Combination of platelet count and neutrophil to lymphocyte ratio is a useful predictor of postoperative survival in patients undergoing surgery for gastric cancer

Elevations of neutrophil-to-lymphocyte ratio and C-reactive protein over time as a precursor to anaplastic transformation of papillary thyroid carcinoma: a case report

BACKGROUND

Papillary thyroid carcinoma rarely undergoes anaplastic transformation. Some risk factors for anaplastic transformation of thyroid cancer are known, but such transformation is difficult to predict in practice. We report a case demonstrating elevations of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) over time as a precursor to anaplastic transformation of thyroid carcinoma.

CASE PRESENTATION

The patient was an 89 year-old woman with a history of chronic aortic dissection. She was referred to our department after her local doctor detected thyroid nodules. She had previously been found to have multinodular goiter and enlarged left cervical lymph nodes on computed tomography. Her chief complaint was cervical discomfort and hoarseness. Blood tests revealed: white blood cells (WBCs), 4900 /µL; CRP, 0.29 mg/dL; neutrophils, 64.4%; and lymphocytes, 25.4%. A 21 mm mass was identified in the upper left lobe. Left III (16 mm) and left VI (16 mm) lymph node were enlarged on ultrasonography. Fine-needle aspiration cytology diagnosed malignant papillary carcinoma. However, due to the advanced age and medical history of the patient, a non-surgical policy was implemented. The primary tumor grew to 4 cm in diameter by 9 months after diagnosis, and blood tests showed: WBC, 7700 /µL; CRP, 0.18 mg/dL; neutrophils, 65.3%; and lymphocytes, 22.3%. By 10 months after diagnosis, the tumor had increased rapidly in diameter to 8 cm, with blood tests showing: WBC, 6500 /µL; CRP, 1.01 mg/dL; neutrophils, 68.2%; and lymphocytes, 19.3%. Anaplastic transformation of papillary thyroid carcinoma was diagnosed, and the patient was placed on treatment under a policy of best supportive care. Multiple lung metastases appeared 11 months after diagnosis, and blood test results showed: WBC, 13,300 /μL; CRP, 11.28 mg/dL; neutrophils, 93.6%; and lymphocytes, 2.3%. Unfortunately, the patient died of disease progression 63 days after identification of undifferentiated metastasis.

CONCLUSIONS

Chances to see the natural history of anaplastic transformation of thyroid cancer are rare. Elevations in NLR and CRP over time may be precursors to anaplastic transformation.

Simple and easily accessible prognostic markers in ewing sarcoma; neutrophil-lymphocyte ratio, neutrophil-platelet score and systemic-inflammation index

Background

Inflammation markers are the new point of view in cancer due to increasing data on the interaction of immune system with tumor cells and their prognostic and predictive importance were found in many different types of solid tumors. Therefore, we aimed to evaluate the prognostic value of neutrophil-lymphocyte ratio (NLR), neutrophil-platelet score (NPS), and systemic inflammation index (SII) in Ewing sarcoma patients in which risk groups are still not clearly defined.

Methods and Results

A total of 64 patients were evaluated retrospectively. Receiver operating characteristic analysis was performed to find cut-off values for NLR and SII. Survival analysis was calculated by using Kaplan-Meier method. Cox regression analysis was performed to determine prognostic factors such as age, stage, and neoadjuvant chemotherapy were statistically significant prognostic factors for OS in multivariate analysis. While patients with low NLR and SII had longer OS (P = 0.003 and P = 0.018), patients with high NPS score had shorter OS (67.7 vs 21.7 months, P = 0.001).

Conclusion

Patients with lower NLR, NPS, and SII score have a better prognosis compared with those with higher NLR, NPS, and SII score and these simple parameters may be monitoring tools of the tumor microenvironment.

A novel approach to distinguish complicated and non-complicated acute cholecystitis: Decision tree method

It is difficult to differentiate between non-complicated acute cholecystitis (NCAC) and complicated acute cholecystitis (CAC) preoperatively, which are two separate pathologies with different management. The aim of this study was to create an algorithm that distinguishes between CAC and NCAC using the decision tree method, which includes simple examinations. In this retrospective study, the patients were divided into 2 groups: CAC (149 patients) and NCAC (885 patients). Parameters such as patient demographic data, American Society of Anesthesiologists (ASA) score, Tokyo grade, comorbidity findings, white blood cell (WBC) count, neutrophil/lymphocyte ratio, C-reactive protein (CRP) level, albumin level, CRP/albumin ratio (CAR), and gallbladder wall thickness (GBWT) were evaluated. In this algorithm, the CRP value became a very important parameter in the distinction between NCAC and CAC. Age was an important predictive factor in patients with CRP levels >57 mg/L, and the critical value for age was 42. After the age factor, the important parameters in the decision tree were WBC and GBWT. In patients with a CRP value of ≤57 mg/L, GBWT is decisive and the critical value is 4.85 mm. Age, neutrophil/lymphocyte ratio, and WBC count were among the other important factors after GBWT. Sex, ASA score, Tokyo grade, comorbidity, CAR, and albumin value did not have an effect on the distinction between NCAC and CAC. In statistical analysis, significant differences were found groups in terms of gender (34.8% vs 51.7% male), ASA score (P < .001), Tokyo grade (P < .001), comorbidity (P < .001), albumin (4 vs 3.4 g/dL), and CAR (2.4 vs 38.4). By means of this algorithm, which includes low-cost examinations, NCAC and CAC distinction can be made easily and quickly within limited possibilities. Preoperative prediction of pathologies that are difficult to manage, such as CAC, can minimize patient morbidity and mortality.

Predicting postoperative gastric cancer prognosis based on inflammatory factors and machine learning technology

OBJECTIVE

There is a strong association between gastric cancer and inflammatory factors. Many studies have shown that machine learning can predict cancer patients' prognosis. However, there has been no study on predicting gastric cancer death based on machine learning using related inflammatory factor variables.

METHODS

Six machine learning algorithms are applied to predict total gastric cancer death after surgery.

RESULTS

The Gradient Boosting Machine (GBM) algorithm factors accounting for the prognosis weight outcome show that the three most important factors are neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and age. The total postoperative death model showed that among patients with gastric cancer from the predictive test group: The highest accuracy was LR (0.759), followed by the GBM algorithm (0.733). For the six algorithms, the AUC values, from high to low, were LR, GBM, GBDT, forest, Tr and Xgbc. Among the six algorithms, Logistic had the highest precision (precision = 0.736), followed by the GBM algorithm (precision = 0.660). Among the six algorithms, GBM had the highest recall rate (recall = 0.667).

CONCLUSION

Postoperative mortality from gastric cancer can be predicted based on machine learning.

Development and validation of a novel nomogram for predicting overall survival in gastric cancer based on inflammatory markers

BACKGROUND

Nearly 66% of occurrences of gastric cancer (GC), which has the second-highest death rate of all cancers, arise in developing countries. In several cancers, the predictive significance of inflammatory markers has been established.

AIM

To identify clinical characteristics and develop a specific nomogram to determine overall survival for GC patients.

METHODS

Nine hundred and four GC patients treated at the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2013 were recruited. Prognostic risk variables were screened for Cox analysis. The C index, receiver operator characteristic (ROC) curve, and decision curve analysis were used to evaluate the nomogram.

RESULTS

Tumor node metastasis stage, carcinoembryonic antigen, systemic immune-inflammation index, and age were identified as independent predictive variables by multivariate analysis. Systemic immune-inflammation index value was superior to that of other inflammatory indicators. The ROC indicated the nomogram had a higher area under the curve than other factors, and its C-index for assessing the validation and training groups of GC patients was extremely reliable.

CONCLUSION

We created a novel nomogram to forecast the prognosis of GC patients following curative gastrectomy based on blood markers and other characteristics. Both surgeons and patients can benefit significantly from this new scoring system.

The relationship of different preoperative inflammatory markers with the prognosis of gastric carcinoma

BACKGROUND

It is aimed to determine the prognostic values of preoperative inflammatory biomarkers in patients undergoing curative surgery for gastric carcinoma and to contribute to the development of prognostic modeling.

OBJECTIVE

To investigate the effect of various different preoperative inflammatory markers on the prognosis of gastric carcinoma.

MATERIAL AND METHOD

The medical data and the mortality status of 91 patients who underwent total or subtotal gastrectomy operation for gastric carcinoma at Mersin City Training and Research Hospital between 2016 and 2020 were retrospectively reviewed from the hospital records and patient files. The patients' demographic characteristics, tumor location, histopathological diagnosis, pathological stage, tumor markers, and preoperative inflammatory and hematological markers were analyzed. Based on these data, tumor stage, metastatic lymph node ratio (MLR), lactate dehydrogenase albumin ratio (LAR), neutrophil-lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) were calculated. The relationship between these parameters and postoperative survival was analyzed. Statistical analyses were performed with IBM SPSS for Windows, version 17.0 (IBM Corporation, Armonk, New York, United States).

RESULTS

The correlation analysis of the parameters affecting survival showed that, in addition to an advanced tumor stage, inflammatory parameters like NLR, PLR, and LAR adversely affected survival.

CONCLUSION

Preoperative NLR, PLR, LAR, and advanced tumor stage may help determine the survival of gastric carcinoma patients. Multiple studies with larger series are needed on this subject.

Preoperative contrast-enhanced computed tomography-based radiomics model for overall survival prediction in hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy with a rising incidence worldwide. The prognosis of HCC patients after radical resection remains poor. Radiomics is a novel machine learning method that extracts quantitative features from medical images and provides predictive information of cancer, which can assist with cancer diagnosis, therapeutic decision-making and prognosis improvement.

AIM

To develop and validate a contrast-enhanced computed tomography-based radiomics model for predicting the overall survival (OS) of HCC patients after radical hepatectomy.

METHODS

A total of 150 HCC patients were randomly divided into a training cohort (n = 107) and a validation cohort (n = 43). Radiomics features were extracted from the entire tumour lesion. The least absolute shrinkage and selection operator algorithm was applied for the selection of radiomics features and the construction of the radiomics signature. Univariate and multivariate Cox regression analyses were used to identify the independent prognostic factors and develop the predictive nomogram, incorporating clinicopathological characteristics and the radiomics signature. The accuracy of the nomogram was assessed with the concordance index, receiver operating characteristic (ROC) curve and calibration curve. The clinical utility was evaluated by decision curve analysis (DCA). Kaplan–Meier methodology was used to compare the survival between the low- and high-risk subgroups.

RESULTS

In total, seven radiomics features were selected to construct the radiomics signature. According to the results of univariate and multivariate Cox regression analyses, alpha-fetoprotein (AFP), neutrophil-to-lymphocyte ratio (NLR) and radiomics signature were included to build the nomogram. The C-indices of the nomogram in the training and validation cohorts were 0.736 and 0.774, respectively. ROC curve analysis for predicting 1-, 3-, and 5-year OS confirmed satisfactory accuracy [training cohort, area under the curve (AUC) = 0.850, 0.791 and 0.823, respectively; validation cohort, AUC = 0.905, 0.884 and 0.911, respectively]. The calibration curve analysis indicated a good agreement between the nomogram-prediction and actual survival. DCA curves suggested that the nomogram had more benefit than traditional staging system models. Kaplan–Meier survival analysis indicated that patients in the low-risk group had longer OS and disease-free survival (all P < 0.0001).

CONCLUSION

The nomogram containing the radiomics signature, NLR and AFP is a reliable tool for predicting the OS of HCC patients.

Association between neutrophil-lymphocyte ratio and lymph node metastasis in gastric cancer: A meta-analysis

INTRODUCTION AND AIM

The prognostic role of neutrophil to lymphocyte ratio (NLR) has been explored extensively in the literature. The aim of this meta-analysis was to evaluate the link between NLR and lymph node metastasis in gastric cancer. A method for increasing specificity and sensitivity of pre-treatment staging has implications on treatment algorithms and survival.

SEARCH STRATEGY

The relevant databases were searched as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. After selection, 12 full text articles that met the inclusion criteria were included for quantitative analysis. 2 × 2 squares were generated using lymph node positive/negative, and NLR high/low data. The effect size for each study was calculated using the DerSimonian-Laird random effects model. P values were calculated using the chi-square method. Finally publication bias was evaluated. All statistics were calculated using R Studio.

RESULTS

Meta-analysis showed a 1.90 times (odds ratio, with 95% CI 1.52-2.38) increase in risk of positive lymph node status with high neutrophil to lymphocyte ratio. This has significant implications for cancer screening and staging, as NLR is a highly reproducible, cost-effective, and widely available prognostic factor for gastric cancer patients. Additionally, high or low NLR values may have implications for management pathways. Patients with lymph node metastasis can be offered neoadjuvant chemotherapy, avoiding salvage therapy in the form of adjuvant chemoradiotherapy, which is poorly tolerated.

CONCLUSION

This meta-analysis shows an association between NLR and positive lymph node status in gastric cancer patients with implications for staging, as well as preoperative personalisation of therapy.

Inflammation-Based Score (Combination of Platelet Count and Neutrophil-to-Lymphocyte Ratio) Predicts Pharyngocutaneous Fistula After Total Laryngectomy

OBJECTIVES/HYPOTHESIS

Postoperative complications may depend on the systemic inflammatory response. We evaluated the predictive potential of the combination of platelet count and neutrophil-to-lymphocyte ratio (COP-NLR) for the incidence of pharyngocutaneous fistula (PCF) in patients who have undergone total laryngectomy.

STUDY DESIGN

Retrospective cohort study.

METHODS

Patients who underwent total laryngectomy between 2000 and 2020 were recruited from four hospitals. The correlations between the incidence of PCF and several risk factors, including the COP-NLR, were examined. Patients with both elevated platelet count and elevated neutrophil-to-lymphocyte ratio (NLR) were categorized as COP-NLR 2, and patients with either one or no abnormal values of both parameters were assigned as COP-NLR 1 and COP-NLR 0, respectively.

RESULTS

A total of 235 patients were identified. The overall incidence of PCF was 12.3%. The cut-off value for NLR before surgery was set at 3.95 (sensitivity = 58.6%, specificity = 69.4%, area under the curve [AUC] = 0.635), and the platelet count was set at 320 × 10⁹ /L (sensitivity = 27.6%, specificity = 87.9%, AUC = 0.571). Multivariate analysis revealed that COP-NLR was an independent risk factor for PCF (COP-NLR 1 vs. COP-NLR 0: odds ratio [OR], 4.17; 95% confidence interval [CI], 1.64 to 10.59; and COP-NLR 2 vs. COP-NLR 0: OR, 5.33; 95% CI, 1.38 to 20.56).

CONCLUSIONS

COP-NLR is a novel predictive factor for the development of PCF in patients undergoing total laryngectomy.

LEVEL OF EVIDENCE

4 Laryngoscope, 2021.

Assessment of Preoperative Clinicophysiologic Findings as Risk Factors for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

Objective

Postoperative pancreatic fistula (POPF) is one of the severe complications that develop after pancreaticoduodenectomy (PD). This study aimed to assess the utility of preoperative clinicophysiologic findings as risk factors for POPF after PD.

Summary of Background Data

We enrolled 350 patients who underwent PD between 2007 and 2012 at Tokyo Women's Medical University.

Methods

In total, 350 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into 2 groups as follows: group A (no fistula/biochemical leak group, 289 patients) and group B (grade B/C of POPF group 61 patients). Variables, including operative characteristics, length of stay in hospital, morbidity, mortality, and data regarding preoperative clinicophysiologic parameters, were collected and analyzed as predictors of POPF for univariate and multivariate analyses.

Results

There were 213 male and 137 female patients. The mean age was 65.4 years (range, 21–87 years). Univariate analysis showed that sex (P = 0.047), amylase level (P = 0.032), prognostic nutritional index (PNI; P = 0.001), and C-reactive protein/albumin ratio (P = 0.005) were independent risk factors for POPF. In contrast, multivariate analysis showed that sex (P = 0.045) and PNI (P = 0.012) were independent risk factors for POPF.

Conclusions

Our results show that PNI (≤48.64 U/mL) and male sex were risk factors for POPF after PD, and especially, PNI can be suggested as an effective biomarker for POPF.

Inflammatory markers for predicting overall survival in gastric cancer patients: A systematic review and meta-analysis

Systemic inflammatory biomarkers have begun to be used in clinical practice to predict prognosis and survival of cancer patients, but the approach remains controversial. We conducted a meta-analysis to determine the predictive value of the c-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and Glasgow prognostic score (GPS)/modified Glasgow prognostic score (mGPS) in the clinical outcome of gastric cancer (GC) patients. We searched literature databases to identify relevant studies. All articles identified in the search were independently reviewed based on predetermined selection criteria. Meta-analysis was conducted to calculate the hazard ratio (HR) and 95% confidence intervals (CI) of overall survival of the included studies. A total of 41 eligible cohort studies, involving a total of 18,348 patients meeting the inclusion criteria, were considered for meta-analysis. Increases in CRP (HR = 1.654, 95% CI: 1.272–2.151), NLR (HR = 1.605, 95% CI: 1.449–1.779), and GPS/mGPS (HR = 1.648, 95% CI: 1.351–2.011) were significantly associated with poorer survival in patients with GC. Substantial heterogeneities were noted in all three markers (I² = 86.479%, 50.799%, 69.774%, in CRP, NLR, and GPS/mGPS, respectively). Subgroup analysis revealed a significant positive correlation between each marker and poor survival, regardless of country, study quality, cancer stage, study design, or the inclusion of patients undergoing chemotherapy. This meta-analysis demonstrates that CRP, NLR, and GPS/mGPS are associated with poor survival in patients with GC. Further prospective studies using standardized measurements are warranted to conclude the prognostic value of various inflammatory markers.

Lymphocyte-Monocyte Ratio Significantly Predicts Recurrence in Papillary Thyroid Cancer

BACKGROUND

A growing body of evidences shows that systemic inflammatory responses are involved in patient prognosis in multiple cancers. Combinations of peripheral leukocyte fractions have been shown to be useful markers for the inflammatory responses. However, significance of such systemic inflammatory responses is still unknown in thyroid cancer. Accordingly, we aimed to clarify clinical impact of peripheral leukocyte fractions in papillary thyroid cancer (PTC).

METHODS

Clinicopathological analyses were performed including preoperative leukocyte fractions in 570 patients with curatively resected PTC. Receiver operating characteristic curves were used to determine cutoffs of leukocyte fraction or inflammation indexes such as lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio. A Kaplan-Meier analysis and a Cox's proportional hazard model were used to conduct prognostic analysis. A multivariable logistic regression analysis was performed for correlation assay.

RESULTS

Preoperative low LMR predicted recurrence with high sensitivity (63.3%) and specificity (68.7%) (P = 0.002). The multivariable prognostic analyses revealed that preoperative low LMR (P = 0.025), pathological N1b (P = 0.019), high metastatic lymph node ratio (node density) (P = 0.014), and high thyroglobulin level (P = 0.002) independently predicted worse prognosis. The combination of these independent parameters clearly enriched high-risk patients (P < 0.001). Of note, low LMR was dramatically associated with recurrence especially in patients with advanced PTC.

CONCLUSIONS

Preoperative low LMR dramatically predicts high-risk patients for recurrences. The results in this study give rational to focusing on immune cell profiles to tackle advanced PTC.

Prognostic Significance of Pre-surgical Combined Platelet Count and Neutrophil-Lymphocyte Ratio for Patients With Hepatocellular Carcinoma

BACKGROUND/AIM

Recent studies have investigated a novel inflammation-based prognostic system using the combination of platelet count and neutrophil-lymphocyte ratio (COP-NLR). As platelet count decreases with liver damage, we hypothesized that COP-NLR could indicate both inflammation and hepatic reserve in patients with hepatocellular carcinoma (HCC). This study was conducted to clarify the prognostic significance of preoperative COP-NLR in patients with HCC.

PATIENTS AND METHODS

We enrolled 176 patients with histologically-proven HCC who underwent initial curative hepatectomy. Patients were assigned one point each for low platelet count (<15×104/μl) or for high NLR (≥2.0), for hepatic-COP-NLR scores (h-COP-NLR) of 0, 1 or 2.

RESULTS

Five-year overall survival (OS) and recurrence-free survival (RFS) rates were 74.5±9%, and 62.2%±9.3% for score 0, 63.6±5.4% and 50.3%±5.6% for score 1, and 45.2±8.8% and 40.6±8.7% for score 2, respectively, and significantly differed (OS: p=0.01; RFS: p=0.03). In multivariate analysis, h-COP-NLR was an independent risk factor for tumor recurrence (HR=1.39, p=0.03) and death (HR=1.71, p=0.02).

CONCLUSION

h-COP-NLR was an independent predictor for prognosis of HCC patients after hepatic resection.

Biomarkers for Evaluating the Inflammation Status in Patients with Cancer

Inflammation can be a causative factor for carcinogenesis or can result from a consequence of cancer progression. Moreover, cancer therapeutic interventions can also induce an inflammatory response. Various inflammatory parameters are used to assess the inflammatory status during cancer treatment. It is important to select the most optimal biomarker among these parameters. Additionally, suitable biomarkers must be examined if there are no known parameters. We briefly reviewed the published literature for the use of inflammatory parameters in the treatment of patients with cancer. Most studies on inflammation evaluated the correlation between host characteristics, effect of interventions, and clinical outcomes. Additionally, the levels of C-reactive protein, albumin, lymphocytes, and platelets were the most commonly used laboratory parameters, either independently or in combination with other laboratory parameters and clinical characteristics. Furthermore, the immune parameters are classically examined using flow cytometry, immunohistochemical staining, and enzyme-linked immunosorbent assay techniques. However, gene expression profiling can aid in assessing the overall peri-interventional immune status. The checklists of guidelines, such as STAndards for Reporting of Diagnostic accuracy and REporting recommendations for tumor MARKer prognostic studies should be considered when designing studies to investigate the inflammatory parameters. Finally, the data should be interpreted after adjusting for clinically important variables, such as age and cancer stage.

Increased neutrophil lymphocyte ratio and platelet lymphocyte ratio in malignant parotid tumors

Introduction

Recently it has been reported that a high preoperative neutrophil–lymphocyte ratio and platelet–lymphocyte ratio may be related to increased recurrence risk, tumor aggressiveness, and worsened prognosis in various malignancies.

Objective

The objective of this research is to explore whether neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in parotid tumors may or may not be used as a cancer marker.

Methods

This retrospective research has been conducted on a total of 228 patients consisting of 83 healthy persons and 145 patients with a mass in the parotid gland, who applied to a tertiary referral center and underwent surgery. Patients have been divided into two groups by their histopathological findings as malignant or benign parotid tumor. A third group consisting of healthy people has been defined as the control group. Also the malignant parotid tumor group has been divided into two subgroups as early stage and advanced stage. The groups have been compared in terms of neutrophil–lymphocyte ratio, platelet–lymphocyte ratio and other laboratory data.

Results

The average neutrophil–lymphocyte ratio values of malignant parotid tumor, benign parotid tumor, healthy control groups were 2.51, 2.01, 1.79 respectively and the difference was statistically significant (p < 0.001). There was no significant difference between advanced stage and early stage parotid tumor groups in terms of average neutrophil–lymphocyte ratio value (p = 0.782). In dual comparisons, the platelet–lymphocyte ratio value of patients in the malignant group was found out to be statistically significantly higher than that of benign and control groups (p < 0.001 and p = 0.001 respectively).

Conclusion

To the best of our knowledge our research is the first in the medical literature comparing neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in patients with parotid tumor. neutrophil–lymphocyte ratio and platelet–lymphocyte ratio can serve as cost-effective, repeatable, easily accessible, and helpful inflammatory markers in order to distinguish patients with malignant parotid tumor from healthy people.

Prognostic value of the fibrinogen-to-platelet ratio as an inflammatory and coagulative index in patients with gastric cancer

PURPOSE

We assessed the prognostic value of the fibrinogen-to-platelet ratio (FPR) as an inflammatory and coagulative index by examining its clinicopathologic and prognostic efficiency in patients with gastric cancer (GC).

METHODS

The subjects of this retrospective study were 182 GC patients whose FPR was measured preoperatively between January, 2001 and December, 2006. The FPR was defined as the plasma fibrinogen divided by the platelet counts.

RESULTS

Patients aged ≥ 65 years and with venous invasion had a significantly higher FPR (p = 0.02 and p < 0.01, respectively) than those aged < 65 years and without venous invasion. We found a correlation between the FPR and all recurrences (p < 0.01). Patients with a low FPR had significantly better overall survival (OS) and relapse-free survival (RFS) rates than patients with a high FPR (p = 0.001 for both). Furthermore, the FPR was an independent predictor of OS and RFS (p = 0.02 and 0.001, respectively), but the fibrinogen level was not. In a subgroup analysis, the FPR was a significant prognostic factor for OS and RFS in patients with pathological stages II/III disease and in patients aged < 65 years.

CONCLUSION

The FPR can be calculated easily and is more useful than the fibrinogen level for predicting the prognosis of GC patients. Patients with a high FPR, particularly those with undifferentiated tumors, those with pStage II/III disease, and those aged < 65 years, require more intensive chemotherapy.

Pre-operative predictors of early recurrence/mortality including the role of inflammatory indices in patients undergoing partial hepatectomy for spontaneously ruptured hepatocellular carcinoma

BACKGROUND AND OBJECTIVES

Spontaneous rupture of Hepatocellular Carcinoma (srHCC) is a life-threatening emergency. We sought to identify the pre-operative predictors of early tumor recurrence/mortality including the role of inflammatory indices after partial hepatectomy for srHCC.

METHODS

Between 2000-2015, 79 patients with srHCC were identified to have undergone upfront partial hepatectomy following srHCC. Clinicopathologic data were retrospectively analyzed to identify pre-operative predictors of early (<1 year) recurrence and mortality.

RESULTS

Seventy-nine patients were identified to have undergone partial hepatectomy for srHCC. The 1-year mortality and 1-year recurrence rate in our series was 30.3% and 41.8% respectively. On multivariate analyses, free tumor rupture and a tumor size > 10 cm were identified to be independent predictors of early recurrence while an alpha fetoprotein (AFP) > 200 ng/mL was an independent predictor of early mortality. Neutrophil-to-lymphocyte ratio > 3 and prognostic nutritional index < 40 were predictors of early recurrence while PLR > 180 was a predictor of early mortality on univariate analyses but not multivariate analyses.

CONCLUSIONS

Tumor size > 10 cm, free tumor rupture, and an AFP > 200 ng/mL were useful predictors in avoiding "futile surgery" in patients with srHCC undergoing a partial hepatectomy. Preoperative inflammatory markers appear to be less useful as predictors of early recurrence/mortality in this cohort of patients.

Comprehensive Analysis of the Neutrophil-to-Lymphocyte Ratio for Preoperative Prognostic Prediction Nomogram in Gastric Cancer

BACKGROUND

The role of neutrophil-to-lymphocyte ratio (NLR) and preoperative prediction model in gastric cancer is controversial, while postoperative prognostic models are available. This study investigated NLR as a preoperative prognostic indicator in gastric cancer.

METHODS

We reviewed patients with primary gastric cancer who underwent surgery during 2007-2010. Preoperative clinicopathologic factors were analyzed with their interaction and used to develop a prognosis prediction nomogram. That preoperative prediction nomogram was compared to a nomogram using pTNM or a historical postoperative prediction nomogram. The contribution of NLR to a preoperative nomogram was evaluated with integrated discrimination improvement (IDI).

RESULTS

Using 2539 records, multivariable analysis revealed that NLR was one of the independent prognostic factors and had a significant interaction with only age among other preoperative factors (especially significant in patients < 50 years old). NLR was constantly significant between 1.1 and 3.1 without any distinctive cutoff value. Preoperative prediction nomogram using NLR showed a Harrell's C-index of 0.79 and an R² of 25.2%, which was comparable to the C-index of 0.78 and 0.82 and R² of 26.6 and 25.8% from nomogram using pTNM and a historical postoperative prediction nomogram, respectively. IDI of NLR to nomogram in the overall population was 0.65%, and that of patients < 50 years old was 2.72%.

CONCLUSIONS

NLR is an independent prognostic factor for gastric cancer, especially in patients < 50 years old. A preoperative prediction nomogram using NLR can predict prognosis of gastric cancer as effectively as pTNM and a historical postoperative prediction nomogram.

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

Background

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

Methods

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

Results

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

Conclusions

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

Thrombocytosis as a Marker for Postoperative Complications in Colorectal Surgery

BACKGROUND

Blood platelet measurement is a widely available and inexpensive test that is performed routinely. Platelets are thought to act by inducing inflammation and play a role in clotting and antimicrobial defence. A postoperative rise in the platelet count (thrombocytosis) is often dismissed as an incidental finding, but there is growing evidence to suggest that it may act as an indicator to underlying pathology. It correlates with significant pyogenic infections as well as multiple malignancies. In addition to this, recent research indicates that thrombocytosis may be a useful prognostic indicator for postoperative outcomes in patients with malignancies. In patients undergoing surgery for gastric cancer, a combination of platelet count and neutrophil-to-lymphocyte (NLR) ratio collected preoperatively was shown to correlate with postoperative survival.

OBJECTIVE

To evaluate whether there is a positive correlation between pre- and postoperative thrombocytosis and the risk of complications following colorectal surgery.

METHODS

This was a retrospective observational study based in Morriston Hospital, Swansea. Patients undergoing elective colorectal surgery for an 18-month period between 2014 and 2016 were included. Data on patient demographics, pre- and postoperative platelet count, the first date at which the highest platelet count was recorded, length of stay, type of operation, and postoperative complications using the Clavien-Dindo classification was obtained from the theatre booking software (TOMS) and Welsh Clinical Portal. Pearson's chi-square test was used for the analysis of the categorical variables.

RESULTS

Of the 201 patients studied, 75 (37%) had postoperative thrombocytosis (platelets ≥ 500 × 109/L, range 501-1136), 120 (59%) had postoperative normocytosis (platelets < 500 × 109/L, range 107-499), and 6 (2.9%) patients were excluded due to insufficient data. Peak platelet level was seen at a median of 8 days postoperatively but ranged from days 1 to 49. In patients with thrombocytosis, the mean time to peak platelet count was 9.5 days and ranged 1 to 49 days. 101/195 (52%) patients had a Clavien-Dindo III/V postoperative complication: 63% patients with postoperative normocytosis and 24% with postoperative thrombocytosis. In the thrombocytosis group, 16/75 (21%) were found to have postoperative pelvic collections compared to 1/120 (0.8%) of the normocytic patients. The total percentage of medical complications (44% versus 20%, p = 0.006) and surgical complications (64% versus 15.8%, p = 0.0001) was higher in the thrombocytosis group compared to the normocytosis group.

CONCLUSION

In this retrospective study, thrombocytosis was shown to have a positive correlation with postoperative medical and surgical complications. An elevated platelet count in the postoperative period should alert the clinician to a developing complication. We recommend that further studies with a larger sample size would test the specific associations with individual complications.

The prognostic role of pretreatment thrombocytosis in gastric cancer: A systematic review and meta-analysis

BACKGROUND

The association between platelet count and the prognosis of patients with gastric cancer has already been reported by numerous studies. As the reports are inconsistent, we conducted this meta-analysis to evaluate the prognostic significance of platelet count in patients with gastric cancer.

METHODS

A comprehensive search was performed in PubMed, Embase, and the Cochrane Library to identify relevant studies, which evaluated the prognostic impact of pretreatment platelet count in patients with gastric cancer. Data was pooled using a random effect model to calculate hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Around 10 studies were included, comprising 8166 patients in total. The result showed that patients with thrombocytosis had significant worse overall survival (HR 1.57, 95% CI 1.36-1.81, P < .001) than those with normal platelet count, and were associated with advanced clinical stage (OR, 1.57; 95% CI, 1.15-2.13; P = .004), deeper tumor invasion (OR,3.49; 95% CI, 2.48-4.91; P < .001), and higher risk of recurrence (OR, 2.28; 95% CI, 1.55-3.35; P < .001).

CONCLUSION

Pretreatment thrombocytosis is a potential effective predictor of overall survival (OS) for patients with gastric cancer and is correlated with higher risks of recurrence, serosal invasion, and advanced stage.

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

Introduction

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Mean Platelet Volume, Red Cell Distribution Width, and Neutrophil-to-Lymphocyte Ratio Before and After Surgery in Patients With Carotid Body Tumors

OBJECTIVE

Carotid body tumors (CBTs) are rare hypervascular benign tumors that originate from the paraganglia at the carotid bifurcation. The red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and mean platelet volume (MPV) may serve as markers in inflammatory, cardiovascular, and neoplastic diseases. However, their prognostic value in CBTs is unknown. The purpose of this study was to assess the leukocyte count, MPV, RDW, and NLR before and after surgery in patients with CBTs.

METHODS

This retrospective trial included data from 80 patients with CBTs and 65 age-matched healthy controls. The leukocyte, neutrophil, lymphocyte and platelet counts, RDW, and MPV were extracted and NLR was calculated from the complete blood count results of participants.

RESULTS

The leukocyte and neutrophil counts as well as RDW levels were significantly increased in patients with CBTs compared with healthy controls (P = 0.005, P = 0.003, and P = 0.026; respectively). Patients with CBTs had lower lymphocytes counts (P = 0.241) and higher NLRs (P = 0.054); however, the difference was statistically insignificant. Moreover, no statistically significant difference was detected between groups in terms of platelet counts and MPV levels. Furthermore, the leukocyte count, platelet numbers, MPV, RDW, and NLR levels in patients with CBTs were not statistically significant after surgery (all; P > 0.05).

CONCLUSION

This is the first study that documents the increased RDW levels and leukocyte count in patients with CBTs. The combined use of RDW and the leukocyte count along with other clinical assessments can be used as a biomarker for CBTs. Further clinical trials with larger cases series are required to determine the actual predictive roles of these systemic biomarkers.

The pretreatment thrombocytosis as one of prognostic factors for gastric cancer: A systematic review and meta-analysis

BACKGROUND & AIMS

At present, increasing reports have shown that pretreatment platelet count was associated with the prognosis of many types of cancer. We performed rounded analysis to comprehensively analyze and evaluate the prognostic significance of pretreatment thrombocytosis for patients with gastric cancer.

METHODS

We identified relevant studies by searching database including PubMed, Embase, Cochrane Library and Web of Science. The relative risk (RR) with its 95% confidence interval (CI) was used to assess the correlation between thrombocytosis and overall survival (OS) of gastric cancer patients. We also conducted subgroup analysis and sensitivity analysis for the prognostic effect of thrombocytosis on OS. The analysis was performed and assessed using Review Manager 5.2.

RESULTS

A total of nine studies including 7158 participants were included in this systematic review. Analysis results showed that pretreatment thrombocytosis had a close relationship with 1, 3 and 5 years survival of gastric cancer, with the pooled RRs being 0.80 (95% CI 0.71-0.90; P = 0.0004), 0.65 (95% CI 0.45-0.92; P = 0.02) and 0.64 (95% CI 0.47-0.87; P = 0.004) respectively.

CONCLUSIONS

The present rounded analysis suggests that pretreatment thrombocytosis may have significant association with poor survival of patients with gastric cancer.

Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis

An accurate, time efficient, and inexpensive prognostic indicator is needed to reduce cost and assist with clinical decision making for cancer management. The neutrophil-to-lymphocyte ratio (NLR), which is derived from common serum testing, has been explored in a variety of cancers. We sought to determine its prognostic value in gastrointestinal cancers and performed a meta-analysis of published studies using the Meta-analysis Of Observational Studies in Epidemiology guidelines. Included were randomized control trials and observational studies that analyzed humans with gastrointestinal cancers that included NLR and hazard ratios (HR) with overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and/or cancer-specific survival (CSS).

We analyzed 144 studies comprising 45,905 patients, two-thirds of which were published after 2014. The mean, median, and mode cutoffs for NLR reporting OS from multivariate models were 3.4, 3.0, 5.0 (±IQR 2.5-5.0), respectively. Overall, NLR greater than the cutoff was associated with a HR for OS of 1.63 (95% CI, 1.53-1.73; P < 0.001). This association was observed in all subgroups based on tumor site, stage, and geographic region. HR for elevated NLR for DFS, PFS, and CSS were 1.70 (95% CI, 1.52-1.91, P < 0.001), 1.64 (95% CI, 1.36-1.97, P < 0.001), and 1.83 (95% CI, 1.50-2.23, P < 0.001), respectively.

Available evidence suggests that NLR greater than the cutoff reduces OS, independent of geographic location, gastrointestinal cancer type, or stage of cancer. Furthermore, DFS, PFS, and CSS also have worse outcomes with elevated NLR.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

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

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

Introduction

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

Material and Methods

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

Result

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

Conclusion

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

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Risk factors of early recurrence after curative hepatectomy in hepatocellular carcinoma

Early recurrence is common after curative hepatectomy for hepatocellular carcinoma and is associated with poor prognosis. This study aimed to identify risk factors of early recurrence after curative hepatectomy in hepatocellular carcinoma. Overall, 63 patients who underwent curative hepatectomy for hepatocellular carcinoma were enrolled. Patients were divided into the early recurrence group, who developed recurrence within 12 months after hepatectomy (n = 10), and the non-early recurrence group (n = 53). Clinicopathological factors of early recurrence were retrospectively analyzed. Among the 63 patients, 10 (15.9%) patients experienced early recurrence. Univariate analysis showed tumor necrosis (p = 0.012), level of PIVKA-II (prothrombin induced by vitamin K absence or antagonist-II; p = 0.002), and microvascular invasion (p = 0.029) to be associated with early recurrence. By multivariate analysis, there were significant differences in high PIVKA-II (p < 0.001) and tumor necrosis (p = 0.012) in patients with early recurrence. The optimal cutoff values of PIVKA-II and tumor necrosis were 46 mAU/mL and 3% of total tumor volume, respectively. Patients with a high preoperative PIVKA-II level and extent of tumor necrosis, which are independent risk factors for early recurrence, should be actively treated and monitored closely after hepatectomy.

Risk Factors for Early Recurrence of Single Lesion Hepatocellular Carcinoma After Curative Resection

BACKGROUND AND OBJECTIVES

Hepatic resection is established as the treatment for HCC. However, patients sometimes experience early recurrence of HCC (ER HCC) after curative resection.

METHODS

A retrospective analysis was conducted for 193 patients with single HCC who underwent curative liver resection in our medical center between April 2000 and March 2013. We divided the cohort into two groups; early recurrence group (ER G) which experienced recurrence within 6 months after resection, and non-early recurrence group (NER G). Risk factors for ER HCC were analyzed.

RESULTS

Thirty-nine out of 193 (20.2 %) patients had ER HCC. Univariate analysis showed Glasgow prognostic score (GPS, p = 0.036), neutrophil to lymphocyte ratio (NLR, p = 0.001), level of PIVKA-II (p = 0.0001), level of AFP (p = 0.0001), amounts of blood loss (p = 0.001), operating time (p = 0.002), tumor size (p = 0.0001), stage III and IV (p = 0.0001), and microvascular invasions (portal vein: p = 0.0001 and hepatic vein: p = 0.001) to be associated with ER HCC. By multivariate analysis, there were significant differences in high NLR (p = 0.029) and high AFP (p = 0.0001) in patients with ER HCC.

CONCLUSIONS

Preoperative high AFP (more than 250 ng/ml) and high NLR (more than 1.829) were independent risk factors for ER HCC.

Evaluation of Complete Blood Count Indices (NLR, PLR, MPV/PLT, and PLCRi) in Healthy Dogs, Dogs With Periodontitis, and Dogs With Oropharyngeal Tumors as Potential Biomarkers of Systemic Inflammatory Response

The aim of the study was to retrospectively assess complete blood count (CBC) indices of dogs with periodontitis (PD; n = 73) and dogs with oropharyngeal tumors (OT; n = 92) in comparison to CBC indices of healthy dogs (HD; n = 71). Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, mean platelet volume to platelet ratio, and platelet large cell ratio index (PLCRi) were evaluated as biomarkers of systemic inflammatory response provoked by PD and OT. Results of multivariable polytomous logistic regression analysis indicated no significant associations between CBC indices and PD. Both NLR and PLCRi were significantly higher in dogs with OT when compared to HD and dogs with PD and could, therefore, indicate a tumor-associated systemic inflammatory response. Additional studies of CBC indices, along with other biomarkers of systemic inflammatory response, are recommended to validate them as reliable indicators of clinical disease activity.

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

Background

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

Materials and methods

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

Results

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

Conclusion

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

Clinical implication of FDG uptake of bone marrow on PET/CT in gastric cancer patients with surgical resection

AIM

To determine the relationship between F-18 fluorodeoxyglucose (FDG) uptake of bone marrow (BM) on positron emission tomography/computed tomography (PET/CT) and clinical factors and to assess the prognostic value of FDG uptake of BM in gastric carcinoma.

METHODS

We retrospectively enrolled 309 gastric cancer patients who underwent staging FDG PET/CT and curative surgical resection. FDG uptake of primary tumor was visually classified as positive or negative FDG uptake. Mean FDG uptake of BM (BM SUV) and BM-to-liver uptake ratio (BLR) were measured. The relationships of BM SUV or BLR with clinical factors were evaluated. The prognostic values of BM SUV, BLR, and other clinical factors for predicting recurrence-free survival (RFS) and overall survival (OS) were assessed.

RESULTS

Of 309 patients, 38 patients (12.3%) experienced cancer recurrence and 18 patients (5.8%) died. Patients with advanced gastric cancer, positive FDG uptake, and recurrence had higher values of BM SUV and BLR than those with early gastric cancer, negative FDG uptake, and no recurrence (P < 0.05). BM SUV and BLR were significantly correlated with hemoglobin level, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (P < 0.05). On multivariate analysis, multiple tumors, T stage, lymph node metastasis, tumor involvement of resection margin, and BLR were significantly associated with RFS (P < 0.05). T stage, lymph node metastasis, hemoglobin level, and BLR were significantly associated with OS (P < 0.05).

CONCLUSION

BLR on PET/CT was an independent prognostic factor for RFS and OS in gastric cancer patients with curative surgical resection.

Impact of systemic inflammation on gastric cancer outcomes

BACKGROUND

The prognostic value of neutrophil-lymphocyte ratio (NLR) and Glasgow Prognostic Score (GPS) has been extensively validated in various cancers. We aimed to examine the usefulness of a combination of NLR and GPS (named CNG) for predicting survival outcomes in patients after curative resection for gastric cancer (GC).

METHODS

We retrospectively analyzed the records of 1056 patients who underwent curative resection as initial treatment for GC from October 2000 to September 2012. The preoperative CNG was calculated as follows: patients with hypoalbuminemia (< 35 g/L), elevated C-reactive protein (> 10 mg/L), and elevated NLR (≥ 2) were allocated a score of 3; patients with two, one, or no abnormal values were allocated a score of 2, 1, or 0, respectively.

RESULTS

The NLR and GPS were the only inflammatory variables independently associated with overall survival (OS) in multivariate analysis. When they were replaced by CNG in multivariate analysis, CNG was independently associated with OS (hazard ratio [HR] for CNG 1 [1.367, 95% CI: 1.065-1.755; P = 0.014], CNG 2 [1.887, 95% CI: 1.182-3.011; P = 0.008], and CNG 3 [2.224, 95% CI: 1.238-3.997; P = 0.008]; P = 0.020). In stage-matched analysis, the prognostic significance was still maintained in stage I-III (P = 0.002, P = 0.042, and P < 0.001, respectively). In addition, 5-year survival rates ranged from 92% (stage I) to 35% (stage III) and from 65%(CNG 0) to 18%(CNG 3) with tumor-nodes-metastasis (TNM) stage or CNG alone. However, the combination of TNM and CNG stratified 5-year survival rates from 98% (TNM I, CNG 0) to 12% (TNM III, CNG 3).

CONCLUSION

The preoperative CNG is a novel predictor of postoperative survival, and the combination of CNG and TNM effectively stratifies outcomes in patients after curative resection for GC.

Preoperative NLR and PLR in the middle or lower ESCC patients with radical operation

Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) had been analysed in many kind of tumours, but its role of predict the oesophageal squamous cell carcinoma (ESCC) patients' prognosis was not reach a consensus. Relationship between NLR, PLR and ESCC located in the middle or lower segment was evaluated. 317 patients with ESCC who underwent attempted curative oesophagectomy were analysed in this study. 157 and 98 patients had elevated NLR and PLR respectively (NLR >3.3 and PLR >150). The median overall survival time (OS) and disease-free survival (DFS) was 34.1 and 19.2 months respectively. Multivariate analysis found PLR >150 (P = 0.018, HR 1.426, 95%CI 1.063-1.912) accompanied by male, lymphatic metastases, tumour size more than 3 cm, tumour located at middle segment and poor differentiation were associated with significantly worse DFS. Meanwhile, gender, lymphatic metastases, tumour location and differentiation along with PLR >150 (P = 0.003, HR 1.595, 95% CI 1.172-2.170) and NLR>3.3 (P = 0.039, HR 1.367, 95% CI 1.015-1.840) were all independent prognostic factors for OS. Preoperative NLR and PLR might be used as predictive factors in patients with ESCC. For DFS, elevated PLR compared to NLR may have an advantage to indicate poor prognosis.

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

Purpose

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

Materials and Methods

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

Results

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

Conclusion

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

Cancer and Thrombosis: The Platelet Perspective

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

A novel scoring system associating with preoperative platelet/lymphocyte and clinicopathologic features to predict lymph node metastasis in early gastric cancer

BACKGROUND

Precise determination of the lymph node status is critical for determining appropriate treatment for early gastric cancer (EGC). This study attempted to establish a simple, effective risk scoring system to predict lymph node metastasis (LNM) in EGC by investigating the relationship between platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) and EGC LNM.

MATERIALS AND METHODS

We retrospectively reviewed 312 operable patients with EGC. The clinical utility of PLR and NLR was tested by receiver operating characteristic curves. The scoring system was developed using independent risk factors. Finally, 89 EGC patients were collected from prospective database to validate the scoring system's accuracy.

RESULTS

The optimal PLR and NLR cut-off values were 106 and 2.97, respectively. High NLR (P = 0.009) and PLR (P = 0.007) values were associated with LNM of EGC in univariate analyses, although only high PLR (P = 0.025) was an independent risk factor in multivariate analyses, together with age (P = 0.009), differentiation (P = 0.017), invasive depth (P < 0.001), and tumor size (P = 0.003). The scoring system's accuracy for retrospective and prospective data was 0.781 (95% confidence interval: 0.721-0.841) and 0.817 (95% confidence interval 0.714-0.920), respectively.

CONCLUSIONS

Preoperative PLR and NLR correlate with EGC LNM. Our scoring system is reliable, accurate, and effective in predicting LNM in EGC patients.

Prognostic significance of preoperative absolute peripheral monocyte count in esophageal squamous cell carcinoma

The objective of this study was to investigate the prognostic value of peripheral blood monocytes in esophageal squamous cell carcinoma (ESCC) patients who underwent esophagectomy. Records from 218 consecutive patients with histologically diagnosed ESCC who underwent esophagectomy at Qilu Hospital of Shandong University from January 2007 to December 2008 were retrospectively reviewed. The median disease-free survival (DFS) of this cohort was 29.0 months, and the 5-year DFS rate was 34.4%. The median overall survival (OS) was 35.0 months, and the 5-year OS rate was 37.6%. The cut-off value of 0.42 × 10⁹ /L for the absolute monocyte count (AMC) was chosen as optimal to discriminate between survival and death by applying receiver operating curve analysis. There were 131 patients (60.1%) who had high AMC (≥0.42 × 10⁹ /L) preoperatively. We found that AMC was significantly associated with gender, tumor location, and platelet count. Kaplan-Meier survival analysis of patients with high preoperative AMC had a significant worse prognosis for DFS (high vs. low: 27.5% vs. 39.0%, P = 0.015) and OS (high vs. low: 31.1% vs. 44.8%, P = 0.009) than those with low preoperative AMC. In a multivariate analysis, preoperative AMC was an independent prognostic factor for DFS (P = 0.025, hazard ratio [HR]: 1.469, 95% confidence interval [CI]: 1.050-2.054) and OS (P = 0.015, HR: 1.547, 95% CI: 1.088-2.200). In addition, among 140 patients without both preoperative and postoperative therapy, significantly worse OS (P = 0.012) and marginally reduced DFS (P = 0.079) were found in the high AMC cohort versus the low AMC cohort. A higher preoperative absolute peripheral monocyte count can be considered as a useful prognostic marker of ESCC patients who underwent esophagectomy.

Neutrophil and lymphocyte counts at diagnosis are associated with overall survival of pancreatic cancer: A retrospective cohort study

Neutrophil to lymphocyte ratio (NLR) has been found to be significantly associated with pancreatic cancer (PC) survival. However, no existing studies discussed the association between neutrophil count, lymphocyte count, and PC survival jointly. In this study, we aimed to analyze the influence of neutrophil and lymphocyte counts measured at disease diagnosis on the overall survival (OS) of PC. A total of 288 PC patients diagnosed between January 1, 2012, and December 31, 2013, were retrospectively selected from a population-based electronic inpatients database. Multivariate Cox model and restricted cubic spline (RCS) were used to estimate the associations between neutrophil count, lymphocyte count, and OS of PC. We found that a decreased lymphocyte count at diagnosis was significantly associated with OS of PC: for PC patients whose lymphocyte counts were less than 1.5 × 10/L, the hazard ratio (HR) was 1.82 (95% confidence interval: 1.37-2.40). Although abnormally increased baseline neutrophil count in general was not associated with OS of PC, RCS found a prominently deteriorated survival for PC patients whose baseline neutrophil counts were close to the cutoff point (7.0 × 10/L). Our study results indicate that neutrophil and lymphocyte counts at diagnosis may have prognostic relevance in PC survival, especially lymphocyte count. The clinical significance of neutrophil inhibition and lymphocyte promotion treatments in PC patients should be further discussed.

Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio in predicting survival for patients with stage I-II gastric cancer

Background

The preoperative neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are associated with poor prognosis of gastric cancer. We aimed to determine whether the combination of NLR and PLR (NLR–PLR) could better predict survival of patients after curative resection for stage I–II gastric cancer.

Methods

We collected data from the medical records of patients with stage I–II gastric cancer undergoing curative resection between December 2000 and November 2012 at the Sun Yat-sen Cancer Center. The preoperative NLR–PLR was calculated as follows: patients with both elevated NLR (≥2.1) and PLR (≥120) were given a score of 2, and patients with only one or neither were given a score of 1 or 0, respectively.

Results

Kaplan–Meier analysis and log-rank tests revealed significant differences in overall survival (OS) among patients with NLR–PLR scores of 0, 1 and 2 (P < 0.001). Multivariate analysis showed that OS was independently associated with the NLR–PLR score [hazard ratio (HR) = 1.51, 95% confidence interval (CI) 1.02–2.24, P = 0.039] and TNM stage (HR = 1.36, 95% CI 1.01–1.83, P = 0.041). However, other systemic inflammation-based prognostic scores, including the modified Glasgow prognostic score, the prognostic nutritional index, and the combination of platelet count and NLR, were not. In TNM stage-stratified analysis, the prognostic significance of NLR–PLR was maintained in patients with stage I (P < 0.001) and stage II cancers (P = 0.022). In addition, the area under the receiver operating characteristic curve for the NLR–PLR score was higher than those of other systemic inflammation-based prognostic scores (P = 0.001).

Conclusion

The preoperative NLR-PLR score is a useful predictor of postoperative survival in the patients with stage I–II gastric cancer and may help identify high-risk patients for rational therapy and timely follow-up.

Preoperative inflammation-based markers predict early and late recurrence of hepatocellular carcinoma after curative hepatectomy

BACKGROUND

Recurrence of hepatocellular carcinoma (HCC) after curative resection remains a major cause of treatment failure and tumor-related death. Patterns of HCC recurrence can be categorized into early recurrence and late recurrence which have different underlying mechanisms. In this study, we investigated if simple inflammation-based clinical markers can distinguish patterns of recurrence after curative resection of HCC.

METHODS

A retrospective analysis of 223 patients who underwent curative hepatectomy for HCC was performed. Preoperative inflammation-based factors including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, gamma-glutamyl transferase/alanine aminotransferase ratio, aspartate aminotransferase/platelet ratio index (APRI) and prognostic nutritional index together with other clinicopathologic parameters were evaluated by univariate analysis and multivariate analysis to identify independent prognostic factors. By combining risk factors, predictive models were established to distinguish populations at high risk of early or late recurrence.

RESULTS

Age ≤50 years, resection margin ≤1 cm, TNM stage III-IV, NLR>2.75, APRI>0.23 and positive alpha-fetoprotein were independent adverse prognostic factors for early recurrence. Patients with three or more risk factors were at significant higher risk of early recurrence. APRI>0.23 and positive hepatitis B e antigen (HBeAg) were independent risk factors of late recurrence, the coexistence of high APRI and positive HBeAg increased the risk of late recurrence.

CONCLUSIONS

Preoperative inflammation-based prognostic factors predict early and late recurrence of HCC after curative resection. Different prognostic factor combinations distinguish high-risk populations of early or late HCC recurrence.

Pretreatment predictive value of blood neutrophil/lymphocyte ratio in R0 gastric cancer resectability

INTRODUCTION

New parameters complementary to clinical TNM classification are needed, to orient preoperative on the possibility of a R0 gastric cancer resection. We analysed the possible predictive value of blood neutrophil/lymphocytic ratio (N/L) in relation to resectability.

METHODS

Two hundred and fifty-seven gastric cancers consecutively diagnosed and without neoadjuvant treatment were retrospectively studied. Univariate and multivariate analysis of the frequency of R0 cases was performed between groups with a normal N/L ratio (<5) and pathological N/L ratio (≥5). Furthermore, we studied the subgroup of operated patients (n=156) analysing the frequency of R0 resection according to N/L ratio<5 or≥5.

RESULTS

One hundred and fifty-six patients underwent surgical intervention, of which 139 had R0 resections. A high N/L ratio was registered in 46 cases (17.9%). Globally, resectability was higher in patients with a N/L ratio<5: 59.7% vs. N/L ratio≥5: 28.6% (P<.001; OR=3.76; 95% CI=1.78-8.04). The relation between N/L ratio<5 and R0 resection was confirmed in the multivariate (P=.006; OR=3.86; 95% CI=1.46-10.22). In the operated subgroup, the higher frequency of R0 resection achievement is maintained in cases with N/L ratio<5: 91.3% vs. 72.2% (P=.015; OR=4.04; 95% CI=1.23-13.26).

CONCLUSIONS

The presence of a N/L ratio<5 at the diagnosis of a gastric carcinoma is related in a significant and independent way with a higher frequency of R0 tumoral resection, globally. This higher proportion of R0 resection cases in patients with a N/L<5 ratio is confirmed in the subgroup of operated patients.