A derived neutrophil to lymphocyte ratio predicts clinical outcome in stage II and III colon cancer patients

Prognostic role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with midgut neuroendocrine tumors undergoing resective surgery

AIM

Several studies demonstrated the prognostic value of the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and platelet-to-white blood cells ratio (PWR) in different types of tumors. However, there is no information about a possible role of NLR, PLR and PWR as predictor of presence of metastasis or multifocal disease in patients undergoing surgery with curative intent for midgut NET. The aim of our study was to test the role of preoperative NLR, PLR and PWR as predictors of patients undergoing surgery with curative intent for midgut NET.

METHODS

We retrospectively enrolled seven foregut, 35 midgut and six hindgut NET patients with gastrointestinal neuroendocrine tumors operated in our Units from January 2005 to June 2016. Details about preoperative laboratory data, surgical operation, histology and follow-up were retrieved. Non-parametric statistics, ROC curve analysis and survival analysis were used.

RESULTS

NLR was significantly higher in patients with distant metastasis (p = 0.04). The ROC curve analysis indicated that a threshold value of NLR of 2.6 predicted the presence of peritoneal metastasis with a specificity of 100% and a sensitivity of 71% and an overall accuracy of AUC = 0.81 (95%CI: 0.59-0.94), p = 0.05. PLR and PWR was not be associated to metastasis but tended to be associated to multifocal disease.

CONCLUSION

In patients with midgut NET, an impaired adaptive immune response, as suggested by a high NLR ratio, was associated to the presence of distant metastasis and in particular of peritoneal metastasis. This information may be helpful when planning the treatment of a patient with a midgut NET.

Commentary on: Nomograms based on inflammatory biomarkers for predicting tumor grade and microvascular invasion in stage I/II hepatocellular carcinoma

Some doubts were generated during the reading of nomograms based on inflammatory biomarkers for preoperatively predicting tumor grade and microvascular invasion in stage I/II hepatocellular carcinoma (HCC). We would like to highlight and discuss with authors. First, neutrophil-lymphocyte ratio (NLR) and derived NLR (dNLR) should not be entered into multivariate analysis simultaneously. Second, authors should clarify how the cutoffs of these variables including lymphocyte-monocyte ratio (LMR), dNLR, age and tumor size were set. We insist that the type of variables should be consistent when we carry out the analysis and establish the nomogram. Last, we have to point out that Li et al.’s (Biosci. Rep. (2018), 38) study failed to validate nomograms using an independent dataset.

Absolute Neutrophil Count Levels among Degree of Differentiation and Tumor Location in Colorectal Cancer Patients in Medan

BACKGROUND:

Absolute Neutrophil Count (ANC) recently a derived score composed of white blood cell and has been evaluated in a large number of the malignancy.

AIM:

The aim of this study was to investigate ANC levels among degree of differentiation and tumor location in Colorectal Cancer (CRC) in Medan.

METHODS:

This study was a cross-sectional analytical study on eighty consecutive patients with CRC. Data collection was obtained from the medical record of the patient at Adam Malik General Hospital, Medan, Indonesia. Inclusion criteria were included male or female aged ≥ 18 years old, the patient with CRC, blood test especially ANC, and the patient with histopathology test. The exclusion criteria were defined as a patient with chemotherapy, HIV, and the patient with sepsis. Data were analyzed with SPSS for window version 21.

RESULTS:

here were Rectal cancer 49.4%, Left side colon cancer 43.2%, and Right-side colon cancer 6.2%. Histopathological findings well differentiated 40.7%, moderate differentiated 32.1%, and poorly differentiated 25.9%. This study showed that no significant differences between ANC and location of the tumor (p = 0.951), but ANC level was significant in histopathological findings (p = 0.0001).

CONCLUSION:

ANC increased in poorly differentiated, and location of the tumor is left side colon cancer.

Haematologic indices in hepatitis B virus-related liver disease

Several markers and prognostic scores have been identified for predicting the development and progression of liver disease; among them, haematological parameters (the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), RDW to platelet ratio (RPR), mean platelet volume (MPV), and mean corpuscular volume (MCV)) have recently gained significant interest. Compared with traditional prognostic factors, haematological indices are easy to obtain and relatively inexpensive. There is growing evidence that these haematological indices play a key role in HBV-related liver diseases and has been proposed as a predictive marker of adverse outcomes in these patients. This article focuses on discussing the diagnostic and prognostic value of the haematological indices in patients with HBV-related liver diseases.

Using Pre-Treatment Neutrophil-to-Lymphocyte Ratio to Predict the Prognosis of Young Patients with Hepatocellular Carcinoma Implemented Minimally Invasive Treatment

Purpose: Neutrophil-to-lymphocyte ratio (NLR) is considered as a prognostic factor in some patients with hepatocellular carcinoma (HCC). This factor has not been extensively examined in young HCC patients. The objective of this study is to assess whether pre-treatment NLR could predict the survival in young HCC patients implemented minimally invasive treatment. Methods: Young HCC patients treated by transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) at our institutes from 2008 to 2017 were retrospectively reviewed. The best cutoff value of NLR was determined with time-dependent receiver operating characteristic curve analysis. The associations between overall survival and various potential risk factors, including tumor size, vascular invasion, hepatitis B virus infection, Child-Pugh scores, Barcelona Clinic Liver Cancer (BCLC) stage, aspartate aminotransferase (AST), and NLR, were analyzed. Results: Data were collected from 47 HCC patients who were <45 years old (range 30-44). In univariate analysis, vascular invasion (p = 0.001), tumor maximum diameter (p = 0.000), BCLC stage (p = 0.001), HBsAg positive (p = 0.025), AST ≥2 × upper limits of normal (ULN) (p = 0.027), and NLR ≥3.09 (p = 0.027) were predictors for poor survival in young HCC patients treated by TACE combined with RFA. The multivariate Cox proportional hazard model analysis showed that except NLR (hazard ratio [HR] = 0.720, 95% CI 0.287-1.808, p = 0.485), tumor maximum diameter ≥5 cm (HR = 0.444, 95% CI 0.199-0.991, p = 0.047) and AST ≥2 × ULN (HR = 4.578, 95% CI 1.544-13.575, p = 0.006) were independent indicators for poor prognosis. Conclusion: Pre-treatment NLR ≥3.09 is related to poor prognosis of young HCC patients implemented minimally invasive treatment. However, it is not an independent indicator for prognosis.

Changes in the neutrophil-to-lymphocyte ratio predict the prognosis of patients with advanced hepatocellular carcinoma treated with sorafenib

BACKGROUND AND AIM

Although sorafenib is the first systemic therapy to show survival benefit for advanced hepatocellular carcinoma (HCC), its survival benefit is variable for HCC. Systemic inflammation may be associated with survival in HCC. We investigated the use of systemic inflammation markers, including neutrophil-to-lymphocyte ratio (NLR), in the prognosis of sorafenib-treated HCC patients.

PATIENTS AND METHODS

We retrospectively analyzed data of 82 patients with advanced HCC who received sorafenib as the first-line treatment. Data on pretreatment and post-treatment (2-3 months after initiating sorafenib therapy, first tumor response evaluation day) clinical, laboratory, and tumor characteristics were collected. Survival-related prognostic factors were analyzed.

RESULTS

Patients were mostly in the intermediate (12.2%) or advanced (87.8%) Barcelona Clinic Liver Cancer stages. Fifty-six (68.3%) patients had vascular invasion and 34 (41.5%) patients had extrahepatic disease. The median progression-free survival (PFS) and overall survival (OS) were 4.7 months [95% confidence interval (CI): 2.8-6.5 months] and 4.7 months (95% CI: 2.8-6.5 months). In multivariate analysis for OS, diarrhea (hazard ratio: 0.588; 95% CI: 0.348-0.993) and NLR decline (decreased compared with pretreatment) (hazard ratio: 0.479; 95% CI: 0.300-0.765) were independent factors of good OS. In the NLR decline group, the median PFS and OS were 7.1 and 7.3 months, respectively. In the NLR nondecline group, the median PFS and OS were 3.0 and 3.2 months, respectively. The difference in OS between the two groups was significant (P = 0.004).

CONCLUSION

A change in NLR after sorafenib therapy was associated with a better prognosis in patients with advanced HCC.

Pre-treatment inflammatory biomarkers predict early treatment response and favorable survival in patients with metastatic colorectal cancer who underwent first line cetuximab plus chemotherapy

Objective

This study was to determine whether peripheral blood biomarkers including neutrophil‑lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) could predict early response to cetuximab; moreover, the prognostic ability of those biomarkers on progression free survival (PFS) and overall survival (OS) of metastatic colorectal cancer (mCRC) patients with wild-type (WT) RAS was also investigated.

Methods

mCRC patients with WT RAS treated with cetuximab plus chemotherapy were retrospectively analyzed, and early response was evaluated according to RECIST 1.1 after three or four treatment cycles. In prior to chemotherapy, hematologic data and clinic-pathological parameters were collected. The associations between pre-treatment inflammatory biomarkers and early response, and the prognostic value of those biomarkers were analyzed. A total of 102 patients were enrolled and divided into low or high NLR, PLR, and SII groups, respectively.

Results

The early response rate was significantly higher in the low NLR (p<0.001), low PLR (p=0.045), and low SII (p=0.011), respectively. In multivariate analyses, primary tumor resection (hazard ratio (HR) 0.411, p<0.001), carcino-embryonic antigen ≤5 ng/mL (HR 0.406, p<0.001), early treatment response (HR 0.322, p<0.001), and low NLR (HR 0.665, p=0.031) were independent factors of longer PFS. Primary tumor resection (HR 0.488, p=0.003) and early response (HR 0.392, p<0.001) were independent factors of longer OS. Further analysis showed that patients with early response, even in the high groups, can achieve better PFS and OS than non-responders.

Conclusion

Pre-treatment inflammatory biomarkers, especially NLR were predictors of benefit from cetuximab-combined therapy in mCRC patients. They were also predictors of significantly longer PFS and OS of early responders compared to non-responders.

Long-term changes in blood counts after intraoperative radiotherapy for breast cancer-single center experience and review of the literature

Background

Intraoperative radiotherapy (IORT) for breast cancer is used as an upfront boost or as accelerated partial breast irradiation (APBI). To date, no description of blood count changes after IORT are available. Our analysis shows blood count changes in breast cancer patients up to 5 years after IORT ± whole breast radiotherapy (WBRT).

Methods

IORT was given as APBI in 58 patients (IORT/APBI-group) and as a boost in 198 patients (IORT/WBRT-group). A median dose of 20 Gy was given intraoperatively with low energy X-rays [INTRABEAM (TM) System] and additionally 46 Gy/2 Gy per fraction to the whole breast, if WBRT was added. Blood counts were collected preoperatively, after 90 days and through year 1–5 of follow-up. Dunnett’s tests were used to calculate changes in blood counts over time. Additionally, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and derived neutrophil-to-lymphocyte ratio (dNLR) were calculated for each time point.

Results

Significantly decreases in the IORT/WBRT-group were seen for erythrocytes, hemoglobin, platelets and leucocytes and an increase for lymphocytes for the total follow-up period. In the IORT/APBI-group significantly decreases were seen for erythrocytes and hemoglobin for the total follow-up period. Regarding changes during follow-up compared to the preoperative value, much more significant changes were seen in the IORT/WBRT-group compared to IORT/APBI-group without any relevant impact of chemotherapy. Regarding PLR-, NLR- and dNLR-values the rate of patients over the range improved over time in both groups.

Conclusions

IORT/APBI seems to have a smaller effect on blood counts compared to IORT/WBRT. Furthermore, PLR-, NLR- and dNLR-values improved over time, suggesting a positive effect on outcome after IORT in general.

Safety and efficacy of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin post-transarterial chemoembolization for unresectable hepatocellular carcinoma

Objective

To investigate the safety, efficacy, and prognostic factors of hepatic arterial infusion chemotherapy (HAIC) with raltitrexed and oxaliplatin post-transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (uHCC).

Methods

Thirty-seven patients with uHCC who received HAIC with raltitrexed and oxaliplatin post-TACE between June 2014 and December 2016 at our hospital were recruited. The primary endpoint was overall survival (OS), and secondary endpoint was progression-free survival (PFS). The overall response rate (ORR) was evaluated using the modified Response Evaluation Criteria in Solid Tumors. Toxicity was assessed according to the Common Terminology Criteria for Adverse Events (v4.0). The OS and prognostic factors were analyzed using the Kaplan–Meier method, log-rank test, and Cox regression models.

Results

Three (8.1%) patients achieved complete response, 17 (46.0%) patients achieved partial response, and the ORR was54.0%.The median OS and median PFS were 19.0 months and 12.0 months, respectively. The common toxicities included grade 3–4 increased aspartate aminotransferase levels (8/37,21.6%), grade 1–2 hyperbilirubinemia (75.7%, 28/37), nonspecific abdominal pain and fever, and grade 2–3 thrombocytopenia (18.9%, 7/37); no patients developed grade 3–4 neutropenia. Univariate analysis showed that the tumor diameter (≤50 mm, p = 0.028), Barcelona Clinic Liver Cancer (BCLC) stage (p = 0.012), hepatitis B virus DNA level (p = 0.033), and derived neutrophil-to-lymphocyte ratio (dNLR; derived neutrophils/leukocytes minus neutrophils) (p = 0.003) were predictive factors for prognosis. Multivariate analysis showed that patients with BCLC stage B disease (p = 0.029) and dNLR≤2 before therapy (p = 0.004) had better prognosis.

Conclusions

HAIC with raltitrexed and oxaliplatin post-TACE is a safe and efficacious therapy for patients with uHCC; in particular, those with BCLC stage B and dNLR≤2 have better prognosis.

Neutrophil-to-Lymphocyte Ratio in Ovarian Cancer Patients with Low CA125 Concentration

Ovarian cancer cases with low CA125 concentration are problematic and increase the high false negative results ratio during routine physical examination testing. Unfortunately, patients without early discovery have very low survival rates. In our study, we investigated the possible role of differential leukocyte counts and the neutrophil-to-lymphocyte ratio (NLR) in ovarian cancer patients to identify an additional discriminative marker to avoid missing diagnoses in normal physical examinations. One hundred seventy-three patients with epithelial ovarian cancer and 70 healthy controls were involved in our study. Based on the results, compared with the healthy controls, NLR was significantly different both in the low CA125 concentration group and in the complete patient group, indicating that NLR could be an effective marker for ovarian cancer screening. According to ROC, sensitivity, specificity, and NPV results, CA125 >35 U/ml is a good indicator for cancer in routine physical examination. However, in patients with low CA125 concentration, the CA125>7.65 U/ml and NLR >1.72 group yielded increased sensitivity with appropriate specificity and higher NPV results than the CA125 >35 U/ml group. We believe CA125>7.65 U/ml and NLR >1.72 should be effective makers for patients with low CA125 concentration. As a more sensitive and cost-effective strategy, this method could be conducted during routine ovarian cancer screening.

Neutrophil extracellular traps induced by activated platelets contribute to procoagulant activity in patients with colorectal cancer

Patients with colorectal cancer (CRC) are at increased risk of venous thrombosis, but the precise mechanisms of thrombogenesis in CRC remain largely unknown. We aimed to identify the novel role of neutrophil extracellular traps (NETs) in the induction of procoagulant activity (PCA) in CRC, and to evaluate its interactions with platelets and endothelial cells (ECs). In this study, we first showed that the levels of NETs in the peripheral blood of CRC patients were increased in parallel with cancer progression and reached significance in stage II patients compared to healthy subjects. In addition, neutrophils from CRC patients were more prone to produce NETs, resulting in shortened coagulation time, significantly increased thrombin-antithrombin (TAT) complexes and fibrin fibrils compared to healthy controls. Furthermore, platelets from CRC patients stimulated healthy neutrophils to extrude NETs, which could be inhibited by the depletion of HMGB1. Conversely, NETs from CRC patients could also induce the exposure of PS on platelets, leading to markedly enhanced PCA. Importantly, ECs were also converted to a procoagulant phenotype when exposed to NETs from CRC patients. The PCA of NETs-activated platelets or ECs could be inhibited either by the cleavage of NETs with DNase1 or the blockage of histone with activated protein C (APC). Our results reveal the complex interactions between neutrophils, platelets and ECs and their potential role in the hypercoagulable state in CRC. We propose that NETs may provide new therapeutic targets to combat the thrombotic consequences of CRC.

Prognostic significance of peripheral blood-derived neutrophil/lymphocyte ratio in patients with digestive cancer

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.

Diagnostic value of derived neutrophil-to-lymphocyte ratio in patients with ovarian cancer

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.

Comparison of Preoperative Inflammation-based Prognostic Scores in Patients With Colorectal Cancer

OBJECTIVE

To evaluate the prognostic impact of the systemic inflammation score (SIS) in colorectal cancer (CRC) patients in comparison with a conventional inflammation-based score, the modified Glasgow Prognostic Score (mGPS).

SUMMARY BACKGROUND DATA

The SIS, which is calculated based on the preoperative serum albumin level and lymphocyte-to-monocyte ratio, is a reported prognostic marker in clear-cell renal cell carcinoma. However, the utility of the SIS in CRC remains unclear.

METHODS

The study involved 727 CRC patients who underwent curative resection between September 2005 and December 2011. The prognostic impact of SIS and mGPS was evaluated using survival analyses. The prognostic impact of each score was compared visually by means of time-dependent receiver operating characteristics analysis.

RESULTS

The median age of the patients was 67 (interquartile range: 58-75) years. The TNM stage distribution was stage I, 29.8%; stage II, 33.6%; stage III, 30.3%; and stage IV, 6.3%. The median follow-up period was 5.61 years (interquartile range: 4.24-7.06). Multivariate analysis revealed that an increased SIS and mGPS were independent prognostic factors (SIS: P = 0.018; mGPS: P = 0.005, respectively). The time-dependent receiver operating characteristics curve of the SIS was superior to that of the mGPS throughout the observation period. The estimated area under the curve (AUC) of the SIS was significantly higher than that of the mGPS (7-yr survival: SIS 0.673, mGPS 0.605, P = 0.030).

CONCLUSIONS

The SIS is a novel prognostic factor in CRC patients. Additionally, the SIS is an alternative inflammation-based biomarker, which may improve the prediction of clinical outcomes.

A competing-risks nomogram for predicting probability of death from CRC in Chinese Han patients with Stage I-III CRC

Background

Many patients with colorectal cancer are elderly with competing comorbidities. When constructing nomogram for assessing survival, we should consider the influence of competing risk. A competing-risks nomogram was developed to estimate the probability of death due to colorectal cancer for patients after curative surgery.

Methods

A total of 2442 patients with non-metastatic colorectal cancer were included to develop competing-risks nomogram. Competing-risks nomogram were established based on the results of Fine and Gray competing-risks proportional hazards model. To maximize the accuracy of prediction, model selection was not carried out, and non-linear continuous variables were flexibly modeled with restricted cubic splines. The nomogram was internal-validated by bootstrapping, and externally validated with a separate database of 299 patients from The Cancer Genome Atlas. The performance of this model was assessed by concordance index and a calibration curve.

Results

There were 332 patients died of colorectal cancer and 46 died of other causes during the follow-up period. Age, T stage, N stage, histological type, tumor location, adjuvant chemotherapy, preoperative carcinoembryonic antigen, lymph vascular invasion, lymph node ratio and sample lymph nodes were integrated into competing-risks nomogram. The competing-risks nomogram for predicting probability of death due to colorectal cancer with a concordance index of 0.768, ameliorating the stratification provided by the seventh edition tumor-node-metastasis staging system of the American Joint Committee on Cancer (AJCC). The concordance index for validation dataset was 0.783.

Conclusion

We developed and externally validated a competing-risks nomogram for Chinese Han patients with non-metastatic colorectal cancer, which could provide probability of death from colorectal cancer in the presence of competing risks.

Neutrophils to lymphocytes ratio as a useful prognosticator for stage II colorectal cancer patients

Background

The incidence of colorectal cancer (CRC) is expected to increase by 80% in year 2035. Even though advantages in treatment of CRC have being made over the last decades, the outcome remains poor. Recently, several inflammatory markers including pretreatment neutrophil to lymphocyte ratio (NLR), have being used as prognostic factors, since host inflammatory response to cancer is believed to determine disease progression.

The aim of this study is to evaluate the prognostic significance of pretreatment NLR, in terms of overall survival (OS), 5-year survival, disease-free survival (DFS) and recurrence, in CRC patients who underwent curative resection.

Methods

We retrospectively reviewed 296 patients, who were submitted to elective surgery as first therapeutic option in curative intent, between January 2010 and December 2015. Pretreatment NLR, as well as demographics, clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS, 5-year survival, DFS and recurrence.

Results

The cutoff point of NLR was calculated with Kaplan-Meier curves and log-rank test to 4.7. Univariate and multivariate analyses disclosed elevated NLR as a significant dismal prognostic factor for DFS (HR 1.88; 95% CI 1.01–3.52; p = 0.048), 5-year survival (HR 2.14; 95% CI 1.12–4.10; p = 0.021) and OS (HR 2.11; 95% CI 1.11–4.03; p = 0.023). In a subgroup analysis, in patients with stage II CRC, NLR > 4.7 was a stronger poor predictor for DFS (HR 2.76; 95% CI 1.07–7.13; p = 0.036), 5-year survival (HR 3.84; 95% CI 1.39–10.63; p = 0.01) and OS (HR 3.62; 95% CI 1.33–4.82; p = 0.012). After adjusting stage for gender, age, location of the primary tumor, differentiation, as well as the presence of perineural, vascular, and lymphovascular invasion, the significance of NLR > 4.7 became more prominent for DFS (HR 2.85; 95% CI 1.21–6.73; p = 0.0176), 5-year survival (HR 4.06; 95% CI 1.66–9.93; p = 0.002) and OS (HR 4.07; 95% CI 1.69–9.91; p = 0.002) in stage II patients.

Conclusion

Pretreatment NLR > 4.7 is a poor prognostic factor for DFS, 5-year survival and OS in CRC patients undergoing curative resection. The dismal prognostic effect of NRL is magnified in Stage II CRC patients.

Elevation of Neutrophil-to-Lymphocyte Ratio before First-Line Chemotherapy Predicts a Poor Prognosis for Second-Line Chemotherapy in Gastric Cancer

OBJECTIVES

The neutrophil-to-lymphocyte ratio (NLR) has been proposed as an indicator of cancer-related inflammation. The aim of our study was to examine the prognostic value of the NLR for patients with advanced gastric cancer receiving second-line chemotherapy.

METHODS

The association of overall survival (OS) in second-line chemotherapy and the clinicopathological findings including NLR were analyzed retrospectively. The selection criteria were patients who received second-line chemotherapy between January 2010 and June 2015, had histologically confirmed gastric adenocarcinoma, and were followed up until death or for 180 days or longer.

RESULTS

Eighty-six patients met the selection criteria. Multivariate analysis revealed that performance status 2, hemoglobin < 10 g/dL, and NLR before first-line chemotherapy ≥3 were adverse predictive markers. NLR before second-line chemotherapy was not associated with OS. A prognostic model was constructed dividing patients into three groups according to the number of adverse predictive factors: good (no factor), intermediate (one factor), and poor (more than two factors). The median OS for the good, intermediate, and poor groups was 14.3, 7.2, and 4.4 months, respectively (p < 0.001).

CONCLUSIONS

Patients with advanced gastric cancer with performance status 2, hemoglobin < 10 g/dL, and NLR before first-line chemotherapy ≥3 are not likely to benefit from second-line chemotherapy.

Prognostic role of derived neutrophil-to-lymphocyte ratio in surgical triple-negative breast cancer

Introduction

The role of derived neutrophil-to-lymphocyte ratio (dNLR) in predicting the prognosis of patients with triple-negative breast cancer (TNBC) has not been well studied. Here, we attempted to investigate the significance of dNLR in predicting the prognosis of patients with surgical (nonmetastatic) TNBC.

Methods

A total of 281 patients diagnosed with surgical TNBC in The First Affiliated Hospital of University of Science and Technology of China from February 2005 to March 2015 were retrospectively included in this study. Kaplan–Meier curve analysis was used to assess the disease-free survival (DFS) and overall survival (OS). We used Cox regression model to assess the prognostic significance of pretreatment dNLR and other clinicopathological parameters in TNBC patients.

Results

The median DFS in TNBC patients who had low dNLR and high dNLR was 28.9 and 15.1 months (P<0.001), respectively, whereas the median OS in patients who had low dNLR and high dNLR was 71.2 and 42.3 months (P<0.001), respectively. In patients aged ≤50 years and with invasive ductal carcinoma, a low dNLR predicted better DFS and OS compared with a high dNLR. Multivariate analysis demonstrated that the increased dNLR was a risk factor of poor DFS (HR=1.90, 95% CI: 1.52–2.46, P=0.007) and OS (HR=2.56, 95% CI: 1.69–3.58, P=0.001).

Conclusion

Pretreatment dNLR is an independent factor of prognosis for TNBC patients, which potentially allows clinical doctors to improve outcomes of patients with high dNLR by treating with aggressive therapy, such as high-dose adjuvant chemotherapy and radiotherapy.

The accuracy of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as a marker for gastrointestinal malignancies

Background

Accurate predictors of locally advanced and recurrence disease in patients with gastrointestinal cancer are currently lacking. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have emerged as possible markers for predicting recurrence in these patients. In this study, we sought to evaluate the utility of NLR and PLR in predicting the presence of regional nodal disease, metastasis and systemic recurrence in patients with gastrointestinal malignancies.

Methods

We queried a comprehensive gastrointestinal oncology database to identify patients who had undergone surgery for a GI malignancy. NLR and PLR values were determined via a complete blood count (CBC). In patients treated with neoadjuvant therapy (NT) the NLR and PLR were calculated from CBCs before and after NT and in patients proceeding to surgery within 2 weeks pre-operatively. The associations between NLR and PLR and the clinicopathologic parameters (sex, age, tumor size, differentiation, positive lymph nodes, and metastatic disease) were assessed via χ² or Fisher's exact tests where appropriate. All the tests were two-sided, and P<0.05 was considered statistically significant.

Results

We identified 116 patients diagnosed with gastrointestinal malignancies. There were 76 (65.5%) males and 40 (34.5%) females with an average age of 69.4±10.7 years. The mean follow up was 14.1±15.5 months. We identified 49 (42.2%) esophageal, 34 (29.3%) pancreatic, 14 (12.1%) colorectal, 13 (11.2%) gastric, and 6 (5.2%) biliary cancers. There were 36 (31.0%) patients with node negative disease, 52 (44.8%) with node positive and 28 (24.2%) with metastatic disease at surgery. Of the metastatic patients 4 (3.4%) were found at staging laparoscopy and 24 (20.6%) were diagnosed pre-operatively. The median NLR for LN- patient's was 1.78 (0.23-8.2) and for LN+ and metastatic patients was 4.69 (2.27-36), P<0.001. The median PLR for LN- patient's was 123.03 (14-257.69) and for LN+ and metastatic patients was 212.42 (105.45-2,185.18), P<0.001. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for a NLR >2.25 was 98.8%, 72.2%, 89%, and 96% respectively. The sensitivity, specificity, PPV, and NPV for PLR >140 was 95%, 78%, 90%, and 88% respectively. Utilizing both NLR and PLR the sensitivity, specificity, PPV and NPV was increased.

Conclusions

Elevation of NLR and PLR can be used to help identify patients with advanced disease GI malignancies and recurrences after surgery. Additionally, failure of normalization of NLR and PLR 3-month post-surgical resection may indicate early recurrence or persistent disease. Individually, NLR has a higher sensitivity and negative predictive value while PLR has a higher specificity and positive predictive value for distinguishing metastatic disease and node positivity. The combination of NLR and PLR has the highest accuracy of predicting advanced disease among all gastrointestinal malignancies.

Increased derived neutrophil-to-lymphocyte ratio and Breast Imaging-Reporting and Data System classification predict poor survival in patients with non-distant metastatic HER2+ breast cancer treated with neoadjuvant chemotherapy

Introduction

The prognostic role of the derived neutrophil-to-lymphocyte ratio (dNLR) in human patients with HER2+ breast cancer is not well understood. Here, we aimed to investigate the prognostic significance of dNLR in patients with HER2+ breast cancer undergoing neoadjuvant chemotherapy.

Methods

A total of 310 patients with non-distant metastatic HER2+ breast cancer who had received neoadjuvant chemotherapy in our hospital from May 2006 to November 2013 were retrospectively included in this study. Kaplan–Meier curves were used to assess overall survival (OS) and disease-free survival (DFS). The Cox regression model was used to evaluate the prognostic value of dNLR and Breast Imaging-Reporting and Data System (BI-RADS) classification, as well as other clinicopathological parameters in patients with HER2+ breast cancer treated with neoadjuvant chemotherapy.

Results

We found that dNLR prior to treatment was positively correlated with tumor size, tumor stage, lymphovascular invasion, and histological grade (P<0.05). The median OS of patients with high dNLR and low dNLR were 44.2 and 69.9, respectively (P<0.001), and the median DFS of patients with high dNLR and low dNLR were 15.3 and 22.1 months, respectively (P<0.001). Multivariate analysis showed that dNLR was an independent risk factor for OS (HR =1.726; 95% CI: 1.072–2.662; P=0.009) and DFS (HR =1.658; 95% CI: 1.125–2.426; P=0.026). Moreover, increased BI-RADS classification independently predicted short OS (HR =1.609; 95% CI: 1.216–2.351; P=0.015) and DFS (HR =1.925; 95% CI: 1.526–2.635; P=0.021).

Conclusion

dNLR prior to treatment and BI-RADS classification are independent prognostic factors in patients with HER2+ breast cancer receiving neoadjuvant chemotherapy.

Development and validation of a nomogram for predicting survival in Chinese han patients with resected colorectal cancer

BACKGROUND

Estimates of survival after curative colorectal cancer (CRC) surgery are the basis of patient care and treatment planning. A nomogram is a useful tool for individualized cancer prognosis.

METHODS

A total of 2450 patients with nonmetastatic CRC were included to develop a nomogram. Prognostic factors were identified and integrated by the Cox proportional hazards model. Then, we developed and validated a prognostic nomogram. The performance of this model was assessed by the concordance index (C-index) and a calibration curve. The nomogram was internally validated by bootstrapping and externally validated with a separate database of 299 patients from The Cancer Genome Atlas.

RESULTS

Age, T stage, N stage, histological type, tumor location, lymph-vascular invasion, preoperative carcinoembryonic antigen, and sample lymph nodes were integrated into the nomogram. The C-index of the nomogram for predicting overall survival was higher than that of the seventh edition American Joint Committee on Cancer TNM staging system (training data set, 0.76 vs 0.68, respectively; P < 0.001; validation data set, 0.78 vs 0.69, respectively; P = 0.003).

CONCLUSION

We developed a prognostic nomogram for patients with nonmetastatic CRC, which could provide a more individualized outcome prognostication than that afforded by the TNM staging system by using common clinicopathologic factors.

Elevated amylase in plasma represents an adverse prognostic marker in patients with metastatic pancreatic cancer : A retrospective analysis

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.

Prognostic impact of preoperative lymphocyte-to-monocyte ratio in patients with colorectal cancer with special reference to myeloid-derived suppressor cells

AIMS

We aimed to investigate the relationship of colorectal cancer prognosis and inflammatory parameters, including neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR), with reference to circulating myeloid-derived suppressor cells (MDSCs) in the current study.

PATIENTS AND METHODS

Thirty-five patients who underwent curative-intent surgery were enrolled.　A receiver-operating characteristic curve (ROC) was used to assess the usefulness of candidates for prognostic factors. Recurrence-free survival (RFS) was calculated using the Kaplan-Meier method, and the candidates for prognostic factors were assessed by a Cox proportional hazard model.

RESULTS

ROC curve analyses determined cutoff values for NLR and LMR as 2.9 and 2.4, respectively. The percentage of MDSCs in patients with LMR ≤ 2.4 was statistically higher than in those with LMR > 2.4 (p = 0.012). The patients with LMR ≤ 2.4 exhibited a statistically lower RFS than those with LMR > 2.4 (p = 0.008). These results were also observed in patients with stage II + III disease. LMR was an independent prognostic factor of RFS in colorectal cancer patients (hazard ratio: 7.757, 95% confidence interval: 1.462-41.152, p = 0.016).

CONCLUSION

Lower LMR was associated with poor prognosis in colorectal cancer patients; whereas, higher circulating MDSCs were observed in patients with lower LMR.

Prognostic significance of Ki67 expression and the derived neutrophil-lymphocyte ratio in nasopharyngeal carcinoma

Purpose

To investigate the association of pretreatment Ki67 expression and the derived neutrophil–lymphocyte ratio (dNLR) with clinical outcomes in nasopharyngeal carcinoma (NPC).

Patients and methods

For the study, 46 patients diagnosed with NPC at our hospital were recruited between April 2013 and December 2015. All patients were histologically confirmed to have non-keratinizing undifferentiated NPC. The expression of Ki67 proteins in NPC tissue was analyzed immunohistochemically, and the dNLR was assessed in the peripheral blood, both before treatment. Stage I and II disease was treated with radiotherapy with or without concurrent chemotherapy, and stage III and IV disease was treated with cisplatin-based radiochemotherapy and neoadjuvant chemotherapy regimens.

Results

Forty-five of the 46 patients met the criteria, and the median follow-up period was 41 months (15–56 months). The cutoff values for Ki67 and dNLR were 77.5% and 2.01%, respectively. The 3-year overall survival (OS) and progression-free survival rates in the high versus low Ki67 expression groups were 62.5% vs. 93.1% (P = 0.009) and 56.3% vs. 93.1% (P = 0.003), respectively. The 3-year OS rate of patients with high dNLR vs. low dNLR was 64.3% vs. 90.3% (P = 0.023). In the Cox risk ratio model, Ki67 expression and dNLR were independent prognostic factors for OS. Patients were then divided into three groups based on Ki67 expression and dNLR (high risk, both factors were high; intermediate risk, one factor was high; and low risk, neither factor was high). The 3-year OS rates were 20%, 85%, and 95% for the high, intermediate, and low risk groups, respectively (P < 0.001).

Conclusion

Pretreatment Ki67 and dNLR levels can be used as independent prognostic markers in NPC, and elevated values are associated with poor prognosis. Concurrently, high Ki67 expression and dNLR predict a significantly adverse outcome.

An inflammation-related nomogram for predicting the survival of patients with non-small cell lung cancer after pulmonary lobectomy

Background

Emerging inflammatory response biomarkers are developed to predict the survival of patients with cancer, the aim of our study is to establish an inflammation-related nomogram based on the classical predictive biomarkers to predict the survivals of patients with non-small cell lung cancer (NSCLC).

Methods

Nine hundred and fifty-two NSCLC patients with lung cancer surgery performed were enrolled into this study. The cutoffs of inflammatory response biomarkers were determined by Receiver operating curve (ROC). Univariate and multivariate analysis were conducted to select independent prognostic factors to develop the nomogram.

Results

The median follow-up time was 40.0 months (range, 1 to 92 months). The neutrophil to lymphocyte ratio (cut-off: 3.10, HR:1.648, P = 0.045) was selected to establish the nomogram which could predict the 5-year OS probability. The C-index of nomogram was 0.72 and the 5-year OS calibration curve displayed an optimal agreement between the actual observed outcomes and the predictive results.

Conclusions

Neutrophil to lymphocyte ratio was shown to be a valuable biomarker for predicting survival of patients with NSCLC. The addition of neutrophil to lymphocyte ratio could improve the accuracy and predictability of the nomogram in order to provide reference for clinicians to assess patient outcomes.

The dynamic change of neutrophil to lymphocyte ratio can predict clinical outcome in stage I-III colon cancer

Whether the dynamic change of neutrophil to lymphocyte ratio (delta-NLR) can predict the outcome in various malignancies remained controversial. The delta-NLR has not been evaluated in colon cancer. Thus, we conducted the study to evaluate the predictive value of the delta-NLR in patients with colon cancer who underwent curative resection. Three-hundred and fifty-four patients with stage I-III colon cancer were retrospectively analysed. Clinicopathological features, preoperative NLR and postoperative NLR were collected. Prognostic factors were evaluated by univariate and multivariate analysis. The one, three and five-year overall survival rate in the delta-NLR < 0 group was 98.2%, 90.7% and 83.6%, respectively; and in the delta-NLR ≥ 0 group was 98.4%, 96.9% and 95.3%, respectively (log-rank test, P = 0.002). Univariate and multivariate analysis showed that there was a strong relationship between delta-NLR and overall survival. In conclusion, the delta-NLR was an independent prognostic factor for overall survival in early stage colon cancer. Patients with increased delta-NLR had an favourable clinical outcome.

Outcomes prediction in pre-operative radiotherapy locally advanced rectal cancer: leucocyte assessment as immune biomarker

Objective

Leukocytes are hypothesized to reflect the inflammatory tumor microenvironment. We aimed to validate their prognostic significance in a large cohort of patients treated with pre-operative radiation for locally advanced rectal cancer (RC).

Results

From 2004 to 2015, 257 RC patients with available biological data underwent a pre-operative radiotherapy, with a median age of 66 years. The median rectal EQD2 was 49.2Gy. Most of patients experienced concurrent chemotherapy (n = 245, 95.4%), mainly with 5-FU (83.3%). Clear surgical margins (i.e. complete resection) were achieved in 234 patients (91.1%). A complete (Mandard TRG1: n = 35, 13.6%) or almost complete pathological response (Mandard TRG2: n = 56, 21.8%) were achieved in 91 patients (35.4%). With a median follow-up of 46.1 months, 8 patients (3.1%) experienced local relapse, 38 (14.8%) experienced metastases and 45 (17.5%) died. Elevated pre-radiation neutrophil to lymphocyte ratio (NLR > 2.8) was identified as an independent predictive factor of increased local relapse, of decreased progression-free survival and overall survival in multivariate analysis. Elevated NLR was marginally associated with incomplete pathological response in multivariate analysis, suggesting a possible value as a biomarker of radio-sensitivity.

Conclusions

Pre-radiation NLR is a simple and robust biomarker for risk stratification in locally advanced RC patients undergoing pre-operative radiotherapy, and might select the subpopulation eligible to treatment intensification or to neoadjuvant chemotherapy.

Material and Methods

Clinical records from consecutive patients treated in a single institution between 2004 and 2015 with curative-intent radiotherapy were retrospectively analyzed. Classical prognosis factors of RC and peripheral immune markers based on lymphocytes and neutrophil counts were studied.

Neutrophil to lymphocyte ratio predicts risk of nodal involvement in T1 colorectal cancer patients

BACKGROUND

Risk of nodal involvement in T1 colorectal cancer is assessed by tumor histological features. In several tumors, the ratio between neutrophils and lymphocytes (NLR) or platelets and lymphocytes (PLR) have been applied to lymph-node metastases prediction. The aim of this study was to evaluate the role of NLR, derived NLR (dNLR) and PLR in predicting nodal involvement in T1 colorectal cancers.

METHODS

NLR, dNLR and PLR in surgical resected T1 colorectal cancers were retrospectively calculated and analysed in nodal positive and negative cases.

RESULTS

Data regarding 102 patients were considered. Nodal involvement rate was 10.8%. NLR values were higher in node positive patients (P=0.04). A trend toward significance (P=0.05) was found for higher dNLR values and positive nodal status. For NLR, ROC curve analysis allowed to choose a predictive cut-off value of 3.7 (AUC of 0.69; 95% CI: 0.48-0.89). Nodal positivity was reported in 71.5% of high NLR patients; only two N0 cases (28.5%) were registered in high NLR group (P<0.001). The logistic regression analysis aimed to evidence the predictive role of high NLR in node positivity resulted in a significant OR of 37.1 (P<0.0001; 95% CI: 0.48-0.89). NLR allowed to distinguish N0 from N1 patients in 99.4% of cases.

CONCLUSIONS

NLR<3.7 was associated with lower risk of lymph-node metastases in T1 colorectal cancer patients. NLR could be used with histopathological data to identify patients at lower risk of nodal metastases.

Prognostic significance of neutrophil-to-lymphocyte ratio in biliary tract cancers: a systematic review and meta-analysis

Background

Inflammation was considered to perform crucial roles in the development and metastasis of malignancies. A heightened neutrophil-lymphocyte ratio has been described to be associated with detrimental survivals in different malignancies. Debate remains over the impact of heightened neutrophil-lymphocyte ratio on survivals in biliary tract cancer. The review evaluated the prognostic value of neutrophil-lymphocyte ratio in biliary tract cancer.

Methods

MEDLINE, the Cochrane Library, EMBASE, and the Chinese SinoMed were systematically searched for relevant articles. Associations between neutrophil-lymphocyte ratio and long-term outcomes were expressed as the hazard ratios and 95% confidence intervals. The odds ratio was utilized to assess the association between neutrophil-lymphocyte ratio and clinicopathological parameters.

Results

Fourteen studies consisting of 3217 patients were analyzed: 1278 (39.73%) in the high pretreatment neutrophil-lymphocyte ratio group and 1939 (60.27%) in the low pretreatment neutrophil-lymphocyte ratio one. The results proved that heightened pretreatment neutrophil-lymphocyte ratio was significantly associated with detrimental overall survival and relapse free survival for biliary tract cancer patients. In addition, elevated neutrophil-lymphocyte ratio was positively correlated with higher carbohydrate antigen 19-9 levels, advanced TNM staging and greater lymph node involvement.

Conclusion

This meta-analysis marked that an increased pretreatment neutrophil-lymphocyte ratio was significantly linked with detrimental long-term outcomes and clinicopathological parameters for patients with biliary tract cancer.

The Predictive Value of Inflammation-Related Peripheral Blood Measurements in Cancer Staging and Prognosis

In this review, we discuss the interaction between cancer and markers of inflammation (such as levels of inflammatory cells and proteins) in the circulation, and the potential benefits of routinely monitoring these markers in peripheral blood measurement assays. Next, we discuss the prognostic value and limitations of using inflammatory markers such as neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios and C-reactive protein measurements. Furthermore, the review discusses the benefits of combining multiple types of measurements and longitudinal tracking to improve staging and prognosis prediction of patients with cancer, and the ability of novel in silico frameworks to leverage this high-dimensional data.

Analysis of preoperative blood platelet parameters in terms of diversity of epithelial ovarian cancer

Smouldering inflammation, thrombocytosis, and platelet hyper-reactivity are linked to malignancy. The relationships between preoperative diagnostic blood morphology parameters and cancer have been the focus of much interest, because some of these parameters are correlated with advanced cancer stages and poor patient survival rates. This study aimed to perform an observational, retrospective analysis of the intradiversity of blood platelet parameters in patients with different International Federation of Gynaecology and Obstetrics (FIGO) stages and different histological types of epithelial ovarian carcinomas (EOC), and also an analysis of the overall survival rate.In all, 94 EOC patients were included in this analysis (23 mucinous, 33 serous, 20 undifferentiated, 14 endometrioid, and 4 clear cell carcinoma cases). Peripheral blood samples were collected and analyzed before drug or surgical treatment.The platelet-to-neutrophil ratio (PNR) was related to the histological type of EOC, particularly mucinous carcinoma. In patients with mucinous cancer, the PNR was significantly lower compared with patients with nonmucinous cancer, and this parameter distinguished between mucinous and nonmucinous groups of patients (area under receiver-operating characteristic [ROC] curve 0.721 ± .056; sensitivity 82.6%; specificity 61%; P < .001; ROC analysis), regardless of the FIGO stage. Moreover, elevated PNR values were correlated with lower survival rate of EOC patients.The reduced PNR, similar to the lower level of cancer antigen 125, is characteristic for mucinous ovarian carcinoma patients. Moreover, elevated PNR index might correlate with poor survival of patients.

Influential factors on radiotherapy efficacy and prognosis in patients with secondary lymph node metastasis after esophagectomy of thoracic esophageal squamous cell carcinoma

Background

The purpose of this study was to clarify whether pretreatment tumor burden-related index, including the gross tumor volume (GTV) of metastatic lymph nodes (V_LN) and maximum diameter of metastatic lymph nodes (D_LN), and inflammatory markers, consisting of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), are useful for assessing the therapeutic effects and prognosis with secondary lymph node metastasis (LNM) receiving chemoradiotherapy (CRT) or radiotherapy (RT) alone after resection of esophageal squamous cell carcinoma (ESCC).

Patients and methods

A total of 119 patients with secondary LNM after resection of ESCC were recruited and received curative RT only or CRT. The enrolled patients were grouped according to the median values of NLR, PLR, V_LN, and D_LN. The relationship between the responsiveness to treatment and these markers was analyzed by logistic analysis. The Kaplan–Meier method and log-rank test were adopted to calculate and compare the overall survival (OS) rates with these markers. The Cox models were used to carry out multivariate analyses.

Results

Univariate logistic regression analysis showed that the responses to treatment were highly associated with treatment method (P=0.011), NLR (P=0.000), PLR (P=0.003), V_LN (P=0.000), and D_LN (P=0.000). Next, multivariate logistic regression analysis showed that therapeutic method (hazard ratio [HR]=1.225, P=0.032), NLR (HR=2.697, P=0.019), and V_LN (HR=4.607, P=0.034) were independent risk factors for tumor response. Additionally, Kaplan–Meier survival analysis of this cohort revealed that NLR (χ²=27.298, P=0.000), PLR (χ²=16.719, P=0.000), V_LN (χ²=48.823, P=0.000), D_LN (χ²=40.724, P=0.000), and treatment methods (χ²=18.454, P=0.018) were significantly associated with OS. Furthermore, multivariate analysis was performed, and the results showed that therapeutic method (HR=1.223, P=0.048), NLR (HR=2.000, P=0.018), V_LN (HR=2.379, P=0.020), and D_LN (HR=2.901, P=0.002) were considered independent prognostic factors for OS.

Conclusion

This study found that NLR and V_LN were promising as predictive markers for therapeutic effects, and NLR combined with V_LN and with D_LN might be useful biomarkers in predicting outcomes in patients with secondary LNM receiving CRT or single RT after esophagectomy.

Colorectal cancer in the young: a possible role for immune surveillance?

BACKGROUND

Younger patients with colorectal cancer (CRC) generally have better survival in spite of worse clinical and pathological features.

METHODS

Twenty-six patients under 50 years operated for primary CRC were enrolled and matched 1:2:2 according to stage, tumor site and gender with 52 patients from 50 to 70 years and 52 patients over 70 years old.

RESULTS

Patients under 50 years had a significantly longer overall, cancer specific and disease free survival (p = .001, p = .007 and p = .05, respectively). However, they had more frequently lymphovascular invasion (p = .006) and they more frequently developed metachronous CRC at follow-up (p = .03). Nevertheless, preoperative lymphocytes blood count/white blood count (LBC/WBC) ratio inversely correlated with age at operation (rho = -.21, p = .04) and it predicted CRC recurrence with an accuracy of 70%, p < .001 (threshold value LBC/WBC = 0.21%) and better overall, cancer specific and disease free survival (p < .0001 for all). At multivariate analysis, stage and LBC/WBC ratio resulted independent predictors of disease free survival (p = .0001 and p = .01, respectively).

CONCLUSIONS

Patients under 50 years had a significantly longer survival with a higher LBC/WBC ratio. These results could suggest a possible role of immunosurveillance in neoplastic control.

Elevated neutrophil-to-lymphocyte ratio is an independent poor prognostic factor in patients with intrahepatic cholangiocarcinoma

We investigated whether elevated neutrophil-to-lymphocyte ratio (NLR) was associated with poor anti-tumor immunity and prognosis in patients with intrahepatic cholangiocarcinoma (ICC). Clinicopathologic data of 102 patients with ICC who underwent hepatectomy was retrospectively analyzed. The Kaplan-Meier method and Cox regression model were used to analyze the survival and prognosis. The percentage of overall lymphocytes, T cells and CD8+ T cells in the high NLR group was lower than that in the low NLR group. The percentage of PD-1+CD4+ and PD-1+CD8+ T cells was higher and the percentage of IFN-γ+CD4+ and IFN-γ+CD8+ T cells was lower in the high NLR group than that in the low NLR group (p = 0.045, p = 0.008; p = 0.012, p = 0.006). Density of tumor-infiltrating CD3+ T cells in the high NLR group was lower than that in the low NLR group (p < 0.001). Elevated NLR was an independent predictor for poor overall survival (OS; p = 0.035) and recurrence-free survival (RFS; p = 0.008). These results indicate that elevated NLR is associated with poor anti-tumor immunity and could be a poor biomarker for prognosis in patients with ICC.

Baseline peripheral blood neutrophil-to-lymphocyte ratio could predict survival in patients with adult polymyositis and dermatomyositis: A retrospective observational study

Recent studies have suggested that neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein-to-albumin ratio (CAR) are emerging markers of disease activity and prognosis in patients with chronic inflammatory diseases, cardiovascular diseases, or malignancies. Therefore, we investigated the clinical significance and prognostic value of the NLR and CAR in adult patients with polymyositis and dermatomyositis. The medical records of 197 patients with newly diagnosed polymyositis/dermatomyositis between August 2003 and November 2016 were retrospectively reviewed. Survival and causes of death were recorded during an average 33-month observational period. Clinical and laboratory findings were compared between survivors and non-survivors. Using receiver operating characteristic curves, the NLR and CAR cut-off values for predicting survival were calculated. Univariate and multivariate analyses using Cox proportional hazard models were performed to identify factors associated with survival. Twenty-six patients (13.2%) died during the study period, and the 5-year survival-rate was estimated to be 82%. The non-survivor group exhibited older age and a higher prevalence of interstitial lung disease (ILD), acute interstitial pneumonia, and acute exacerbation of ILD compared to that in the survivor group. NLR and CAR values were significantly higher in the non-survivors and in patients with polymyositis/dermatomyositis-associated ILD, and the death rates increased across NLR and CAR quartiles. Furthermore, when stratified according to the NLR or CAR optimal cut-off values, patients with a high NLR (>4.775) or high CAR (>0.0735) had a significantly lower survival rate than patients with low NLR or CAR, respectively. In addition, old age (>50 years), the presence of acute interstitial pneumonia, hypoproteinemia (serum protein <5.5 g/dL), and high NLR (but not high CAR) were independent predictors for mortality. The results indicate that a high NLR is independently associated with worse overall survival. Thus, the baseline NLR level may be a simple, cost-effective prognostic marker in patients with polymyositis/dermatomyositis.

Association of peripheral blood cell count-derived ratios, biomarkers of inflammatory response and tumor growth with outcome in previously treated metastatic colorectal carcinoma patients receiving cetuximab

The aim of the present study was to investigate the association of peripheral-blood cell count (PBC)-derived ratios, other biomarkers of inflammation and biomarkers of tumor growth with outcome in a cohort of patients presenting for the next line of therapy after the failure of prior systemic treatment. The data of 51 patients with advanced/metastatic colorectal carcinoma treated with cetuximab in the second or higher line of therapy were retrospectively analyzed. The median duration of cetuximab therapy and the median survival were 5.1 and 12.1 months, respectively. C-reactive protein (CRP), but not urinary neopterin correlated significantly with PBC-derived ratios. Both CRP and urinary neopterin correlated positively with carcinoembryonic antigen (CEA) concentrations and biomarkers of liver dysfunction. Although a number of parameters predicted overall survival in univariate analysis, only hemoglobin, CEA change and serum bilirubin were independent predictors of survival. In conclusion, in patients with metastatic colorectal carcinoma and predominantly liver metastases, the outcome of therapy in the advanced line setting was associated with initial hemoglobin level, a decrease of CEA concentration and initial presence of liver dysfunction. Urinary neopterin did not correlate with PBC-derived ratios, in contrast to CRP, but both urinary neopterin and serum CRP concentrations correlated with laboratory parameters of liver dysfunction.

Maturation of tertiary lymphoid structures and recurrence of stage II and III colorectal cancer

Tertiary lymphoid structures (TLS) are associated with favorable outcome in non-metastatic colorectal carcinoma (nmCRC), but the dynamics of TLS maturation and its association with effective anti-tumor immune surveillance in nmCRC are unclear. Here, we hypothesized that not only the number of TLS but also their composition harbors information on recurrence risk in nmCRC. In a comprehensive molecular, tissue, laboratory, and clinical analysis of 109 patients with stage II/III nmCRC, we assessed TLS numbers and degree of maturation in surgical specimens by multi-parameter immunofluorescence of follicular dendritic cell (FDC) and germinal center (GC) markers. TLS formed in most tumors and were significantly more prevalent in highly-microsatellite-instable (MSI-H) and/or BRAF-mutant nmCRC. We could distinguish three sequential TLS maturation stages which were characterized by increasing prevalence of FDCs and mature B-cells: [1] Early TLS, composed of dense lymphocytic aggregates without FDCs, [2] Primary follicle-like TLS, having FDCs but no GC reaction, and [3] Secondary follicle-like TLS, having an active GC reaction. A simple integrated TLS immunoscore reflecting these parameters identified a large subgroup of nmCRC patients with a very low risk of recurrence independently of clinical co-variables such as ECOG performance status, age, stage, and adjuvant chemotherapy. We conclude that (1) mismatch repair and BRAF mutation status are associated with the formation of TLS in nmCRC, (2) TLS formation in nmCRC follows sequential maturation steps, culminating in germinal center formation, and (3) this maturation process harbors important prognostic information on the risk of disease recurrence.

The role of the systemic inflammatory response in predicting outcomes in patients with operable cancer: Systematic review and meta-analysis

Cancer remains a leading causes of death worldwide and an elevated systemic inflammatory response (SIR) is associated with reduced survival in patients with operable cancer. This review aims to examine the evidence for the role of systemic inflammation based prognostic scores in patients with operable cancers. A wide-ranging literature review using targeted medical subject headings for human studies in English was carried out in the MEDLINE, EMBASE, and CDSR databases until the end of 2016. The SIR has independent prognostic value, across tumour types and geographical locations. In particular neutrophil lymphocyte ratio (NLR) (n = 158), platelet lymphocyte ratio (PLR) (n = 68), lymphocyte monocyte ratio (LMR) (n = 21) and Glasgow Prognostic Score/ modified Glasgow Prognostic Score (GPS/mGPS) (n = 60) were consistently validated. On meta-analysis there was a significant relationship between elevated NLR and overall survival (OS) (p < 0.00001)/ cancer specific survival (CSS) (p < 0.00001), between elevated LMR and OS (p < 0.00001)/CSS (p < 0.00001), and elevated PLR and OS (p < 0.00001)/CSS (p = 0.005). There was also a significant relationship between elevated GPS/mGPS and OS (p < 0.00001)/CSS (p < 0.00001). These results consolidate the prognostic value of the NLR, PLR, LMR and GPS/mGPS in patients with resectable cancers. This is particularly true for the NLR/GPS/mGPS which should form part of the routine preoperative and postoperative workup.

Elevated neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio and decreased platelet-to-lymphocyte ratio are associated with poor prognosis in multiple myeloma

Elevated inflammatory markers are associated with poor outcomes in various types of cancers; however, their clinical significance in multiple myeloma (MM) have seldom been explored. This study investigated the prognostic relevance of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) in MM. Totally 559 MM patients were included in this study. NLR, PLR and MLR were calculated from whole blood counts prior to therapy. Kaplan-Meier curves and multivariate Cox proportional models were used for the evaluation of the survival. It has shown that newly diagnosed MM patients were characterized by high NLR and MLR. Elevated NLR and MLR and decreased PLR were associated with unfavorable clinicobiological features. Applying cut-offs of 4 (NLR), 100 (PLR) and 0.3 (MLR), elevated NLR, MLR and decreased PLR showed a negative impact on outcome. Importantly, elevated NLR and decreased PLR were independent prognostic factors for progression-free survival. Thus, elevated NLR and MLR, and decreased PLR predict poor clinical outcome in MM patients and may serve as the cost-effective and readily available prognostic biomarkers.

Neutrophil-to-lymphocyte ratio predicts survival in European patients with hepatocellular carcinoma administered sorafenib

Neutrophil-to-lymphocyte ratio (NLR) is considered a prognostic factor in patients with hepatocellular carcinoma (HCC). Our aim is to investigate the prognostic significance of NLR in patients with HCC treated with sorafenib.

Results

Median follow-up time was 7 months. Patients were mostly in the intermediate (27.3%) or advanced (72.7%) BCLC stages, 38.6% had vascular invasion and 27.5% extrahepatic disease. A large proportion (38.9%) had been previously treated with TACE. Liver function was preserved: 65.8% were classed as Child A. Median overall survival was 7.7 months (95% CI: 5.8-9.6). In univariate analysis, vascular invasion (P = 0.004), ECOG-PS ≥ 1 (P < 0.001), high bilirubin (P < 0.001), clinical ascites (P = 0.036), BCLC stage (P = 0.004), no previous TACE (P = 0.041) and NRL ≥ 2.3 (P = 0.005) were predictors of poor survival. Skin toxicity (P = 0.039) or hypertension (P = 0.033) during treatment were related to better survival. In multivariate analysis NLR ≥ 2.3 [HR 1.72 (95% CI: 1.03-2.71)], hyperbilirubinemia [HR 3.42 (95% CI: 1.87-6.25)] and ECOG-PS ≥ 1 [HR 1.97 (95% CI: 1.19-3.26)] were found as independent indicators of poor overall survival. Dermatologic adverse effects were an indicator of good overall survival [HR 0.59 (95% CI: 0.38-0.92)].

Material and Methods

One hundred and fifty-four consecutive HCC patients treated with sorafenib in four different Spanish hospitals between August 2005 and October 2013 were analysed. Clinical, laboratory, and tumour features were obtained. Survival was calculated from the moment sorafenib treatment was initiated. Log-rank and Cox regression were used to analyse the ability of NLR to predict survival.

Conclusions

NLR is an independent prognostic indicator for overall survival in HCC patients treated with sorafenib.

Inflammatory biomarkers in metastatic colorectal cancer: prognostic and predictive role beyond the first line setting

Introduction

Inflammatory biomarkers are useful prognostic tools in cancer patients. However, the prognostic and predictive value of inflammatory biomarkers beyond the 1^st-line setting in metastatic colorectal cancer (mCRC) is unclear.

Results

In multivariate analysis 1 standard deviation increase in neutrophil-lymphocyte-ratio (NLR) was associated with an 8.5% absolute lower objective-response-rate (ORR) in 1^st-line (p<0.0001), 3% lower ORR in 2^nd-line (p< 0.0001), and 3% lower ORR in 3^rd-line (p=0.24), respectively. Regarding progression free survival (PFS), an increase in the NLR was significantly associated with rising hazard-ratios (HR) over all treatment lines (HR=1.30, p= 0.021 1^st-line); (HR=1.37, p<0.0001 2^nd-line); (HR=1.44, p=0.042 3^rd-line). The platelet-lymphocyte-ratio (PLR) was associated with 6-month PFS over all three treatment lines. Higher C-reactive-protein (CRP) predicted for worse PFS in the first two chemotherapy lines and in best supportive care (BSC). (HR=1.49 (p<0.0001 1^st-line); HR=1.25 (p=0.007 2^nd-line); HR=1.09 (95%CI 0.81–1.48, p=0.552 3^rd-line and HR=1.43 (p= 0.002 in BSC)).

Methods

Two-hundred-fifty-eight patients with mCRC undergoing palliative chemo(immuno-)therapy were retrospectively included. Primary endpoints were 6-month PFS and ORR during 1st-line, 2nd-line, and 3rd-line treatment, and 6-month overall survival during BSC.

Conclusion

This study shows that inflammatory biomarkers are useful predictors of disease outcome and treatment response over several treatment lines in mCRC patients.

The prognostic value of derived neutrophil to lymphocyte ratio in oesophageal cancer treated with definitive chemoradiotherapy

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].

MMC/UFT/LV in refractory colorectal cancer: phase II study and analysis of predictive variables of progression

BACKGROUND

The treatment of refractory metastatic colorectal cancer (rmCRC) and the lack of predictive variables are matters of debate.

PATIENTS AND METHODS

We conducted a multicentre phase II trial assessing the disease control rate (DCR) of the combination of tegafur/uracil and mitomycin C in rmCRC. The number of previous lines of chemotherapy, carcinoembryonic antigen (CEA) levels, progression-free survival of the last chemotherapy regimen (PPFS), and the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio at the time of study entry were evaluated as indicators of early progression.

RESULTS

We enrolled 42 patients. The combination was well tolerated with a DCR of 26.2% and median overall survival of 6.9 months. Low CEA levels, PPFS >6 months and low NLR were significantly associated with better prognosis.

CONCLUSION

The study failed its primary endpoint. However, some putative indicators of early progressive patients have been described.

The prognostic value of neutrophil to lymphocyte and platelet to lymphocyte ratios for patients with lung cancer

As the leading cause of cancer-associated mortality globally among males in 2012, lung cancer is a disease of particular concern. Previously, the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) were revealed to be prognostic factors for various types of cancer, including lung cancer. In the present study, a retrospective review was conducted with patients who were diagnosed with lung cancer between January 1, 2000 and December 31, 2005 in the Fourth Hospital of Hebei Medical University. A total of 695 patients were included, and the optimal cutoffs of the NLR and the PLR were 6.0 and 248.0, respectively. There were statistically significant associations between tumor-node-metastasis (TNM) stage, surgery, metastasis incidence and NLR (P<0.001). The associations between TNM stage, surgery incidence and PLR were also revealed to be statistically significant (P<0.001). Patients in the low NLR group demonstrated longer overall survival (OS) than patients in the high NLR group (819.57 days vs. 629.86 days, P=0.041). The NLR at diagnosis was demonstrated to be an independent prognostic factor for OS. Thus, the NLR may be a promising approach for predicting the prognosis of patients with lung cancer.

Preoperative monocyte-lymphocyte and neutrophil-lymphocyte but not platelet-lymphocyte ratios are predictive of clinical outcomes in resected patients with non-metastatic Siewert type II/III adenocarcinoma of esophagogastric junction: a prospective cohort study (the AMONP corhort)

AIMS

To propectively reveal the clinicopathological and prognostic significances of monocyte-lymphocyte ratio (MLR), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in resected patients with non-metastatic Siewert type II/III adenocarcinoma of esophagogastric junction (AEG).

METHODS

A total of 611 patients diagnosed with Siewert type II/III AEG and undergoing surgery between 2006 and 2011 were prospectively followed-up until April 2016. Associations between preoperative peripheral MLR, NLR, and PLR and clinicopathological parameters were quantified using the multivariate Logistic regression model with adjustment. The correlation between the 3 ratios and cancer-specific survival (CSS) was investigated using the univariate and adjusted multivariate Cox regression models with stratifications. The periodical survival rates for the low- and high-level arms were obtained using the Kaplan-Meier method.

RESULTS

We set the medians (0.223, 2.22, and 124.4) as the cut-off values of preoperative MLR, NLR, and PLR, respectively. MLR was higher in male patients and those > 63 years; PLR was higher in patients with type II tumors. The (marginally-)significantly inverse ratio-CSS association was detected in male patients, those ≤ 63 years, those with type III tumors, and those with pTNM stage III tumors for MLR, and in female patients, those > 63 years, those with type III tumors, those with vessel invasion, and those with stage III tumors for NLR, but was generally negative concerning PLR. The association majorly existed in type III and pTNM stage III tumors.

CONCLUSION

MLR and NLR might be prognostic factors for patients with non-metastatic Siewert type II/III AEG, while PLR had limited significance.

The Prognostic Significance of Pretreatment Hematologic Parameters in Patients Undergoing Resection for Colorectal Cancer

OBJECTIVES

The prognostic value of several hematologic parameters, including platelet, lymphocyte, and neutrophil counts, has been studied in a variety of solid tumors. In this study, we examined the significance of inflammatory markers and their prognostic implications in patients with colorectal cancer (CRC).

MATERIALS AND METHODS

Patients with stage I-III CRC who underwent surgical resection at the Stanford Cancer Institute between 2005 and 2009 were included. Patients were excluded if they did not have preoperative complete blood counts performed within 1 month of surgical resection, underwent preoperative chemotherapy or radiation, had metastatic disease at diagnosis, or had another previous malignancy. We included 129 eligible patients with available preoperative complete blood counts in the final analysis.

RESULTS

A preoperative neutrophil-to-lymphocyte ratio of>3.3 was significantly associated with worse disease-free (DFS) and overall survival (OS) (P=0.009, 0.003), as was a preoperative lymphocyte-to-monocyte ratio of ≤2.6 (P=0.01, 0.002). Preoperative lymphopenia (P=0.002) was associated with worse OS but not DFS (P=0.09). In addition, preoperative thrombocytosis was associated with worse DFS (P=0.006) and OS (P=0.010). Preoperative leukocytosis was associated with worse OS (P=0.048) but not DFS (P=0.49). Preoperative hemoglobin was neither associated with OS (P=0.24) or DFS (P=0.15).

CONCLUSIONS

Pretreatment lymphopenia, thrombocytosis, a decreased lymphocyte-to-monocyte ratio, and an elevated neutrophil-to-lymphocyte ratio independently predict for worse OS in patients with CRC.