in many types of cancer. However, the relationship between dNLR and ovarian cancer and its value in the differential diagnosis of benign and malignant ovarian tumors remain unknown. Methods A total of 262 patients with ovarian cancer, 258 with benign ovarian disease, and 232 healthy controls were included in this study. dNLR was calculated using whole blood cell parameters. Receiver operating characteristic curves were generated to obtain sensitivity, specificity, and area under the ROC curve (AUC) to evaluate the diagnostic values of dNLR. Results dNLR was significantly different among the ovarian cancer, benign ovarian disease, and healthy control groups (all P < 0.001). Moreover, there were significant differences in dNLR between patients with early‐stage (I and II) and advanced‐stage (III and IV) disease (P < 0.001). dNLR was positively correlated with stage and carbohydrate antigen‐125 in ovarian cancer. A cutoff value of dNLR ≤2.11 was diagnostic in distinguishing ovarian cancer from benign ovarian disease with AUC of 0.729 (95% confidence interval [CI], 0.689‐0.767; P = 0.0001). A cutoff value of dNLR ≤1.9 was diagnostic in distinguishing ovarian cancer from healthy controls with an AUC of 0.821 (95% CI, 0.784‐0.854; P = 0.0001). Conclusion dNLR may be a useful indicator for distinguishing between ovarian cancer and benign ovarian disease and for identifying early and advanced ovarian cancer.
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Affiliation(s)
- Yang-Yang Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuan-Yuan Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jin-Qiu Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xuan Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fa-Quan Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Severe Neutropenia is Associated with Better Clinical Outcomes in Patients with Advanced Pancreatic Cancer Who Receive Modified FOLFIRINOX Therapy. Cancers (Basel) 2018; 10:cancers10110454. [PMID: 30453583 PMCID: PMC6265962 DOI: 10.3390/cancers10110454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 12/13/2022] Open
Abstract
While modified FOLFIRINOX therapy is effective for treating advanced pancreatic cancer, it frequently causes severe neutropenia. The present study investigated the effect of severe neutropenia on clinical outcomes in advanced pancreatic cancer patients who received modified FOLFIRINOX. The study subjects were 51 patients (30 males and 21 females) with advanced pancreatic cancer who received modified FOLFIRINOX (2h bolus injection of oxaliplatin at 85 mg/m², 2 h bolus injection of L-leucovorin at 200 mg/m², 90min bolus injection of irinotecan at 150 mg/m², followed by continuous infusion of 5-fluorouracil for 46 h at 2400 mg/m² without bolus 5-fluorouracil) during the period from January 2014 to May 2018. No patients had prior history of chemotherapy. Adverse events, including neutropenia, were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. Median overall survival (OS) was the primary endpoint, while median time to treatment failure (TTF), overall response rate (ORR), and the incidence of other adverse events were secondary endpoints. Severe neutropenia (grade ≥3) occurred in 39 patients (76.4%), and Cox proportional hazard analysis identified high total bilirubin level as a significant risk factor. Median duration of OS was significantly longer in patients with severe neutropenia than in those without it (21.3 months versus 8.9 months, p = 0.020). Moreover, there was a significant correlation between OS and the grade of neutropenia (r = 0.306, p = 0.029). ORR tended to be higher, though not significantly, in patients with severe neutropenia. In contrast, the incidence rates of other adverse events were not different between the two groups. Severe neutropenia is an independent predictor of prognosis in advanced pancreatic cancer patients received modified FOLFIRINOX therapy.
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Gogoi P, Sinha P, Gupta B, Firmal P, Rajaram S. Neutrophil-to-lymphocyte ratio and platelet indices in pre-eclampsia. Int J Gynaecol Obstet 2018; 144:16-20. [PMID: 30362112 DOI: 10.1002/ijgo.12701] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/08/2018] [Accepted: 10/24/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet indices between women with pre-eclampsia and normotensive pregnant women. METHODS A cross-sectional study conducted from January to July 2017 at a tertiary care hospital in Delhi, India. The study compared pregnant women aged 18-40 years with pre-eclampsia diagnosed at term with healthy pregnant women matched for gestational age. Venous blood samples were drawn and complete blood count was analyzed. The parameters recorded were hemoglobin, red cell distribution width (RDW), platelet count, mean platelet volume (MPV), plateletcrit, and platelet distribution width. RESULTS There were 67 women included in each group. NLR was higher in women with pre-eclampsia compared with the control group (6.8 ± 7.6 vs 3.0 ± 0.98; P=0.001). Both PLR (14.18 ± 14.4 vs 9.54 ± 3.6; P=0.012) and MPV (9.45 ± 1.19 vs 9.02 ± 1.1; P=0.029) were higher in the study group compared with the control group. Platelet count was lower in pre-eclamptic women compared with the control group (188 ± 89.7 vs 200.1 ± 62.36; P=0.014). RDW was also higher in the study group (P=0.025). CONCLUSIONS The present study found that the inflammatory markers NLR, PLR, RDW, and MPV were higher in women with pre-eclampsia. Measuring NLR and PLR may be useful in predicting pre-eclampsia among women at high risk during prenatal follow-up.
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Affiliation(s)
- Priyanka Gogoi
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Pallavi Sinha
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Bindiya Gupta
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Priyanka Firmal
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Shalini Rajaram
- Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Schlick K, Magnes T, Ratzinger L, Jaud B, Weiss L, Melchardt T, Greil R, Egle A. Novel models for prediction of benefit and toxicity with FOLFIRINOX treatment of pancreatic cancer using clinically available parameters. PLoS One 2018; 13:e0206688. [PMID: 30412592 PMCID: PMC6226156 DOI: 10.1371/journal.pone.0206688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/17/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite modern chemotherapy regimens, survival of pancreatic cancer patients remains dismal. Toxicity is a major concern and it is a challenge to upfront identify patients with the highest benefit from aggressive polychemotherapy. We aimed to evaluate ORR and side effects of the FOLFIRINOX regimen, highlighting dose modification and to explore possible prognostic response factors as a clinical tool. METHODS This retrospective study includes 123 patients with metastatic PC that were treated with FOLFIRINOX between the years 2007 to 2016 in a single academic institution. Survival rates were analysed using the Kaplan-Meier method. Prognostic models including laboratory and clinical parameters were calculated using Cox proportional models in univariate and multivariate analyses. RESULTS Median age at diagnosis was 64 years (47-78 years), 71 (57, 7%) were male and the majority had an ECOG performance status of 0 or 1 (63 patients; 83.7%). After a median follow up of 17.8 months, median progression free survival (PFS) and overall survival (OS) were 5.7 (4.55-6.84; 95%CI) and 11.8 months (9.35-14.24; 95%CI) respectively. Overall response rate with FOLFIRINOX was 34.9% and stable disease rate was 21.9%. Regarding Grade 3/4 side effects, 62 events, were reported in 37 patients. Looking at risk factors e.g. patient characteristics, tumor marker, inflammatory markers and body composition multivariate analyses proved CEA >4 elevation and BMI > 25 at the time point before palliative chemotherapy to be independent negative prognostic factors for OS. Grouping patients with no risk factor, one or two of these risk factors we analyzed a median OS of 17.4 moths, 9.6 months and 6.7 months (p<0.001) respectively. In addition we identified thrombocytosis and low BMI as predictors of early toxicity. CONCLUSION This study identifies two easily available factors influencing overall survival with FOLFIRINOX therapy. By combining these two factors to create a score for OS, we propose a prognostic tool for physicians to identify patients, who are unlikely to benefit more from FOLFIRINOX or likely to experience toxicity.
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Affiliation(s)
- Konstantin Schlick
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Teresa Magnes
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Ratzinger
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Jaud
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Weiss
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Melchardt
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Richard Greil
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
- * E-mail:
| | - Alexander Egle
- IIIrd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Salzburg Cancer Research Institute, Salzburg, Austria
- Cancer Cluster Salzburg, Salzburg, Austria
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Kim NH, Kim HJ. Preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after curative intent surgical resection. Hepatobiliary Pancreat Dis Int 2018; 17:450-455. [PMID: 30237091 DOI: 10.1016/j.hbpd.2018.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postoperative early recurrence (ER) in patients with pancreatic ductal adenocarcinoma (PDAC) is frequently encountered after curative intent surgery. Nonetheless, clinical significance and risk factors of ER after surgery for PDAC have not been extensively investigated. The aim of this study was to determine preoperative risk predictors for ER in patients with PDAC after upfront surgery. METHODS Eighty-one consecutive patients with PDAC who underwent curative intent surgical resection at Kangbuk Samsung Hospital between January 2004 and May 2015 were enrolled. ER was defined as tumor relapse within 6 months after surgery. RESULTS ER occurred in 26 patients (32.1%), whereas 49 patients (60.5%) had late recurrence (≥ 6 months after surgery), and 6 patients had no recurrence (7.4%). Univariate analysis showed that C-reactive protein (CRP) > 3.0 mg/dL, modified Glasgow prognostic score (mGPS) = 2, decrease of total lymphocyte count by > 50% of baseline value in the preoperative period, prognostic nutritional index (PNI) < 45, neutrophil-to-lymphocyte ratio (NLR) ≥ 3, and preoperative maximum standardized uptake value (SUVmax) were significantly associated with ER. Multivariate logistic regression analysis revealed that CRP > 3.0 mg/dL, decrease of total lymphocyte count by > 50% of baseline value, and preoperative SUVmax were significant and independent contributors of ER in patients with resectable PDAC who underwent curative intent surgery. CONCLUSIONS Postoperative ER for resectable PDAC was frequent with poor prognosis after curative intent upfront surgery. It is reasonable to suggest that there is a subgroup of resectable PDAC patients at high-risk of ER and neoadjuvant therapy should be considered in these patients in a clinical trial setting.
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Affiliation(s)
- Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
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Oxidative stress in healthy pregnancy and preeclampsia is linked to chronic inflammation, iron status and vascular function. PLoS One 2018; 13:e0202919. [PMID: 30204759 PMCID: PMC6133366 DOI: 10.1371/journal.pone.0202919] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/07/2018] [Indexed: 01/22/2023] Open
Abstract
Background During normal pregnancy, placental oxidative stress (OS) is present during all three trimesters and is necessary to obtain normal cell function. However, if OS reaches a certain level, pregnancy complications might arise. In preeclampsia (PE), a dangerous pregnancy specific hypertensive disorder, OS induced in the ischemic placenta causes a systemic inflammatory response and activates maternal endothelial cells. In this study, we aimed to quantify superoxide concentrations (as a measure of systemic OS) using electron paramagnetic resonance (EPR) and correlate them to markers of systemic inflammation, iron status and vascular function. Methods Fifty-nine women with a healthy pregnancy (HP), 10 non-pregnant controls (NP) and 28 PE patients (32±3.3weeks) were included. During HP, blood samples for superoxide, neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV) and iron status were taken at 10, 25 and 39 weeks. Vascular measurements for arterial stiffness (carotid-femoral pulse wave velocity (CF-PWV), augmentation index (AIx), augmentation Pressure (AP)) and microvascular endothelial function (reactive hyperemia index (RHI)) were performed at 35 weeks. In PE, all measurements were performed at diagnosis. CMH (1-hydroxy-3-methoxycarbonyl-2,2,5,5-tetramethylpyrrolidine) was used as spin probe for EPR, since the formed CM radical corresponds to the amount of superoxide. Results Superoxide concentration remains stable during pregnancy (p = 0.92), but is significantly higher compared to the NP controls (p<0.0001). At 25 weeks, there is a significant positive correlation between superoxide and ferritin concentration. (p = 0.04) In PE, superoxide, systemic inflammation and iron status are much higher compared to HP (all p<0.001). During HP, superoxide concentrations correlate significantly with arterial stiffness (all p<0.04), while in PE superoxide is significantly correlated to microvascular endothelial function (p = 0.03). Conclusions During HP there is an increased but stable oxidative environment, which is correlated to ferritin concentration. If superoxide levels increase, there is an augmentation in arterial stiffness. In PE pregnancies, systemic inflammation and superoxide concentrations are higher and result in a deterioration of endothelial function. Together, these findings support the hypothesis that vascular function is directly linked to the amount of OS and that measurement of OS in combination with vascular function tests might be used in the prediction of PE.
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Ye S, Bai L. Comparison and validation of the value of preoperative inflammation marker-based prognostic scores in resectable pancreatic ductal adenocarcinoma. Cancer Manag Res 2018; 10:3405-3417. [PMID: 30237742 PMCID: PMC6138957 DOI: 10.2147/cmar.s173444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose We aimed to compare and validate the prognostic value of inflammation-based prognostic scores for patients with resectable pancreatic ductal adenocarcinoma (PDAC) and to establish a novel, effective nomogram incorporating inflammation-based prognostic scores to predict disease-free survival (DFS) in these patients. Patients and methods Clinicopathological characteristics and follow-up data were retrieved from our prospective database. A total of 420 patients with PDAC who underwent radical resection were evaluated between January 2007 and December 2016. Blood samples were obtained within 7 days prior to surgical intervention. Time-dependent receiver operating characteristic curves were generated to determine optimal cutoff values for independent prognostic factors. Nomograms for DFS were established based on multivariate Cox proportional hazard models, and the results were internally validated using bootstrap resampling. Results Neutrophil-lymphocyte ratio (NLR) >2.13 and platelet-lymphocyte ratio (PLR) >140 were independent prognostic factors for DFS and overall survival. Stratified analyses indicated that these associations were not present among patients with stage III disease. Independent predictors of DFS, including Eastern Cooperative Oncology Group performance status score, tumor stage, differentiation, adjuvant treatment, NLR, and PLR, were incorporated into two nomograms for prediction of DFS in a cohort of PDAC patients after curative surgery. The area under receiver operating characteristic curve of the nomogram including NLR and PLR (0.804) was higher than that without NLR and PLR (0.711). The bootstrap-corrected AUC for the model including NLR and PLR was 0.803, while that for the model without NLR and PLR was 0.711. Conclusion Our study demonstrates that high NLR and high PLR are important clinical predictors of poor survival in patients with resectable PDAC. Additionally, a nomogram including NLR and PLR can objectively and reliably predict DFS among patients with PDAC following curative surgery.
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Affiliation(s)
- Sisi Ye
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing 100853, China,
| | - Li Bai
- Department of Medical Oncology, Chinese PLA General Hospital, Beijing 100853, China,
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Asamer E, Szkandera J, Gibiser P, Lembeck AL, Stojakovic T, Kornprat P, Lackner C, Winder T, Schlick K, Stöger H, Gerger A, Pichler M, Stotz M. Elevated amylase in plasma represents an adverse prognostic marker in patients with metastatic pancreatic cancer : A retrospective analysis. Wien Klin Wochenschr 2018; 130:569-574. [PMID: 30132196 PMCID: PMC6209010 DOI: 10.1007/s00508-018-1383-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/31/2018] [Indexed: 01/07/2023]
Abstract
Background and aim The aim of this study was to investigate the prognostic relevance of plasma amylase and lipase concerning survival of patients suffering from metastatic pancreatic cancer (PC). Method This retrospective study included 351 patients with metastatic PC, who were treated in a single academic institution. Cancer-specific survival (CSS) was analyzed using the Kaplan-Meier method. To further evaluate the prognostic significance of lipase and amylase, univariate and multivariate values were calculated using Cox proportional models. Results In univariate analysis, an increased amylase level was associated with shorter CSS in PC patients (hazard ratio HR = 1.258; 95% confidence interval CI = 1.011–1.566; p = 0.039). In multivariate analysis, including gender, age, CA19-9 and administration of chemotherapy, increased amylase levels prevailed as an independent prognostic factor for CSS (HR = 1.373; 95%CI = 1.004–1.878; p = 0.047). Conclusions Plasma amylase was found to be an independent prognostic factor in patients with metastatic PC. The results indicate that amylase might represent a novel and useful marker for better patient stratification in PC management.
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Affiliation(s)
- Eva Asamer
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Paul Gibiser
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Anna Lena Lembeck
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Peter Kornprat
- Division of General Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Caroline Lackner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Thomas Winder
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Paracelsus Medical University, Salzburg, Austria
| | - Herbert Stöger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Eyff TF, Bosi HR, Toni MS, Zilio MB, Corso CO, Bersch VP, Osvaldt AB. THE ROLE OF IMMUNOINFLAMMATORY MARKERS IN THE PROGNOSIS AND RESECTABILITY OF PANCREATIC ADENOCARCINOMA. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1366. [PMID: 29972394 PMCID: PMC6044203 DOI: 10.1590/0102-672020180001e1366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/29/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pancreatic adenocarcinoma has a high mortality rate. A prognostic tool is essential for a better risk stratification. The neutrophil/lymphocyte ratio and adaptations and the platelet/lymphocyte ratio seem promising for this purpose. AIM Evaluate the prognostic value of neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio, analyze the ideal cutoff values and investigate their utility in predicting resectability. METHODS Data were collected of patients with pancreatic adenocarcinoma in Hospital de Clínicas de Porto Alegre between 2003 and 2013. The studied ratios were determined by blood count collected at hospital admission and after two cycles of palliative chemotherapy. RESULTS Basal neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio did not have prognostic impact in survival (p=0.394, p=0.152, p=0.177 respectively). In subgroup analysis of patients submitted to palliative chemotherapy, neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio determined after two cycles of chemotherapy were prognostic for overall survival (p=0.003, p=0.009, p=0.001 respectively). The ideal cutoff values found were 4,11 for neutrophil/lymphocyte ratio (sensitivity 83%, specificity 75%), 2,8 for derived neutrophil/lymphocyte ratio (sensitivity 87%, specificity 62,5%) and 362 for platelet/lymphocyte ratio (sensitivity 91%, specificity 62,5%), Neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were not able to predict resectability (p=0.88; p=0.99; p=0.64 respectively). CONCLUSIONS Neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are useful as prognostic markers of overall survival in patients with pancreatic adenocarcinoma submitted to palliative chemotherapy. Its use as resectability predictor could not be demonstrated.
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Affiliation(s)
- Tatiana Falcão Eyff
- Programa de Pós-graduação em Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul
- Serviço de Cirurgia do Aparelho Digestivo, Hospital de Clínicas de Porto Alegre)
- Grupo do Pâncreas, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Henrique Rasia Bosi
- Serviço de Cirurgia do Aparelho Digestivo, Hospital de Clínicas de Porto Alegre)
| | - Mariana Sandrin Toni
- Serviço de Cirurgia do Aparelho Digestivo, Hospital de Clínicas de Porto Alegre)
| | - Mariana Blanck Zilio
- Programa de Pós-graduação em Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul
- Serviço de Cirurgia do Aparelho Digestivo, Hospital de Clínicas de Porto Alegre)
- Grupo do Pâncreas, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Carlos Otavio Corso
- Programa de Pós-graduação em Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul
- Serviço de Cirurgia do Aparelho Digestivo, Hospital de Clínicas de Porto Alegre)
| | - Vivian Pierri Bersch
- Serviço de Cirurgia do Aparelho Digestivo, Hospital de Clínicas de Porto Alegre)
- Grupo do Pâncreas, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Alessandro Bersch Osvaldt
- Programa de Pós-graduação em Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul
- Serviço de Cirurgia do Aparelho Digestivo, Hospital de Clínicas de Porto Alegre)
- Grupo do Pâncreas, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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The impact of the neutrophil:lymphocyte ratio in response and survival of patients with de novo diffuse large B-cell lymphoma. Leuk Res 2018; 67:82-85. [DOI: 10.1016/j.leukres.2018.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 12/15/2022]
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Liu C, Li L, Lu WS, Du H, Yan LN, Wen TF, Wei WR, Jiang L, Xu MQ. A novel combined systemic inflammation-based score can predict survival of intermediate-to-advanced hepatocellular carcinoma patients undergoing transarterial chemoembolization. BMC Cancer 2018; 18:216. [PMID: 29466970 PMCID: PMC5822668 DOI: 10.1186/s12885-018-4121-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 02/12/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is currently limited information regarding the prognostic ability of the dNLR-PNI (the combination of the derived neutrophil-to-lymphocyte ratio [dNLR] and prognostic nutritional index [PNI]) for hepatocellular carcinoma (HCC). This study aimed to assess the predictive ability of the dNLR-PNI in patients with intermediate-to-advanced HCC after transarterial chemoembolization (TACE). METHODS A total of 761 HCC patients were enrolled in the study. The dNLR-PNI was retrospectively calculated in these patients, as follows: patients with both an elevated dNLR and a decreased PNI, as determined using the cutoffs obtained from receiver operating characteristic curve analysis, were allocated a score of 2, while patients showing one or neither of these alterations were allocated a score of 1 or 0, respectively. RESULTS During the follow-up period, 562 patients died. Multivariate analysis suggested that elevated total bilirubin, Barcelona Clinic Liver Cancer C stage, repeated TACE, and dNLR-PNI were independently associated with unsatisfactory overall survival. The median survival times of patients with a dNLR-PNI of 0, 1, and 2 were 31.0 (95% confidence interval [CI] 22.5-39.5), 16.0 (95% CI 12.2-19.7) and 6.0 (95% CI 4.8-7.2) months, respectively (P < 0.001). CONCLUSIONS The dNLR-PNI can predict the survival outcomes of intermediate-to-advanced HCC patients undergoing TACE, and should be further evaluated as a prognostic marker for who are to undergo TACE treatment.
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Affiliation(s)
- Chang Liu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lei Li
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wu-Sheng Lu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Hua Du
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lu-Nan Yan
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tian-Fu Wen
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wu-Ran Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Li Jiang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ming-Qing Xu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China
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Gong J, Liang YL, Zhou W, Jie Y, Xiao C, Chong Y, Hu B. Prognostic value of neutrophil-to-lymphocyte ratio associated with prognosis in HBV-infected patients. J Med Virol 2018; 90:730-735. [PMID: 29315654 DOI: 10.1002/jmv.25015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/09/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Jiao Gong
- Department of Laboratory Medicine; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou P.R. China
| | - Yan-Lan Liang
- Department of Laboratory Medicine; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou P.R. China
| | - Wenying Zhou
- Department of Laboratory Medicine; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou P.R. China
| | - Yusheng Jie
- Department of Infectious Diseases; Key Laboratory of Liver Disease of Guangdong Province; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou P.R. China
| | - Cuicui Xiao
- Cell-gene Therapy Translational Medicine Research Center; Key Laboratory of Liver Disease of Guangdong Province; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou P.R. China
| | - Yutian Chong
- Department of Infectious Diseases; Key Laboratory of Liver Disease of Guangdong Province; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou P.R. China
| | - Bo Hu
- Department of Laboratory Medicine; Third Affiliated Hospital of Sun Yat-sen University; Guangzhou P.R. China
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Guo J, Wu M, Guo L, Zuo Q. Pretreatment blood neutrophil/lymphocyte ratio is associated with metastasis and predicts survival in patients with pancreatic cancer. Bull Cancer 2017; 105:146-154. [PMID: 29290332 DOI: 10.1016/j.bulcan.2017.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/29/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The predictive value of systemic inflammatory markers has been explored in various types of cancer. In the present study, we aimed to investigate the association between pretreatment neutrophil/lymphocyte ratio (NLR) and tumor metastasis in pancreatic cancer, and the values of NLR as a prognostic factor of overall survival. METHODS Clinical and laboratory data from 256 consecutive pancreatic cancer patients were analyzed retrospectively. The NLR was recorded before treatment and analyzed along with clinicopathological characteristics and overall survival of pancreatic cancer patients. RESULTS Multivariate analysis revealed that pretreatment NLR (HR: 2.393; 95% CI: 1.326-4.320; P=0.004) was an independent risk factor for distant metastasis. Furthermore, COX regression analysis showed that in addition to pretreatment NLR (HR: 1.871; 95% CI: 1.413-2.477; P<0.001), metastasis and stage were independent prognostic factors. CONCLUSION Pretreatment NLR values were significantly associated with distant metastasis in pancreatic cancer patients. Higher NLR values were detected in metastatic disease and may be an independent prognostic factor of overall survival in pancreatic cancer patients.
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Affiliation(s)
- Jing Guo
- Southern medical university, Nanfang hospital, department of oncology, Guangzhou, Guangdong Province, China
| | - Mengwan Wu
- Southern medical university, Nanfang hospital, department of oncology, Guangzhou, Guangdong Province, China
| | - Lihong Guo
- Southern medical university, Nanfang hospital, department of oncology, Guangzhou, Guangdong Province, China
| | - Qiang Zuo
- Southern medical university, Nanfang hospital, department of oncology, Guangzhou, Guangdong Province, China.
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Gong J, Zhou W, Xiao C, Jie Y, Zhu S, Zheng J, Chong Y, Hu B. A nomogram for predicting prognostic value of inflammatory biomarkers in patients with acute-on-chronic liver failure. Clin Chim Acta 2017; 478:7-12. [PMID: 29247632 DOI: 10.1016/j.cca.2017.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/16/2017] [Accepted: 12/12/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) in china is a critical clinical syndrome with a high short-term mortality. This study aimed to construct and validate a model for neutrophil to lymphocyte ratio (NLR)-based nomogram for 3-month mortality estimation for patients with ACLF. METHODS The nomogram was based on a retrospectively study of 96 patients with ACLF. The predictive accuracy and discriminative ability of nomogram were evaluated by a concordance index (C-index), and calibration curve, comparing with model for end-stage liver disease (MELD) score. The results were validated using bootstrap resampling and an external cohort of 88 patients. RESULTS A total of 184 patients with ACLF were enrolled, with 3-month mortality of 40.76%. The cut-off value for NLR was 5.7 using X-tile program. Patients with NLR>5.7 had significantly higher mortality (p<0.001). On multivariate analysis of the training cohort, independent factors for survival were age, NLR and total bilirubin, which were all selected into the nomogram. The calibration curve for probability of survival showed optimal agreement between prediction by nomogram and actual observation. The C-index of nomogram was higher than that of MELD score for predicting survival (0.72 vs 0.56). The results were confirmed in validation cohort. CONCLUSIONS The proposed nomogram with NLR resulted in more accurate prognostic prediction for patients with HBV-related ACLF.
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Affiliation(s)
- Jiao Gong
- Department of Laboratory Medicine, Third Affiliated Hospital, Sun Yat-sen University, PR China
| | - Wenying Zhou
- Department of Laboratory Medicine, Third Affiliated Hospital, Sun Yat-sen University, PR China
| | - Cuicui Xiao
- Cell-gene Therapy Translational Medicine Research Center, Key Laboratory of Liver Disease of Guangdong Province, Third Affiliated Hospital of Sun Yat-sen University, PR China
| | - Yusheng Jie
- Department of Infectious Diseases, Key Laboratory of Liver Disease of Guangdong Province, Third Affiliated Hospital of Sun Yat-sen University, PR China
| | - Shuguang Zhu
- Department of Hepatic Surgery and Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Jun Zheng
- Department of Hepatic Surgery and Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Yutian Chong
- Cell-gene Therapy Translational Medicine Research Center, Key Laboratory of Liver Disease of Guangdong Province, Third Affiliated Hospital of Sun Yat-sen University, PR China.
| | - Bo Hu
- Department of Laboratory Medicine, Third Affiliated Hospital, Sun Yat-sen University, PR China.
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Yuan J, Liang H, Li J, Li M, Tang B, Ma H, Xie X, Yin X, Zhang L, Ren Z. Peripheral blood neutrophil count as a prognostic factor for patients with hepatocellular carcinoma treated with sorafenib. Mol Clin Oncol 2017; 7:837-842. [PMID: 29181175 PMCID: PMC5700259 DOI: 10.3892/mco.2017.1416] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/15/2017] [Indexed: 12/16/2022] Open
Abstract
Sorafenib is currently the only efficient molecular targeted therapy for hepatocellular carcinoma (HCC), although its effect is relatively moderate and variable between individuals. The present study aimed to evaluate the significance of peripheral blood neutrophils in the prognosis of HCC patients treated with sorafenib. A total of 464 patients with HCC were treated with sorafenib at Zhongshan Hospital (Shanghai, China) between January 1st, 2008 and December 31st, 2012, among which 120 patients were enrolled in the study. The optimal cutoff point for low vs. high neutrophil count (3.65×109) was obtained from a receiver operating characteristic curve. Overall survival (OS) was compared between the patients with low and high peripheral neutrophil counts. Univariate and multivariate analyses were used to explore the prognostic factors associated with OS in the patients treated with sorafenib. A nomogram model was also performed to predict the OS times of these patients. The median OS time was 9.0 months (95% confidence interval, 5.9-12.1 months) in the whole group of patients, with 1-, 2- and 3-year OS rates of 36, 24 and 16%, respectively. Using a cutoff level of 3.65×109 neutrophils/l, the median OS time was longer in the group of patients with a low peripheral neutrophil count than in those with a high peripheral neutrophil count (11.5 vs. 5.0 months, respectively; P<0.001). The multivariate analysis showed that peripheral neutrophil count, α-fetoprotein level and tumor size were independent prognostic factors for OS. In addition, using the nomogram model for the prediction of OS, the Harrell's c-index was 0.79. Therefore, it was concluded that a lower peripheral blood neutrophil count was associated with a better prognosis following treatment with sorafenib therapy.
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Affiliation(s)
- Jia Yuan
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
| | - Hongming Liang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
| | - Jinghuan Li
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
| | - Miao Li
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
| | - Bei Tang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
| | - Hui Ma
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
| | - Xiaoying Xie
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
| | - Xin Yin
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
| | - Lan Zhang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
| | - Zhenggang Ren
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai 200032, P.R. China
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Cox S, Hurt C, Grenader T, Mukherjee S, Bridgewater J, Crosby T. The prognostic value of derived neutrophil to lymphocyte ratio in oesophageal cancer treated with definitive chemoradiotherapy. Radiother Oncol 2017; 125:154-159. [PMID: 28893415 PMCID: PMC5648078 DOI: 10.1016/j.radonc.2017.08.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE The derived neutrophil-lymphocyte ratio (dNLR) is a validated prognostic biomarker for cancer survival but has not been extensively studied in locally-advanced oesophageal cancer treated with definitive chemoradiotherapy (dCRT). We aimed to identify the prognostic value of dNLR in patients recruited to the SCOPE1 trial. MATERIALS AND METHODS 258 patients were randomised to receive dCRT±cetuximab. Kaplan-Meier's curves and both univariable and multivariable Cox regression models were calculated for overall survival (OS), progression free survival (PFS), local PFS inside the radiation volume (LPFSi), local PFS outside the radiation volume (LPFSo), and distant PFS (DPFS). RESULTS An elevated pre-treatment dNLR≥2 was significantly associated with decreased OS in univariable (HR 1.74 [95% CI 1.29-2.35], p<0.001) and multivariable analyses (HR 1.64 [1.17-2.29], p=0.004). Median OS was 36months (95% CI 27.8-42.4) if dNLR<2 and 18.4months (95% CI 14.1-24.9) if dNLR≥2. All measures of PFS were also significantly reduced with an elevated dNLR. dNLR was prognostic for OS in cases of squamous cell carcinoma with a non-significant trend for adenocarcinoma/undifferentiated tumours. CONCLUSIONS An elevated pre-treatment dNLR may be an independent prognostic biomarker for OS and PFS in oesophageal cancer patients treated with definitive CRT. dNLR is a simple, inexpensive and readily available tool for risk-stratification and should be considered for use in future oesophageal cancer clinical trials. The SCOPE1 trial was an International Standard Randomised Controlled Trial [number 47718479].
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Affiliation(s)
- Samantha Cox
- Department of Oncology, Velindre Cancer Centre, Cardiff, United Kingdom.
| | - Christopher Hurt
- Wales Cancer Trials Unit, Cardiff University, Cardiff, United Kingdom.
| | - Tal Grenader
- Oncology Institute, Shaare Zedek Medical Centre, Jerusalem, Israel.
| | - Somnath Mukherjee
- Department of Oncology, Oxford Cancer Centre, University of Oxford, Churchill Hospital, Oxford, United Kingdom.
| | - John Bridgewater
- University College Hospital Macmillan Cancer Centre, London, United Kingdom.
| | - Thomas Crosby
- Department of Oncology, Velindre Cancer Centre, Cardiff, United Kingdom.
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Huang QT, Man QQ, Hu J, Yang YL, Zhang YM, Wang W, Zhong M, Yu YH. Prognostic significance of neutrophil-to-lymphocyte ratio in cervical cancer: A systematic review and meta-analysis of observational studies. Oncotarget 2017; 8:16755-16764. [PMID: 28187430 PMCID: PMC5369999 DOI: 10.18632/oncotarget.15157] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/06/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND AIMS The prognostic role of neutrophil-to-lymphocyte ratio (NLR) in cervical cancer are controversial. We conducted this meta-analysis to obtain a more accurate assessment of prognostic significance of NLR in cervical cancer. RESULTS A total of 9 studies, consisting of 2,804 patients, were selected in this meta-analysis. Our pooled results showed that high pre-treatment NLR level was significantly associated with poorer overall survival (HR: 1.88, 95% CI 1.30-2.73) and shorter progression free survival (HR 1.65, 95% CI 1.18-2.29). Additionally, increased NLR was also significantly correlated with tumor size (OR 2.05, 95% CI 1.14-3.65), advanced FIGO stage (OR 2.12, 95% CI1.28-3.49) and lymph node involvement (OR 2.24, 95% CI 1.65-3.04). MATERIALS AND METHODS We conducted a systematic literature search using the electronic databases PubMed, Web of Science, and Embase up to May 2016.Statistical analysis was performed using Stata 10.0. CONCLUSIONS Elevated pretreatment NLR could serve as a predicative factor of poor prognosis for cervical cancer patients.
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Affiliation(s)
- Qi-Tao Huang
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qian-Qian Man
- Southern Medical University, Guangzhou, 510515, China
| | - Jia Hu
- Southern Medical University, Guangzhou, 510515, China
| | - Yi-Lin Yang
- Southern Medical University, Guangzhou, 510515, China
| | - Yue-Mei Zhang
- Southern Medical University, Guangzhou, 510515, China
| | - Wei Wang
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Mei Zhong
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yan-Hong Yu
- Division of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
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Jin H, Sun J, Zhu K, Liu X, Zhang Q, Shen Q, Gao Y, Yu J. The prognostic value of neutrophil-lymphocyte ratio is superior to derived neutrophil-lymphocyte ratio in advanced gastric cancer treated with preoperative chemotherapy and sequential R0 resection: a 5-year follow-up. Onco Targets Ther 2017; 10:2655-2664. [PMID: 28579803 PMCID: PMC5449100 DOI: 10.2147/ott.s135641] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIM The role of neutrophil-lymphocyte ratio (NLR) and derived neutrophil-lymphocyte ratio (d-NLR) in outcome prediction is assessed in patients with advanced gastric cancer receiving preoperative chemotherapy in a 5-year follow-up cohort. PATIENTS AND METHODS Patients undergoing preoperative chemotherapy and sequential R0 resection for advanced gastric cancer were enrolled from July 2004 to November 2011. Wilcoxon matched-pairs signed-rank test was used to evaluate the change of peripheral blood parameters. Receiver operating curve was used to identify the optimal cutoff values of NLR and d-NLR. Survival function was analyzed using Kaplan-Meier curves and Cox proportional hazard model. RESULTS Significant difference was found between baseline and post-chemotherapy blood parameters, including leukocytes, neutrophils, lymphocytes, NLR and d-NLR (all P<0.05). High baseline NLR group (NLR ≥2.230) had a significant shorter recurrence-free survival (RFS) (hazard ratio [HR] =1.814, 95% confidence interval [95% CI]: 1.112-2.960, P=0.015) and shorter overall survival (OS) (HR =1.867, 95% CI: 1.129-3.089, P=0.013) than those of the low baseline NLR group (NLR <2.230). High baseline d-NLR group (d-NLR ≥1.885) also had a shorter RFS (HR =1.805, 95% CI: 1.116-2.919, P=0.014) and shorter OS (HR =1.783, 95% CI: 1.091-2.916, P=0.019) than those of the low baseline d-NLR group (d-NLR <1.885). However, post-chemotherapy NLR and d-NLR showed no prognostic significance on RFS and OS (all P>0.05). Multivariate analysis showed that higher baseline NLR but not d-NLR was identified as an independent factor associated with worse RFS (HR =1.707, 95% CI: 1.042-2.797, P=0.034) and worse OS (HR =1.758, 95% CI: 1.058-2.919, P=0.029). CONCLUSION Baseline NLR and d-NLR may serve as convenient, easily measured prognostic indicators in advanced gastric cancer treated with preoperative chemotherapy and sequential R0 resection, especially to baseline NLR, which showed independent prognostic significance on RFS and OS, while post-chemotherapy NLR and d-NLR lost their usefulness due to the inhibition of bone marrow hematopoietic function. Patients with high baseline NLR and d-NLR values need multimodal therapy.
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Affiliation(s)
- Hailong Jin
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Jianyi Sun
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Kankai Zhu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiaosun Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Qing Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Qianyun Shen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Yuan Gao
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, People's Republic of China
| | - Jiren Yu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, People's Republic of China
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Kast RE, Hill QA, Wion D, Mellstedt H, Focosi D, Karpel-Massler G, Heiland T, Halatsch ME. Glioblastoma-synthesized G-CSF and GM-CSF contribute to growth and immunosuppression: Potential therapeutic benefit from dapsone, fenofibrate, and ribavirin. Tumour Biol 2017; 39:1010428317699797. [PMID: 28459367 DOI: 10.1177/1010428317699797] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Abstract
Increased ratio of circulating neutrophils to lymphocytes is a common finding in glioblastoma and other cancers. Data reviewed establish that any damage to brain tissue tends to cause an increase in G-CSF and/or GM-CSF (G(M)-CSF) synthesized by the brain. Glioblastoma cells themselves also synthesize G(M)-CSF. G(M)-CSF synthesized by brain due to damage by a growing tumor and by the tumor itself stimulates bone marrow to shift hematopoiesis toward granulocytic lineages away from lymphocytic lineages. This shift is immunosuppressive and generates the relative lymphopenia characteristic of glioblastoma. Any trauma to brain-be it blunt, sharp, ischemic, infectious, cytotoxic, tumor encroachment, or radiation-increases brain synthesis of G(M)-CSF. G(M)-CSF are growth and motility enhancing factors for glioblastomas. High levels of G(M)-CSF contribute to the characteristic neutrophilia and lymphopenia of glioblastoma. Hematopoietic bone marrow becomes entrained with, directed by, and contributes to glioblastoma pathology. The antibiotic dapsone, the lipid-lowering agent fenofibrate, and the antiviral drug ribavirin are Food and Drug Administration- and European Medicines Agency-approved medicines that have potential to lower synthesis or effects of G(M)-CSF and thus deprive a glioblastoma of some of the growth promoting contributions of bone marrow and G(M)-CSF.
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Affiliation(s)
| | - Quentin A Hill
- 2 Department of Haematology, St James's University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Didier Wion
- 3 INSERM U1205, Centre de Recherche Biomédicale Edmond J. Safra, Grenoble, France
| | - Håkan Mellstedt
- 4 Department of Oncology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Daniele Focosi
- 5 North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | | | - Tim Heiland
- 6 Department of Neurosurgery, University of Ulm, Ulm, Germany
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The Neutrophil/Lymphocyte Ratio at Diagnosis Is Significantly Associated with Survival in Metastatic Pancreatic Cancer Patients. Int J Mol Sci 2017; 18:ijms18040730. [PMID: 28353661 PMCID: PMC5412316 DOI: 10.3390/ijms18040730] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 12/11/2022] Open
Abstract
Different inflammation-based scores such as the neutrophil/lymphocyte ratio (NLR), the Odonera Prognostic Nutritional Index (PNI), the Glasgow Prognostic Score, the platelet/lymphocyte ratio, and the C-reactive protein/albumin ratio have been found to be significantly associated with pancreatic cancer (PDAC) prognosis. However, most studies have investigated patients undergoing surgery, and few of them have compared these scores. We aimed at evaluating the association between inflammatory-based scores and PDAC prognosis. In a single center cohort study, inflammatory-based scores were assessed at diagnosis and their prognostic relevance as well as that of clinic-pathological variables were evaluated through multiple logistic regression and survival probability analysis. In 206 patients, age, male sex, tumor size, presence of distant metastasis, access to chemotherapy, and an NLR > 5 but not other scores were associated with overall survival (OS) at multivariate analysis. Patients with an NLR < 5 had a median survival of 12 months compared to 4 months in those with an NLR > 5. In the 81 patients with distant metastasis at diagnosis, an NLR > 5 resulted in the only variable significantly associated with survival. Among patients with metastatic disease who received chemotherapy, the median survival was 3 months in patients with an NLR > 5 and 7 months in those with an NLR < 5. The NLR might drive therapeutic options in PDAC patients, especially in the setting of metastatic disease.
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Davis JL, Langan RC, Panageas KS, Zheng J, Postow MA, Brady MS, Ariyan C, Coit DG. Elevated Blood Neutrophil-to-Lymphocyte Ratio: A Readily Available Biomarker Associated with Death due to Disease in High Risk Nonmetastatic Melanoma. Ann Surg Oncol 2017; 24:1989-1996. [PMID: 28303429 DOI: 10.1245/s10434-017-5836-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Elevated peripheral blood neutrophil-to-lymphocyte ratio (NLR) is associated with poor oncologic outcomes in patients with stage IV melanoma and other solid tumors, but its impact has not been characterized for patients with high-risk, nonmetastatic melanoma. METHODS Retrospective review of a melanoma database identified patients with high-risk melanoma who underwent operation with curative intent at a single institution. NLR was calculated from blood samples obtained within 2 weeks before operation. Multiple primary melanomas and concurrent hematologic or other metastatic malignancies were excluded. Cumulative incidence of death due to disease was estimated, and Gray's test was used to examine the effect of NLR on melanoma disease-specific death (DOD). Multivariable competing risks regression models assessed associated factors. RESULTS Data on 1431 patients with high-risk, nonmetastatic melanoma were analyzed. Median follow-up for survivors was 4 years. High NLR (≥3 or as continuous variable) was associated with older age, male sex, thicker primaries, higher mitotic index, and more advanced nodal status. On multivariate analysis, high NLR (≥3 or as a continuous variable), older age, male sex, ulcerated primary, lymphovascular invasion, and positive nodal status were all independently associated with worse DOD. CONCLUSIONS NLR is a readily available blood test that was independently associated with DOD in patients with high-risk, nonmetastatic melanoma. It is unclear whether high NLR is a passive indicator of poor prognosis or a potential therapeutic target. Further studies to evaluate the prognostic role of NLR to potentially identify those more likely to benefit from adjuvant immunotherapy may prove informative.
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Affiliation(s)
- Jeremy L Davis
- Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Russell C Langan
- Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael A Postow
- Melanoma and Immunotherapeutics Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Mary S Brady
- Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charlotte Ariyan
- Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel G Coit
- Department of Surgery; Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Formica V, Morelli C, Ferroni P, Nardecchia A, Tesauro M, Pellicori S, Cereda V, Russo A, Riondino S, Guadagni F, Roselli M. Neutrophil/lymphocyte ratio helps select metastatic pancreatic cancer patients benefitting from oxaliplatin. Cancer Biomark 2017; 17:335-345. [PMID: 27434293 DOI: 10.3233/cbm-160645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND High Neutrophil/Lymphocyte ratio (NLR), as a measure of enhanced inflammatory response, has been negatively associated with prognosis in patients with localized pancreatic ductal adenocarcinoma (PDA). OBJECTIVE In the present study, we aimed at investigating the prognostic value of NLR in two homogeneous groups of chemotherapy-naïve metastatic PDA patients. Patients were treated with either gemcitabine (GEM) or gemcitabine/oxaliplatin (GEMOXA). We also assessed whether NLR could identify patients benefiting from the use of oxaliplatin. METHODS Consecutive PDA patients treated at the Medical Oncology Unit of Tor Vergata University Hospital of Rome with either GEM or GEMOXA were included (n= 103). NLR was assessed before and during chemotherapy and correlated with outcome together with common clinical and biochemical variables. RESULTS Among 17 analyzed variables NLR, Karhofsky Perfomance Status (KPS), d-dimer and erythrocyte sedimentation rate were found to be significantly associated with median Overall Survival (mOS) at the univariate analysis. Only NLR and KPS were independent prognosticator at multivariate analysis, with NLR displaying the highest statistical significance. NLR was also predictive of oxaliplatin activity, as only patients with NLR > 2.5 (cutoff determined upon ROC analysis) derived benefit from GEMOXA over GEM. CONCLUSIONS NLR is both an independent prognostic and predictive factor in metastatic PDA, since only patients with high NLR seem to benefit from the addition of oxaliplatin. NLR may help select patients for whom a particularly poor prognosis might justify more intensive, yet less tolerable, combination regimens.
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Affiliation(s)
- Vincenzo Formica
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Cristina Morelli
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Patrizia Ferroni
- San Raffaele Roma Open University, Rome, Italy.,Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy
| | - Antonella Nardecchia
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Manfredi Tesauro
- Department of Systems Medicine, Internal Medicine, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Stefania Pellicori
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Vittore Cereda
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
| | - Antonio Russo
- Section of Medical Oncology, Department of Surgical and Oncology Sciences, University of Palermo, Italy
| | - Silvia Riondino
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy.,Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy
| | - Fiorella Guadagni
- San Raffaele Roma Open University, Rome, Italy.,Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, Rome, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology, Tor Vergata Clinical Center, Tor Vergata University of Rome, Rome, Italy
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Critical evaluation of the potential prognostic value of the pretreatment-derived neutrophil-lymphocyte ratio under consideration of C-reactive protein levels in clear cell renal cell carcinoma. Br J Cancer 2016; 116:85-90. [PMID: 27907929 PMCID: PMC5220155 DOI: 10.1038/bjc.2016.393] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/09/2016] [Accepted: 11/03/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We investigated the prognostic value of the pretreatment-derived neutrophil-lymphocyte ratio (dNLR) and original NLR in relation to the commonly used inflammation marker C-reactive protein (CRP) in a large cohort of patients with clear cell renal cell carcinoma (RCC). METHODS Clinicopathological data from 587 consecutive non-metastatic clear cell RCC patients, operated between 2000 and 2010 at a single tertiary academic center, were evaluated retrospectively. Patients were categorised according to a cutoff value derived from receiver operating curve analysis. Overall (OS), cancer-specific (CSS) as well as metastasis-free survival (MFS) were assessed using the Kaplan-Meier method and multivariate Cox proportional models were applied. Spearman's rank correlation coefficient tested the association between dNLR and other markers of the systemic inflammatory response. RESULTS The significant correlation between pretreatment NLR and dNLR was strong (ρ=0.84), whereas between dNLR and CRP it was weak (ρ=0.18). In multivariate analyses, dNLR achieved independent predictor status regarding CSS (P=0.037) and MFS (P=0.041), whereas CRP was confirmed as independent predictor of OS (P=0.010), CSS (P=0.039) and MFS (P=0.005), respectively. The NLR failed to reach independent predictor status regarding OS, CSS and MFS when CRP was included into the multivariate model. CONCLUSIONS In the cohort studied, an elevated (⩾10.0) pretreatment CRP level and elevated dNLR (>2) were robust independent predictors of CSS and MFS. Our data suggest that CRP might be superior to both NLR and dNLR.
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Kadokura M, Ishida Y, Tatsumi A, Takahashi E, Shindo H, Amemiya F, Takano S, Fukasawa M, Sato T, Enomoto N. Performance status and neutrophil-lymphocyte ratio are important prognostic factors in elderly patients with unresectable pancreatic cancer. J Gastrointest Oncol 2016; 7:982-988. [PMID: 28078122 DOI: 10.21037/jgo.2016.06.06] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The usefulness of various prognostic factors for pancreatic cancer (PC) has been reported, but the number of elderly patients in these studies is disproportionately fewer compared with those in everyday practice. The purpose of this study was to investigate the prognostic factors for unresectable PC in elderly patients. METHODS We retrospectively analyzed 67 elderly (age ≥75 years) patients with unresectable PC who underwent chemotherapy between January 2006 and December 2014 at our hospital. Univariate and multivariate Cox regression models were applied to investigate independent prognostic factors. RESULTS Multivariate analysis revealed that an increased neutrophil-lymphocyte ratio (NLR) [hazard ratio (HR) 1.91, P=0.03] and Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 (HR 2.74, P=0.01) were independent negative prognostic factors. CONCLUSIONS The two prognostic factors identified herein are useful in the identification of patients with a poor prognosis and subsequent administration of supportive care alone, which may help avoid the unnecessary adverse effects and complications of systemic chemotherapy.
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Affiliation(s)
- Makoto Kadokura
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu City, Yamanashi, Japan
| | - Yasuaki Ishida
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu City, Yamanashi, Japan
| | - Akihisa Tatsumi
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu City, Yamanashi, Japan
| | - Ei Takahashi
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Shimokato, Chuo, Yamanashi, Japan
| | - Hiroko Shindo
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Shimokato, Chuo, Yamanashi, Japan
| | - Fumitake Amemiya
- Department of Gastroenterology, Kofu Municipal Hospital, Kofu City, Yamanashi, Japan
| | - Shinichi Takano
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Shimokato, Chuo, Yamanashi, Japan
| | - Mitsuharu Fukasawa
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Shimokato, Chuo, Yamanashi, Japan
| | - Tadashi Sato
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Shimokato, Chuo, Yamanashi, Japan
| | - Nobuyuki Enomoto
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Shimokato, Chuo, Yamanashi, Japan
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Chen YM, Lai CH, Rau KM, Huang CH, Chang HC, Chao TY, Tseng CC, Fang WF, Chung YH, Wang YH, Su MC, Huang KT, Liu SF, Chen HC, Chang YC, Chang YP, Wang CC, Lin MC. Impact of clinical parameters and systemic inflammatory status on epidermal growth factor receptor-mutant non-small cell lung cancer patients readministration with epidermal growth factor receptor tyrosine kinase inhibitors. BMC Cancer 2016; 16:868. [PMID: 27821111 PMCID: PMC5100346 DOI: 10.1186/s12885-016-2917-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 10/31/2016] [Indexed: 11/21/2022] Open
Abstract
Background Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) readministration to lung cancer patients is common owing to the few options available. Impact of clinical factors on prognosis of EGFR-mutant non-small cell lung cancer (NSCLC) patients receiving EGFR-TKI readministration after first-line EGFR-TKI failure and a period of TKI holiday remains unclear. Through this retrospective study, we aimed to understand the impact of clinical factors in such patients. Methods Of 1386 cases diagnosed between December 2010 and December 2013, 80 EGFR-mutant NSCLC patients who were readministered TKIs after failure of first-line TKIs and intercalated with at least one cycle of cytotoxic agent were included. We evaluated clinical factors that may influence prognosis of TKI readministration as well as systemic inflammatory status in terms of neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR). Baseline NLR and LMR were estimated at the beginning of TKI readministration and trends of NLR and LMR were change amount from patients receiving first-Line TKIs to TKIs readministration. Results Median survival time since TKI readministration was 7.0 months. In the univariable analysis, progression free survival (PFS) of first-line TKIs, baseline NLR and LMR, and trend of LMR were prognostic factors in patients receiving TKIs readministration. In the multivariate analysis, only PFS of first-line TKIs (p < 0.001), baseline NLR (p = 0.037), and trend of LMR (p = 0.004) were prognostic factors. Conclusion Longer PFS of first-line TKIs, low baseline NLR, and high trend of LMR were good prognostic factors in EGFR-mutant NSCLC patients receiving TKI readministration. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2917-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Mu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Chien-Hao Lai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Kun-Ming Rau
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hua Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chih Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Tung-Ying Chao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Chia-Cheng Tseng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan.,Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Yu-Hsiu Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Yi-Hsi Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Mao-Chang Su
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Kuo-Tung Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Shih-Feng Liu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Hung-Chen Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Ya-Chun Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Yu-Ping Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, Taiwan.
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Caliskan B, Korkmaz AN. Can Neutrophil/Lymphocyte Ratio be a Predictor for Bone Metastases of Solid Tumors? World J Nucl Med 2016; 15:196-9. [PMID: 27651741 PMCID: PMC5020794 DOI: 10.4103/1450-1147.174711] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cancer-associated inflammation has been receiving increased attention due to its role in cancer development. It is known that tumors can cause an inflammatory reaction and inflammatory cells play an important role in neoplastic growth. In this study, we aimed to investigate any relationship between bone metastases and the neutrophil-to-lymphocyte ratio (NLR). Patients who were referred for bone scintigraphy to investigate bone metastasis were enrolled in the study. Patients’ hematological parameters were obtained from the hospital database retrospectively. Patients with a nonmetastatic bone scan were categorized as Group A (N = 171), patients who had metastatic bone disease without any other organ metastases were categorized as group B (N = 25), and patients who had metastatic bone disease with the other organ metastases were categorized as Group C (N = 48). The median NLR of the patients in Group A was 2.55 (range: 0.38–20.7), in Group B was 2.83 (range: 1.56–31.8), and in Group C was 4.12 (range: 1.79–38). NLR was significantly higher in Group C patients compared to Group A and B patients (P < 0.001). In conclusion, the NLR is significantly associated with the other organ metastases but has no significant correlation with bone metastases.
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Affiliation(s)
- Billur Caliskan
- Department of Nuclear Medicine, Abant Izzet Baysal University, Bolu, Turkey
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