Low lymphocyte count and high monocyte count predicts poor prognosis of gastric cancer

A Novel Clinical Five-Risk Factor Panel for Individualized Recurrence Risk Assessment of Patients With Acute Anterior Uveitis

Purpose

Detecting and managing relapses of acute anterior uveitis (AAU) is necessary for improving follow-up planning to minimize recurrences and further complications. However, reliable clinical and laboratory risk factors are lacking, as is a predictive model for use in clinical practice that is capable of identifying patients at high risk for recurrence after remission.

Methods

We analyzed 38 laboratory parameters and clinical data from a large longitudinal retrospective cohort of 233 patients with AAU. Association of laboratory parameters with recurrence-free survival (RFS) was evaluated using univariate Cox proportional hazards regression. A clinically applicable predictive model was developed using a logistic regression model.

Results

Of the 38 laboratory parameters studied, we identified 5 parameters (HDL, ankylosing spondylitis, HLA-B27, MO, and LDL) to be associated with RFS. We developed a clinical five-risk factor panel (5RF-panel), which was capable of effectively distinguishing recurrent patients from nonrelapsed patients (area under the curve [AUC] = 0.837), as well as between patients with high and low risks of AAU recurrence (hazard ratio [HR] = 45.874, 95% confidence interval [CI] = 5.232-402.2, P < 0.001). The robust performance of the 5RF-panel was further validated in the testing cohort (AUC = 0.725, and HR = 51.982, 95% CI = 4.438-608.9, P = 0.024). Furthermore, the 5RF-panel demonstrated superior performance in stratifying recurrence risk based on known risk factors.

Conclusions

We identified and validated a novel clinical 5RF-panel to predict individualized risk of AAU recurrence and improved patient classification for clinical management.

Translational Relevance

The present study identified and validated a 5RF-panel that is a promising individualized predictive tool to monitor recurrence risk and guide personalized management of patients with AAU.

Prognostic Impact of Indicators of Systemic Inflammation and the Nutritional Status of Patients with Resected Carcinoma of the Ampulla of Vater: A Single-Center Retrospective Study

BACKGROUND

Several indicators of systemic inflammation and nutritional status were recently shown to serve as novel prognostic factors for certain cancers. Here, we aimed to investigate the prognostic impact of preoperative indicators of systemic inflammation and nutritional status associated with the survival of patients with resected ampulla of Vater carcinoma (AC).

METHODS

We retrospectively analyzed the records of 91 patients who underwent pancreatoduodenectomy (PD) for AC from January 2002 through December 2018. Indices for systemic inflammation and nutritional status (Systemic immune-inflammation index [SII], Prognostic nutritional index [PNI], modified Glasgow prognostic score [mGPS], and Controlling nutritional status score [CONUT]) were determined using preoperative blood tests. Clinicopathological factors and these indices were analyzed to identify predictors of overall survival (OS).

RESULTS

The median preoperative SII and PNI values were 456.7 and 47.5, respectively, and their optimal cut-off values were 670.0 and 50.0, respectively. Univariate analysis revealed that high SII, low PNI, mGPS ≥ 1, and malnutrition, assessed using the CONUT, were significant predictors of shorter OS. Multivariate analysis revealed that high SII (HR = 2.71, p = 0.023) and malnutrition assessed using the CONUT (hazard ratio = 3.98, p = 0.006) were independent predictors of shorter OS.

CONCLUSION

SII and the CONUT predicted the survival of patients with AC after radical resection. These indicators are easily calculated using preoperative blood tests and may contribute to the development of improved strategies to treat AC.

Prognostic Value of Combined Preoperative Carcinoembryonic Antigen and Prognostic Nutritional Index in Patients With Stage II-III Colon Cancer

Background: Tumor status can affect patient prognosis. Prognostic nutritional index (PNI), as a nutritional indicator, is closely related to the prognosis of cancer. However, few studies have examined the combined prognostic value of CEA and PNI in patients. This study investigated the relationship between CEA/PNI and prognosis of colon cancer patients.

Methods: A total of 513 patients with stage II–III colon cancer who underwent curative resection at two medical centers from 2009 to 2019 were included. Clinicopathological factors were assessed and overall survival (OS) was assessed in a cohort of 413 patients. Multivariate analysis was used to identify independent prognostic variables to construct histograms predicting 1-year and 3-year OS. Data from 100 independent patients in the validation group was used to validate the prognostic model.

Results: The median OS time was 33.6 months, and mortality was observed in 54 patients. Multivariate analysis revealed that preoperative CEA/PNI, lymph node metastasis, peripheral nerve invasion, operation mode, and postoperative chemotherapy were independent factors for prognosis evaluation and thus were utilized to develop the nomogram. The C-index was 0.788 in the learning set and 0.836 in the validation set. The calibration curves reached favorable consensus among the 1-, 3-year OS prediction and actual observation.

Conclusion: The combined use of CEA and PNI is an independent prognostic factor and thus can serve as a basis for a model to predict the prognosis of patients with stage II–III colon cancer.

The Predictive Values of Pretreatment Controlling Nutritional Status (CONUT) Score in Estimating Short- and Long-term Outcomes for Patients with Gastric Cancer Treated with Neoadjuvant Chemotherapy and Curative Gastrectomy

Purpose

Previous studies have demonstrated the usefulness of the controlling nutritional status (CONUT) score in nutritional assessment and survival prediction of patients with various malignancies. However, its value in advanced gastric cancer (GC) treated with neoadjuvant chemotherapy and curative gastrectomy remains unclear.

Materials and Methods

The CONUT score at different time points (pretreatment, preoperative, and postoperative) of 272 patients with advanced GC were retrospectively calculated from August 2004 to October 2015. The χ² test or Mann-Whitney U test was used to estimate the relationships between the CONUT score and clinical characteristics as well as short-term outcomes, while the Cox proportional hazard model was used to estimate long-term outcomes. Survival curves were estimated by using the Kaplan-Meier method and log-rank test.

Results

The proportion of moderate or severe malnutrition among all patients was not significantly changed from pretreatment (13.5%) to pre-operation (11.7%) but increased dramatically postoperatively (47.5%). The pretreatment CONUT-high score (≥4) was significantly associated with older age (P=0.010), deeper tumor invasion (P=0.025), and lower pathological complete response rate (CONUT-high vs. CONUT-low: 1.2% vs. 6.6%, P=0.107). Pretreatment CONUT-high score patients had worse progression-free survival (P=0.032) and overall survival (OS) (P=0.026). Adjusted for pathologic node status, the pretreatment CONUT-high score was strongly associated with worse OS in pathologic node-positive patients (P=0.039).

Conclusions

The pretreatment CONUT score might be a straightforward index for immune-nutritional status assessment, while being a reliable prognostic indicator in patients with advanced GC receiving neoadjuvant chemotherapy and curative gastrectomy. Moreover, lower pretreatment CONUT scores might indicate better chemotherapy responses.

Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer

Background

Since inflammation and the immune system contribute to the development and progression of malignancies, parameters that reflect a host’s immune-inflammatory status may be useful prognostic indicators of gastric cancer (GC). The present study examined the clinical significance of a preoperative systemic immune-inflammation index (SII) for predicting postoperative survival outcomes in GC.

Methods

A total of 447 patients who underwent curative gastrectomy for GC were included in the present study. SII was calculated as platelet count × neutrophil count/lymphocyte count. The prognostic impact of preoperative SII was examined using univariate and multivariate analyses.

Results

Preoperative SII ranged between 105 and 4455 (median 474), and the optimal cutoff value for predicting overall survival (OS) was 395 based on a receiver operating characteristic curve. The 5-year OS rate of the SII ≥ 395 group was 80.0%, which was significantly worse than that (92.7%) of the SII < 395 group (p < 0.001). The multivariate analysis identified SII ≥ 395 (hazard ratio [HR] 2.95; 95% confidence interval [CI] 1.49–6.39; p = 0.001), heart disease (HR 2.14, 95% CI 1.07–4.07), C-reactive protein ≥ 0.5 (HR 2.45, 95% CI 1.15–4.94), pT4 (HR 4.46, 95% CI 2.44–8.14), and pN+ (HR 4.02, 95% CI 2.10–7.93) as independent predictors of worse OS. Peritoneal recurrence was more frequent in the high SII group than in the low SII group (p = 0.028).

Conclusion

Preoperative SII may be a useful predictor of postoperative survival outcomes in GC. The meticulous surveillance of GC relapse, particularly peritoneal dissemination, is necessary for patients with SII ≥ 395 even after curative gastrectomy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-021-02286-3.

Association between absolute lymphocyte count and overall mortality in patients with surgically resected gastric cancer

BACKGROUND/AIMS

Lymphocytes are an important component of the cell-mediated immune system. As lymphopenia is reportedly associated with poor prognoses in patients with various cancers, we investigated this notion in patients who underwent curative gastrectomy.

METHODS

We retrospectively analyzed the association between absolute lymphocyte count (ALC) and prognosis in patients with stage I-III gastric cancer who underwent curative surgical resection. Ever lymphopenic patients were defined as those with ALCs < 1,000/μL at any time post-diagnosis except within 30 days post-surgery. Adjusted multivariable regression models were used to evaluate the associations between lymphopenia and overall mortality, gastric cancer-specific mortality, and disease-free survival.

RESULTS

We investigated 1,222 patients diagnosed between January 2011 and December 2015. Fifty-six patients (4.6%) were lymphopenic at diagnosis and nearly one-quarter (24.8%) were ever lymphopenic with a mean minimum ALC of 640/μL. Older age (odds ratio [OR], 1.02) and higher stage (stage III vs. I; OR, 3.01) were positively associated with ever lymphopenia. On multivariable analysis, ever lymphopenia predicted higher overall mortality (hazard ratio [HR], 1.83; p = 0.008), higher gastric cancer-specific mortality (HR, 1.58; p = 0.048), and shorter disease-free survival (HR, 1.83; p = 0.006). The 5-year gastric cancer-specific mortality rates for ever- and never lymphopenic patients were 10.9% and 3.7%, respectively; their 5-year cumulative recurrence rates were 15.1% and 4.6%, respectively.

CONCLUSION

This study demonstrate that ever lymphopenia is independent prognostic factor for overall mortality and recurrence in patients with potentially curable gastric cancer; hence, ALCs may be a biomarker for predicting the prognoses of patients with stage I-III gastric cancer who had curative gastrectomy.

Systemic Inflammatory Score predicts Overall Survival in patients with Cervical Cancer

Background: To evaluate the prognostic value of the systemic inflammatory score (SIS) in cervical cancer patients.

Methods: A total of 264 patients with FIGO stage (2009) IB-IIA cervical cancer undergoing radical resection from January 2014 to December 2017 were recruited. The optimal cutoff values for inflammatory biomarkers were calculated by X-tile software. The prognostic factors were investigated using univariate and multivariate Cox analyses. Time-dependent receiver operating characteristic (time-ROC) analysis and the concordance index (C-index) were used to compare the prognostic impact of factors.

Results: In total, 264 patients with cervical cancer were included in the study. The optimal cutoff value for lymphocyte-to-monocyte ratio (LMR) was 4.1. In multivariate analysis, FIGO stage, lymphovascular invasion, lymph node metastasis, preoperative serum albumin (Alb), and LMR were independent prognostic factors (P<0.05). Then, we combined preoperative Alb and LMR to establish the SIS. Multivariate analysis showed that the SIS was an independent factor that affected survival (P<0.05). When stratified by FIGO stage, significant differences in survival were also found for patients with different SISs (P<0.05). When the SIS and FIGO stage were combined, the time-ROC curve was superior to that of FIGO stage only. The C-index of the model combining the SIS and FIGO stage was 0.786 (95% CI 0.699-0.873), which was significantly higher than that of the model with FIGO stage only (0.676, 95% CI 0.570-0.782, P=0.0049).

Conclusions: The preoperative SIS is a simple and useful prognostic factor for postoperative survival in patients with cervical cancer. It might assist in the identification of high-risk patients among patients with the same FIGO stage.

Pre-treatment absolute lymphocyte count predicts for improved survival in human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma

BACKGROUND

The prognostic value of pretreatment complete blood count (CBC) data, including absolute lymphocyte count (ALC) and the neutrophil-to-lymphocyte ratio (NLR), has been reported for many diseases with decreased ALC and increased absolute neutrophil count (ANC) and NLR values correlating with worse outcomes. There is minimal data relating these hematologic parameters to oropharyngeal squamous cell carcinoma (OPSCC) prognosis. This study evaluates the prognostic value of pretreatment CBC data in OPSCC on overall survival (OS) and progression-free survival (PFS) in relation to HPV status.

METHODS

A single-institutional retrospective review of patients with pretreatment hematologic data who received radiation for OPSCC was performed. Univariate and multivariate (UVA/MVA) Cox proportional hazard regression analyses were performed to identify prognostic variables. Translational studies related outcomes to the degree of tumor-infiltrating lymphocytes (TILs) in histologic specimens.

RESULTS

From 2007 to 2018, 201 patients were treated for OPSCC. Median follow-up was 40 months. 3-year OS was 86.2% in the HPV-positive cohort, 46.3% for HPV-negative. Median NLR was 3.04. NLR ≥ 3 was associated with worse PFS (HR 1.67, p = 0.044. In the subset of 158 HPV + patients, MVA revealed increasing ALC to be associated with improved OS (HR 0.53; p = 0.040) and PFS (HR = 0.48; p = 0.0075). On UVA, high-TIL infiltration at diagnosis was associated with improved OS.

CONCLUSION

In a cohort of HPV + OPSCC patients, increasing ALC is associated with improved OS and PFS. Our study is the first to identify pre-treatment ALC as an independent prognostic factor in HPV-associated OPSCC.

Inflammatory Markers in Cancer Immunotherapy

Simple Summary

Inflammation has been recognized to be linked to tumor development. Several markers of inflammation can be detected via blood such as variety of blood cells, which can be readily and easily obtained. These markers have been studied as ways to predict and prognosticate tumor response to chemotherapy. With the development of immunotherapy, namely immune checkpoint inhibitors (ICIs) such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed death ligand 1 (PDL-1) PDL-1 inhibitors, several markers have also been studied in assessing tumor response. In this review, we will discuss the various inflammatory markers that have been studied in several tumors treated with ICIs.

Abstract

Chronic inflammation is considered a major risk factor for cancer formation. Inflammation within the tumor environment plays a role in its response to therapy, growth, and prognosis. Cancer associated inflammation is known to occur in the tumor microenvironment and in the systemic circulation, and is correlated with disease progression and prognosis in many cancers. Blood cells such as neutrophils, lymphocytes, platelets, and circulating proteins such as C-reactive protein, and interleukins, such as IL-6, have been associated with inflammatory responses, which contribute to tumorigenesis. Cancer has found ways to evade the immune response; a pathway that can attenuate the innate immune response is via blocking immune checkpoints. Development of monoclonal antibodies against inhibitory immune checkpoints such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) have given rise to immunotherapy, which has shown remarkable responses in anti-tumor activity resulting in several U.S. Federal and Drug Administration (FDA)-approved checkpoint inhibitors. Various inflammatory markers and their prognostic and predictive implications in malignancies treated with immunotherapy will be discussed in this review.

Prognostic value of the preoperative lymphocyte-to-monocyte ratio for survival after lung cancer surgery

Background

The aim of this study was to assess the effect of the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on overall survival and disease-free survival in patients with lung cancer treated with radical surgery.

Methods

We performed a retrospective review of patients with lung cancer who prospectively underwent radical resection between 2004 and 2012. Blood samples were taken as part of the preoperative workup. The inflammatory markers studied were absolute values of lymphocytes, monocytes, neutrophils and platelets, with subsequent calculation of ratios. Median follow-up was 52 months.

Results

Two hundred and sixty-eight patients underwent surgery, of whom 218 (81.3%) were men. Mean age was 62.9 ± 8.7 years. A lymphocyte-to-monocyte ratio ≥ 2.5 was independently associated with longer disease-free survival (hazard ratio [HR] 0.476 (0.307–0.738), p = 0.001) and longer overall survival (HR, 0.546; 95% CI: 0.352–0.846; p = 0.007), in models adjusted for age, sex, stage, and type of resection. No other systemic inflammatory marker showed a significant association.

Conclusion

Preoperative LMR is an independent prognostic factor of overall survival and recurrence-free survival in patients with surgically-resected early stage lung cancer.

Elevated peripheral absolute monocyte count related to clinicopathological features and poor prognosis in solid tumors: Systematic review, meta-analysis, and meta-regression

BACKGROUND

Absolute monocyte count (AMC) is often used to be assessed in cancer follow-up, which has regained interest as a potential prognostic indicator in many solid tumors, though not consistently or comprehensively. In the present study, we set out to perform a comprehensive meta-analysis of all available data regarding the prognostic significance of AMC in solid tumors. We also evaluated the association between AMC and clinical features in solid tumors.

METHODS

A hazard ratio (HR) and corresponding 95% confidence interval (CI) or a p value (p) from eligible studies were extracted and subsequently pooled analyzed. Subgroup analyses and meta-regression analyses were conducted according to the confounders of included studies. In addition, the relationships between AMC and clinical characteristics were also explored in the meta-analysis.

RESULTS

Overall, ninety-three articles comprising 104 studies with 32229 patients were finally included. The results showed that elevated AMC was associated with worse overall survival (OS) (HR = 1.615; 95% CI: 1.475-1.768; p < 0.001), disease-free survival (DFS) (HR:1.488; 95% CI: 1.357-1.633; p < 0.001), progressive-free survival (PFS) (HR: 1.533; 95% CI: 1.342-1.751; p < 0.001) and cancer-specific survival (CSS) (HR: 1.585; 95% CI: 1.253-2.006; p < 0.001) in non-hematological tumors. Subgroup analyses according to each confounder further proved the consistent prognostic value of AMC in solid tumor outcomes. Moreover, elevated AMC was more likely to be observed in male group and patients with smoking history, and associated with longer tumor length and advanced T stage.

CONCLUSION

In short, the meta-analysis found that elevated AMC might indicate poor long-term outcomes in non-hematologic cancers, thus AMC may be a valuable marker in the prognosis for patients with solid tumors.

The role of lymphocyte-monocyte ratio on axial spondyloarthritis diagnosis and sacroiliitis staging

Background

Axial spondyloarthritis (axial SpA) is a chronic inflammatory disorder could lead to disability due to the failure of timely treatment. The role of lymphocyte-to-monocyte ratio (LMR) in axial SpA remains unclear. The aim of this study was to investigate the role of LMR in axial SpA diagnosis, disease activity classification and sacroiliitis staging.

Methods

Seventy-eight axial SpA patients [51males and 27 females; mean age 41.0 (29–52) years] and 78 healthy controls (HCs) [55males and 23 females; mean age 40 (30–53) years] were enrolled in this study. The diagnosis of axial SpA was performed according to the New York criteria or the Assessment of Spondyloarthritis international Society (ASAS) classification criteria, whereas the staging of sacroiliitis in axial SpA patients was determined by X-ray examination. Comparisons of LMR levels between groups were performed using t test. Pearson or Spearman correlation analysis were used to assess correlations between LMR and other indicators. Receiver operating characteristic (ROC) curves were used to determine the role of LMR in the diagnosis of axial SpA.

Results

Higher neutrophil-to-lymphocyte ratio(NLR), red blood cell distribution width(RDW), platelet-to-lymphocyte ratio(PLR), mean platelet volume(MPV), erythrocyte sedimentation rate (ESR), and C-reactive protein(CRP) levels and lower red blood cell (RBC), hemoglobin (Hb), Hematocrit (Hct), LMR, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin/globulin (A/G) levels were noted in axial SpA patients compared to HCs. Positive correlations were observed between LMR and RBC, Hb, Hct and A/G, whereas negative correlations were found between LMR and NLR, PLR, AST, and TBIL (P < 0.05). ROC curves showed that the area under the curve (AUC) for LMR in the diagnosis of ankylosing spondylitis was 0.803 (95% CI = 0.734–0.872) with a sensitivity and specificity of 62.8 and 87.2%, respectively, and the AUC (95% CI) for the combination of ESR, CRP and LMR was 0.975 (0.948–1.000) with a sensitivity and specificity of 94.9 and 97.4%, respectively. LMR levels were lower (P < 0.05) and significant differences in LMR values were observed among different stages (P < 0.05).

Conclusions

Our study suggested that LMR might be an important inflammatory marker to identify axial SpA and assess disease activity and X-ray stage of sacroiliitis.

Perineural invasion, lactate dehydrogenase, globulin, and serum sodium predicting occult metastasis in oral cancer

OBJECTIVE

This study aimed to develop a nomogram to predict the neck occult metastasis in early (T1-T2 cN0) oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

The nomogram was developed in a training cohort of 336 early OSCC patients and was validated in a validation cohort including 88 patients. Independent predictors were calculated by univariate and multivariate logistic regression analyses.

RESULTS

In univariate logistical regression analysis, gender, perineural invasion (PNI), blood vessel invasion, mean corpuscular hemoglobin, aspartate aminotransferase, prealbumin, globulin (GLO), lactate dehydrogenase (LDH), serum sodium (NA), and serum chloride were significant associated with neck occult metastasis. Multivariate logistical regression analysis identified PNI (p < .001), LDH (p = .003), GLO (p = .019), and NA (p = .020) as independent predictors of neck occult metastasis. Cut-off values for LDH, GLO, and NA obtained from AUC were 142.5, 26.35, and 139.5, respectively. The nomogram based on PNI and categorical GLO, LDH, and NA exhibited a strong discrimination, with a C-indexes of 0.748 (95%CI = 0.688 to 0.810) in the training cohort and 0.751 (95%CI = 0.639 to 0.863) in the validation cohort.

CONCLUSIONS

A nomogram based on PNI, LDH, GLO, and NA for predicting the risk of neck lymph nodes occult metastasis in OSCC could help surgeons with therapy decision-making.

Relationship of circulating immune cells with lifestyle factors and cancer recurrence in early-stage breast cancer

PURPOSE

To evaluate the relationship of circulating immune cells with recurrence and metabolic/lifestyle factors in patients with early-stage breast cancer.

METHODS

Patients with early-stage breast cancer were identified from the electronic record and institutional registry. Lymphocyte and monocyte counts were obtained from blood samples at time of diagnosis prior to any chemotherapy. Correlations between lymphocyte and monocyte and recurrence were assessed in the entire cohort and among obese patients, those reporting alcohol consumption and smoking. Competing risk regression was used to analyze time to recurrence.

RESULTS

A total of 950 patients with ≥ 5 years of follow-up were identified; 433 had complete data and were eligible for analysis. 293 (68%) had hormone receptor-positive breast cancer, 82 (19%) HER2 positive, and 53 (13%) triple negative. Patients in the highest quintile of lymphocytes compared to the lowest quintile had lower risk of recurrence (subhazard ratio (SHR) = 0.17, 95% CI [0.03-0.93], p = 0.041) while patients in the highest quintile of monocytes had lower risk for recurrence (SHR = 0.19, 95% CI [0.04, 0.92], p = 0.039). Higher monocytes were more strongly associated with lower recurrence among those reporting alcohol consumption (HR = 0.10, 95% CI [0.01, 0.91], p = 0.04). In obese patients, higher lymphocytes were associated with lower risk of recurrence (p = 0.046); in non-obese patients, higher monocytes were associated with lower risk of recurrence (p = 0.02). There were no correlations among patients who reported tobacco use.

CONCLUSIONS

High lymphocyte and monocyte counts are associated with lower recurrence rate in early-stage breast cancer, particularly in obese patients and those reporting alcohol consumption.

Longitudinal analysis of complete blood count parameters in advanced-stage lung cancer patients

BACKGROUND

Metastatic lung cancer is a debilitating disease, but with the advances in immunotherapy, therapeutic options have vastly increased. Numerous complete blood count parameters (CBC) have been described as easily accessible biomarkers that might predict response to immunotherapy. However, to date, no comprehensive study has been performed on the longitudinal changes of these parameters during cancer progression.

METHODS

The clinicopathological variables and CBC parameters of 986 advanced stage lung cancer patients were retrospectively analyzed. Blood tests were performed as part of the routine checkup and the results were recorded at the time of the diagnosis of the primary tumor, the diagnosis of brain or bone metastases, and also during the last available follow-up.

RESULTS

In the experimental subcohort, 352 and 466 patients were diagnosed with brain and bone metastases, respectively. The control group consisted of 168 patients without clinically detectable or other distant organ metastases. In our longitudinal analyses, we found significantly decreasing absolute lymphocyte count (ALC: P < 0.001), and significantly increasing absolute neutrophil count (ANC: P < 0.001) levels in all patient subgroups, irrespective of histopathological type and metastatic site. Interestingly, patients with brain metastases had significantly descending-ascending platelet count (PLT) trendlines (P < 0.001), while the bone metastatic subgroup exhibited significantly ascending-descending trendlines (P = 0.043).

CONCLUSIONS

Significantly decreasing ALC, significantly increasing ANC and fluctuating PLT levels may be found in brain and bone metastatic lung cancer patients during disease progression. Our findings might contribute to improve personalized healthcare in this devastating malignancy.

KEY POINTS

SIGNIFICANT FINDINGS OF THE STUDY: Significantly decreasing ALC, and significantly increasing ANC levels can be found in advanced-stage lung cancer patients during disease progression Patients with brain metastases have descending-ascending PLT trendlines, while patients with bone metastases exhibit ascending-descending trendlines during disease progression WHAT THIS STUDY ADDS: The descending values for ALC, and the ascending mean values for PLT and ANC, might be suggestive of poor response to second- or third-line immunotherapy in advanced-stage lung cancer patients. The current study might help to improve patient selection and treatment strategies for brain and/or bone metastatic lung cancer patients.

Low Multiplication Value of Absolute Monocyte Count and Absolute Lymphocyte Count at Diagnosis May Predict Poor Prognosis in Neuroblastoma

Despite the growing evidences that immune dysfunction contributes to tumor progression, the prognostic value in patients with neuroblastoma regarding circulating immune blood cell counts has not been well characterized. To answer this, we conducted a retrospective study to evaluate the prognostic value of the circulating immune cell counts at diagnosis in a cohort of 55 patients with neuroblastoma. Based on a novel index by multiplying the absolute monocyte count (AMC)/μl and absolute lymphocyte count (ALC)/μl, we sub-grouped patients with AMC × ALC ≥ 1 × 10⁶ (/μl)² as high group and patients with AMC × ALC < 1 × 10⁶ (/μl)² as low group. In the entire cohort, the 4-year progression-free survival (PFS), and overall survival (OS) for high group (n = 38) vs low group (n = 17) was 81.7% (95%CI; 63.6-91.3%) and 90.7% (95%CI; 73.8-96.9%) vs 31.7% (11.6-54.1%) and 56.5% (29.7-76.4%; p < 0.001 for PFS and p = 0.015 for OS), respectively, suggesting that a low AMC × ALC is associated with poor prognosis. In the subgroup analysis for high-risk patients, the 4-year PFS and OS for high group (n = 17) vs low group (n = 13) was 59.8% (31.2-79.7%) and 79.8% (49.4-93.0%) vs 8.5% (0.5-31.7%) and 42.0% (15.4-66.8%; p < 0.001 for PFS and p = 0.089 for OS), respectively. Our data demonstrate that AMC × ALC at diagnosis is a cost-effective and easily measurable biomarker for predicting prognosis in neuroblastoma.

Systemic Reprogramming of Monocytes in Cancer

Monocytes influence multiple aspects of tumor progression, including antitumor immunity, angiogenesis, and metastasis, primarily by infiltrating tumors, and differentiating into tumor-associated macrophages. Emerging evidence suggests that the tumor-induced systemic environment influences the development and phenotype of monocytes before their arrival to the tumor site. As a result, circulating monocytes show functional alterations in cancer, such as the acquisition of immunosuppressive activity and reduced responsiveness to inflammatory stimuli. In this review, we summarize available evidence about cancer-induced changes in monopoiesis and its impact on the abundance and function of monocytes in the periphery. In addition, we describe the phenotypical alterations observed in tumor-educated peripheral blood monocytes and highlight crucial gaps in our knowledge about additional cellular functions that may be affected based on transcriptomic studies. We also highlight emerging therapeutic strategies that aim to reverse cancer-induced changes in monopoiesis and peripheral monocytes to inhibit tumor progression and improve therapy responses. Overall, we suggest that an in-depth understanding of systemic monocyte reprogramming will have implications for cancer immunotherapy and the development of clinical biomarkers.

Preoperative C-reactive protein-to-albumin ratio predicts long-term outcomes in extrahepatic cholangiocarcinoma patients

BACKGROUND

Systemic inflammation may have prognostic value in some malignancies and association with lymph node metastasis. This study aimed to evaluate the impact of systemic inflammatory biomarkers on long-term and oncological outcomes as well as to assess the association between biomarkers with lymph node metastasis in extrahepatic cholangiocarcinoma patients.

METHODS

We enrolled 271 consecutive patients who underwent surgical resection for extrahepatic cholangiocarcinoma. Poor prognostic factors were compared to identify the biomarkers that were most associated with overall survival (OS) and disease-free survival (DFS) using receiver operating characteristic curves and multivariable analysis. Furthermore, we evaluated the relationship between biomarkers and lymph node metastasis.

RESULTS

Four and two biomarkers were predictive for OS and DFS, respectively, among which, the C-reactive protein-to-albumin ratio (CAR) had the highest area under the curve values (OS: 0.631, DFS: 0.624). Multivariable analysis showed that a high CAR was an independent prognostic factor for both OS and DFS (P = .002 and P < .001, respectively). Although a high CAR was not significantly correlated with lymph node metastasis (P = .645), carbohydrate antigen 19-9 showed a significant correlation (P < .001).

CONCLUSIONS

Preoperative CAR is the most accurate prognostic factor for OS and DFS in extrahepatic cholangiocarcinoma patients and is independent of lymph node metastasis.

Association between gestational age at delivery and lymphocyte-monocyte ratio in the routine second trimester complete blood cell count

BACKGROUND

We aimed to determine whether routine second trimester complete blood cell (CBC) count parameters, including neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ratio (PLR), could predict obstetric outcomes.

METHODS

We included singleton pregnancies for which the 50-g oral glucose tolerance test and CBC were routinely performed between 24 and 28 weeks of gestation in our outpatient clinic from January 2015 to December 2017. The subjects were divided into three groups according to their pregnancy outcomes as follows: group 1, spontaneous preterm births, including preterm labor and preterm premature rupture of membranes; group 2, indicated preterm birth due to maternal, fetal, or placental causes (hypertensive disorder, fetal growth restriction, or placental abruption); and group 3, term deliveries, regardless of the indication of delivery. We compared the CBC parameters using a bivariate correlation test.

RESULTS

The study included 356 pregnancies. Twenty-eight subjects were in group 1, 20 in group 2, and 308 in group 3. There were no significant differences between the three groups in neutrophil, monocyte, lymphocyte, and platelet counts. Although there was no significant difference in NLR, LMR, and PLR between the three groups, LMR showed a negative correlation with gestational age at delivery (r=-0.126, p=0.016).

CONCLUSION

We found that a higher LMR in the second trimester was associated with decreased gestational age at delivery. CBC parameters in the second trimester of pregnancy could be used to predict adverse obstetric outcomes.

Neutrophil-to-lymphocyte ratio and red blood cell distribution width-to-platelet ratio predict cardiovascular events in hemodialysis patients

Cardiovascular diseases are among the primary causes of decreased quality of life as well as mortality of hemodialysis patients with end-stage renal disease. The aim of the present study was to evaluate the predictive value of the red blood cell distribution width (RDW)-to-platelet ratio (RPR) and neutrophil-to-lymphocyte ratio (NLR) regarding the occurrence or development of cardiovascular events in hemodialysis patients, as well as the prognostic value of this metric. A total of 219 hemodialysis patients with cardiovascular events (HCE group) and 276 hemodialysis patients with no cardiovascular events (HNCE group) were enrolled in the present study. The clinical characteristics and laboratory parameters on admission, including RDW, as well as neutrophil, lymphocyte and platelet counts, were recorded. The NLR and RPR were increased in the HCE group compared with those in the HNCE group and there was a positive association between the NLR or RPR and the incidence of cardiovascular events in hemodialysis patients. In the receiver operating characteristics curve analysis, the area under the curve of the RPR for predicting cardiovascular events in hemodialysis patients was 0.88, while that for the NLR was 0.84. The sensitivity and specificity of the RPR for predicting cardiovascular events in hemodialysis patients were 0.87 and 0.82 respectively, and for the NLR, they were 0.75 and 0.79, respectively. The RPR was an independent risk factor for the prognosis regarding cardiovascular events in hemodialysis patients. In addition, the NLR and RPR were correlated with brain natriuretic peptide (BNP), cardiac troponin I (cTnI), creatine kinase isoenzyme-MB (CK-MB), and associated with ST segment changes in HCE patients. In conclusion, it was possible to predict the incidence of cardiovascular events in hemodialysis patients using the NLR and RPR, while the RPR had a better sensitivity and specificity than the NLR. The RPR was an independent risk factor for the prognosis regarding cardiovascular events in hemodialysis patients. These routinely available parameters should be considered as novel diagnostic markers for the occurrence and development of cardiovascular events in hemodialysis patients and their prognosis.

Diagnostic Value of Albumin to Fibrinogen Ratio in Cervical Cancer

BACKGROUND

Albumin to fibrinogen ratio (AFR) play a crucial role in the progression and prognosis of many malignant tumors. This study aimed to comprehensively assess the diagnostic value of AFR as single markers or in combination with squamous cell carcinoma antigen (SCC-Ag), cancer antigen 125 (CA-125) in cervical cancer.

METHODS

A total of 323 cervical cancer inpatients, 143 patients with cervical intraepithelial neoplasia (CIN) and 317 healthy controls were analyzed. Differences in laboratory parameters and clinicopathological features were calculated using the Mann-Whitney U or Kruskal-Wallis H test. The receiver operating characteristic (ROC) curve was used to evaluate the predicted value of AFR, alone or combined with SCC-Ag, CA-125 for the diagnosis of cervical cancer.

RESULTS

The levels of AFR in patients with cervical cancer were significantly lower than those in the CIN patients and the control subjects. AFR were not only negatively correlated with the tumor stage, but also related to histology typing, lymph node metastasis, distant metastasis, depth of stromal infiltration, tumor size, and tumor stage; however, it was not associated with the blood group. AFR combined with SCC-Ag possessed a larger area under the curve (AUC; AUC_AFR+SCC-Ag = 0.924, 95% confidence interval (CI) 0.900, 0.944) than AFR (P < 0.001), SCC-Ag (P < 0.001), or CA-125 (P < 0.001) did alone.

CONCLUSIONS

The pretreatment levels of AFR, alone or combined with SCC-Ag, CA-125 could improve the diagnostic efficiency of cervical cancer.

Combining the Fibrinogen/Albumin Ratio and Systemic Inflammation Response Index Predicts Survival in Resectable Gastric Cancer

Aims

Predicting the prognosis of gastric cancer using tumour-node-metastasis (TNM) staging is difficult as patients with the same TNM stage exhibit different prognoses.

Methods

This study investigated the prognostic value of the preoperative fibrinogen/albumin ratio (FAR)-systemic inflammation response index (SIRI) score in resectable gastric cancer (rGC).

Results

Clinicopathological features of 231 rGC patients were analysed retrospectively. Patients were divided into three groups: FAR-SIRI score 2 (FAR ≥ 0.071 and SIRI ≥ 0.84), 1 (FAR < 0.071 and SIRI ≥ 0.84), and 0 (SIRI < 0.84). Higher FAR-SIRI scores were associated with larger tumours, poorer differentiation, and advanced TNM stage (P < 0.05). Compared to those with FAR-SIRI scores of 0, patients with scores of 2 had poorer overall survival (OS). The FAR-SIRI score was an independent prognostic factor for OS in rGC.

Conclusion

The present data demonstrated that FAR-SIRI scores predicted radical gastric cancer surgical outcomes and may serve as a blood marker for identifying high-risk patients.

Evaluation and validation of the prognostic value of nutrition and immunity parameters in gastric cancer after R0 resection

Precise predictive tools are critical for choosing the individualized treatment protocols and follow-up procedures for patients with gastric cancer (GC). In this study, we aimed to evaluate and validate the prognostic abilities of preoperative nutrition and immunity parameters in GC after curative R0 resection.We established two nomograms based on 437 patients who underwent curative radical gastrectomy for gastric cancer to predict the postoperative overall survival (OS) and recurrence-free survival (RFS), and then compared the predictive accuracy and discriminative ability of the nomograms with the TNM stage systems for GC. An internal validation cohort of 141 patients and an external validation cohort of 116 patients were used to validate the result.The independent predictive factors for OS or RFS, including T stage, N stage, differentiated degree, neutrophil monocyte lymphocyte ratio (NMLR) and albumin globulin ratio (AGR) were used to establish the 2 nomograms. The C-index of the OS nomogram was 0.802, which was higher than that of the AGR, the NMLR and the TNM stage. The C-index of the RFS nomogram was 0.850, which was higher than that of the AGR, the NMLR and the TNM stage. Analogously, the areas under the receiver operating characteristics curves (AUROCs, 0.920 for OS and 0.897 for RFS, respectively) of the two nomograms were higher than that of the NMLR, the AGR and the TNM stage. In the internal validation cohort, the C-indexes of the OS and RFS nomograms were 0.812 and 0.826, respectively. In the external validation cohort, the C-indexes of the OS and RFS nomograms were 0.866 and 0.880, respectively.The proposed nomograms including nutrition and immunity parameters were proved to have excellent predictive ability in survival and recurrence for patients with GC after R0 resection.

Immune Response in H. pylori-Associated Gastritis and Gastric Cancer

Helicobacter pylori (H. pylori) is the dominant member of the gastric microbiota and has infected more than half of the human population, of whom 5–15% develop gastric diseases ranging from gastritis and metaplasia to gastric cancer. These diseases always follow inflammation induced by cell surface and intracellular receptors and subsequent signaling, such as the NF-κB pathway and inflammasomes. Some types of immune cells are recruited to enforce an antibacterial response, which could be impeded by H. pylori virulence factors with or without a specific immune cell. Following decreased inflammation, neoplasm may appear with a little immune surveillance and may inhibit antitumor immunity. Therefore, the balance between H. pylori-associated inflammation and anti-inflammation is crucial for human health and remains to be determined. Here, we discuss multiple inflammation and immunoregulatory cells in gastritis and summarize the main immune evasion strategies employed by gastric cancer.

[Association of adenylate cyclase-associated protein 2 expression with histopathology and long-term prognosis of gastric cancer]

OBJECTIVE

To explore association of the expression levels of adenylate cyclase-associated protein 2 (CAP2) in gastric cancer tissues with the histopathology and long-term prognosis of the malignancy.

METHODS

This study was conducted among a total of 105 patients with gastric cancer undergoing radical gastrectomy in our hospital between January, 2010 and October, 2013. Immunohistochemistry was used to quantitatively assess the expression of CAP2 in gastric cancer tissues and the adjacent tissues. Based on the median relative expression level of CAP2 of 3.5, the patients were divided into low CAP2 expression group (n=52) and high CAP2 expression group (n=53). The Cox regression model was used to analyze the effect of CAP2 expression on the 5-year survival rate of the patients, and ROC curve analysis was used to assess the predictive value of CAP2 expression for the patients' long-term survival.

RESULTS

Immunohistochemical analysis showed that the expression levels of CAP2 (P &lt; 0.01) and Ki67 (P &lt; 0.01) were significantly higher in gastric cancer tissues than in the adjacent tissues, and the expression level of CAP2 was positively correlated with Ki67 (P &lt; 0.01), peripheral blood CEA (P &lt; 0.01) and CA19-9 (P &lt; 0.01). The percentages of patients with CEA≥5 μg/L, CA19-9≥37 kU/L, pathological grade of G3-G4, T stage of 3-4, and N stage of 2-3 were significantly higher in patients with high CAP2 expression than in those with low CAP2 expression (P &lt; 0.05). Kaplan- Meier survival analysis showed that the 5-year survival rate was significantly lower in patients with a high CAP2 expression (P &lt; 0.01). A high expression level of CAP2, CEA≥5μg/L, CA19-9≥37 and pathological grades G3-G4 were all independent risk factors for shortened 5-year survival after radical gastrectomy (P &lt; 0.01). With the relative expression level of 3.45 as the cut-off value, the sensitivity of CAP2 was 70.15% for predicting death 5 years after the surgery, with a specificity of 71.05% and an area under the curve of 0.779 (P &lt; 0.01).

CONCLUSIONS

CAP2 is highly expressed in gastric cancer tissues in close relation with the tumor progression. CAP2 is an independent risk factor for 5-year survival rate after radical gastrectomy for gastric cancer and can be of clinical value in prognostic evaluation of the patients.

Immunohistochemical phenotyping of T cells, granulocytes, and phagocytes in the muscle of cancer patients: association with radiologically defined muscle mass and gene expression

BACKGROUND

Inflammation is a recognized contributor to muscle wasting. Research in injury and myopathy suggests that interactions between the skeletal muscle and immune cells confer a pro-inflammatory environment that influences muscle loss through several mechanisms; however, this has not been explored in the cancer setting. This study investigated the local immune environment of the muscle by identifying the phenotype of immune cell populations in the muscle and their relationship to muscle mass in cancer patients.

METHODS

Intraoperative muscle biopsies were collected from cancer patients (n = 30, 91% gastrointestinal malignancies). Muscle mass was assessed histologically (muscle fiber cross-sectional area, CSA; μm²) and radiologically (lumbar skeletal muscle index, SMI; cm²/m² by computed tomography, CT). T cells (CD4 and CD8) and granulocytes/phagocytes (CD11b, CD14, and CD15) were assessed by immunohistochemistry. Microarray analysis was conducted in the muscle of a second cancer patient cohort.

RESULTS

T cells (CD3+), granulocytes/phagocytes (CD11b+), and CD3-CD4+ cells were identified. Muscle fiber CSA (μm²) was positively correlated (Spearman's r = > 0.45; p = < 0.05) with the total number of T cells, CD4, and CD8 T cells and granulocytes/phagocytes. In addition, patients with the smallest SMI exhibited fewer CD8 T cells within their muscle. Consistent with this, further exploration with gene correlation analyses suggests that the presence of CD8 T cells is negatively associated (Pearson's r = ≥ 0.5; p = <0.0001) with key genes within muscle catabolic pathways for signaling (ACVR2B), ubiquitin proteasome (FOXO4, TRIM63, FBXO32, MUL1, UBC, UBB, UBE2L3), and apoptosis/autophagy (CASP8, BECN1, ATG13, SIVA1).

CONCLUSION

The skeletal muscle immune environment of cancer patients is comprised of immune cell populations from the adaptive and innate immunity. Correlations of T cells, granulocyte/phagocytes, and CD3-CD4+ cells with muscle mass measurements indicate a positive relationship between immune cell numbers and muscle mass status in cancer patients. Further exploration with gene correlation analyses suggests that the presence of CD8 T cells is negatively correlated with components of muscle catabolism.

Evaluating and validating the predictive ability of preoperative systemic inflammatory/immune cells in gastric cancer following R0 resection

The present study aimed to compare the predictive abilities of preoperative systemic inflammatory/immune cell ratios in gastric cancer (GC) following curative R0 resection, and to screen the optimal parameter incorporated into nomograms to predict the postoperative overall survival (OS) and recurrence-free survival (RFS). A total of 679 patients with GC were included in the study, divided into a primary cohort (300 cases), an internal validation cohort (278 cases), and an external validation cohort (101 cases). In the primary cohort, the prognostic abilities of all systemic inflammatory/immune cell accounts or ratios were compared by receiver operating characteristic (ROC) curve analysis. The area under the ROC curve (AUC) of the neutrophil-monocyte-lymphocyte ratio (NMLR) was largest for the prediction of OS (AUC=0.728) and RFS (AUC=0.695). The independent predictive factors for OS or RFS, including NMLR, degree of differentiation (DD), T-stage and N-stage were used to establish the 2 nomograms. The comprehensive predictive power of nomograms was compared with that of the tumor-nodes-metastasis (TNM) staging system and validated by bootstrap resampling. The concordance indexes (C-indexes) of the nomograms for OS [C-index, 0.851; 95% confidence interval (CI), 0.817-0.883] and RFS (C-index, 0.860; 95% CI, 0.831-0.889), were increased compared with those for the DD, the NMLR and the TNM stage. The AUCs of the 2 nomograms (0.933 for OS and 0.944 for RFS) were largest among all predictive scoring systems. In the internal validation cohort, the C-indexes of the nomograms for OS and RFS were 0.840 and 0.916, respectively. In the external validation cohort, the C-indexes of the nomograms for OS and RFS nomograms were 0.827 and 0.891, respectively. The present study demonstrated that the NMLR was an independent prognostic factor for patients with GC. The proposed nomograms were demonstrated to have a good predictive ability with improved sensitivity and accuracy in survival and recurrence in patients with GC undergoing R0 resection.

Prediction of future gastric cancer risk using a machine learning algorithm and comprehensive medical check-up data: A case-control study

A comprehensive screening method using machine learning and many factors (biological characteristics, Helicobacter pylori infection status, endoscopic findings and blood test results), accumulated daily as data in hospitals, could improve the accuracy of screening to classify patients at high or low risk of developing gastric cancer. We used XGBoost, a classification method known for achieving numerous winning solutions in data analysis competitions, to capture nonlinear relations among many input variables and outcomes using the boosting approach to machine learning. Longitudinal and comprehensive medical check-up data were collected from 25,942 participants who underwent multiple endoscopies from 2006 to 2017 at a single facility in Japan. The participants were classified into a case group (y = 1) or a control group (y = 0) if gastric cancer was or was not detected, respectively, during a 122-month period. Among 1,431 total participants (89 cases and 1,342 controls), 1,144 (80%) were randomly selected for use in training 10 classification models; the remaining 287 (20%) were used to evaluate the models. The results showed that XGBoost outperformed logistic regression and showed the highest area under the curve value (0.899). Accumulating more data in the facility and performing further analyses including other input variables may help expand the clinical utility.

Context Drives Diversification of Monocytes and Neutrophils in Orchestrating the Tumor Microenvironment

Recent preclinical/clinical studies have underscored the significant impact of tumor microenvironment (TME) on tumor progression in diverse scenarios. Highly heterogeneous and complex, the tumor microenvironment is composed of malignant cancer cells and non-malignant cells including endothelial cells, fibroblasts, and diverse immune cells. Since immune compartments play pivotal roles in regulating tumor progression via various mechanisms, understanding of their multifaceted functions is crucial to developing effective cancer therapies. While roles of lymphoid cells in tumors have been systematically studied for a long time, the complex functions of myeloid cells have been relatively underexplored. However, constant findings on tumor-associated myeloid cells are drawing attention, highlighting the primary effects of innate immune cells such as monocytes and neutrophils in disease progression. This review focuses on hitherto identified contextual developments and functions of monocytes and neutrophils with a special interest in solid tumors. Moreover, ongoing clinical applications are discussed at the end of the review.

Perioperative change in lymphocyte count and prognosis in esophageal squamous cell carcinoma

Background

Preoperative lymphocyte count (pre-LC) predicts the relapse and survival in patients with esophageal squamous cell carcinoma (ESCC), the clinical application of postoperative lymphocyte count (post-LC) change (LCc) remains unclear.

Methods

A retrospective analysis of patients with newly diagnosed ESCC who received curative resection from 2008 to 2015 was conducted. Complete blood counts from preoperative within seven days to postoperative within seven days were analyzed. LCc was defined as LCc increased (post-LC higher than pre-LC) and LCc decreased (post-LC lower than pre-LC). LCc was evaluated for an association with disease-free survival (DFS).

Results

A total of 677 patients who reach the standard were enrolled into the study. There were 579 (85.5%) male and 98 (14.5%) female patients with ESCC. The median age was 61 years (range, 39-84 years). In univariate analysis, LCc significantly correlated to DFS (P=0.006, HR =0.593, 95% CI: 0.409-0.862). In multivariate analysis (COX model), LCc was an independent prognostic factor for DFS (P=0.011, HR =0.617, 95% CI: 0.424-0.897).

Conclusions

The dynamic change of LC after surgery may serve as a simple and new prognostic factor in patients with newly diagnosed ESCC.

Monocytes as an Early Predictor for Patients with Acute Paraquat Poisoning: A Retrospective Analysis

BACKGROUND

The predictive values of monocytes in the prognosis of patients with acute paraquat (PQ) poisoning are unclear. This retrospective study investigated the predictive values of monocytes in the prognosis of patients with acute PQ poisoning.

METHODS

Adult patients who suffered from acute PQ poisoning in the emergency care unit of Cangzhou Central Hospital from May 2012 to December 2018 were enrolled. The patients were divided into groups, namely, survival and nonsurvival, according to a 90-day prognosis. Moreover, correlation, logistic regression, receiver-operator characteristic (ROC), and Kaplan-Meier curve analyses were applied to evaluate the monocyte values used to predict the prognosis of patients with acute PQ poisoning.

RESULT

Among the 109 patients, 45 survived within 90 days after the poisoning, resulting in a 41.28% survival rate. The monocyte count of the nonsurvivors was significantly higher than that of the survivors (P< 0.001). Correlation analysis showed that monocyte count positively correlated with plasma PQ concentration (r= 0.413; P< 0.001) and negatively correlated with survival time (r= 0.512; P< 0.001) and 90-day survival (r= 0.503; P< 0.001). Logistic regression analysis showed that elevated monocytes were the independent risk factors for the 90-day survival. The area under the ROC curve of the monocyte count used to predict the 90-day survival was 0.826 (95% CI: 0.751-0.904), the optimal cut-off was 0.51×109/L, sensitivity was 73.4%, and specificity was 86.7%.

CONCLUSION

This study demonstrated that elevated monocyte count is a useful early predictor of 90-day survival in patients with acute PQ poisoning. However, further studies are warranted to draw firm conclusions.

Short-term evaluation of immune levels and nutritional values of EN versus PN in gastric cancer: a systematic review and a meta-analysis

BACKGROUND

Postsurgical patients' oral feeding begins with clear fluids 1-3 days after surgery. This might not be sufficiently nutritious to boost the host immune system and provide sufficient energy in gastric neoplastic patients to achieve the goal of enhanced recovery after surgery (ERAS). Our objective was to analyze the significance of early postoperative feeding tubes in boosting patients' immunity and decreasing incidence of overall complications and hospital stay in gastric cancer patients' post-gastrectomy.

METHODS

From January 2005 to May 24, 2019, PubMed and Cochrane databases were searched for studies involving enteral nutrition (EN) feeding tubes in comparison to parenteral nutrition (PN) in gastric cancer patients undergoing gastrectomy for gastric malignancies. Relative risk (RR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI) were used to estimate the effect sizes, and heterogeneity was assessed by using Q and χ² statistic with their corresponding P values. All the analyses were performed with Review Manager 5.3 and SPSS version 22.

RESULTS

Nine randomized trials (n = 1437) and 5 retrospective studies (n = 421) comparing EN feeding tubes and PN were deemed eligible for the pooled analyses, with a categorized time frame of PODs ≥ 7 and PODs < 7. Ratio of CD4+/CD8+ in EN feeding tubes was the only outcome of PODs < 7, which showed significance (MD 0.22, 95% CI 0.18-0.25, P < 0.00001). Regarding other immune indicators, significant outcomes in favor of EN feeding tubes were measured on POD ≥ 7: CD3+ (SMD 1.71; 95% CI 0.70, 2.72; P = 0.0009), CD4+ (MD 5.84; 95% CI 4.19, 7.50; P < 0.00001), CD4+/CD8+ (MD 0.28; 95% CI 0.20; 0.36, P < 0.00001), NK cells (SMD 0.94; 95% CI 0.54, 1.30; P < 0.00001), nutrition values, albumin (SMD 0.63; 95% CI 0.34, 0.91; P < 0.001), prealbumin (SMD 1.00; 95% CI 0.52, 1.48; P < 0.00001), and overall complications (risk ratio 0.73 M-H; fixed; 95% CI 0.58, 0.92; P = 0.006).

CONCLUSION

EN feeding tube support is an essential intervention to elevate patients' immunity, depress levels of inflammation, and reduce the risk of complications after gastrectomy for gastric cancer. Enteral nutrition improves the innate immune system and nutrition levels but has no marked significance on certain clinical outcomes. Also, EN reduces the duration of hospital stay and cost, significantly.

Clinical and prognostic significance of combined plasma fibrinogen concentrations and the monocyte-to-lymphocyte ratio in patients with ovarian cancer

Background

Fibrinogen concentrations and the monocyte-to-lymphocyte ratio (FC-MLR) are associated with progression and outcomes of many malignancies. This study aimed to assess the clinical and prognostic significance of the combination of plasma FC-MLR in patients with ovarian cancer.

Methods

A total of 155 patients with epithelial ovarian cancer (EOC) and 102 patients with benign gynecological disease were retrospectively reviewed. The clinical and pathological data of all patients with EOC were analyzed. Plasma fibrinogen concentrations and the white blood cell (WBC) count were measured to calculate the MLR and neutrophil-to-lymphocyte ratio (NLR). Furthermore, the association of fibrinogen concentrations, the MLR, and FC-MLR with tumor stage, lymphatic and venous metastasis, and 5-year survival was assessed. Regression analysis was performed to evaluate the risk factors for progression of EOC. Receiver operating characteristic (ROC) curves were constructed to assess the prognostic power of plasma fibrinogen concentrations, the MLR, and FC-MLR, and to determine the optimal cutoff values of fibrinogen and the MLR. On the basis of the cutoff values, patients with EOC were divided into three groups: no abnormality, either increased, and both increased groups, respectively. The effect of FC-MLR on overall survival was calculated by the Kaplan-Meier method and compared by the log-rank test in the three groups.

Results

Patients with EOC had higher fibrinogen concentrations and a higher MLR than did controls (both P<0.01), and FC-MLR was closely associated with tumor stage and lymphatic and venous metastasis (all P<0.001). Furthermore, FC-MLR was an independent risk factor for progression of EOC (OR =8.985; 95% CI: 4.912-27.166; P<0.001), and patients with high fibrinogen concentrations and a high MLR showed a lower 5-year survival rate (P<0.001).

Conclusions

FC-MLR may be used as a predictor of tumor progression and prognosis for ovarian cancer.

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.

Prognostic significance of peripheral blood absolute lymphocyte count and derived neutrophil to lymphocyte ratio in patients with newly diagnosed extranodal natural killer/T-cell lymphoma

Background: Accumulating evidence suggested that tumor microenvironment and host immune system played important roles in determining the clinical course and outcome of human malignancies. The derived neutrophil to lymphocyte ratio (dNLR) and absolute lymphocyte count (ALC) were demonstrated to act as a prognostic factor in several malignancies. Nevertheless, the prognostic significance of them in extranodal natural killer/T-cell lymphoma (ENKTL) patients has never been explored.

Patients and methods: A total of 33 newly diagnosed patients with ENKTL were included in this study. Clinicopathological characteristics were collected and prognostic significance of dNLR and ALC were evaluated.

Results: Elevated dNLR and low ALC were both associated with poor survival rates. Patients with dNLR ≥3.6 revealed significantly shorter overall survival (OS) (P=0.001) and progression-free survival (PFS) (P=0.008) than those with dNLR <3.6. Patients with ALC <0.8×10⁹/L had worse OS (P=0.008) and PFS (P<0.001) than those with ALC ≥0.8×10⁹/L. An independent significant association between low ALC and poor clinical outcome in multivariate analysis for OS (HR, 36.023; 95% CI, 2.438–532.243; P=0.009) as well as PFS (HR, 7.698; 95%CI, 1.573–37.679; P=0.012) was identified.

Conclusion: In this study, we validated for the first time the prognostic value of dNLR and ALC in ENKTL patients. Elevated dNLR and low ALC were both associated with aggressive tumor process and poor survival.ALC value at diagnosis represented an independent favorable prognostic factor for the clinical outcome of ENKTL patients.