Combination of platelet count and neutrophil to lymphocyte ratio is a useful predictor of postoperative survival in patients with colorectal cancer

Integrative analysis identifies DNMTs against immune-infiltrating neutrophils and dendritic cells in colorectal cancer

Molecular characterizations, including microsatellite instability (MSI) and the CpG island methylator phenotype (CIMP) showed strong associations in colorectal carcinoma (CRC) and provided a deeper understanding of the etiology of disease. However, the global relationship between epigenetic alternations and changes in mRNA expression in CRC remains largely undefined, especially regarding the roles of DNA methyltransferases (DNMTs). Here, we conducted a systematic network comparison to explore the global conservation between co-expressed and co-methylated modules. We successfully identified immune-related modules that were regulated by DNMTs and had strong associations with immune-infiltrating neutrophils and dendritic cells in CRC. Moreover, we found that genes in those modules were prognostic for CRC, with 97.1% (168/173) being significantly influenced by DNMTs. Thus, this study resolved an interaction between DNA methylation and mRNA expression through DNMTs. Additionally, we provided evidence that DNMTs control the global hypomethylation of oncogenes, including ALOX5AP and CSF3R that otherwise have high methylation in normal colons. Such genes were also more sensitive to DNMT changes, such as in CRC. Collectively, our analyzes provided a systems biology approach to investigate the association among different molecular phenotypes in diseases.

An enrichment model using regular health examination data for early detection of colorectal cancer

Objective

Challenges remain in current practices of colorectal cancer (CRC) screening, such as low compliance, low specificities and expensive cost. This study aimed to identify high-risk groups for CRC from the general population using regular health examination data.

Methods

The study population consist of more than 7,000 CRC cases and more than 140,000 controls. Using regular health examination data, a model detecting CRC cases was derived by the classification and regression trees (CART) algorithm. Receiver operating characteristic (ROC) curve was applied to evaluate the performance of models. The robustness and generalization of the CART model were validated by independent datasets. In addition, the effectiveness of CART-based screening was compared with stool-based screening.

Results

After data quality control, 4,647 CRC cases and 133,898 controls free of colorectal neoplasms were used for downstream analysis. The final CART model based on four biomarkers (age, albumin, hematocrit and percent lymphocytes) was constructed. In the test set, the area under ROC curve (AUC) of the CART model was 0.88 [95% confidence interval (95% CI), 0.87-0.90] for detecting CRC. At the cutoff yielding 99.0% specificity, this model's sensitivity was 62.2% (95% CI, 58.1%-66.2%), thereby achieving a 63-fold enrichment of CRC cases. We validated the robustness of the method across subsets of test set with diverse CRC incidences, aging rates, genders ratio, distributions of tumor stages and locations, and data sources. Importantly, CART-based screening had the higher positive predictive value (1.6%) than fecal immunochemical test (0.3%).

Conclusions

As an alternative approach for the early detection of CRC, this study provides a low-cost method using regular health examination data to identify high-risk individuals for CRC for further examinations. The approach can promote early detection of CRC especially in developing countries such as China, where annual health examination is popular but regular CRC-specific screening is rare.

Clinical significance of the globulin-to-albumin ratio for prediction of postoperative survival in patients with colorectal cancer

AIM

A previous study has revealed that the albumin/globulin ratio (GAR) before treatment is a predictor of cancer-specific survival in patients with colorectal cancer (CRC). The aim of the present study was to investigate the clinical significance of GAR for prediction of postoperative survival in patients with CRC.

METHODS

Nine hundred and forty-one patients who had undergone elective CRC surgery were enrolled. Uni- and multivariate analysis models were performed to detect the clinical characteristics that were most closely associated with overall survival (OS). All recommended cutoff values were defined using receiver operating characteristic curve (ROC) analyses. Kaplan-Meier analysis was used to compare the OS curves between the high GAR (GAR > 0.83) and low GAR (GAR ≤ 0.83) groups.

RESULTS

Multivariate analysis using eight clinical characteristics selected by univariate analyses showed that the GAR was associated with OS (>0.83/≤0.83) (hazard ratio [HR], 1.979; 95% CI, 1.321-2.966; P = 0.001) along with carcinoembryonic antigen (CEA; >8.7/≤8.7, ng/mL; HR, 2.319; 95% CI, 1.569-3.428; P < 0.001), carbohydrate antigen 19-9 (CA19-9; >18.5/≤18.5, U/mL; HR, 1.727; 95% CI, 1.178-2.532; P = 0.005), and the neutrophil-to-lymphocyte ratio (NLR; >2.9/≤2.9; HR, 2.132; 95% CI, 1.454-3.126; P < 0.001), and the area under the ROC (AUROC) curve revealed that the GAR had the largest AUROC among these four clinical characteristics (GAR 0.711 > CEA 0.698 > CA19-9 0.676 > NLR 0.635). A significant difference in OS was observed between patients with low GAR and those with high GAR (P < 0.001).

CONCLUSION

Globulin-to-albumin ratio is a useful predictor of postoperative survival in patients with CRC.

The systemic immune-inflammation index is an independent predictor of survival for metastatic colorectal cancer and its association with the lymphocytic response to the tumor

BACKGROUND

Systemic inflammation and immune dysfunction has been proved to be significantly associated with cancer progression and metastasis in many cancer types, including colorectal cancer. We examined the prognostic significance of the systemic immune-inflammation index (SII) in patients with metastatic colorectal cancer (mCRC) and the relationship between the lymphocytic response to the tumor and this index.

METHODS

This retrospective study evaluated 240 consecutive patients with newly diagnosed stage IV mCRC who underwent surgical resection. The SII values were calculated based on preoperative laboratory data regarding platelet, neutrophil, and lymphocyte counts. Tumor-infiltrating lymphocytes were evaluated using the surgical specimens. The overall survival and their 95% confidence interval (95% CI) were estimated by regression analyses and the Kaplan-Meier method.

RESULTS

After a mean follow-up of 26.7 (1.1-92.4) months, 146 patients (60.8%) died. In the univariate analysis, a high SII was significantly associated with poor overall survival (P = 0.009). The multivariable analysis also confirmed that a high SII was independently associated with poor overall survival (hazard ratio: 1.462, 95% confidence interval 1.049-2.038, P = 0.025). The SII value was significantly correlated with the TILs value at the tumor's center (P = 0.04), but not at the invasive margin (P = 0.39). When we evaluated overall survival for groupings of the tumor-infiltrating lymphocytes and SII values, we identified three distinct prognostic groups. The group with low tumor-infiltrating lymphocyte values and high SII values had the worst prognosis.

CONCLUSIONS

A high SII value independently predicts poor clinical outcomes among patients with mCRC. In addition, combining the lymphocytic response to the tumor and SII could further enhance prognostication for mCRC.

Preoperative platelet-lymphocyte ratio is an independent prognostic factor in ampullary carcinoma following pancreaticoduodenectomy

The objective of the present study was to evaluate whether preoperative platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) could predict the prognosis for curative resected ampullary carcinoma. A total of 94 patients were retrospectively included over a 6-year period in which consecutive cases underwent pancreaticoduodenectomy for ampullary malignancy. Preoperative blood results were available in the 94 cases of resected ampullary carcinoma. Preoperative PLR and NLR cut-off values of 226.8 and 2.58 were determined to represent the optimal cut-off values in the cases for survival analysis. PLR remained a significant independent predictor of survival in multivariate analysis (Cox, P<0.001) in addition to tumor differentiation (P<0.001), nodal status (P<0.001) and stage (P<0.001). While NLR failed to serve as a prognostic factor in univariate (P=0.0637) and multivariate (P=0.164) survival analysis. Furthermore, the nodal involvement rate was higher in high PLR group (74.2 vs. 19.05%, P<0.001). Preoperative PLR and NLR merit further evaluation as a prognostic index in curative resected ampullary carcinoma. Additionally, it is a candidate predictor for the lymph node metastasis.

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.

Efficacy and safety of trastuzumab as maintenance or palliative therapy in advanced HER2-positive gastric cancer

BACKGROUND

Human epidermal growth factor receptor 2 (HER2)-positive gastric cancer (GC) is a unique subtype of this disease. Few studies focus on the feasibility of trastuzumab as maintenance or palliative therapy for patients with HER2-positive advanced GC.

PATIENTS AND METHODS

We retrospectively analyzed the data of 11 patients, evaluated the efficacy and safety of trastuzumab, and attempted to investigate the prognostic factors for trastuzumab treatment. Among the 11 patients, one achieved partial response (PR), six achieved stable disease (SD), and four were evaluated as progressive disease (PD).

RESULTS

The overall response rate (ORR) was 9.10%, and the disease control rate (DCR) was 63.64%. The median overall survival (OS) was 6.10 months, and the median progression-free survival (PFS) was 6.10 months. A significant association was found between trastuzumab treatment cycles and efficacy (P=0.027), cycles and PFS (P=0.001), and cycles and OS (P=0.005). Among the five patients who accepted more than five cycles of trastuzumab, the median OS and median PFS achieved 23.83 months and 14.67 months, respectively. Moreover, we have found the correlation between tumor marker changes and efficacy (P=0.002) and HER2 status and PFS (P=0.027). No association was found between HER2 status and OS (P=0.597).

CONCLUSION

The most common adverse events were left ventricular ejection fraction (LVEF) reduction, fatigue, and anorexia. LVEF reduction was found in seven of 11 patients, but the absolute decline in the LVEF was within 10% from the baseline. The results of this study suggest that trastuzumab is a feasible option as maintenance or palliative therapy for patients with HER2-positive metastatic GC.

Evaluation of platelet indices as diagnostic biomarkers for colorectal cancer

Altered platelet indices, including platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), have been found in various cancer types. This study aimed to evaluate the role of platelet indices as potential biomarkers for the diagnosis of colorectal cancer (CRC), and to assess the association between platelet indices and CRC clinicopathological characteristics. The study included 783 subjects with CRC, 463 subjects with colorectal adenomas (CA), and 689 control subjects from June 2015 to October 2017. All participants' clinicopathological characteristics were collected and analyzed. Here, we found that PC, MPV and PCT levels in CRC patients were significantly higher than those in CA patients and healthy participants (p < 0.001); however, PDW level in CRC patients was significantly higher than that in healthy participants while lower than that in CA patients. Receiver-operating characteristic (ROC) analysis indicated that combined detection of PCT and CEA appears to be a more effective marker to distinguish CRC patients from CA patients, with 70% sensitivity and 83% specificity. Among CRC patients, PC and PCT levels were associated with TNM stages and tumor size; MPV and PCT levels were associated with vascular invasion. Our findings suggest that altered PC, MPV and PCT levels might serve as potential biomarkers for the diagnosis and prognosis of CRC.

Prognostic value of platelet count and lymphocyte to monocyte ratio combination in stage IV non-small cell lung cancer with malignant pleural effusion

Introduction

A combination of platelet and lymphocyte to monocyte ratio (LMR) (abbreviated as COP-LMR) has been recently evaluated as systemic inflammatory marker for prognostication in lung cancer. While previous study on COP-LMR has evaluated its prognostic value in NSCLC patients who underwent curative resections, the combination of these two markers has not been evaluated in advanced NSCLC yet.

Objectives

In this study, we evaluated the prognostic value of COP-LMR in stage IV NSCLC with malignant pleural effusion under active anticancer treatment.

Methods

Between January 2012 and July 2016, 217 patients with stage IV NSCLC and MPE undergoing active anticancer treatment were selected for evaluation. If patients had both low LMR (< 2.47) and increased platelet (> 30.0 ×10⁴ mm-3), they were assigned to COP-LMR group 2. Patients with one parameter were assigned to COP-LMR group 1. If none, patients were assigned to COP-LMR group 0.

Results

Median overall survival (OS) (P < 0.001), progression free survival (PFS) (P < 0.001) and histological feature (P = 0.003) showed significant differences among COP-LMR groups. For COP-LMR groups 0, 1 and 2, median survival times were 35.9, 14.7 and 7.4 months, respectively, while median progression free times were 19.2, 13.3 and 7.4 months, respectively. Older age, male, low albumin, high CRP and high COP-LMR (0 vs 1, P = 0.021, hazard ratio (HR): 1.822, 95% confidence interval (CI): 1.096–3.027 and 0 vs 2, P = 0.003, HR: 2.464, 95% CI: 1.373–4.421) were independent predictive factors for shorter OS. Age, sex, histology, albumin, or CRP had no significant influence on PFS. High COP-LMR was the significant factor in predicting shorter PFS (0 vs 1, P = 0.116 and 0 vs 2, P = 0.007, HR: 1.902, 95% CI: 1.194–3.028).

Conclusions

A combination of pretreatment LMR and platelet levels can be used to predict short survival in stage IV NSCLC patients who underwent active anticancer treatment.

Poor prognostic role of the pretreatment platelet counts in colorectal cancer: A meta-analysis

BACKGROUND

Recently, a wide variety of studies have suggested that elevated platelet counts are associated with survival in patients with colorectal cancer. On one hand several studies suggest a negative connection in colorectal cancer patients with pre-operative thrombocytosis, on the other hand other studies contradicts this. However, it remains unknown whether elevated platelet counts are associated with survival in colorectal cancer patients. We therefore conducted this meta-analysis to evaluate the prognostic role of platelet counts in colorectal cancer.

METHODS

PubMed, Embase, and the Cochrane Library databases were searched from their inception to October 15, 2016 to identify relevant studies that have explored the prognostic role of platelet counts in colorectal cancer. Studies that examined the association between platelet counts and prognoses in colorectal cancer and that provided a hazard ratio (HR) and 95% confidence interval (CI) for overall survival (OS) and/or disease-free survival (DFS) were included.

RESULTS

This meta-analysis included 9 retrospective cohort studies involving 3413 patients with colorectal cancer. OS was shorter in patients with elevated platelet counts than in patients with normal counts (HR 2.11, 95% CI: 1.68-2.65). For DFS, an elevated platelet count was also a poor predictor (HR 2.51, 95% CI: 1.84-3.43).

CONCLUSION

In this meta-analysis, we suggest that an elevated platelet count is a negative predictor of survival in both primary colorectal cancer and resectable colorectal liver metastases.

Association of pretreatment neutrophil-lymphocyte ratio and outcome in emergency colorectal cancer care

Introduction The association between the neutrophil-lymphocyte ratio (NLR) and outcome in elective colorectal cancer surgery is well established; the relationship between NLR and the emergency colorectal cancer patient is, as yet, unexplored. This paper evaluates the predictive quality of the NLR for outcome in the emergency colorectal cancer patient. Materials and Methods A total of 187 consecutive patients who underwent emergency surgery for colorectal cancer were included in the study. NLR was calculated from the haematological tests done on admission. Receiver operating characteristic analyses were used to determine the most suitable cut-off for NLR. Outcomes were assessed by mortality at 30 and 90 days using stepwise Cox proportional hazards regression. Results An NLR cut-off of 5 was found to have the highest sensitivity and specificity. At 30 days, age and time from admission to surgery were associated with increased mortality; a high NLR was associated with an increased risk of mortality in univariate but not multivariate analysis. At 90 days, age, NLR, time from admission to surgery and nodal status were all significantly associated with increased mortality on multivariate analysis. Conclusions Pre-operative NLR is a cheap, easily performed and useful clinical tool to aid prediction of outcome in the emergency colorectal cancer patient.

The role of neutrophil-lymphocyte ratio as a prognostic indicator in patients undergoing nephrectomy for renal cell carcinoma

INTRODUCTION

Prognosis in patients with cancer is influenced by underlying tumour biology and also the host inflammatory response to the disease. There is limited evidence to suggest that an elevated neutrophil-lymphocyte ratio (NLR) predicts a poorer prognosis in patients undergoing nephrectomy for renal cell carcinoma (RCC). The aim of this paper is to investigate if patients undergoing nephrectomy for RCC with NLR ≤4 have a better overall and recurrence-free survival than patients with NLR >4.

METHODS

All patients who underwent nephrectomy at a single centre between January 1, 2011 and December 31, 2014 were identified. Patients were included if postoperative histology demonstrated RCC and if preoperative NLR was available. Patients were excluded if nephrectomy was not curative intent (i.e., cytoreductive nephrectomy), if primary tumour was graded to be T3b-4 disease, if there was presence of nodal or metastatic disease on preoperative staging, or if adequate followup notes were not available. Primary and secondary outcomes were overall survival and recurrence-free survival, respectively.

RESULTS

A total of 154 patients were included in analysis of overall survival; 146 patients were included in analysis of recurrence-free survival. Patients with NLR ≤4 had a much better overall survival than patients with NLR >4 (95% vs. 78%; p=0.0219). Patients with NLR >4 also had higher rates of recurrence (p=0.0218).

CONCLUSIONS

NLR may be a useful tool in identifying patients who may benefit from more frequent surveillance in the early postoperative period and may allow clinicians to offer surveillance schemes tailored to the individual patient.

Systemic inflammatory markers have independent prognostic value in patients with metastatic testicular germ cell tumours undergoing first-line chemotherapy

Background:

The prognostic utility of systemic inflammatory markers has so far not been investigated in patients with metastatic testicular germ cell tumours (GCTs).

Methods:

International Germ Cell Cancer Cooperative Group (IGCCCG) risk groups and blood-based systemic inflammatory markers (haemoglobin, leukocytes, platelets (P), neutrophils (N), lymphocytes (L), C-reactive protein (CRP) and albumin) of 146 patients undergoing first-line chemotherapy for GCT were retrieved. In addition, N to L ratio (NLR), P to L ratio and the systemic immune-inflammation index (SII=N × P/L) were calculated. The prognostic ability of these markers for overall survival (OS) were assessed using regression analyses and Kaplan–Meier curves with log-rank tests.

Results:

In univariate Cox regression, low haemoglobin and albumin as well as high leukocytes, N, NLR, SII and CRP were associated with a shorter OS. In multivariable Cox regression analyses, high leukocyte (hazard ratio (HR) 1.274 (95% confidence interval (CI) 1.057–1.535); P=0.011) and N count (1.470 (1.092–1.980); P=0.011), higher NLR (84.5 (2.2–3193.4); P=0.017) and SII (12.15 (1.17–126.26); P=0.037) remained independent prognostic predictors for OS besides the IGCCCG risk groups.

Conclusions:

Systemic inflammatory markers might have prognostic utility for patients with metastatic GCT. The planned IGCCCG update could be an opportunity to test these markers in a larger data set.

Combination of CRP and NLR: a better predictor of postoperative survival in patients with gastric cancer

Objectives

C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) were independent predictive factors for gastric cancer (GC). Our study was designed to prove the prognostic value of the combination of CRP and NLR (COC-NLR) in GC patients.

Materials and methods

A total of 1,058 GC patients who underwent D2 resection from Sun Yat-Sen University Cancer Center between 2003 and 2013 were included. They were divided into three groups (low: NLR ≤2.5, CRP ≤6.1; medium: NLR >2.5, CRP ≤4.5; high: NLR >2.5, CRP >4.5 or NLR ≤2.5, CRP >6.1) by the random forest method. Survival analysis stratified by COC-NLR groups was performed.

Results

The mean survival time for each group was: for the low group 75.44 months (95% CI: 72.48–78.40), the medium group 56.50 months (95% CI: 50.68–62.31), and the high group 38.65 months (95% CI: 34.51–42.97). The low group showed obviously better overall survival (OS) than other two groups (p<0.001). Survival analysis showed that COC-NLR had statistical significance in both univariate and multivariate analyses (p<0.01).

Conclusion

This study showed that COC-NLR could work as an independent prognostic factor in GC and provide more accurate prediction than single NLR or CRP.

Prognostic indices of inflammatory markers, cognitive function and fatigue for survival in patients with localised colorectal cancer

Background

Inflammation promotes the development of malignancy, while a variety of systemic markers of inflammation predict for worse cancer outcomes including recurrence and survival. Here, we evaluate the prognostic impact of cytokine concentrations, full blood count (FBC) differential ratios, cognitive function and fatigue on survival in patients with localised colorectal cancer (CRC).

Patients and methods

Data are from a prospective longitudinal study comparing cognitive function and fatigue in patients with CRC who did (n=173) and did not (n=116) receive adjuvant/neoadjuvant chemotherapy. Baseline blood results (prior to any chemotherapy) included cytokines and FBC from which neutrophil lymphocyte ratio, lymphocyte monocyte ratio, platelet lymphocyte ratio and platelet monocyte ratio were derived. Fatigue was measured with the Functional Assessment of Cancer Therapy-Fatigue subscale and cognitive function by a neuropsychological test battery. Kaplan-Meier methods were used to estimate disease-free survival (DFS) and overall survival (OS). Univariable and multivariable Cox regression analyses were performed to evaluate factors potentially prognostic of outcomes.

Results

At a median follow-up of 91.2 months, 227 subjects (79%) are still alive, and 212 (73%) have no evidence of a recurrence. Five-year OS and DFS are 86% (95% CI 81% to 90%) and 77% (95% CI 71% to 82%), respectively. None of the cytokines (interleukin (IL-6), IL-1 and tumour necrosis factor) or differential ratios of blood components, fatigue or cognitive function was statistically related to DFS or OS. Patient educational status (P=0.018), stage of disease (P=0.032), alanine transaminase (P=0.003), lactate dehydrogenase (P=0.008) and carcinoembryonic antigen (P=0.002) were significant as prognostic covariates of OS in univariable analyses, with similar results for DFS.

Conclusion

None of the a priori selected markers of inflammation, fatigue or cognitive function was associated with OS or DFS in this cohort of patients.

Trial registration number

NCT00188331, Post-results.

Modified combination of platelet count and neutrophil "to" lymphocyte ratio as a prognostic factor in patients with advanced head and neck cancer

BACKGROUND

We evaluated the prognostic potential of the combination of platelet count and neutrophil to lymphocyte ratio (COP-NLR) in patients with advanced head and neck cancer.

METHODS

We proposed a modified COP-NLR scoring system defined as follows: score 0 (platelet count level <300 × 10⁹ /L and NLR <3); score 1 (platelet count level ≥300 × 10⁹ /L and NLR <3); and score 2 (NLR ≥3). We assessed whether the modified scoring system had better performance as an indicator of prognosis than the existing COP-NLR scoring system (original and 4-group scores).

RESULTS

A total of 248 patients were enrolled. The Akaike Information Criterion value with the modified COP-NLR score was the smallest among the 3 models. The 3-year survival rates according to the modified COP-NLR scores of 0, 1, and 2 were 80.6%, 59.9%, and 23.8%, respectively.

CONCLUSION

The modified COP-NLR score is a useful prognostic marker in patients with advanced head and neck cancer.

Correlation of Inflammatory Markers, Survival, and COX2 Expression in Oral Cancer and Implications for Prognosis

Objective Peripheral blood-derived inflammation-based scores, such as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and the combination of platelet count and NLR, have recently been proposed as prognostic markers in solid tumors. The purpose of this study was to investigate the validity of inflammatory markers as predictive prognostic factors for locally advanced oral squamous cell carcinoma (OSCC). In addition, we evaluated the potential correlation between systemic inflammation and local expression of COX2. Study Design Retrospective chart review and histologic analysis. Setting Tertiary referral academic center. Subjects and Methods We conducted a retrospective analysis of 94 patients with advanced OSCC treated with surgery at our hospital between 2007 and 2015. The relationship among patient survival, systemic inflammatory markers, and local COX2 expression was evaluated. Local COX2 expression in surgical specimens was measured by immunohistochemistry. Results High NLR and high PLR were associated with significantly shorter overall survival and cancer-specific survival. Multivariate analysis revealed that cN stage, NLR, and postoperative radiation/chemoradiation were significantly associated with overall survival and cancer-specific survival. PLR and combination of platelet count and NLR were significantly correlated with tumor expression of COX2. Finally, patients with cN2 stage disease and high local COX2 expression had a significantly worse prognosis than other patient groups. Conclusion Pretreatment inflammatory markers are useful as prognostic factors in advanced OSCC. Our study suggests that local COX2 may be affected by systemic inflammation and that the prognostic impact of COX2 expression depends on host factors and tumor characteristics.

Valuation of Neutrophil/Lymphocyte Ratio in Renal Cell Carcinoma Grading and Progression

Introduction

We investigated the association of the neutrophil/lymphocyte ratio (NLR) with tumor size and Fuhrman grade in nonmetastatic renal cell carcinoma (RCC) cases.

Materials and methods

Data of nonmetastatic RCC (T1-4N0M0) cases, operated between 2010 and 2016, were retrospectively reviewed and 103 patients were included in the study. The patients were divided into two groups according to tumor diameter (Group 1 T < 4 cm, Group 2 T ≥ 4 cm) and into three groups according to Fuhrman grade. Twenty-eight patients with a tumor diameter of 4 cm or less in Group 1 and 75 patients with a tumor diameter greater than 4 cm in Group 2 were compared. In both grouping systems, the NLR, mean platelet volume (MPV), red cell distribution width (RDW), white blood cell (WBC), red blood cell (RBC), platelet (PLT), lymphocyte, and neutrophil values and age were compared.

Results

There were no differences in age, MPV, RDW, neutrophil, WBC, RBC, PLT counts in groups of tumor diameter (Group 1 T < 4 cm, Group 2 T ≥ 4 cm). However, the lymphocyte amount was significantly higher in cases with a tumor diameter less than 4 cm compared to the cases with a tumor diameter greater than 4 cm (p = 0.015). It was observed that the NLR had a tendency to increase in patients with tumor size greater than 4 cm compared to patients with tumor size smaller than 4 cm (p = 0.029). There were no differences in age, MPV, RDW, lymphocyte, neutrophil, WBC, RBC, PLT counts, and the NLR in different Fuhrman-graded cases.

Conclusions

There is a linear relation between the tumor size and the NLR in nonmetastatic RCC cases. Therefore, the NLR is a cheap parameter that can be used to show the tumor size, and thus it can be used to get an idea about the prognosis of the patient.

Combination of the neutrophil to lymphocyte ratio and the platelet to lymphocyte ratio as a useful predictor for recurrence following radiofrequency ablation of hepatocellular carcinoma

The aim of the present study was to investigate the prognostic potential of a novel inflammation-based system, the combination of the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) (CNP), for predicting the survival time of patients with hepatocellular carcinoma (HCC) who had received radiofrequency ablation (RFA). A total of 287 HCC patients treated with RFA were enrolled in the study. Patients with an elevated NLR (>2.58) and an elevated PLR (>131.78) were allocated a score of 2, and patients exhibiting one or neither of these characteristics were allocated a score of 1 or 0, respectively. The association between the CNP and various HCC clinicopathological factors, patterns of recurrence and prognoses were analyzed. The CNP was associated with liver cirrhosis (P=0.015), Child-Pugh class (P=0.024), total bilirubin level (P=0.028), neutrophil count (P<0.001), lymphocyte count (P<0.001) and platelet count (P<0.001). Compared with their low-CNP counterparts, patients with an elevated CNP were more likely to develop distant intrahepatic recurrence [52.3% (CNP 2) vs. 33.9% (CNP 0) and 34.6% (CNP 1), P=0.015; CNP 0 vs. CNP 1, P=0.922; CNP 1 vs. CNP 2, P=0.020] and extrahepatic metastasis [25.0% (CNP 2) vs. 7.6% (CNP 0) and 18.5% (CNP 1), P=0.003; CNP 0 vs. CNP 1, P=0.020; CNP 1 vs. CNP 2, P=0.309], and had shorter overall survival (OS) time (CNP 0 vs. CNP 1, P<0.001; CNP 1 vs. CNP 2, P<0.001) and recurrence-free survival (RFS; CNP 0 vs. CNP 1, P=0.012; CNP 1 vs. CNP 2, P=0.004). Moreover, multivariate analysis revealed that the CNP was superior to the NLR and the PLR as an independent prognostic marker of OS and RFS. Therefore, it was concluded that the CNP may represent a useful predictor for recurrence and prognosis in patients with HCC treated with RFA.

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.

Can preoperative neutrophil lymphocyte ratio predict malignancy in patients undergoing partial nephrectomy because of renal mass?

Purpose:

To evaluate the importance of preoperative neutrophil lymphocyte ratio (NLR) predicting malignancy in patients who undergo partial nephrectomy due to renal mass.

Materials and Methods:

Seventy nine patients who underwent open partial nephrectomy for renal masses were included in this retrospective study. In preoperative routine blood tests, renal ultrasonography and contrast-enhanced computed tomography were performed for all patients. Preoperative neutrophil lymphocyte ratio were compared in patients with clear cell renal cell carcinoma (Group1, 65 patients) and benign lesions (Group 2, 14 patients). The predictive ability of NLR was analyzed by ROC curves and Youden Index method was used to identify the cut-off value for NLR.

Results:

The mean age of patients was 59.8±11.7 years in Group1 and 57.4±12.6 years in Group 2 (p=0.493). The mean tumor size was 3.8±1.2 cm in Group 1 and 3.3±1.0 cm in Group 2 (p=0.07). The median NLR was 2.48 (1.04) in Group 1 and 1.63 (0.96) in Group 2 (p<0.001). The area under a ROC curve was 0.799 (p<0.001).

Conclusions:

Preoperative neutrophil lymphocyte ratio may predict renal masses that can not be distinguished radiologically. Our results must be confirmed by large and properly designed prospective, randomized trials.

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.

The combination of preoperative platelet count and neutrophil lymphocyte ratio as a prognostic indicator in localized renal cell carcinoma

Introduction

The combination of platelet count and neutrophil to lymphocyte ratio (COP-NLR) has been shown to provide prognostic information in several cancers, whereas its prognostic value in renal cell carcinoma (RCC) has not been reported. The objective of the present study was to examine the preoperative prognostic value of the COP-NLR in patients with localized RCC undergoing nephrectomy.

Material and Methods

The record of 268 patients, who underwent nephrectomy due to a diagnosis of RCC at our institute was analyzed in the study. The cut-off value of platelet count and NLR were defined by receive operating characteristic (ROC) analysis and the areas under the curve (AUC). Patients with both an increased platelet count (> 310×10⁹/l) and an elevated NLR (> 3.85) were assigned to the score 2, and patients with one or neither of these indicators were assigned to the score 1 or 0, respectively. The impact of the COP-NLR and other clinicopathological characteristics on overall survival (OS) and recurrence-free survival (RFS) were evaluated using the univariate and multivariate Cox regression analysis.

Result

The median follow-up duration after surgical resection was 60 months. Multivariate analysis using the 10 clinicopathological findings selected by univariate analyses demonstrated that the preoperative COP-NLR was an independent prognostic factor for OS (HR: 2.32, 95%CI: 1.22 to 4.26, p=0.011) and RFS (HR: 1.91, 95%CI: 1.02 to 3.53, p=0.044).

Conclusion

The findings of the current study suggested that the preoperative COP-NLR is an independent prognostic indicator of OS and RFS for patients with localized RCC.

Successful identification of a predictive biomarker for lymph node metastasis in colorectal cancer using a proteomic approach

Colorectal cancer (CRC)-associated mortality is primarily caused by lymph node (LN) and distant metastasis, highlighting the need for biomarkers that predict LN metastasis and facilitate better therapeutic strategies. We used an Isobaric Tags for Relative and Absolute Quantification (iTRAQ)-based comparative proteomics approach to identify novel biomarkers for predicting LN metastasis in CRC patients. We analyzed five paired samples of CRC with or without LN metastasis, adjacent normal mucosa, and normal colon mucosa, and differentially expressed proteins were identified and subsequently validated at the protein and/or mRNA levels by immunohistochemistry and qRT-PCR, respectively. We identified 55 proteins specifically associated with LN metastasis, from which we selected ezrin for further analysis and functional assessment. Expression of ezrin at both the protein and mRNA levels was significantly higher in CRC tissues than in adjacent normal colonic mucosa. In univariate analysis, high ezrin expression was significantly associated with tumor progression and poor prognosis, which was consistent with our in vitro findings that ezrin promotes the metastatic capacity of CRC cells by enabling cell invasion and migration. In multivariate analysis, high levels of ezrin protein and mRNA in CRC samples were independent predictors of LN metastasis. Our data thus identify ezrin as a novel protein and mRNA biomarker for predicting LN metastasis in CRC patients.

Combination of platelet count and neutrophil-lymphocyte ratio as a prognostic marker to predict chemotherapeutic response and survival in metastatic advanced gastric cancer

AIM

The study evaluated the prognostic impact of combination of platelet count and neutrophil-lymphocyte ratio (COP-NLR) for first-line chemotherapeutic response and survival outcomes in metastatic advanced gastric cancer patients.

METHODS

Two hundred and seventy-three patients were categorized into three COP-NLR groups (COP-NLR 0, 1, 2) according to their platelet count and neutrophil-lymphocyte ratio.

RESULTS

The COP-NLR 0 had a significantly higher disease control rate (93%) than the other two groups (p = 0.011). A logistic regression model showed that COP-NLR was an independent risk factor for response to chemotherapy (odds ratio: 2.247; 95% CI: 1.303-3.874; p = 0.044). The median overall survival for COP-NLR 0, 1 and 2 was 14.8, 10.3 and 9.1 months, respectively (p = 0.001).

CONCLUSION

COP-NLR is a useful predictor of survival outcomes and chemotherapeutic response in patients with metastatic advanced gastric cancer.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

The clinical use of the platelet/lymphocyte ratio and lymphocyte/monocyte ratio as prognostic predictors in colorectal cancer: a meta-analysis

BACKGROUND

Conflicting evidence exists regarding the effects of platelet/lymphocyte ratio (PLR) and lymphocyte/monocyte ratio(LMR) on the prognosis of colorectal cancer (CRC) patients. This study aimed to evaluate the roles of the PLR and LMR in predicting the prognosis of CRC patients via meta-analysis.

METHODS

Eligible studies were retrieved from the PubMed, Embase,andChina National Knowledge Infrastructure (CNKI) databases, supplemented by a manual search of references from retrieved articles. Pooled hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated using the generic inverse variance and random-effect model to evaluate the association of PLR and LMR with prognostic variables in CRC, including overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS).

RESULTS

Thirty-three studies containing 15,404 patients met criteria for inclusion. Pooled analysis suggested that elevated PLR was associated with poorer OS (pooled HR = 1.57, 95% CI: 1.41 - 1.75, p< 0.00001, I2=26%) and DFS (pooled HR = 1.58, 95% CI: 1.31 - 1.92, p< 0.00001, I2=66%). Conversely, high LMR correlated with more favorable OS (pooled HR = 0.59, 95% CI: 0.50 - 0.68, p< 0.00001, I2=44%), CSS (pooled HR = 0.54, 95% CI: 0.40 - 0.72, p< 0.00001, I2=11%) and DFS (pooled HR = 0.82, 95% CI: 0.71- 0.94,p=0.005, I2=29%).

CONCLUSIONS

Elevated PLR was associated with poor prognosis, while high LMR correlated with more favorable outcomes in CRC patients. Pretreatment PLR and LMR could serve as prognostic predictors in CRC patients.

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/Lymphocyte and Platelet/Lymphocyte Ratios are Not Different among Breast Cancer Subtypes

Background:

Breast cancer is a heterogeneous complex of diseases comprising different subtypes that have different treatment responses and clinical outcomes. Systemic inflammation is known to be associated with poor prognosis in many types of cancer. The neutrophil / lymphocyte ratio (NLR) and platelet / lymphocyte ratio (PLR) are factors used as indicators of inflammation. In this study, we evaluated NLR and PLR ratios in breast cancer subtypes.

Methods:

A total of 255 breast cancer patients were evaluated retrospectively. Patients were classified into three subtypes: estrogen receptor (ER)- or progesterone receptor (PR)-positive tumors were classified as luminal tumors; human epidermal growth factor receptor-2 (HER2)-overexpressed and ER-negative tumors were classified as HER2-positive tumors; and ER, PR, and HER2-negative tumors were classified as triple-negative tumors. The NLR and PLR were calculated.

Results:

The median NLR and PLR were 3 (0.37–37,1) and 137 (37.1–421.3), respectively. 66.7% of the patients were luminal type, 19.2% were HER2 positive, and 14.1% were triple negative. NLR was not associated with grade (p: 0.412), lymphovascular invasion (p: 0.326), tumor size (p: 0.232) and metastatic lymph node involvement (p: 0.406). PLR was higher in the patients with lymph node metastasis than in those without lymph node metastasis (p: 0.03). The NLR was 2 in the luminal group, 1.8 in the HER2-positive group, and 1.9 in the triple-negative group, but the differences were not significant(p: 0.051). PLR was 141 in the luminal group, 136 in the HER2-positive group, and 130 in the triple-negative group, but the differences were not significant.

Conclusion:

We could not find any significant differences for NLR and PLR according to breast cancer subtypes.

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.

Association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with ER and PR in breast cancer patients and their changes after neoadjuvant chemotherapy

PURPOSE

Proinflammatory markers, including neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), are associated with many aspects of different malignancies. The aim of this study was to assess the associations of NLR and PLR with estrogen receptor (ER) and progesterone receptor (PR) expression in locally advanced breast cancer patients and their changes after neoadjuvant chemotherapy (NAC). Whether these parameters were predictive for the response to NAC in breast cancer patients was also evaluated.

METHODS

132 Female primary locally advanced breast cancer patients treated with either ET (epirubicin-docetaxel), TEC (docetaxel-epirubicin-cyclophosphamide), or CEF (cyclophosphamide-epirubicin-fluorouracil) as NAC were retrospectively studied. NLR and PLR were calculated from peripheral blood cell count and their optimal cutoff levels were determined by receiver operating characteristic curves.

RESULTS

The proportion of ER-positive breast cancers before NAC was higher both in NLRlow (<2.05) group and PLRlow group (<159.01). Changes in ER or PR expression level or status were observed in some patients. The alterations of NLR and PLR after NAC correlated with chemotherapy regimens, and elevated PLR was found. The patients with low pretreatment NLR (<1.67) or PLR (<151.27) had better responses to NAC than those with high NLR (≥1.67, 67.3 vs. 47.1%, P < 0.05) or PLR (≥151.27, 64.0 vs. 45.1%, P < 0.05).

CONCLUSIONS

The patients with low pretreatment NLR (<2.05) or PLR (<159.01) had higher ER expression. Changes in ER and PR expression status or level occured following NAC. Elevated PLR was found aft-NAC. Pretreatment NLR and PLR may be important predictive indicators for NAC response in breast cancer patients.

Prognostic significance of preoperative platelet-lymphocyte ratio in a Chinese cohort patient with colorectal cancer

Cancer-related systemic inflammation affects many aspects of malignancy. The platelet-to-lymphocyte ratio (PLR), an easily applicable inflammatory marker based on platelet and lymphocyte counts, is associated with the clinical outcome of some cancers. The present study aimed to investigate the prognostic significance of the preoperative PLR in a cohort of colorectal cancer (CRC) patients. A total of 138 patients with CRC were enrolled in this retrospective study. The optimal cutoff value for the PLR was calculated using receiver operating curve (ROC) analysis. The correlation of PLR with the clinicopathological characteristics of patients was explored. Cox proportional hazard analysis was applied to determine the independent prognostic effect of PLR. PLR of 248 yielded the most optimal predictive value for the prognosis of CRC [area under the curve (AUC) = 0.820]. High level of PLR was significantly associated with lymph node and distance metastasis (P<0.001 and = 0.003, respectively), vascular and perinural invasion (P<0.001), advanced TNM stage (P<0.001), and poor differentiation (P = 0.037). Furthermore, the univariable analysis showed a significant impact of increased PLR on OS (HR = 4.326, 95% CI: 2.903-6.445, P<0.001), while this association remained significant in multivariable analysis (adjusted HR = 4.605, 95% CI: 2.786-7.611, P<0.001). Our findings indicated that elevated preoperative PLR might have potential value in predicting poor outcome in patients with CRC.

A novel systematic inflammation related index is prognostic in curatively resected non-metastatic colorectal cancer

BACKGROUD

To better identify patients with high mortality risk, we developed a systematic inflammation index (IPI) based on neutrophil to lymphocyte ratio (NLR) and albumin.

METHODS

The performance of pretreatment IPI was evaluated in patients with surgically resected non-metastatic colorectal cancer. IPI was predefined and compared with Glasgow Prognostic Score (GPS)/modified GPS in terms of discrimination and calibration abilities.

RESULTS

In multivariate analysis, patients with an IPI of 1 or 2 had 1.68(95%CI:1.15-2.44) or 3.56(95%CI:2.12-5.98)-fold increased cancer specific mortality risk(CSMR) respectively in comparison to patients with an IPI of 0. The prognostic significance was independent of tumor locations and nodal status. Compared with the GPS/mGPS, IPI had the higher c statistics and lower Akaike Information Criterion. IPI showed good calibration in predicting 1-year, 3-year and 5-year CSMR.

CONCLUSIONS

IPI is readily available, independently prognostic and may reflect the host inflammation, immune and nutritional status that could have impact on cancer progression.

Significance of inflammation-based indices in the prognosis of patients with non-metastatic colorectal cancer

Previous studies demonstrated that several inflammation-based hematological indices are closely related to various malignancies, including colorectal cancer (CRC). In this study, the prognostic value of inflammation-based markers, including a combination index termed coNLR-PDW, comprising the preoperative neutrophil-to-lymphocyte ratio (NLR) and the platelet distribution width (PDW), was evaluated in 206 patients with non-metastatic CRC treated with surgery at a single medical center. The association of patient demographics, blood chemistry, and serum biochemical indices with recurrence-free survival (RFS) and overall survival (OS) were examined through univariate and multivariate analysis. Receiver operating characteristic curve analysis revealed the optimal cut-off values of the NLR and lymphocyte-to-monocyte ratio (LMR) to be, respectively, 2.0 and 3.32 for both RFS and OS. For PDW, cut-off values of 17.25% and 17.35% were defined for RFS and OS, respectively. On univariate analysis, lymph node involvement, stage, presence of intravascular emboli (IVE), carbohydrate antigen 199 (CA199) ≥ 35 kU/L, NLR ≥ 2.0, LMR ≤ 3.32, elevated PDW, a high coNLR-PDW score, high blood glucose, and high neutrophil and lymphocyte percentages correlated with poorer RFS and OS (P < 0.05). On multivariate analysis, lymph node involvement, IVE, CA199, PDW, and coNLR-PDW correlated with both RFS and OS (P < 0.05), while NLR correlated only with OS (P = 0.001). These results highlight the usefulness of the coNLR-PDW index as a prognostic marker of non-metastatic CRC outcome. In clinical practice, its assessment could contribute to establishing more personalized regimes for patients undergoing tumor resection surgery.

Proteomics analysis of differential protein expression identifies heat shock protein 47 as a predictive marker for lymph node metastasis in patients with colorectal cancer

The discovery of biomarkers to predict the potential for lymph node (LN) metastasis in patients with colorectal cancer (CRC) is essential for developing improved strategies for treating CRC. In the present study, they used isobaric tags for relative and absolute quantitation to conduct a proteomic analysis designed to identify novel biomarkers for predicting LN metastasis in patients with CRC. They identified 60 differentially expressed proteins specifically associated with LN metastasis in CRC patients and classified the molecular and functional characteristics of these proteins by bioinformatic approaches. A literature search led them to select heat shock protein 47 (HSP47) as the most suitable candidate biomarker for predicting LN metastasis. Validation analysis by immunohistochemistry showed that HSP47 expression in patients with CRC and the number of HSP47-positive spindle cells in the tumor stroma were significantly higher compared with those in adjacent normal colonic mucosa, and the number of the latter cells increased with tumor progression. Further, the number of HSP47-positive spindle cells in stroma was a more informative marker for identifying LN metastasis than HSP47expression. Multivariate analysis identified spindle cells that expressed elevated levels of HSP47 as an independent predictive biomarker for CRC with LN metastasis. Moreover, these cells served as an independent marker of disease-free and overall survival of patients with CRC. Their data indicate that the number of HSP47-positive spindle cells in the stroma of CRC may serve as a novel predictive biomarker of LN metastasis, early recurrence and poor prognosis.

The elevated NLR, PLR and PLT may predict the prognosis of patients with colorectal cancer: a systematic review and meta-analysis

Recently, several studies have reported that inflammatory response and elevated platelet counts may be associated with the poor prognosis of colorectal cancer. This meta-analysis was designed to analyze and evaluate the prognostic role of elevated preoperative or pretreatment neutrophils-to-lymphocytes ratio, platelet-to-lymphocytes ratio or platelet counts in patients with colorectal cancer. We searched PubMed, EMBASE, Cochrane Library and Web of Science to April, 2016. A total of 23 studies (N = 11762 participants) were included for this meta-analysis. Elevated neutrophils-to-lymphocytes ratio have a close relationship with the poor Overall Survival of colorectal cancer with the pooled HR being 1.92 [95% CI 1.57–2.34; P < 0.00001]. This meta-analysis indicated that elevated neutrophils-to-lymphocytes ratio, platelet-to-lymphocytes ratio or platelet counts may be a cost-effective and noninvasive serum biomarker for poor prognosis for patients with colorectal cancer.

Pretreatment combination of platelet counts and neutrophil-lymphocyte ratio predicts survival of nasopharyngeal cancer patients receiving intensity-modulated radiotherapy

Background

Increased cancer-related inflammation has been associated with unfavorable clinical outcomes. The combination of platelet count and neutrophil–lymphocyte ratio (COP-NLR) has related outcomes in several cancers, except for nasopharyngeal carcinoma (NPC). This study evaluated the prognostic value of COP-NLR in predicting outcome in NPC patients treated with intensity-modulated radiotherapy (IMRT).

Materials and methods

We analyzed the data collected from 232 NPC patients. Pretreatment total platelet counts, neutrophil–lymphocyte ratio (NLR), and COP-NLR score were evaluated as potential predictors. Optimal cutoff values for NLR and platelets were determined using receiver operating curve. Patients with both elevated NLR (>3) and platelet counts (>300×10⁹/L) were assigned a COP-NLR score of 2; those with one elevated or no elevated value were assigned a COP-NLR a score of 1 or 0. Cox proportional hazards model was used to test the association of these factors and relevant 3-year survivals.

Results

Patients (COP-NLR scores 1 and 2=85; score 0=147) were followed up for 55.19 months. Univariate analysis showed no association between pretreatment NLR >2.23 and platelet counts >290.5×10⁹/L and worse outcomes. Multivariate analysis revealed that those with COP-NLR scores of 0 had better 3-year disease-specific survival (P=0.02), overall survival (P=0.024), locoregional relapse-free survival (P=0.004), and distant metastasis-free survival (P=0.046). Further subgrouping by tumor stage also revealed COP-NLR to be an unfavorable prognostic indicator of 3-year failure-free survival (P=0.001) for locally advanced NPC.

Conclusion

COP-NLR score, but not NLR alone or total platelet count alone, predicted survival in NPC patients treated with IMRT-based therapy, especially those with stage III/IVA, B malignancies.

α-Lipoic Acid Mitigates Arsenic-Induced Hematological Abnormalities in Adult Male Rats

BACKGROUND

Arsenic toxicity is a major global health problem and exposure via contaminated drinking water has been associated with hematological and other systemic disorders. The present investigation has been conducted in adult male rats to evaluate the protective ability of α-lipoic acid (ALA) against such hematological disorders.

METHODS

Twenty-four adult male Wister rats (b.wt.130±10g) were grouped and accordingly group I (control) received the normal diet, group II (treated) was given arsenic orally for 28 consecutive days as arsenic trioxide (3 mg/kgbw/rat/day) whereas group III (supplemented) received the same dose of arsenic along with ALA (25 mg/kgbw/rat/day) as oral supplement. Hematological profile, plasma oxidant/antioxidant status, and erythrocyte morphology were assessed. Statistical analysis was done by one-way ANOVA using SPSS software (version 16.0).

RESULTS

Arsenic exposure caused reduction of erythrocyte (P=0.021), leucocyte (P<0.001), and hemoglobin (P=0.031) associated with echinocytic transformation as evidenced by light and scanning electron microscopic studies. The other significantly altered parameters include increased mean corpuscular volume (P=0.041) and lymphocytopenia (P<0.001) with insignificant neutropenia and eosinophilia. Altered serum oxidative balance as evidenced by decreased TAS (P<0.001) and increased TOS (P<0.001) with OSI (P<0.001) was also noted. The dietary supplementation of ALA has a beneficial effect against the observed (P<0.05) arsenic toxicities. It brings about the protection by restoring the hematological redox and inflammatory status near normal in treated rats. Arsenic-induced morphological alteration of erythrocytes was also partially attenuated by ALA supplementation.

CONCLUSION

It is concluded that arsenicosis is associated with hematological alterations and ALA co-supplementation can partially alleviate these changes in an experimental male rat model.

Baseline serum albumin and other common clinical markers are prognostic factors in colorectal carcinoma: A retrospective cohort study

The aim of the present study was to define the prognostic role of baseline serum albumin (BSA) in colorectal cancer (CRC) across tumor-node-metastasis (TNM) stages and other well defined prognostic factors. Many prognostic models in medicine employ BSA to define or refine treatments in very specific settings; in CRC, BSA has been found to be a prognostic factor as well. A retrospective cohort study of consecutive patients with CRC demonstrated by biopsy, who attended a cancer center during a 7-year period. Multivariate analysis was utilized to define prognostic factors associated with overall survival (OS) employing the Cox model. In this retrospective cohort study, 1465 patients were included; 46.6% were females and 53.4% males (mean age, 59.1 years). Mean BSA was inversely correlated with TNM stages. By multivariate analysis, it was an independent explanatory variable. TNM stages, "R" classification, age, lymphocyte count, neutrophil/platelet ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, postoperative morbidity, and BSA were independently associated with OS. Morbidities, surgery type, chemotherapy, and radiotherapy were considered confounders after adjusting by TNM stages. BSA is a significant and independent prognostic factor in patients with CRC, and its effect is maintained across TNM strata and other well known clinical prognostic factors. It can be easily used in prognostic models and should be employed to stratify prognosis in therapeutic randomized clinical trials.

Are Markers of Systemic Inflammation Good Prognostic Indicators in Colorectal Cancer?

Systemic inflammation has been proved to play a crucial role in promoting cancer progression and metastasis in many cancer types, including colorectal cancer (CRC). The aim of the present review was to provide an overview of studies regarding the prognostic value of inflammation-based markers in patients with CRC. A literature search was performed for articles reporting the prognostic value of the Glasgow prognostic score (GPS), modified GPS (mGPS), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in relation to CRC outcomes. In resectable early-stage CRC, high GPS scores seem significantly associated with cancer-specific survival. It has also been suggested that adjuvant chemotherapy for stage II CRC could improve cancer-specific survival in patients with high GPS scores. In patients with both resectable and unresectable metastatic CRC and a higher GPS score, all studies suggested poorer overall survival. In early-stage and resectable metastatic CRC, the NLR seemed related to overall survival; however, the data for disease-free survival were discordant. In metastatic disease, a possible correlation between a greater NLR and poorer response to bevacizumab has been suggested. Data concerning the prognostic and predictive role of the PLR and LMR in CRC are to date insufficient. In patients with unresectable metastatic disease, inflammation markers can be used to predict the chemotherapeutic outcome and monitor tumor progression. However, further prospective studies might lead to better risk stratification for patients eligible for curative surgery, thus, allowing the restriction of neoadjuvant and adjuvant therapy to patients with high-risk CRC.

Patterns of acute inflammatory symptoms prior to cancer diagnosis

Although many studies have examined the role of chronic inflammation in cancer development, few studies discuss the patterns of acute inflammation prior to cancer diagnosis. Patients with lung, colorectal, prostate, or breast cancer between 1 July 2006 and 31 December 2009 and their metastatic status at diagnosis were determined through the Swedish Cancer Register. Non-steroidal anti-inflammatory drugs (NSAIDs) use in the year prior to cancer diagnosis was assessed through the Swedish Prescribed Drug Register. There were 13,945 patients identified with breast cancer, 6501 with prostate cancer, 5508 with lung cancer, and 12,723 with colon cancer. For metastatic patients, there is strong evidence of higher NSAIDs use 1–3 months compared to 10–12 months prior to diagnosis (breast odds ratio (OR) = 3.54, 95% CI 2.26–5.54; prostate OR = 3.90, 95% CI 3.10–4.90; lung OR = 2.90 95% CI 2.44–3.44; colorectal OR = 1.67, 95% CI 1.36–2.05). For non-metastatic patients, increased NSAIDs use 1–3 months prior to diagnosis was also observed, but only to a smaller extent for lung and prostate cancer (prostate OR = 1.48, 95% CI 1.27–1.72; lung 1.41, 95% CI 1.19–1.67). In conclusion, if NSAIDs use reflects underlying inflammatory symptoms, there is support for the hypothesis that advanced cancer was associated with an acute inflammatory process.

Systemic inflammatory markers and outcome in patients with locally advanced adenocarcinoma of the oesophagus and gastro-oesophageal junction

BACKGROUND

Raised levels of systemic inflammatory markers are associated with poor survival in patients with cancer. The aim of this study was to assess the prognostic value of markers of systemic inflammation in patients with adenocarcinoma of the oesophagus or gastro-oesophageal junction.

METHODS

Data from a consecutive series of patients undergoing transthoracic oesophagectomy following neoadjuvant therapy at a single centre were analysed. Fibrinogen, albumin, C-reactive protein, leucocyte differential and platelet counts were measured before surgery. The upper quartile (75th percentile) was used as a cut-off for dichotomization. Multivariable regression analysis was performed to identify independent prognostic factors.

RESULTS

A series of 199 patients underwent transthoracic oesophagectomy following neoadjuvant therapy. Univariable analysis indicated that reduced median survival was associated with a raised platelet : lymphocyte ratio (158 or above; 25.6 versus 44·4 months for patients with a normal ratio, P = 0·038) and increased fibrinogen levels (4·9 g/l or above; 22·8 versus 59·9 months for those with a normal level, P = 0·005). On multivariable analysis a combination of one or more markers of systemic inflammation was associated with poorer overall survival (hazard ratio 2·12, 95 per cent c.i. 1·20 to 3·74; P = 0·010).

CONCLUSION

Preoperative markers of systemic inflammation predict poor outcome in patients undergoing curative treatment for locally advanced oesophageal and gastro-oesophageal adenocarcinoma.

The pretreatment thrombocytosis may predict prognosis of patients with colorectal cancer: a systematic review and meta-analysis

AIM

Recently, several studies have reported that thrombocytosis may be associated with the poor prognosis of colorectal cancer (CRC). Nevertheless, their conclusions were still controversial. Results & methodology: We searched PubMed, Embase, Cochrane Library and Web of Science up to April 2016. A total of 30 studies including 9129 patients were included in this meta-analysis. Thrombocytosis had a close relationship with the poor overall survival of CRC compared with normal platelet counts, with the pooled hazard ratios being 1.89 (95% CI: 1.45-2.47; p < 0.00001) and 1.83 (95% CI: 1.33-2.53; p = 0.0002), with univariate and multivariate analyses, respectively.

DISCUSSION & CONCLUSION

This meta-analysis indicated that thrombocytosis may be a cost-effective and noninvasive indicator for poor prognosis of patients with CRC, especially for overall survival.

Novel Inflammation-Based Prognostic Score for Predicting Survival in Patients with Metastatic Urothelial Carcinoma

Purpose

We developed a novel inflammation-based model (NPS), which consisted of a neutrophil to lymphocyte ratio (NLR) and platelet count (PC), for assessing the prognostic role in patients with metastatic urothelial carcinoma (UC).

Materials and Methods

We performed a retrospective analysis of patients with metastatic UC who underwent systemic chemotherapy between January 1997 and December 2014 in Kaohsiung Chang Gung Memorial Hospital. The defined cutoff values for the NLR and PC were 3.0 and 400 × 10³/μL, respectively. Patients were scored 1 for either an elevated NLR or PC, and 0 otherwise. The NPS was calculated by summing the scores, ranging from 0 to 2. The primary endpoint was overall survival (OS) by using Kaplan–Meier analysis. Multivariate Cox regression analysis was used to identify the independent prognostic factors for OS.

Results

In total, 256 metastatic UC patients were enrolled. Univariate analysis revealed that patients with either a high NLR or PC had a significantly shorter survival rate compared with those with a low NLR (P = .001) or PC (P < .0001). The median OS in patients with NPS 0, 1, and 2 was 19.0, 12.8, and 9.3 months, respectively (P < .0001). Multivariate analysis revealed that NPS, along with the histologic variant, liver metastasis, age, and white cell count, was an independent factor facilitating OS prediction (hazard ratio 1.64, 95% confidence interval 1.20–2.24, P = .002).

Conclusion

The NLR and PC are independent prognostic factors for OS in patients with metastatic UC. The NPS model has excellent discriminant ability for OS.

Cancer and Thrombosis: The Platelet Perspective

Platelets are critical to hemostatic and immunological function, and are key players in cancer progression, metastasis, and cancer-related thrombosis. Platelets interact with immune cells to stimulate anti-tumor responses and can be activated by immune cells and tumor cells. Platelet activation can lead to complex interactions between platelets and tumor cells. Platelets facilitate cancer progression and metastasis by: (1) forming aggregates with tumor cells; (2) inducing tumor growth, epithelial-mesenchymal transition, and invasion; (3) shielding circulating tumor cells from immune surveillance and killing; (4) facilitating tethering and arrest of circulating tumor cells; and (5) promoting angiogenesis and tumor cell establishment at distant sites. Tumor cell-activated platelets also predispose cancer patients to thrombotic events. Tumor cells and tumor-derived microparticles lead to thrombosis by secreting procoagulant factors, resulting in platelet activation and clotting. Platelets play a critical role in cancer progression and thrombosis, and markers of platelet-tumor cell interaction are candidates as biomarkers for cancer progression and thrombosis risk.

Neutrophil-lymphocyte ratio as a prognostic marker for chemotherapy in advanced lung cancer

BACKGROUND

Lung cancer ranks first both in morbidity and mortality in malignancies, but prognostic biological markers are lacking. The neutrophil-lymphocyte ratio (NLR) was proposed as a convenient biological marker. This study aimed to explore the prognostic value of NLR in advanced non-small cell lung cancer (NSCLC).

METHODS

This retrospective study screened patients admitted from October 2007 to October 2014. Patients had histopathologically confirmed, treatment-naïve, metastatic NSCLC, and were prescribed platinum doublet chemotherapy. NLR and demographic data were collected, together with the outcome of chemotherapy. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and Cox regression model.

RESULTS

A total of 325 patients were enrolled. The cutoff value for NLR (3.19) was determined by receiver operator characteristic analysis. Patients were dichotomized into high (≥3.19) and low (&lt;3.19) NLR groups. Both groups had similar demographic features. However, the low-NLR group had longer PFS (6.1 months) and OS (22.3 months) than the high-NLR group (5.1 months, p = 0.002; 13.1 months, p&lt;0.001, respectively). Multivariate analysis confirmed that NLR was inversely related to the prognosis of these patients (HR = 1.684, 95%: 1.297-2.185, p&lt;0.001).

CONCLUSIONS

This study argues that NLR is a convenient prognostic biological marker for advanced NSCLC patients treated with first-line chemotherapy and warrants further validation.