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Zhang H, Li J, Chen X, Wu N, Xie W, Tang H, Li C, Wu L, Xiang Y, Zhong L, Li Y. Association of Systemic Inflammation Score With Atrial Fibrillation: A Case-Control Study With Propensity Score Matching. Heart Lung Circ 2017; 27:489-496. [PMID: 28579228 DOI: 10.1016/j.hlc.2017.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Inflammation plays a key role in the initiation and progression of atrial fibrillation (AF). We developed a novel systemic inflammation score (SIS) based on integration of biomarkers used routinely in clinical settings. We aim to explore the association between SIS and AF. METHODS A matched case-control study with 376 pairs of AF cases and controls was performed using a propensity score matching system. The SIS was developed by integrating albumin (ALB), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocytes to monocytes ratio (LMR). Univariate and multivariate analyses were performed to examine the association of each marker and SIS with AF. RESULTS The conditional multivariate logistic regression analysis showed that elevated levels of ALB and LMR were significantly associated with decreased risk of AF with an OR of 0.74 (95% CI: 0.65, 0.85) and 0.73 (95% CI: 0.64, 0.83), respectively. Patients with elevated SIS had a significantly higher risk of AF. Compared to the patients with SIS equal to 1, the patients with SIS equal to 3 and 4 had an OR of 2.16 (95% CI: 1.40 3.32), and 2.55 (95% CI: 1.66, 3.92), respectively. The SIS was positively correlated with left atrial diameter and right atrial diameter in patients with AF. CONCLUSIONS In conclusion, this study provides further clinical epidemiological evidence that systemic inflammatory status was correlated with AF. The SIS, as an index to evaluate the intensity of systemic inflammatory status, could be useful for early prediction of AF development and understanding of AF mechanism.
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Affiliation(s)
- Huan Zhang
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People's Republic of China; Evidence-based Medicine and Clinical Epidemiology Center, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - Jun Li
- Department of Thoracic and Cardiac Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - Xinghua Chen
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - Na Wu
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People's Republic of China; Evidence-based Medicine and Clinical Epidemiology Center, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - Weijia Xie
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People's Republic of China; Evidence-based Medicine and Clinical Epidemiology Center, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - He Tang
- Institute of Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - Chengying Li
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People's Republic of China; Evidence-based Medicine and Clinical Epidemiology Center, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - Long Wu
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People's Republic of China; Evidence-based Medicine and Clinical Epidemiology Center, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - Ying Xiang
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People's Republic of China; Evidence-based Medicine and Clinical Epidemiology Center, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - Li Zhong
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, People's Republic of China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing 400038, People's Republic of China; Evidence-based Medicine and Clinical Epidemiology Center, Third Military Medical University, Chongqing 400038, People's Republic of China.
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Cai YJ, Dong JJ, Dong JZ, Yang NB, Song M, Wang YQ, Chen YP, Lin Z, Shi KQ. Neutrophil-lymphocyte ratio predicts hospital-acquired bacterial infections in decompensated cirrhosis. Clin Chim Acta 2017; 469:201-207. [PMID: 28412195 DOI: 10.1016/j.cca.2017.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 03/07/2017] [Accepted: 04/12/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bacterial infection is a frequent complication and severe burden in cirrhotic patients. We determined the utility of neutrophil-to-lymphocyte ratio (NLR) to predict the hospital-acquired (HA) bacterial infections episode in patients with decompensated cirrhosis. METHODS We retrospectively included 2066 consecutive decompensated cirrhotic patients from two separate tertiary hospitals, divided into training (n=1377) and validation (n=689) set. All data were collected on admission and all overt bacterial infections occurring after >48h of hospital stay were registered. RESULTS The incidence of HA bacterial infections in training and validation cohort was 35.87% and 31.05% respectively. Multivariate analysis showed that total bilirubin (TBil), albumin, white blood cell count (WBC) and NLR were independent predictors of HA bacterial infections. We established a Model_NTWA using these four variables and a Model_TWA which did not include NLR. Areas under the curves (AUC) of Model_NTWA (0.859) and NLR (0.824) were higher than which of Model_TWA (0.713), WBC (0.675), TBil (0.593) and Albumin (0.583). Consistent with training cohort, validation cohort showed similar results. Patients with NLR of at least 4.33 had a significantly lower survival (P<0.001). CONCLUSIONS NLR can be used as a novel noninvasive marker to predict the occurrence of HA bacterial infections in decompensated cirrhotic patients.
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Affiliation(s)
- Yi-Jing Cai
- Department of Infection and Liver Diseases, Hepatology Institute of Wenzhou Medical University, Key Laboratory of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jia-Jia Dong
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jin-Zhong Dong
- Department of Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Nai-Bing Yang
- Department of Infection and Liver Diseases, Hepatology Institute of Wenzhou Medical University, Key Laboratory of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mei Song
- Department of Infection and Liver Diseases, Hepatology Institute of Wenzhou Medical University, Key Laboratory of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yu-Qun Wang
- Department of Infection and Liver Diseases, Hepatology Institute of Wenzhou Medical University, Key Laboratory of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yong-Ping Chen
- Department of Infection and Liver Diseases, Hepatology Institute of Wenzhou Medical University, Key Laboratory of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhuo Lin
- Department of Infection and Liver Diseases, Hepatology Institute of Wenzhou Medical University, Key Laboratory of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Ke-Qing Shi
- Department of Infection and Liver Diseases, Hepatology Institute of Wenzhou Medical University, Key Laboratory of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Chen Y, Wang Y, Shi Y, Dai G. Timing of chemotherapy-induced neutropenia predicts prognosis in metastatic colon cancer patients: a retrospective study in mFOLFOX6 -treated patients. BMC Cancer 2017; 17:242. [PMID: 28376763 PMCID: PMC5379656 DOI: 10.1186/s12885-017-3240-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/29/2017] [Indexed: 01/19/2023] Open
Abstract
Background The occurrence of Chemotherapy-induced neutropenia (CIN) was reported to be a predictor of better survival in several cancers. The objective of our study is to evaluate the relationship between the timing of CIN and prognosis. Methods Between June 2012 and August 2014, 290 patients with confirmed metastatic colon cancer received at least one cycle of mFOLFOX6 as first-line chemotherapy were eligible for assessment as all patients group. Of the 232 received at least six cycles of mFOLFOX6 and survived 150 days after treatment were considered as landmark group. Timing of CIN was categorized into absence, early-onset and late-onset CIN groups. The end of cycle 3 was the cutoff to differentiate early-onset or late-onset. The correlation between timing of CIN with survival was analyzed by Kaplan-Meier method and Cox proportional hazards model. Results In all patients group, the median survival of patients without neutropenia, early-onset and late-onset neutropenia were 6.7, 20.7 and 12.8 months (P < 0.001). The patients with early-onset and late-onset CIN had better prognosis than CIN absence by multivariate analysis. Findings were much the same for landmark group. Conclusions In conclusion, timing of CIN is an independent predictor of prognosis in metastatic colon cancer patients received mFOLFOX6, whereas an early-onset of CIN predicts longer survival.
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Affiliation(s)
- Yang Chen
- Medical Oncology Department 2, Chinese People's Liberation Army General Hospital, Beijing, 100853, People's Republic of China
| | - YanRong Wang
- Medical Oncology Department 2, Chinese People's Liberation Army General Hospital, Beijing, 100853, People's Republic of China
| | - Yan Shi
- Medical Oncology Department 2, Chinese People's Liberation Army General Hospital, Beijing, 100853, People's Republic of China
| | - GuangHai Dai
- Medical Oncology Department 2, Chinese People's Liberation Army General Hospital, Beijing, 100853, People's Republic of China.
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He W, Wei M, Yang X, Chen B, Wu Q, Zheng E, Deng X, Wang Z. Do inflammatory markers predict prognosis in patients with synchronous colorectal cancer? Medicine (Baltimore) 2017; 96:e6607. [PMID: 28445257 PMCID: PMC5413222 DOI: 10.1097/md.0000000000006607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/12/2017] [Accepted: 03/23/2017] [Indexed: 02/06/2023] Open
Abstract
Systematic inflammatory response markers are considered as the most informative prognostic factors in many types of cancer. However, in synchronous colorectal cancer (synCRC), the prognostic value of inflammatory markers, including prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (d-NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), had rarely been evaluated. Thus, this present study reviewed our consecutive patients with synCRC to investigate the prognostic value of those factors.The primary endpoint was overall survival (OS), and disease-free survival (DFS) was considered as the secondary endpoint. Receiver-operating characteristic curve analysis was conducted to determine optimal cutoff levels for the 5 markers. Kaplan-Meier survival curves and Cox proportional hazards models were applied to assess the relationship between OS, DFS, and inflammatory markers.In total, 114 patients with pathologically confirmed synCRC at initial diagnosis were identified among 5742 patients who underwent surgery for colorectal cancer from October 2009 to May 2013. In the multivariate analysis, elevated postoperative NLR (≥10.50) was confirmed as an independent prognostic factor for 3-year OS (P = .001; hazard ratio [HR] 4.123, 95% confidence interval [CI] 1.750-9.567) and DFS (P = .001; HR 3.342, 95% CI 1.619-6.898). In addition, for 3-year OS, both tumor grade and pN stage were confirmed as independent prognostic factors. And pN stage was confirmed as an independent prognostic factor for 3-year DFS.In conclusion, this study identified elevated postoperative NLR is associated with a poor prognosis in patients with synCRC underwent surgery resection, and the NLR provides improved accuracy for predicting clinical outcomes to stratify patients into different risk categories.
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Affiliation(s)
- Wanbin He
- Department of Gastrointestinal Surgery
| | - Mingtian Wei
- Department of Gastrointestinal Surgery
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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105
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Peripheral Neutrophil to Lymphocyte Ratio Improves Prognostication in Colon Cancer. Clin Colorectal Cancer 2017; 16:115-123.e3. [PMID: 28365393 DOI: 10.1016/j.clcc.2017.01.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/17/2016] [Accepted: 01/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND We studied the role of peripheral neutrophil to lymphocyte ratio (NLR) on survival outcomes in colon and rectal cancer to determine if its inclusion improved prognostication within existing staging systems. PATIENTS AND METHODS Disease-free (DFS) and overall survival (OS) hazard ratios (HRs) of pretreatment NLR were calculated for 2536 patients with stage I to III colon or rectal cancer and adjusted for age, positive/total number of nodes, T stage, and grade. The association of NLR with clinicopathologic features and survival was evaluated and compared with the American Joint Committee on cancer (AJCC) TNM staging and Memorial Sloan Kettering Cancer Center (MSKCC) models. RESULTS High NLR was significantly associated with worse DFS (HR, 1.36; 95% confidence interval [CI], 1.08-1.70; P = .009) and OS (HR, 1.65; 95% CI, 1.29-2.10; P < .0005) in all stages for patients with colon, but not rectal, cancer. High NLR was significantly associated with site-specific worse prognosis, which was stronger in the left versus right colon; an inverse relationship with grade was found. The impact of high NLR on DFS and OS occurred early, with the majority of deaths within 2 years following surgery. Adjusted HRs for 5-year and 2-year outcomes in colon cancer per each additional 2-unit increase in NLR were 1.15 (95% CI, 1.08-1.23) and 1.20 (95% CI, 1.10-1.30), respectively. The addition of NLR enhanced the prognostic utility of TNM (TNM alone vs. TNM + NLR: concordance index, 0.60 vs. 0.68), and MSKCC (MSKCC alone vs. MSKCC + NLR: concordance index, 0.71 vs. 0.73) models for colon cancer patients. CONCLUSION NLR is an independent prognostic variable for nonmetastatic colon cancer that enhances existing clinical staging systems.
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Kim JH, Lee JY, Kim HK, Lee JW, Jung SG, Jung K, Kim SE, Moon W, Park MI, Park SJ. Prognostic significance of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with stage III and IV colorectal cancer. World J Gastroenterol 2017; 23:505-515. [PMID: 28210087 PMCID: PMC5291856 DOI: 10.3748/wjg.v23.i3.505] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/05/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with colorectal cancer (CRC).
METHODS Between April 1996 and December 2010, medical records from a total of 1868 patients with CRC were retrospectively reviewed. The values of simple inflammatory markers including NLR and PLR in predicting the long-term outcomes of these patients were evaluated using Kaplan-Meier curves and Cox regression models.
RESULTS The median follow-up duration was 46 mo (interquartile range, 22-73). The estimation of NLR and PLR was based on the time of diagnosis. In multivariate Cox regression analysis, high NLR (≥ 3.0) and high PLR (≥ 160) were independent risk factors predicting poor long-term outcomes in patients with stage III and IV CRC. However, high NLR and high PLR were not prognostic factors in patients with stage I and II CRC.
CONCLUSION In this study, we identified that high NLR (≥ 3.0) and high PLR (≥ 160) are useful prognostic factors to predict long-term outcomes in patients with stage III and IV CRC.
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107
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He X, Guo S, Chen D, Yang G, Chen X, Zhang Y, He Q, Qin Z, Liu Z, Xue Y, Zhang M, Liu R, Zhou F, Han H, Yao K. Preoperative Albumin to Globulin Ratio (AGR) as Prognostic Factor in Renal Cell Carcinoma. J Cancer 2017; 8:258-265. [PMID: 28243330 PMCID: PMC5327375 DOI: 10.7150/jca.16525] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/15/2016] [Indexed: 12/18/2022] Open
Abstract
Background: Malnutrition and systemic inflammatory response are frequently associated with prognosis in patients with several types of cancer, including renal cell carcinoma (RCC). The study is aimed to investigate the ability of preoperative serum albumin to globulin ratio (AGR) to predict the long-term mortality of RCC patients. Methods: The study is a retrospective study of an unselected cohort of 895 RCC patients who underwent a curative radical or partial nephrectomy at the Department of Urology in the Sun Yat-Sen University Cancer Center between January 2000 and December 2012 and had documented preoperative serum total protein and albumin (ALB) levels. The preoperative AGR was calculated as the ratio of ALB to (total protein-ALB) and its association with other clinical indices was assessed using survival analysis. Results: Low preoperative AGR was associated with older population, lower hemoglobin, higher total protein, lower ALB, lower body mass index and advanced stage. The univariate and multivariate Cox analyses demonstrated that preoperative AGR was an independent prognostic indicator of overall survival (OS) (hazard ratio (HR): 0.63, 95% confidence interval (CI): 0.43 to 0.93, P=0.022). In addition, patients with low preoperative AGR at pT1-2, pT3-4, pN0, pN1, pM0 and pM1 stages had significantly shorter OS than patients with high preoperative AGR. Conclusion: Preoperative AGR is a proven objective, reproducible, inexpensive survival predictor of RCC patients following surgical resection and should be considered for routine clinical use.
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Affiliation(s)
- Xiaobo He
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Medical Oncology, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Shengjie Guo
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Dong Chen
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guangwei Yang
- Department of Medical Oncology, the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Xin Chen
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yijun Zhang
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Qiuming He
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zike Qin
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhuowei Liu
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yunfei Xue
- Medicine school of Sun Yat-Sen University, Guangzhou, China
| | - Meng Zhang
- Medicine school of Sun Yat-Sen University, Guangzhou, China
| | - Ruiwu Liu
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, California, United States of America
| | - Fangjian Zhou
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hui Han
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Kai Yao
- Department of Urology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Critical evaluation of the potential prognostic value of the pretreatment-derived neutrophil-lymphocyte ratio under consideration of C-reactive protein levels in clear cell renal cell carcinoma. Br J Cancer 2016; 116:85-90. [PMID: 27907929 PMCID: PMC5220155 DOI: 10.1038/bjc.2016.393] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/09/2016] [Accepted: 11/03/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We investigated the prognostic value of the pretreatment-derived neutrophil-lymphocyte ratio (dNLR) and original NLR in relation to the commonly used inflammation marker C-reactive protein (CRP) in a large cohort of patients with clear cell renal cell carcinoma (RCC). METHODS Clinicopathological data from 587 consecutive non-metastatic clear cell RCC patients, operated between 2000 and 2010 at a single tertiary academic center, were evaluated retrospectively. Patients were categorised according to a cutoff value derived from receiver operating curve analysis. Overall (OS), cancer-specific (CSS) as well as metastasis-free survival (MFS) were assessed using the Kaplan-Meier method and multivariate Cox proportional models were applied. Spearman's rank correlation coefficient tested the association between dNLR and other markers of the systemic inflammatory response. RESULTS The significant correlation between pretreatment NLR and dNLR was strong (ρ=0.84), whereas between dNLR and CRP it was weak (ρ=0.18). In multivariate analyses, dNLR achieved independent predictor status regarding CSS (P=0.037) and MFS (P=0.041), whereas CRP was confirmed as independent predictor of OS (P=0.010), CSS (P=0.039) and MFS (P=0.005), respectively. The NLR failed to reach independent predictor status regarding OS, CSS and MFS when CRP was included into the multivariate model. CONCLUSIONS In the cohort studied, an elevated (⩾10.0) pretreatment CRP level and elevated dNLR (>2) were robust independent predictors of CSS and MFS. Our data suggest that CRP might be superior to both NLR and dNLR.
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Caputo D, Caricato M, Coppola A, La Vaccara V, Fiore M, Coppola R. Neutrophil to Lymphocyte Ratio (NLR) and Derived Neutrophil to Lymphocyte Ratio (d-NLR) Predict Non-Responders and Postoperative Complications in Patients Undergoing Radical Surgery After Neo-Adjuvant Radio-Chemotherapy for Rectal Adenocarcinoma. Cancer Invest 2016; 34:440-451. [PMID: 27740855 DOI: 10.1080/07357907.2016.1229332] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In order to evaluate neutrophil-to-lymphocyte ratio (NLR) and derived neutrophil-to-lymphocyte ratio (d-NLR) in predicting response and complications in rectal cancer patients who underwent surgery after neo-adjuvant radio-chemotherapy, 87 patients were evaluated. Cutoffs before and after radio-chemotherapy were respectively 2.8 and 3.8 for NLR, and 1.4 and 2.3 for d-NLR. They were analyzed in relation to clinical and pathological outcomes. Patients with preoperative NLR and d-NLR higher than cutoffs had significantly higher rates of tumor regression grade response (TRG ≥ 4) and postoperative complications. Elevated NLR and d-NLR after radio-chemotherapy are associated with worse pathological and clinical outcome.
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Affiliation(s)
- Damiano Caputo
- a Department of General Surgery , University Campus Bio-Medico di Roma , Rome , Italy
| | - Marco Caricato
- a Department of General Surgery , University Campus Bio-Medico di Roma , Rome , Italy
| | - Alessandro Coppola
- b International PhD Programme in Endocrinology and Metabolic Diseases, University Campus Bio-Medico di Roma , Rome , Italy
| | - Vincenzo La Vaccara
- a Department of General Surgery , University Campus Bio-Medico di Roma , Rome , Italy
| | - Michele Fiore
- c Department of Radiation Oncology , University Campus Bio-Medico di Roma , Rome , Italy
| | - Roberto Coppola
- a Department of General Surgery , University Campus Bio-Medico di Roma , Rome , Italy
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Periasamy S, Liu CT, Wu WH, Chien SP, Liu MY. Dietary Ziziphus jujuba Fruit Influence on Aberrant Crypt Formation and Blood Cells in Colitis-Associated Colorectal Cancer in Mice. Asian Pac J Cancer Prev 2016; 16:7561-6. [PMID: 26625762 DOI: 10.7314/apjcp.2015.16.17.7561] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Ziziphus jujuba (ZJ) fruit is rich in bioactive functional components such as polysaccharides, triterpenoid acid, flavonoids and oleamide. It has been commonly used in the treatment of various diseases including diabetes, digestive disorders, diarrhea, skin infections, liver and urinary complaints. However, dietary effects with regard to chemoprevention of colon cancer have not been studied. The present study was performed to evaluate the protective effects of dietary ZJ against colitis-associated colon carcinogenesis in azoxymethane (AOM)-dextran sodium sulphate (DSS)-treated mice. AOM was injected (10 mg/kg b.wt., i.p.) and three cycles of 2% DSS in drinking water for 7 days with 14 days of normal drinking water in-between were administered to induce colitis-associated colon cancer. ZJ fruit was supplemented into feed at levels of 5 and 10%. Dietary ZJ significantly attenuated aberrant crypt foci (ACF) formation and also decreased the progression of hyperplasia to dysplasia. In addition, it significantly reduced circulating white blood cells, lymphocytes, neutrophils, monocytes, eosinophils, basophils and platelets compared to colon cancer mice. We conclude that ZJ supplementation may delay the progression of colon cancer from hyperplasia to dysplasia and ultimately adenocarcinoma and cancer. In addition, it decreased circulating tumor-related leukocytes, main regulators of cancer inflammation. Dietary consumption of ZJ fruit attenuated the formation of ACF and delayed the progression of colon cancer.
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Affiliation(s)
- Srinivasan Periasamy
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan E-mail :
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Liu Z, Jin K, Guo M, Long J, Liu L, Liu C, Xu J, Ni Q, Luo G, Yu X. Prognostic Value of the CRP/Alb Ratio, a Novel Inflammation-Based Score in Pancreatic Cancer. Ann Surg Oncol 2016; 24:561-568. [PMID: 27650825 DOI: 10.1245/s10434-016-5579-3] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The C-reactive protein/albumin (CRP/Alb) ratio is associated with outcome in septic patients. However, as an inflammation-based score, its prognostic value for cancer has scarcely been investigated. METHODS Between February 2010 and January 2015, we enrolled 386 patients with pancreatic ductal adenocarcinoma. Univariate and multivariate survival analysis between the groups were evaluated. Receiver operating characteristics curves were generated and areas under the curve (AUC) were compared to evaluate the discriminatory ability of the inflammation-based prognostic scoring systems, including CRP/Alb ratio, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and modified Glasgow prognostic score (mGPS). RESULTS The optimal cutoff level of the CRP/Alb ratio was defined as 0.180. The prognosis of patients with CRP/Alb ratio ≥0.180 was significantly worse than CRP/Alb ratio <0.180 in univariate analysis (p < 0.001). In multivariate analysis, the CRP/Alb ratio was still associated with overall survival (p < 0.001). In addition, the CRP/Alb ratio had significantly higher AUC values compared with PLR (6, 12, and 24 months: p < 0.001, 0.017, 0.012) and mGPS (6, 12, and 24 months: p = 0.002, 0.020, 0.046) and had similar AUC values to NLR (6, 12, and 24 months: p = 0.052, 0.139, 0.041). CONCLUSIONS The current study demonstrated the CRP/Alb ratio may serve as a significant and promising inflammatory prognostic score in pancreatic cancer. An elevated CRP/Alb ratio is an independent factor for poor prognosis with the cutoff value of 0.180.
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Affiliation(s)
- Zuqiang Liu
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Kaizhou Jin
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Meng Guo
- Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Jiang Long
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Liang Liu
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Chen Liu
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Jin Xu
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Quanxing Ni
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China
| | - Guopei Luo
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China. .,Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China.
| | - Xianjun Yu
- Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China. .,Pancreatic Cancer Institute, Fudan University, Shanghai, People's Republic of China.
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112
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Saito T, Toya R, Matsuyama T, Semba A, Matsuyama K, Oya N. Prognostic value of parameters derived from white blood cell and differential counts in patients receiving palliative radiotherapy. Mol Clin Oncol 2016; 5:241-246. [PMID: 27602221 DOI: 10.3892/mco.2016.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/27/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to identify white blood cell (WBC) parameters with high prognostic value for the survival of patients receiving palliative radiotherapy. The prognostic value of seven parameters derived from WBC and differential counts was retrospectively evaluated in patients who underwent palliative radiotherapy between October, 2010 and June, 2013. The analyzed parameters were the total WBC count, the absolute and relative lymphocyte count, the absolute and relative neutrophil count, and the neutrophil-to-lymphocyte and lymphocyte-to-monocyte ratios. Following univariate analysis, multivariate Cox regression analysis was performed to adjust for gender, age, disease type, previous chemotherapy, previous radiotherapy and the levels of albumin and lactate dehydrogenase. A total of 220 patients with a median survival of 4.7 months were identified. All seven parameters were found to be statistically significant predictors of survival on univariate Cox regression analysis (P<0.05). Of these parameters, the low relative lymphocyte and high relative neutrophil counts were consistent predictors of poor survival in patients who received chemotherapy within 1 month prior to blood sampling (n=68) and in patients who received steroid treatment at the time of sampling (n=49). Multivariate Cox regression analysis revealed that the relative lymphocyte and neutrophil counts were independent predictors of survival in all 220 patients (P<0.05). In conclusion, relative lymphocyte and neutrophil counts were of high prognostic value for the survival of patients receiving palliative radiotherapy, even in those receiving medications that affect WBC and differential counts.
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Affiliation(s)
- Tetsuo Saito
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto 860-8556, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto 860-8556, Japan; Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto 860-8556, Japan
| | - Akiko Semba
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto 860-8556, Japan
| | - Keiya Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto 860-8556, Japan
| | - Natsuo Oya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto 860-8556, Japan
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113
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Tanrikulu AC, Abakay A, Komek H, Abakay O. Prognostic value of the lymphocyte-to-monocyte ratio and other inflammatory markers in malignant pleural mesothelioma. Environ Health Prev Med 2016; 21:304-311. [PMID: 27068290 PMCID: PMC5305982 DOI: 10.1007/s12199-016-0530-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/29/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Inflammation plays a role in malignant pleural mesothelioma (MPM) prognosis and symptoms. We investigated the roles of the new and old inflammatory indexes and markers in MPM prognosis. METHODS Two hundred and ninety-two MPM patients (167 male and 125 female) were included in this retrospective study. Demographic parameters were collected from the patients' files. Kaplan-Meier curves and multivariate Cox regression analyses were used for the analysis of prognosis. RESULTS The mean age of the patients was 58.4 years. The mean survival time was 14.6 ± 13.0 months. Twenty-four potential prognostic factors associated with a poor outcome were calculated in the univariate analysis, and 16 potential prognostic factors were associated with a poor prognosis. These 16 potential prognostic factors were also analyzed in multivariate analysis. Multivariate analysis showed that increased age, stage 3-4 disease, the non-epithelial type, a low Karnofsky performance score, a high white blood cell count, and a low lymphocyte-to-monocyte ratio (LMR) were associated with a poor prognosis. The results of the multivariate analysis showed that a decreased LMR was associated with poor survival. Patients with LMR ≤2.6 had poor survival compared with those with LMR >2.6 (mean 9.6 vs. 17.0 months, respectively; p = 0.004). CONCLUSIONS LMR is an independent marker of prognosis in patients with MPM and is superior to the other inflammation-based markers. The inexpensive nature and easy reproducibility of the hemogram should encourage the use of the LMR in clinical practice.
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Affiliation(s)
| | - Abdurrahman Abakay
- Department of Chest Diseases, Medical School of Dicle University, Diyarbakir, Turkey.
| | - Halil Komek
- Department of Nuclear Medicine, Diyarbakir Education and Training Hospital, Diyarbakir, Turkey
| | - Ozlem Abakay
- Department of Chest Diseases, Medical School of Dicle University, Diyarbakir, Turkey
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114
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Singel KL, Segal BH. Neutrophils in the tumor microenvironment: trying to heal the wound that cannot heal. Immunol Rev 2016; 273:329-43. [PMID: 27558344 PMCID: PMC5477672 DOI: 10.1111/imr.12459] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neutrophils are the first responders to infection and injury and are critical for antimicrobial host defense. Through the generation of reactive oxidants, activation of granular constituents and neutrophil extracellular traps, neutrophils target microbes and prevent their dissemination. While these pathways are beneficial in the context of trauma and infection, their off-target effects in the context of tumor are variable. Tumor-derived factors have been shown to reprogram the marrow, skewing toward the expansion of myelopoiesis. This can result in stimulation of both neutrophilic leukocytosis and the release of immature granulocytic populations that accumulate in circulation and in the tumor microenvironment. While activated neutrophils have been shown to kill tumor cells, there is growing evidence for neutrophil activation driving tumor progression and metastasis through a number of pathways, including stimulation of thrombosis and angiogenesis, stromal remodeling, and impairment of T cell-dependent anti-tumor immunity. There is also growing appreciation of neutrophil heterogeneity in cancer, with distinct neutrophil populations promoting cancer control or progression. In addition to the effects of tumor on neutrophil responses, anti-neoplastic treatment, including surgery, chemotherapy, and growth factors, can influence neutrophil responses. Future directions for research are expected to result in more mechanistic knowledge of neutrophil biology in the tumor microenvironment that may be exploited as prognostic biomarkers and therapeutic targets.
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Affiliation(s)
- Kelly L. Singel
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Brahm H. Segal
- Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY, USA
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
- Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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115
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Del Prete M, Giampieri R, Loupakis F, Prochilo T, Salvatore L, Faloppi L, Bianconi M, Bittoni A, Aprile G, Zaniboni A, Falcone A, Scartozzi M, Cascinu S. Prognostic clinical factors in pretreated colorectal cancer patients receiving regorafenib: implications for clinical management. Oncotarget 2016; 6:33982-92. [PMID: 26334693 PMCID: PMC4741819 DOI: 10.18632/oncotarget.5053] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/04/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We assessed the impact on survival of angiogenesis and inflammation-related factors, particularly LDH serum levels, platelet, neutrophil and lymphocyte counts, and neutrophil-to-lymphocyte ratio (NLR), in metastatic colorectal cancer patients receiving regorafenib monotherapy. METHODS LDH serum levels, neutrophil, lymphocyte and platelet counts were collected at the start of regorafenib monotherapy. Cut-off values were calculated by ROC curve analysis. Survival analyses were performed by Kaplan-Meier method, and multivariate analysis by Cox method. RESULTS A total of 208 patients were eligible for analysis. Among factors who were related with worse overall survival and who maintained their role at the multivariate analysis, high platelet count (Exp(b):1.4963, 95% CI:1.0130-2.2103, p = 0.0439) and high neutrophil/lymphocyte ratio (Exp(b):1.6963, 95% CI:1.0757-2.6751, p = 0.0237) were those who more deeply were related to worse overall survival. High lymphocyte count (Exp(b):0.4527, 95% CI:0.2801-0.7316, p = 0.0013) was correlated with improved overall survival. CONCLUSIONS High neutrophil, high platelet, low lymphocyte count and/or high NLR may represent negative prognostic factors in patients receiving regorafenib monotherapy. It is advisable that these factors are taken into account in the design of subsequent trials in colorectal cancer patients receiving this drug.
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Affiliation(s)
- Michela Del Prete
- Medical Oncology, AO Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Riccardo Giampieri
- Medical Oncology, AO Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Fotios Loupakis
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - Lisa Salvatore
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Luca Faloppi
- Medical Oncology, AO Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Maristella Bianconi
- Medical Oncology, AO Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Bittoni
- Medical Oncology, AO Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Giuseppe Aprile
- Medical Oncology, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Udine, Italy
| | | | - Alfredo Falcone
- Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Scartozzi
- Medical Oncology, Azienda Ospedaliero-Universitaria di Cagliari, Monserrato, Cagliari, Italy
| | - Stefano Cascinu
- Medical Oncology, AO Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
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116
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Kennelly RP, Murphy B, Larkin JO, Mehigan BJ, McCormick PH. Activated systemic inflammatory response at diagnosis reduces lymph node count in colonic carcinoma. World J Gastrointest Oncol 2016; 8:623-628. [PMID: 27574555 PMCID: PMC4980653 DOI: 10.4251/wjgo.v8.i8.623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/06/2016] [Accepted: 05/27/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer.
METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio (NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ2 tests where appropriate.
RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9 (P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio (≥ 0.25, P = 0.044).
CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.
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117
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Chen L, Zhang F, Sheng XG, Zhang SQ, Chen YT, Liu BW. Peripheral platelet/lymphocyte ratio predicts lymph node metastasis and acts as a superior prognostic factor for cervical cancer when combined with neutrophil: Lymphocyte. Medicine (Baltimore) 2016; 95:e4381. [PMID: 27512849 PMCID: PMC4985304 DOI: 10.1097/md.0000000000004381] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Inflammation-based indicators such as neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), and platelet/lymphocyte ratio (PLR) have been reported to possess significant predictive value for several types of cancer. We investigated the predictive value of these 3 biomarkers on lymph node metastasis (LNM) and clinical outcome in patients with stage Ib1-IIa cervical cancer undergoing radical surgery.A total of 407 patients with FIGO stage Ib1-IIa cervical cancer, who underwent radical surgery between January 2006 and December 2009 at the Department of Gynecological and Oncology of Shandong Cancer Hospital Affiliated to Shandong University were recruited. Binary logistic regression analysis was performed to determine the relationship between PLR, NLR, dNLR, and LNM. Multivariate Cox regression analysis was performed to determine the association between the 3 indices and recurrence-free survival (RFS) and overall survival (OS).Optimal cut-off values for the 3 indices were determined by applying receiver operating curve (ROC) analysis. Univariate and binary logistic regression analyses both indicate that PLR was significantly associated with increased LNM (P < 0.05). In the multivariate survival analysis, increased preoperative PLR and NLR were significantly associated with reduced RFS (P = 0.001 and P = 0.002, respectively), whereas a combination of both PLR and NLR revealed a more significant association with reduced RFS (P < 0.001). Furthermore, increased preoperative PLR and NLR were significantly associated with reduced OS (P = 0.007 and P = 0.009, respectively), whereas the combined use of PLR and NLR revealed a more significant association with reduced OS (P = 0.003).PLR is an independent risk factor for increased LNM and clinical outcome in patients with stage Ib1-IIa cervical cancer. A combination of PLR and NLR may enable better risk stratification for predicting survival.
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Affiliation(s)
- Liang Chen
- Department of Gynecological Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences
| | - Fang Zhang
- Department of Radiology, Provincial Hospital Affiliated to Shandong University
| | - Xiu-gui Sheng
- Department of Gynecological Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences
| | - Shi-qian Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, PR China
| | - Yue-ting Chen
- Department of Gynecological Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences
| | - Bo-wen Liu
- Department of Gynecological Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences
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118
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Melichar B, Študentová H, Vitásková D, Šrámek V, Kujovská Krčmová L, Pešková E, Solichová D, Kalábová H, Ryška A, Hrůzová K, Havlík R. Association of urinary neopterin, neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios with long-term survival of patients with breast cancer. Pteridines 2016. [DOI: 10.1515/pterid-2016-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
The immune response crucially determines the survival of patients with malignant tumors including breast carcinoma. The aim of the present study was to evaluate retrospectively an association of peripheral blood cell count (PBC)-derived ratios and urinary neopterin concentration with prognosis in breast cancer patients. Urinary neopterin, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) were retrospectively analyzed in a cohort of 474 breast cancer patients. NLR and PLR correlated positively with each other and negatively with LMR, but no correlation between neopterin concentrations and PBC-derived ratios was observed. Increased urinary neopterin concentration was a significant predictor of poor survival in patients with active disease, but PLR, NLR or LMR were not significantly associated with survival in multivariate analysis. In conclusion, increased urinary neopterin was a significant predictor of poor survival in patients with breast cancer and active disease.
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Affiliation(s)
- Bohuslav Melichar
- Department of Oncology, Palacký University Medical School and Teaching Hospital, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
- Fourth Department of Medicine, Charles University Teaching Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
- Institute of Molecular and Translational Medicine, Palacký University Medical School and Teaching Hospital, Hněvotínská 5, 779 00 Olomouc, Czech Republic
| | - Hana Študentová
- Department of Oncology, Palacký University Medical School and Teaching Hospital, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
| | - Denisa Vitásková
- Department of Oncology, Palacký University Medical School and Teaching Hospital, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
| | - Vlastislav Šrámek
- Department of Oncology, Palacký University Medical School and Teaching Hospital, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
| | - Lenka Kujovská Krčmová
- Third Department of Medicine, Charles University Teaching Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
- Department of Analytical Chemistry, Charles University School of Pharmacy, Akademika Heyrovského 1203, 500 05 Hradec Králové, Czech Republic
| | - Eliška Pešková
- Fourth Department of Medicine, Charles University Teaching Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Dagmar Solichová
- Third Department of Medicine, Charles University Teaching Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Hana Kalábová
- Department of Oncology, Palacký University Medical School and Teaching Hospital, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
| | - Aleš Ryška
- The Fingerland Department of Pathology, Charles University Medical School and Teaching Hospital, Sokolská 581, 500 05 Hradec Králové, Czech Republic
| | - Klára Hrůzová
- Department of Oncology, Palacký University Medical School and Teaching Hospital, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
| | - Roman Havlík
- Department of Surgery, Palacký University Medical School and Teaching Hospital, I.P. Pavlova 6, 779 00 Olomouc, Czech Republic
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119
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Tural Onur S, Sokucu SN, Dalar L, Iliaz S, Kara K, Buyukkale S, Altin S. Are neutrophil/lymphocyte ratio and platelet/lymphocyte ratio reliable parameters as prognostic indicators in malignant mesothelioma? Ther Clin Risk Manag 2016; 12:651-6. [PMID: 27217757 PMCID: PMC4853168 DOI: 10.2147/tcrm.s104077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Malignant mesothelioma (MM) is an aggressive asbestos-related pleural tumor. The incidence is increasing with intensive use of asbestos in developing countries. We need an easily accessible, inexpensive, and reliable method for determining the low survival time prognosis of this tumor. The aim of our study was to investigate the viability of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) as prognostic indicators in MM. PATIENTS AND METHODS Thirty-six patients with MM, whose histopathologic diagnosis and follow-up were performed by our clinic and whose complete archive data were accessible, were included in this retrospective study. The patients' histopathologic disease types and stages, complete blood count parameters at diagnosis, and survival were recorded. RESULTS Eighteen of the patients with MM were male and the remaining 18 of them were female; the average follow-up period was 24.83±3.61 months. The PLR levels of the patients were statistically significant (P<0.05). The NLR and PLR area under the receiver operating characteristic curve values were 0.559 and 0.749, respectively (P=0.631 and P=0.044, respectively). CONCLUSION PLR was a significant prognostic indicator of MM at diagnosis on complete blood count parameters; however, NLR was not a significant prognostic indicator. A large number of prospective studies are needed to prove the reliability of the parameters.
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Affiliation(s)
- Seda Tural Onur
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sinem Nedime Sokucu
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Levent Dalar
- Department of Pulmonary Medicine, Faculty of Medicine, Istanbul Bilim University, Istanbul, Turkey
| | - Sinem Iliaz
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kaan Kara
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Songül Buyukkale
- Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sedat Altin
- Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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120
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Suzuki R, Takagi T, Hikichi T, Konno N, Sugimoto M, Watanabe KO, Nakamura J, Waragai Y, Kikuchi H, Takasumi M, Watanabe H, Ohira H. Derived neutrophil/lymphocyte ratio predicts gemcitabine therapy outcome in unresectable pancreatic cancer. Oncol Lett 2016; 11:3441-3445. [PMID: 27123132 DOI: 10.3892/ol.2016.4381] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/15/2016] [Indexed: 12/18/2022] Open
Abstract
As gemcitabine is a key anti-tumor agent for unresectable pancreatic ductal adenocarcinoma (PDAC), it is important to predict the outcomes of gemcitabine chemotherapy. The present study aimed to confirm whether the derived neutrophil-to-lymphocyte ratio (dNLR) is able to predict chemotherapy outcomes. To elucidate the role of dNLR in patients that underwent chemotherapy, the current study evaluated clinicopathological variables in 31 patients with unresectable PDAC treated with gemcitabine. The correlation between clinicopathological variables, and progression-free survival (PFS) and overall survival (OS) time were investigated. Univariate analysis revealed that there were no significant differences in PFS and OS as a function of age (<65 vs. ≥65 years), gender, tumor location (pancreas head vs. body/tail), tumor diameter (<23 vs. ≥23 mm) or serum carbohydrate antigen 19-9 concentration level (<3,800 vs. ≥3,800 U/ml). However, disease stage (locally advanced vs. metastatic) and the dNLR (<2.5 vs. ≥2.5) significantly affected PFS and OS. Multivariate analysis subsequently revealed that a dNLR of ≥2.5 was an independent prognostic factor for poor PFS (P=0.003) and OS (P=0.026). In conclusion, data from the present study suggests that the pre-treatment dNLR is an independent prognostic factor to predict PFS and OS in patients with unresectable PDAC treated with gemcitabine. This indicates that dNLR has a potential role in stratifying patients that may benefit from gemcitabine therapy.
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Affiliation(s)
- Rei Suzuki
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Takuto Hikichi
- Department of Endoscopy, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Naoki Konno
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - K O Watanabe
- Department of Endoscopy, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Jun Nakamura
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yuichi Waragai
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hitomi Kikuchi
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Mika Takasumi
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hiroshi Watanabe
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology and Rheumatology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
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Kucuk A, Erol MF, Senel S, Eroler E, Yumun HA, Uslu AU, Erol AM, Tihan D, Duman U, Kucukkartallar T, Solak Y. The role of neutrophil lymphocyte ratio to leverage the differential diagnosis of familial Mediterranean fever attack and acute appendicitis. Korean J Intern Med 2016; 31:386-91. [PMID: 26864298 PMCID: PMC4773722 DOI: 10.3904/kjim.2015.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/18/2015] [Accepted: 06/17/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by attacks of fever and diffuse abdominal pain. The primary concern with this presentation is to distinguish it from acute appendicitis promptly. Thus, we aimed to evaluate the role of neutrophil lymphocyte ratio (NLR) to leverage the differential diagnosis of acute FMF attack with histologically proven appendicitis. METHODS Twenty-three patients with histologically confirmed acute appendicitis and 88 patients with acute attack of FMF were included in the study. NLR, C-reactive protein and other hematologic parameters were compared between the groups. RESULTS Neutrophil to lymphocyte ratio was significantly higher in patients with acute appendicitis compared to the FMF attack group (8.24 ± 6.31 vs. 4.16 ± 2.44, p = 0.007). The performance of NLR in diagnosing acute appendicitis with receiver operating characteristic analysis with a cut-off value of 4.03 were; 78% sensitivity, 62% specificity, and area under the curve 0.760 (95% confidence interval, 0.655 to 0.8655; p < 0.001). CONCLUSIONS This study showed that NLR, the simple and readily available inflammatory marker may have a useful role in distinguishing acute FMF attack from acute appendicitis.
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Affiliation(s)
- Adem Kucuk
- Division of Rheumatology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
- Correspondence to Adem Kucuk, M.D. Division of Rheumatology, Department of Internal Medicine, Meram School of Medicine, Necmettin Erbakan University, Meram, Konya 42060, Turkey Tel: +90-332-223-6548 Fax: +90-332-223-6548 E-mail:
| | - Mehmet Fatih Erol
- Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey
| | - Soner Senel
- Division of Rheumatology, Department of Internal Medicine, Cumhuriyet University, Sivas, Turkey
| | - Emir Eroler
- Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey
| | - Havvanur Alparslan Yumun
- Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey
| | - Ali Ugur Uslu
- Department of Internal Medicine, Cumhuriyet University, Sivas, Turkey
| | - Asiye Mukaddes Erol
- Department of Physical Medicine and Rehabilitation, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey
| | - Deniz Tihan
- Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey
| | - Ugur Duman
- Department of General Surgery, Bursa Sevket Yilmaz Research and Training Hospital, Bursa, Turkey
| | | | - Yalcin Solak
- Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
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Neutrophil-to-Lymphocyte Ratio Predicts Early Mortality in Patients with HBV-Related Decompensated Cirrhosis. Gastroenterol Res Pract 2016; 2016:4394650. [PMID: 26949385 PMCID: PMC4754485 DOI: 10.1155/2016/4394650] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/30/2015] [Accepted: 01/03/2016] [Indexed: 12/25/2022] Open
Abstract
Background. The neutrophil-to-lymphocyte ratio (NLR) is an inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the clinical value of NLR in the prediction of 30-day mortality in patients with HBV-related decompensated cirrhosis (HBV-DeCi). Methods. This was a retrospective cohort study that included 148 patients with HBV-DeCi. Results. An elevated NLR was associated with increased severity of liver disease and mortality within 30 days. Multivariate analysis suggested that NLR, similar to the model for end-stage liver disease (MELD) score, is an additional independent predictor of 30-day mortality (P < 0.01). Conclusion. Our results suggest that a high NLR can be considered a new independent biomarker for predicting 30-day mortality in patients with HBV-DeCi.
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Lee BS, Lee SH, Son JH, Jang DK, Chung KH, Lee YS, Paik WH, Ryu JK, Kim YT. Neutrophil-lymphocyte ratio predicts survival in patients with advanced cholangiocarcinoma on chemotherapy. Cancer Immunol Immunother 2016; 65:141-50. [PMID: 26728479 PMCID: PMC11028491 DOI: 10.1007/s00262-015-1780-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 12/05/2015] [Indexed: 12/13/2022]
Abstract
The blood neutrophil-to-lymphocyte ratio (NLR) is reported to be a prognostic marker in several cancers. However, the prognostic role of NLR in patients with advanced cholangiocarcinoma on chemotherapy is unknown. A total of 221 patients with pathologically confirmed locally advanced or metastatic cholangiocarcinoma receiving first-line palliative chemotherapy were enrolled. Associations between baseline clinical and laboratory variables including NLR and survival were investigated. Patients were classified into two groups according to the NLR level (≤ 5 vs. >5). Median overall survival (OS) and time to progression (TTP) in patients with NLR ≤ 5 were 10.9 and 6.7 months, respectively, and 6.8 and 4.1 months in patients with NLR > 5 (P < 0.001, P = 0.002, respectively). In multivariate analysis, number of cycles of chemotherapy was a significant predictor of longer OS (HR 0.86, P < 0.001), whereas adverse prognostic factors for OS were CA 19-9 > 300 (HR 1.43, P = 0.025), CEA > 5 (HR 1.44, P = 0.029), higher stage (HR 1.69, P = 0.004), and NLR > 5 (HR 1.87, P < 0.001). NLR > 5 was also associated with reduced TTP (HR 1.66, P = 0.007). Among 50 patients with initial NLR > 5, 33 patients had NLR ≤ 5 after two cycles of chemotherapy and they had significantly better survival than the others (HR 0.48, P = 0.015). NLR independently predicts survival in patients with advanced cholangiocarcinoma undergoing chemotherapy. Considering cost-effectiveness and easy availability, NLR may be a useful biomarker for prognosis prediction.
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Affiliation(s)
- Ban Seok Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, South Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Jun Hyuk Son
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Dong Kee Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kwang Hyun Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Yoon Suk Lee
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang, South Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Yong-Tae Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
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Heterogeneity of the Mac-1 expression on peripheral blood neutrophils in patients with different types of epithelial ovarian cancer. Immunobiology 2016; 221:323-32. [DOI: 10.1016/j.imbio.2015.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/08/2015] [Accepted: 10/23/2015] [Indexed: 01/03/2023]
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125
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Suppan C, Bjelic-Radisic V, La Garde M, Groselj-Strele A, Eberhard K, Samonigg H, Loibner H, Dandachi N, Balic M. Neutrophil/Lymphocyte ratio has no predictive or prognostic value in breast cancer patients undergoing preoperative systemic therapy. BMC Cancer 2015; 15:1027. [PMID: 26715527 PMCID: PMC4696229 DOI: 10.1186/s12885-015-2005-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/15/2015] [Indexed: 01/26/2023] Open
Abstract
Background The primary goal of preoperative systemic treatment (PST) in patients with breast cancer is downsizing of tumors to enhance the rate of breast conserving surgery. Additionally, preoperative systemic treatment offers the possibility to assess for chemosensitivity of early stage disease. In various cancers the prognostic value of neutrophil/lymphocyte ratio (NLR) was demonstrated, indicating that high NLR determines worse prognosis of the patients. The goal of our study was to evaluate the predictive and prognostic value of NLR in early stage breast cancer patients undergoing PST. Methods 247 female patients with histologically proven breast cancer were analysed in this retrospective analysis. The NLR before the initiation of PST was documented. Histopathological response in surgically removed specimens was evaluated using a modified Sinn regression score and the pCR defined as no invasive tumor in primary tumor and lymph nodes. NLR was correlated with response to PST and disease free survival. Results PST was categorized into five groups (anthracycline containing, anthracycline and taxane containing, taxane containing, hormone treatment and other chemotherapies). pCR rate was defined as no invasive rest of tumor either in primary tumor or (ypT0 = Sinn) or in primary tumor and in lymph nodes (ypT0isypN0). Median NLR in patients without any invasive tumor rest was significantly higher than in patients either with some invasive tumor rest or not responding to chemotherapy. Despite this primary difference, the results were not stable across the analysed treatment groups particularly in the group with highest pCR rates (taxane and anthracycline treatment). Further, no association with disease free survival could be observed. Conclusions Although there was a reverse trend with the higher NLR prior to systemic treatment in patients who achieved pCR, we could not demonstrate predictive or prognostic value of NLR in the cohort of early stage breast cancer patients treated with PST.
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Affiliation(s)
- Christoph Suppan
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Vesna Bjelic-Radisic
- Department of Gynaecology and Obstetrics, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | - Marlen La Garde
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Department of Gynaecology and Obstetrics, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| | - Andrea Groselj-Strele
- Research Facility for Biostatistics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria.
| | - Katharina Eberhard
- Research Facility for Biostatistics, Center for Medical Research, Medical University of Graz, Stiftingtalstraße 24, 8010, Graz, Austria.
| | - Hellmut Samonigg
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Hans Loibner
- Apeiron Biologics AG, Campus-Vienna-Biocenter 5, 1030, Vienna, Austria.
| | - Nadia Dandachi
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Zhang B, Yu W, Zhou LQ, He ZS, Shen C, He Q, Li J, Liu LB, Wang C, Chen XY, Fan Y, Hu S, Zhang L, Han WK, Jin J. Prognostic Significance of Preoperative Albumin-Globulin Ratio in Patients with Upper Tract Urothelial Carcinoma. PLoS One 2015; 10:e0144961. [PMID: 26681341 PMCID: PMC4682975 DOI: 10.1371/journal.pone.0144961] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/25/2015] [Indexed: 12/24/2022] Open
Abstract
Background Preoperative albumin-globulin ratio (AGR) reflects both malnutrition and systemic inflammation in cancer patients. In particular, systemic inflammation has been reported to contribute to tumor progression and poor oncological outcome in various malignancies. However, the prognostic value of preoperative AGR in upper tract urothelial carcinoma (UTUC) has not been examined. Methods We retrospectively reviewed medical data of 187 operable UTUC patients in a Chinese cohort with a high incidence of chronic kidney disease (CKD). AGR was calculated as [AGR = albumin/(serum total protein—albumin)]. The associations of preoperative AGR with clinicopathologic characteristics and prognosis were assessed. Multivariate analyses using Cox regression models were performed to determine the independent prognostic factors. Results The median (IQR) preoperative AGR was 1.50 (1.30–1.70), and the optimal cutoff value was determined to be 1.45 according to the receiver operating curve analysis. Low AGR was significantly associated with female gender, high CKD stage and tumor grade (P < 0.05). Eighty-three patients died before the follow-up endpoint. Kaplan-Meier analysis showed that an AGR < 1.45 predicted significantly poorer overall and cancer-specific survivals compared to an AGR ≥ 1.45 (P < 0.001 and P = 0.008, respectively). Multivariate analyses showed that an AGR < 1.45 was an independent risk factor for poorer overall and cancer-specific survivals (P = 0.002 and P = 0.015, respectively). Conclusions Preoperative AGR can act as an effective biomarker with easy accessibility for evaluating the prognosis of patients with UTUC. AGR should be applied in UTUC patients for risk stratification and determination of optimal therapeutic regimens.
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Affiliation(s)
- Bo Zhang
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Zhi-Song He
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Qun He
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Jun Li
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Li-Bo Liu
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Cong Wang
- Peking University Health Science Center, Beijing, People’s Republic of China
| | - Xiao-Yu Chen
- Peking University Health Science Center, Beijing, People’s Republic of China
| | - Yu Fan
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Shuai Hu
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
| | - Wen-Ke Han
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
- * E-mail: (WKH); (JJ)
| | - Jie Jin
- Department of Urology, Peking University First Hospital, Beijing, People’s Republic of China
- Institute of Urology, Peking University, Beijing, People’s Republic of China
- National Urological Cancer Center, Beijing, People’s Republic of China
- * E-mail: (WKH); (JJ)
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Xu YJ, Li SY, Cheng Q, Chen WK, Wang SL, Ren Y, Miao CH. Effects of anaesthesia on proliferation, invasion and apoptosis of LoVo colon cancer cells in vitro. Anaesthesia 2015; 71:147-54. [PMID: 26669824 DOI: 10.1111/anae.13331] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 01/24/2023]
Abstract
Tumour cell proliferation, invasion and apoptosis are crucial steps in tumour metastasis. We evaluated the effect of serum from patients undergoing colon cancer surgery receiving thoracic epidural and propofol anaesthesia on colon cancer cell biology. Patients were randomly assigned to receive propofol anaesthesia with a concomitant thoracic epidural (PEA, n = 20) or sevoflurane anaesthesia with opioid analgesia (SGA, n = 20). Venous blood was obtained before induction of anaesthesia and 24 hours postoperatively. The LoVo colon cancer cells were cultured with patient serum from both groups and the effects on proliferation, invasion and apoptosis were measured. Twenty-four hours after surgery, the absorbance value of LoVo cells at 10% serum concentration from PEA was decreased when compared with SGA (0.302 (0.026) vs 0.391 (0.066), p = 0.005). The inhibitory rate of LoVo cells at 10% serum concentration from PEA was higher than that from SGA (p = 0.004) 24 h after surgery. The number of invasive LoVo cells at 10% serum concentration from PEA was reduced when compared with SGA (44 (4) vs 62 (4), p < 0.001). Exposure of LoVo cells to postoperative serum from patients receiving PEA led to a higher luminescence ratio (apoptosis) than those receiving SGA (0.36 (0.04) vs 0.27 (0.05), p < 0.001). Serum from patients receiving PEA for colon cancer surgery inhibited proliferation and invasion of LoVo cells and induced apoptosis in vitro more than that from patients receiving SGA. Anaesthetic technique might influence the serum milieu in a way that affects cancer cell biology and, thereby, tumour metastastasis.
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Affiliation(s)
- Y J Xu
- Department of Anaesthesiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - S Y Li
- Pathology Office, Shanghai University of Tranditional Chinese Medicine, Shanghai, China
| | - Q Cheng
- Department of Anaesthesiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - W K Chen
- Department of Anaesthesiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - S L Wang
- Department of Anaesthesiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Y Ren
- Department of Anaesthesiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - C H Miao
- Department of Anaesthesiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Troppan KT, Melchardt T, Wenzl K, Schlick K, Deutsch A, Bullock MD, Reitz D, Beham-Schmid C, Weiss L, Neureiter D, Tränkenschuh W, Greil R, Neumeister P, Egle A, Pichler M. The clinical significance of fibrinogen plasma levels in patients with diffuse large B cell lymphoma. J Clin Pathol 2015; 69:326-30. [PMID: 26644520 DOI: 10.1136/jclinpath-2015-203356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/17/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fibrinogen plays a crucial role in the pathophysiology of tumour cell growth, invasion and metastasis. The aim of this study was to evaluate the prognostic significance of pretreatment plasma fibrinogen levels in patients with diffuse large B cell lymphoma (DLBCL) METHODS: Data from 372 patients with DLBCL, diagnosed and treated between 2004 and 2013 at two Austrian centres, were evaluated retrospectively. The prognostic influences of plasma fibrinogen levels and other factors, including age, tumour stage and the National Comprehensive Cancer Network-International Prognostic Index, on 5-year overall survival (OS) and 5-year disease-free survival (DFS) were studied using Kaplan-Meier curves as well as univariate and multivariate Cox regression models. RESULTS Kaplan-Meier analysis revealed that a high fibrinogen plasma level is associated with decreased 5-year OS and 5-year DFS in patients with DLBCL (p<0.001, log-rank test). Furthermore, in multivariate analysis, elevated serum fibrinogen was found to be an independent marker of poor clinical outcome: 5-year OS (HR=1.69, 95% CI 1.06 to 2.72, p=0.029) and 5-year DFS (HR=1.68, 95% CI 1.08 to 2.61, p=0.021). CONCLUSIONS In the current study, we demonstrate that high plasma fibrinogen levels at diagnosis predict poor outcome in patients with DLBCL. TRIAL REGISTRATION NUMBER 25-434 ex 12713 and 415-EP/73/127-2012.
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Affiliation(s)
- Katharina T Troppan
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Kerstin Wenzl
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Alexander Deutsch
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Marc D Bullock
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel Reitz
- Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | | | - Lukas Weiss
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Richard Greil
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Graz, Austria
| | - Martin Pichler
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Sun W, Zhang L, Luo M, Hu G, Mei Q, Liu D, Long G, Hu G. Pretreatment hematologic markers as prognostic factors in patients with nasopharyngeal carcinoma: Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Head Neck 2015; 38 Suppl 1:E1332-40. [PMID: 26362911 DOI: 10.1002/hed.24224] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pretreatment hematological markers of inflammatory response have emerged as prognostic factors for patients with cancer. In this study, we evaluated the prognostic significance of various hematologic parameters in patients with nasopharyngeal carcinoma (NPC). METHODS Clinical data from 251 patients with NPC were retrospectively collected. Neutrophil counts, lymphocyte counts, platelet counts, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were adopted as potential prognostic biomarkers. The Kaplan-Meier method and log-rank test were adopted to calculate and compare the progression-free survival (PFS) and overall survival (OS) rates. The Cox proportional hazards model was used to carry out univariate and multivariate analyses. RESULTS NLR ≥2.7 (hazard ratio [HR] = 2.01; 95% confidence interval [CI] = 1.23-3.29; p = .005) and PLR ≥167.2 (HR = 2.12; 95% CI = 1.35-3.33; p = .001) were significantly associated with shorter PFS, whereas PLR ≥163.4 (HR = 2.64; 95% CI = 1.25-5.60; p = .011) was correlated with poor OS. CONCLUSION Pretreatment NLR and PLR can be independent prognostic factors for patients with NPC. © 2015 Wiley Periodicals, Head Neck 38: E1332-E1340, 2016.
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Affiliation(s)
- Wei Sun
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, People's Republic of China
| | - Linli Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, People's Republic of China
| | - Min Luo
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, People's Republic of China
| | - Guangyuan Hu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, People's Republic of China
| | - Qi Mei
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, People's Republic of China
| | - Dongbo Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, People's Republic of China
| | - Guoxian Long
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, People's Republic of China
| | - Guoqing Hu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, People's Republic of China
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Belaj K, Pichler M, Hackl G, Rief P, Eller P, Hafner F, Brodmann M, Gary T. Association of the Derived Neutrophil-Lymphocyte Ratio With Critical Limb Ischemia. Angiology 2015; 67:350-4. [PMID: 26058674 DOI: 10.1177/0003319715590701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neutrophil and leukocyte counts are laboratory parameters that reflect the systemic inflammatory response in patients with atherosclerotic diseases. Based on the means of these parameters, the derived neutrophil-lymphocyte ratio (dNLR) can be calculated. We investigated a possible association of critical limb ischemia (CLI) and the dNLR in patients with peripheral arterial disease (PAD). We performed a retrospective data analysis including 1995 patients with PAD treated at our department in the years 2005 to 2010. The cohort was divided into tertiles according to dNLR. Higher dNLR values were associated with an increased CLI rate. In the tertile with lowest dNLR, the CLI rate was 20.4%, in the second tertile the CLI rate was 26.1%, and in the third tertile the CLI rate was 36.1%. Statistical significance was shown using a Jonckheere-Terpstra test (P < .001). A high dNLR is associated with an increased rate of CLI in patients with PAD. This might be a useful parameter to highlight patients at increased risk of CLI.
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Affiliation(s)
- Klara Belaj
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Gerald Hackl
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Peter Rief
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Philipp Eller
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
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131
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Chen L, Zhang F, Sheng XG, Zhang SQ. Decreased pretreatment lymphocyte/monocyte ratio is associated with poor prognosis in stage Ib1-IIa cervical cancer patients who undergo radical surgery. Onco Targets Ther 2015; 8:1355-62. [PMID: 26089685 PMCID: PMC4467643 DOI: 10.2147/ott.s82174] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Recently, pretreatment monocyte counts and the lymphocyte/monocyte ratio (LMR) have been proven to be significantly associated with the clinical outcomes of several types of cancer. In this study, we analyzed the prognostic significance of the LMR in stage Ib1–IIa cervical cancer patients who underwent a radical operation. Methods A total of 485 patients with stage Ib1–IIa cervical cancer were included in this retrospective study. We evaluated the prognostic values of the absolute lymphocyte count, absolute monocyte count, and LMR by applying receiver operating characteristic curves. Kaplan–Meier curves and multivariate Cox proportional analyses were used to determine the recurrence-free survival (RFS) and overall survival (OS). Results The area under the curve was 0.640 for the RFS and 0.647 for the OS using the LMR. In the univariate analysis, an elevated preoperative LMR was significantly associated with an increased RFS (hazard ratio [HR], 0.373; 95% confidence interval [CI]: 0.247–0.563; P<0.001), and this result remained significant in the multivariate analysis (HR, 0.439; 95% CI: 0.279–0.693; P<0.001). In the univariate analysis, an elevated LMR was also significantly associated with an increased OS (HR, 0.381; 95% CI: 0.233–0.622; P<0.001), and the significance persisted in the multivariate analysis (HR, 0.417; 95% CI: 0.244–0.714; P=0.001). Conclusion A decreased pretreatment LMR is associated with a poor prognosis in stage Ib1–IIa cervical cancer patients who undergo a radical operation. A prospective study is warranted for further validation of our findings.
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Affiliation(s)
- Liang Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People's Republic of China ; Department of Gynecological Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China
| | - Fang Zhang
- Department of Radiology, Provincial Hospital Affiliated with Shandong University, Jinan, People's Republic of China
| | - Xiu-Gui Sheng
- Department of Gynecological Oncology, Shandong Cancer Hospital and Institute, Jinan, People's Republic of China
| | - Shi-Qian Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, People's Republic of China
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Yu L, Lv CY, Yuan AH, Chen W, Wu AW. Significance of the preoperative neutrophil-to-lymphocyte ratio in the prognosis of patients with gastric cancer. World J Gastroenterol 2015; 21:6280-6286. [PMID: 26034363 PMCID: PMC4445105 DOI: 10.3748/wjg.v21.i20.6280] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/02/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) in the prognosis of patients with gastric cancer (GC).
METHODS: The clinical data of 291 GC patients were analysed retrospectively; these patients were divided into two groups according to their preoperative NLR: a high-NLR group (NLR ≥ 3.5, 131 cases) and a low-NLR group (NLR < 3.5, 160 cases). The clinicopathological characteristics and five-year survival rates of the two groups were compared. The NLR and other clinicopathological factors were subjected to univariate and multivariate survival analysis to evaluate the effects of the NLR on the prognosis of GC patients.
RESULTS: The lowest preoperative NLR among the 291 patients was 0.56, whereas the highest preoperative NLR was 74.5. The mean preoperative NLR was 5.99 ± 8.98. Age, tumour size, T staging, tumour-node-metastasis (TNM) staging and platelet count were significantly different between the high- and low-NLR groups (P < 0.05). The five-year survival rate of the high-NLR group was 17.0%, which was significantly lower than that of the low-NLR group (43.6%; 17.0% vs 43.6%, P < 0.05). The univariate analysis results showed that the five-year survival rate was related to age, tumour size, T staging, N staging, TNM staging, carcinoembryonic antigen value and NLR (P < 0.05). Multivariate analysis results showed that the NLR was an independent risk factor that likely affected the five-year survival rate of GC patients (P = 0.003, HR = 0.626, 95%CI: 0.460-0.852).
CONCLUSION: The preoperative NLR could be used as a prognostic factor for GC patients; in particular, a high NLR corresponded to poor prognosis of GC patients.
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133
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Choi WJ, Cleghorn MC, Jiang H, Jackson TD, Okrainec A, Quereshy FA. Preoperative Neutrophil-to-Lymphocyte Ratio is a Better Prognostic Serum Biomarker than Platelet-to-Lymphocyte Ratio in Patients Undergoing Resection for Nonmetastatic Colorectal Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S603-13. [PMID: 25900206 DOI: 10.1245/s10434-015-4571-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Current risk stratification tools for patients with colorectal cancer (CRC) rely on final surgical pathology but may be improved with the addition of novel serum biomarkers. The objective of this study was to evaluate the utility of preoperative NLR and PLR in predicting long-term oncologic outcomes in patients with operable CRC. METHODS All patients who underwent curative resection for adenocarcinoma at a large tertiary academic hospital were identified. High NLR/PLR was evaluated preoperatively and defined by maximizing log-rank statistics. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariable Cox proportional hazard regression was used to identify associations with outcome measures. RESULTS A total of 549 patients were included in the study. High NLR (≥2.6) was associated with worse RFS (hazard ratio [HR] 2.03, 95 % confidence interval [CI] 1.48-2.79, p < 0.001) and OS (HR 2.25, 95 % CI 1.54-3.29, p < 0.001). High PLR (≥295) also was associated with worse RFS (HR 1.68, 95 % CI 1.06-2.65, p = 0.028) and OS (HR 1.81, 95 % CI 1.06-3.06, p = 0.028). In the multivariable model, high NLR retained significance for reduced RFS (HR 1.59, 95 % CI 1.1-2.28, p = 0.013) and OS (HR 1.91, 95 % CI 1.26-2.9, p = 0.002). Significantly more patients in the high NLR group were older at diagnosis, had mucinous adenocarcinoma, higher T stage, and advanced cancer stage. CONCLUSIONS High preoperative NLR in this series was shown to be a negative independent prognostic factor in patients undergoing surgical resection for nonmetastatic CRC. The prognostic utility of this serum biomarker may help to guide use of adjuvant therapies and patient counselling.
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Affiliation(s)
- Woo Jin Choi
- Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada
| | - Michelle C Cleghorn
- Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada
| | - Haiyan Jiang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Timothy D Jackson
- Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Allan Okrainec
- Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Fayez A Quereshy
- Division of General Surgery, Toronto Western Hospital - University Health Network, Toronto, ON, Canada. .,Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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Validation of the pretreatment neutrophil-lymphocyte ratio as a predictor of overall survival in a cohort of patients with pancreatic ductal adenocarcinoma. Pancreas 2015; 44:471-7. [PMID: 25423560 DOI: 10.1097/mpa.0000000000000271] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The circulating neutrophil-lymphocyte ratio (NLR) has been shown to be a prognostic factor for a variety of tumors. In this study, we evaluated the prognostic significance of NLR in a large cohort of Chinese patients with pancreatic ductal adenocarcinomas (PDACs). METHODS A total of 381 patients with PDAC who underwent potentially curative surgery were recruited from 2 centers in Shanghai, China, between January 2004 and September 2011. Analysis of overall survival (OS) was performed using the Kaplan-Meier and log-rank tests and the Cox proportional hazards regression model. RESULTS The most optimal cutoff of NLR was NLR 2.0 or greater, and the NLR was divided into 2 groups: high (≥ 2.0) and low (< 2.0). The high NLR (≥ 2.0) was associated with advanced UICC (Union for International Cancer Control) stages, p T stage, lymphoid node invasion, and poorer tumor differentiation. Multivariate analysis identified increased NLR as an independent prognostic factor for OS (hazard ratio = 1.51; 95 % confidence interval, 1.15-1.99; P = 0.003). Furthermore, neutrophil counts rather than lymphocyte counts were associated with OS of PDAC. CONCLUSIONS The pretreatment NLR is a simple and useful potential biomarker for OS in patients with PDAC after curative resection.
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135
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Prognostic performance of inflammation-based prognostic indices in patients with resectable colorectal liver metastases. Med Oncol 2015; 32:144. [PMID: 25807934 DOI: 10.1007/s12032-015-0590-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/14/2015] [Indexed: 12/13/2022]
Abstract
A range of prognostic cellular indices of the systemic inflammatory response, namely the neutrophil-lymphocyte ratio (NLR), derived NLR (dNLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), combination of platelet count and neutrophil-lymphocyte ratio (COP-NLR) and prognostic nutritional index (PNI), have been developed and found to have prognostic utility across varied malignancies. The current study is the first to examine the prognostic value of these six inflammatory scores in patients with resectable colorectal liver metastases (CRLM). Data from 302 consecutive patients undergoing surgery for resectable CRLM were evaluated. The prognostic influence of clinicopathological variables and the inflammatory scores NLR, dNLR, PLR, LMR, COP-NLR and PNI upon overall survival (OS) and cancer-specific survival (CSS) were determined by log-rank analysis and univariate and multivariate Cox regression analyses. High preoperative NLR was the only inflammatory variable independently associated with shortened OS (HR 1.769, 95 % CI 1.302-2.403, P < 0.001) or CSS (HR 1.927, 95 % CI 1.398-2.655, P < 0.001) following metastasectomy. When NLR was replaced by dNLR in analyses, high dNLR was independently associated with shortened OS (HR 1.932, 95 % CI 1.356-2.754, P < 0.001) and CSS (HR 1.807, 95 % CI 1.209-2.702, P = 0.004). The inflammatory scores PLR, LMR, COP-NLR and PNI demonstrated no independent association with either overall or cancer-specific survival in the study population. Our findings support high preoperative NLR and dNLR as independent prognostic factors for poor outcome in patients undergoing CRLM resection, with prognostic value superior to other cellular-based systemic inflammatory scores.
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136
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Guina T, Biasi F, Calfapietra S, Nano M, Poli G. Inflammatory and redox reactions in colorectal carcinogenesis. Ann N Y Acad Sci 2015; 1340:95-103. [PMID: 25727454 DOI: 10.1111/nyas.12734] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
It has been established that there is a relationship between chronic inflammation and cancer development. The constant colonic inflammation typical of inflammatory bowel diseases is now considered a risk factor for colorectal carcinoma (CRC) development. The inflammatory network of signaling molecules is also required during the late phases of carcinogenesis, to enable cancer cells to survive and to metastasize. Oxidative reactions are an integral part of the inflammatory response, and are generally associated with CRC development. However, when the malignant phenotype is acquired, increased oxidative status induces antioxidant defenses in cancer cells, favoring their aggressiveness. This contradictory behavior of cancer cells toward redox status is of great significance for potential anticancer therapies. This paper summarizes the essential background information relating to the molecules involved in regulating oxidative stress and inflammation during carcinogenesis. Understanding more of their function in CRC stages might provide the foundation for future developments in CRC treatment.
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Affiliation(s)
- Tina Guina
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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137
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Neutrophil–Lymphocyte and Platelet–Lymphocyte Ratios as Prognostic Factors after Stereotactic Radiation Therapy for Early-Stage Non–Small-Cell Lung Cancer. J Thorac Oncol 2015; 10:280-5. [DOI: 10.1097/jto.0000000000000399] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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138
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Leithead JA, Rajoriya N, Gunson BK, Ferguson JW. Neutrophil-to-lymphocyte ratio predicts mortality in patients listed for liver transplantation. Liver Int 2015; 35:502-9. [PMID: 25234369 DOI: 10.1111/liv.12688] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/09/2014] [Accepted: 09/11/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS In the absence of overt infection, the systemic inflammatory response is increasingly recognised as a pathogenetic factor in the circulatory dysfunction of advanced cirrhosis. Our aim was to determine whether the neutrophil-to-lymphocyte ratio, a marker of systemic inflammation, is predictive of mortality in patients with end-stage cirrhosis listed for liver transplantation. METHODS A single centre study of 570 patients listed for first elective single-organ liver transplantation January 2007-June 2011. RESULTS The median listing neutrophil-to-lymphocyte ratio was 2.9 (IQR 1.9-4.7). Neutrophil-to-lymphocyte ratio demonstrated a positive correlation with listing serum bilirubin (P < 0.001), negative correlation with serum sodium (P < 0.001), and positive correlation with the MELD score (P < 0.001). Neutrophil-to-lymphocyte ratio increased with increasing severity of ascites (P < 0.001). A higher neutrophil count (P < 0.001) and lower lymphocyte count (P = 0.001) were predictors of wait-list death. In a multivariate competing risk Cox model, neutrophil-to-lymphocyte ratio remained independently associated with mortality (HR 1.10; 95% CI 1.05-1.15, P < 0.001). The proportion of patients with a neutrophil-to-lymphocyte ratio <2, 2-4.9, and ≥5 who had died by 3 months of listing was 3%, 13.8% and 37.3% respectively (P < 0.001). After adjusting for MELD, increasing increments of neutrophil-to-lymphocyte ratio were predictive of death by 3 months (P = 0.043). CONCLUSIONS The blood neutrophil-to-lymphocyte ratio, a simple and readily available marker of systemic inflammation, is an independent predictor of mortality in patients with liver failure listed for liver transplantation.
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Affiliation(s)
- Joanna A Leithead
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
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139
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Bilen Y, Cankaya E, Bilen N, Keles M, Erdem F, Uyanik A, Hamidullah Uyanik M. Peritonitis incidence was correlated with duration of peritoneal dialysis rather than leptin or neutrophil to lymphocyte (n/l) ratio in peritoneal dialysis patients. Eurasian J Med 2015; 46:145-50. [PMID: 25610316 DOI: 10.5152/eajm.2014.45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 08/28/2013] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE End stage renal disease (ESRD) has a high worldwide prevalence and incidence. Peritonitis is one of the leading causes of hospitalization in peritoneal dialysis patients. Although inflammatory markers show increased inflammatory responses, cellular immune response was decreased in ESRD patients. Leptin is an adipocyte-derived hormone that has activity in energy, nutrition and immune system. Neutrophil to lymphocyte ratio (N/L) was emerged as a predictive and prognostic criterion in many instances. In this study, we aimed to investigate the relationships between increased inflammation in peritoneal dialysis patients and leptin, N/L ratio. MATERIALS AND METHODS Forty-one ESRD patients, who were been at least 12 months of peritoneal dialysis therapy, were included in the study. Patients' demographic properties were recorded. Serum leptin level, WBC count, C-reactive protein, erythrocyte sedimentation rate and biochemical markers were measured. Patients with active viral or bacterial infection, malignancy, inflammatory disease, immunosuppressive medication users were all excluded from the study. Age and sex-matched healthy control group was included in the study only for their leptin levels. RESULTS The measured mean serum leptin level of the patient group was statistically significantly higher than control group (1624.88±1608.16 and 416±439.85). The calculated mean peritonitis incidence was 0.041±0.047 peritonitis/per year. The number of peritonitis attack was significantly correlated with duration of peritoneal dialysis, body mass index (BMI), age and presence of cardiovascular disease. Serum leptin level was significantly correlated with sex, age, primary cause of ESRD, BMI, blood glucose level and duration of peritoneal dialysis (PD). CONCLUSION We detected that ESRD patients have higher serum leptin levels compare to healthy adults. Increased leptin was correlated with sex, age, BMI, primary cause of ESRD and serum glucose level. Number of peritonitis attack and peritonitis incidence was significantly correlated with the duration of PD, BMI and sex. We weren't able to show the predictive N/L value in PD patients in case of peritonitis.
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Affiliation(s)
- Yusuf Bilen
- Department of Hematology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Erdem Cankaya
- Department of Nephrology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Nurhan Bilen
- Department of Internal Medicine, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Keles
- Department of Nephrology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Fuat Erdem
- Department of Hematology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Abdullah Uyanik
- Department of Nephrology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - M Hamidullah Uyanik
- Department of Microbilology, Ataturk University Faculty of Medicine, Erzurum, Turkey
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140
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Yildirim M, Demir Cendek B, Filiz Avsar A. Differentiation between benign and malignant ovarian masses in the preoperative period using neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. Mol Clin Oncol 2014; 3:317-321. [PMID: 25798260 DOI: 10.3892/mco.2014.481] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/20/2014] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to evaluate the association between preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the pathological diagnosis of adnexal masses. The predictive effect of inflammatory markers on epithelial ovarian cancer was also investigated. The present study included a total of 306 patients with adnexal masses who underwent surgical resection and the diagnosis was based on pathological investigation. The patients were divided into six groups based on their pathological findings and compared with respect to their NLR and PLR values. We used receiver-operating characteristic curves to calculate optimal cut-off values for NLR and PLR to predict ovarian cancer preoperatively. Patients with ovarian cancer exhibited significantly higher NLR and PLR values (P<0.05 and P<0.001, respectively). The multivariate analysis demonstrated that higher NLR and PLR values predicted ovarian cancer at the cut-off value of 3.35, sensitivity of 55% and specificity of 81% for NLR [95% confidence interval (CI): 0.544-0.752, P<0.05] and at the cut-off value of 572.9, sensitivity of 100% and specificity of 0.38% for PLR (95% CI: 0.192-0. 381, P=0.001). Therefore, preoperative NLR and PLR values may help identify ovarian cancer in patients with adnexal masses.
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Affiliation(s)
- Melahat Yildirim
- Department of Obstetrics and Gynecology, Ankara Ataturk Training and Research Hospital, Bilkent
| | - Busra Demir Cendek
- Department of Obstetrics and Gynecology, Sincan Dr. Nafiz Korez State Hospital, Sincan
| | - Ayse Filiz Avsar
- Department of Obstetrics and Gynecology, Yildirim Beyazit University, Bilkent, Ankara, Turkey
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141
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The tumour-induced systemic environment as a critical regulator of cancer progression and metastasis. Nat Cell Biol 2014; 16:717-27. [PMID: 25082194 DOI: 10.1038/ncb3015] [Citation(s) in RCA: 651] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent pre-clinical and clinical research has provided evidence that cancer progression is driven not only by a tumour's underlying genetic alterations and paracrine interactions within the tumour microenvironment, but also by complex systemic processes. We review these emerging paradigms of cancer pathophysiology and discuss how a clearer understanding of systemic regulation of cancer progression could guide development of new therapeutic modalities and efforts to prevent disease relapse following initial diagnosis and treatment.
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142
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Shen L, Zhang H, Liang L, Li G, Fan M, Wu Y, Zhu J, Zhang Z. Baseline neutrophil-lymphocyte ratio (≥2.8) as a prognostic factor for patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. Radiat Oncol 2014; 9:295. [PMID: 25518933 PMCID: PMC4300208 DOI: 10.1186/s13014-014-0295-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/10/2014] [Indexed: 02/23/2023] Open
Abstract
Background The neutrophil-lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response and may predict the clinical outcome in some cancers, such as head and neck cancer and gastric cancer. However, the value of this ratio is variable in different cancers. Studies of the relationship between NLR and both survival and response to chemoradiation have been limited with respect to locally advanced rectal cancer. Methods and materials From 2006 to 2011, 199 consecutive locally advanced rectal cancer patients who were treated with neoadjuvant chemoradiation in the Shanghai Cancer Center were enrolled and analysed retrospectively. Tumor response was evaluated by pathological findings. The baseline total white blood cell count (WBC) and the neutrophil, lymphocyte, platelet counts were recorded. The neutrophil-lymphocyte ratio (NLR) and the relationship with clinical outcomes such as overall survival (OS) and disease-free survival (DFS) was analyzed. Results With ROC analysis, the baseline NLR value was found to significantly predict prognosis in terms of OS well in locally advanced rectal cancer patients. A multivariate analysis identified that a cut-off value of NLR ≥ 2.8 could be used as an independent factor to indicate decreased OS (HR, 2.123; 95% CI, 1.140-3.954; P = 0.018). NLR ≥ 2.8 was also associated with worse DFS in univariate analysis (HR, 1.662; 95% CI, 1.037-2.664; P = 0.035), though it was not significant in the multivariate analysis (HR, 1.363; 95% CI, 0.840-2.214; P = 0.210). There was no observed significant correlation of mean value of NLR to the response to neoadjuvant chemoradiation. The mean NLR in the ypT0-2 N0 group was 2.68 ± 1.38, and it was 2.77 ± 1.38 in the ypT3-4/N+ group, with no statistical significance (P = 0.703). The mean NLR in the TRG 0–1 group was 2.68 ± 1.42, and it was 2.82 ± 1.33 in the TRG 2–3 group with no statistical significance (P = 0.873). Conclusions An elevated baseline NLR is a valuable and easily available prognostic factor for OS in addition to tumor response after neoadjuvant therapy. Baseline NLR could be a useful candidate factor for stratifying patients and making treatment decisions in locally advanced rectal cancer.
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Affiliation(s)
- Lijun Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Hui Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Liping Liang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Guichao Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Ming Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Yongxin Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Ji Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Szkandera J, Gerger A, Liegl-Atzwanger B, Stotz M, Samonigg H, Friesenbichler J, Stojakovic T, Leithner A, Pichler M. The derived neutrophil/lymphocyte ratio predicts poor clinical outcome in soft tissue sarcoma patients. Am J Surg 2014; 210:111-6. [PMID: 25586599 DOI: 10.1016/j.amjsurg.2014.10.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/22/2014] [Accepted: 10/06/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Inflammation plays an important role in tumor proliferation and survival in cancer patients. The aim of this study was to investigate the prognostic impact of the pre-operative-derived neutrophil/lymphocyte ratio (dNLR) in a large cohort of soft tissue sarcoma (STS) patients after curative surgical resection. METHODS The impact of preoperative dNLR on disease-free survival (DFS) and overall survival (OS) in retrospectively evaluated 340 STS patients was assessed using Kaplan-Meier curves and Cox proportional models. RESULTS Applying receiver operating curve analysis, we determined a cut-off value of 2.39 for the dNLR to be optimal for discrimination of patients' survival in the whole cohort. Kaplan-Meier curves revealed a dNLR greater than or equal to 2.39 as a marker for decreased DFS (P = .031) and OS (P = .007, log-rank test) in STS patients. In multivariate analysis, increased dNLR was significantly associated with poor OS (hazard ratio 1.60, 95% confidence interval 1.07 to 2.40, P = .022). CONCLUSIONS This study demonstrates that preoperative dNLR might represent a well-correlated surrogate marker for the widely validated NLR. The dNLR is easily obtainable and can provide important information for individual risk assessment in clinical trials.
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Affiliation(s)
- Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria; Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria.
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria; Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | | | - Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria; Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Hellmut Samonigg
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | | | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
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144
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Ying HQ, Deng QW, He BS, Pan YQ, Wang F, Sun HL, Chen J, Liu X, Wang SK. The prognostic value of preoperative NLR, d-NLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med Oncol 2014; 31:305. [PMID: 25355641 DOI: 10.1007/s12032-014-0305-0] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 10/23/2014] [Indexed: 12/11/2022]
Abstract
Accumulating evidences indicate cancer-triggered inflammation plays a pivotal role in carcinogenesis. Systematic inflammatory response biomarkers are considered as potential prognostic factors for improving predictive accuracy in colorectal cancer (CRC). Preoperative neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (d-NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte- to-monocyte ratio (LMR) were investigated and compared in 205 surgical CRC patients. ROC curve was applied to determine thresholds for four biomarkers, and their prognostic values were assessed using Kaplan-Meier curve, univariate and multivariate COX regression models. Moreover, a number of risk factors were used to form nomograms for evaluating risk of survival, and Harrell's concordance index (c-index) was used to evaluate predictive accuracy. Results showed that elevated NLR was significantly associated with diminished recurrent-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) in surgical CRC patients. Moreover, multivariate COX analysis identified elevated NLR as an independent factor for poor RFS (P < 0.001, HR 2.52, 95% CI 1.65-3.83), OS (P < 0.001, HR 2.73, 95% CI 1.74-4.29) and CSS (P < 0.001, HR 2.77, 95% CI 1.72-4.46). Additionally, predictive nomograms including NLR for RFS, OS and CSS could be more effective in predicting RFS (c-index: 0.810 vs. 0.656), OS (c-index: 0.809 vs. 0.690) and CSS (c-index: 0.802 vs. 0.688) in surgical CRC patients, respectively. These findings indicate that preoperative elevated NLR can be considered as an independent prognostic biomarker for RFS, OS and CSS. Nomograms containing NLR provide improved accuracy for predicting clinical outcomes in surgical CRC patients under surgery resection.
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Affiliation(s)
- Hou-Qun Ying
- Medical College, Southeast University, Nanjing, 210009, Jiangsu, China
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145
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Inoue D, Ozaka M, Matsuyama M, Yamada I, Takano K, Saiura A, Ishii H. Prognostic value of neutrophil-lymphocyte ratio and level of C-reactive protein in a large cohort of pancreatic cancer patients: a retrospective study in a single institute in Japan. Jpn J Clin Oncol 2014; 45:61-6. [DOI: 10.1093/jjco/hyu159] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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146
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Stotz M, Szkandera J, Seidel J, Stojakovic T, Samonigg H, Reitz D, Gary T, Kornprat P, Schaberl-Moser R, Hoefler G, Gerger A, Pichler M. Evaluation of uric acid as a prognostic blood-based marker in a large cohort of pancreatic cancer patients. PLoS One 2014; 9:e104730. [PMID: 25133546 PMCID: PMC4136788 DOI: 10.1371/journal.pone.0104730] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/11/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Recently, chemical blood parameters gain more attraction as potential prognostic parameters in pancreatic cancer (PC). In the present study we investigated the prognostic relevance of the uric acid (UA) level in blood plasma at the time of diagnosis for overall survival (OS) in a large cohort of patients with PC. PATIENTS AND METHODS Data from 466 consecutive patients with ductal adenocarcinoma of the pancreas were evaluated retrospectively. Overall survival (OS) was analysed using the Kaplan-Meier method. To further evaluate the prognostic significance of the UA level, univariate and multivariate Cox regression models were calculated. RESULTS None of the clinicopathological parameters (tumour grade, clinical stage, age, CA19-9 level, Karnofski Index (KI) or surgical resection) except gender was associated with UA level. In univariate analysis we observed the elevated UA level (<5.1 versus ≥5.1 mg/dl, p = 0.017) as poor prognostic factor for OS. In the multivariate analysis that included age, gender, tumour grade, tumour stage, surgical resection, CA19-9 level, the KI and UA level we confirmed the UA level as independent prognostic factor for OS (HR = 1.373%; CI = 1.077-1.751; p = 0.011). CONCLUSION In conclusion, we identified the UA level at time of diagnosis as an independent prognostic factor in PC patients. Our results indicate that the UA level might represent a novel and useful marker for patient stratification in PC management.
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Affiliation(s)
- Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Julia Seidel
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Hellmut Samonigg
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Reitz
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Gary
- Division of Angiology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Peter Kornprat
- Division of General Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Renate Schaberl-Moser
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Gerald Hoefler
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
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147
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Hutterer GC, Stoeckigt C, Stojakovic T, Jesche J, Eberhard K, Pummer K, Zigeuner R, Pichler M. Low preoperative lymphocyte-monocyte ratio (LMR) represents a potentially poor prognostic factor in nonmetastatic clear cell renal cell carcinoma. Urol Oncol 2014; 32:1041-8. [PMID: 25027686 DOI: 10.1016/j.urolonc.2014.04.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 03/31/2014] [Accepted: 04/03/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To explore the potential prognostic significance of the lymphocyte-monocyte ratio (LMR) in patients with nonmetastatic renal cell carcinoma (RCC), as the LMR has been repeatedly proposed to have a negative effect on patient׳s survival in various hematological and solid cancers. However, findings about LMR׳s prognostic significance in RCC have not been reported yet. METHODS AND MATERIALS We retrospectively evaluated the prognostic significance of the LMR in a cohort comprising 678 patients with nonmetastatic clear cell RCC, who were operated between 2000 and 2010 with curative radical or partial nephrectomy at a single tertiary academic center. Preoperative LMR was calculated 1 day before surgical intervention. Patients were categorized using an LMR cutoff of 3.0. Cancer-specific survival (CSS), metastasis-free survival, and overall survival were assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of the LMR, multivariate Cox regression models were applied. Additionally, the influence of the LMR on the predictive accuracy of the Leibovich prognosis score was determined using the Harrell concordance index (c-index) and decision curve analysis. RESULTS Low LMR was statistically significantly associated with older patients (≥65 y), high tumor grade (G3+G4), advanced pathologic T category (pT3+pT4), the presence of histologic tumor necrosis, and male gender (P<0.05). Multivariate analysis identified a low LMR as an independent prognostic factor for patients׳ CSS (hazard ratio = 2.33; 95% CI: 1.10-4.94; P = 0.027). The estimated c-index was 0.83 using the Leibovich prognosis score and 0.86 when the LMR was added. CONCLUSIONS Regarding CSS of patients with RCC, a decreased LMR represents an independent prognostic factor. Adding the LMR to well-established prognostic models, such as the Leibovich prognosis score, might improve their predictive ability.
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Affiliation(s)
- Georg C Hutterer
- Department of Urology, Medical University of Graz, Graz, Austria.
| | - Caroline Stoeckigt
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Johanna Jesche
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Katharina Eberhard
- Research Facility for Biostatistics, Medical University of Graz, Graz, Austria
| | - Karl Pummer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX
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148
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Seretis F, Seretis C. Immuno-PCI: a proposal for the implementation of "seed and soil" concept in the treatment of peritoneal carcinomatosis from colorectal cancer. Med Hypotheses 2014; 83:137-41. [PMID: 24893828 DOI: 10.1016/j.mehy.2014.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/25/2014] [Accepted: 05/01/2014] [Indexed: 01/05/2023]
Abstract
The advent of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has revolutionized the approach to peritoneal carcinomatosis of colorectal cancer origin in appropriately selected cases. However, the high postoperative morbidity and mortality following the procedure underlines the need for optimizing the patient selection criteria, finally aiming to establish a patient-tailored approach. The introduction of tools enabling the quantification of the peritoneal spread of the metastatic deposits has been of paramount importance in the decision-making and the estimation of the prognosis. However, we believe that it is high time to attempt a further evolution of the current practice, by incorporating in the above mentioned quantification scores parameters indicative of the immune-response against the disease progression, fact which will probably reflect more accurately the dynamics of cancer progression and will sequentially be a crucial step towards individualized treatment of peritoneal carcinomatosis.
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Affiliation(s)
| | - Charalampos Seretis
- 2nd Department of General Surgery, 401 General Army Hospital of Athens, Greece.
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149
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C-reactive protein level is a prognostic indicator for survival and improves the predictive ability of the R-IPI score in diffuse large B-cell lymphoma patients. Br J Cancer 2014; 111:55-60. [PMID: 24874478 PMCID: PMC4090740 DOI: 10.1038/bjc.2014.277] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/17/2014] [Accepted: 04/28/2014] [Indexed: 12/22/2022] Open
Abstract
Background: High levels of C-reactive protein (CRP), an acute phase protein, proofed being associated with decreased clinical outcome in small-scale studies in diffuse large B-cell lymphoma (DLBCL). The aim of this study was to evaluate the prognostic impact of pretreatment CRP levels on overall survival (OS) and disease-free survival (DFS) in a large bicentre study of DLBCL patients. Methods: Data from 477 DLBCL patients, diagnosed and treated between 2004 and 2013 at two Austrian centres, were evaluated retrospectively. The prognostic influence of CRP and other factors, including age, tumour stage, and revised International Prognostic Index (R-IPI) on 5-year OS and 5-year DFS, were studied by Kaplan–Meier curves as well as univariate and multivariate Cox regression models. Influence of CRP on the predictive accuracy of the R-IPI score was determined by the Harrell concordance index. Results: Kaplan–Meier curves revealed elevated CRP as a factor for decreased 5-year OS and DFS in DLBCL patients (P<0.001, log-rank test). An independent significant association between high CRP levels and poor clinical outcome in multivariate analysis for 5-year OS (HR=1.51, CI 95%=1.04–2.20, P=0.031) and for DFS (HR=1.91, CI 95%=1.28–2.85, P=0.002) was found. The estimated concordance index was 0.75 using the original R-IPI score and 0.79 when CRP was added. Conclusions: In the present study, we demonstrated high CRP levels at diagnosis of DLBCL as an independent poor prognostic factor for clinical outcome. Adding CRP to the well-established prognostic models such as the R-IPI score might improve their predictive ability.
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150
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Krenn-Pilko S, Langsenlehner U, Thurner EM, Stojakovic T, Pichler M, Gerger A, Kapp KS, Langsenlehner T. The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients. Br J Cancer 2014; 110:2524-30. [PMID: 24675383 PMCID: PMC4021515 DOI: 10.1038/bjc.2014.163] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/01/2014] [Accepted: 03/04/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The elevation of the platelet-to-lymphocyte ratio (PLR), an easily applicable blood test based on platelet and lymphocyte counts has been associated with poor prognosis in patients with different types of cancer. The present study was aimed to investigate the prognostic significance of the preoperative PLR in a large cohort of breast cancer patients. METHODS Data from 793 consecutive non-metastatic breast cancer patients, treated between 1999 and 2004, were evaluated retrospectively. The optimal cutoff values for the PLR were calculated using receiver operating curve analysis. Cancer-specific survival (CSS), overall survival (OS) as well as distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of PLR, multivariable Cox regression models were applied for all three different end points. RESULTS Univariable analysis revealed a significant association between the elevated preoperative PLR and CSS (hazard ratio (HR): 2.75, 95% confidence interval (CI): 1.57-4.83, P<0.001) that remained statistically significant in multivariable analysis (HR: 2.03, 95% CI: 1.03-4.02, P=0.042). An increased PLR was also significantly associated with decreased OS in univariable (HR: 2.45, 95% CI: 1.43-4.20, P=0.001) and in multivariable analysis (HR: 1.92, 95% CI: 1.01-3.67, P=0.047). Furthermore, univariable analysis showed a significant impact of increased PLR on DMFS (HR: 2.02, 95% CI: 1.18-3.44, P=0.010). Subgroup analysis revealed significant associations of the elevated PLR on the primary end point CSS for all breast cancer subtypes. This association retained its significance in multivariable analysis in patients with luminal B tumours (HR: 2.538, 95% CI: 1.043-6.177, P=0.040). CONCLUSIONS In this study, we identified the preoperative PLR as an independent prognostic marker for survival in breast cancer patients. Independent validation of our findings is needed.
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Affiliation(s)
- S Krenn-Pilko
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036 Graz, Austria
| | - U Langsenlehner
- Division of Internal Medicine, Outpatient Department Graz, Graz, Austria
| | - E-M Thurner
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036 Graz, Austria
| | - T Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - M Pichler
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - K S Kapp
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036 Graz, Austria
| | - T Langsenlehner
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036 Graz, Austria
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