Preoperative platelet/lymphocyte ratio is a superior prognostic factor compared to other systemic inflammatory response markers in ovarian cancer patients

Predictive Value of PLR, PNI, and HALP Scores in Ovarian Cancer Staging

Purpose

Ovarian cancer (OC) is a leading cause of gynecologic cancer mortality, where accurate staging is vital for prognosis and treatment. This study aims to evaluate the prognostic potential of the Platelet-to-Lymphocyte Ratio (PLR), Prognostic Nutritional Index (PNI), and Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) scores in OC staging.

Methods

The study was conducted at the Sivas Cumhuriyet University Faculty of Medicine, Department of Obstetrics and Gynecology, between January 1, 2009, and December 31, 2021. A total of 96 OC patients were retrospectively analyzed. Preoperative PLR, PNI, and HALP scores were calculated from routine laboratory parameters. Associations between these scores and clinicopathological factors, including OC stage, were evaluated. The discriminatory power of each index was assessed through ROC curve and AUC (area under the curve) analysis.

Results

The AUC for PLR was 0.689 (p < 0.05), indicating significant prognostic value, while the HALP score showed an AUC of 0.671 (p < 0.05). Both markers were significantly associated with OC stages, with higher PLR and lower HALP scores correlating with advanced stages. In contrast, PNI demonstrated a lower AUC of 0.398 (p > 0.05), indicating limited prognostic utility.

Conclusion

PLR and HALP scores are useful prognostic markers for OC staging, offering cost-effective and accessible tools in clinical practice. PNI, however, was less predictive. These findings suggest that PLR and HALP could complement existing staging methods, aiding in clinical decision-making. Future large-scale studies are warranted to validate these results.

The prognostic and clinical value of neutrophil-to-lymphocyte ratio (NLR) in ovarian cancer: A systematic review and meta-analysis

Background

Ovarian cancer (OC) is a major gynecological malignancy with varying prognosis. The Neutrophil-toLymphocyte Ratio (NLR) has been proposed as a potential prognostic biomarker. This study aimed to evaluate the prognostic and clinical value of NLR in OC.

Methods

A systematic review and meta-analysis were performed following PRISMA guidelines, including studies that evaluated the association between NLR and survival outcomes in OC patients. Search was performed in PubMed, Embase, Web of Science, and Cochrane Library databases. Quality assessment was done using Newcastle-Ottawa Scale (NOS). Heterogeneity was assessed, and pooled hazard ratios (HRs) were calculated using fixed or random-effects models as appropriate.

Preoperative neutrophil/lymphocyte ratio as prognostic factor in epithelial ovarian cancer

Objectives

To determine if there is an association between the neutrophil to lymphocyte ratio (NLR) and prognosis in patients with epithelial ovarian cancer (EOC) diagnosed and treated in a Spanish population.

Material and methods

Retrospective cohort of patients with epithelial ovarian cancer who had neutrophil and lymphocyte values in complete blood count before the histopathological diagnosis and survival of at least three months, in an intermediate complexity hospital. Convenience sampling. Measured variables included age, menopausal stage, parity, International Federation of Gynecology and Obstetrics (FIGO) stage, treatment type, residual tumor, lymph node involvement, presence of ascites, cytology, histologic type, differentiation grade, and CA-125 values. Additionally, outcomes, overall survival, disease/progression-free survival were also measured. Bivariate inferential and Cox regression analyses were performed.

Results

Out of 78 candidates, 60 women with EOC were included. Of them, 24 (40%) had a low NLR (≤ 2,9) while 36 (60%) had a high NLR (> 2,9). An association was found between high NLR levels and suboptimal cytoreductive surgery. High NLR ratios were associated with lower overall survival (Hazard ratio (HR): 4.1; 95% CI: 1.4-11.8) and lower 5-year disease-free survival (HR: 2.6; 95% CI: 1.2-5.7).

Conclusions

A plasma neutrophil to lymphocyte ratio of more than 2.9 was associated with poor prognosis in patients with epithelial ovarian cancer in our setting. There is a need to establish the optimal cut-off point and conduct prospective studies with larger patient numbers in order to support this information.

Prognostic and clinicopathological significance of C-reactive protein in patients with ovarian cancer: a meta-analysis

BACKGROUND

Many studies have explored the relationship between C-reactive protein (CRP) levels and survival outcomes in patients with ovarian cancer (OC); however, consistent results have not been reported. As such, this meta-analysis was performed to accurately assess the prognostic and clinicopathological roles of CRP in OC.

METHODS

The PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for relevant studies published from inception to April 7, 2023. The effect of CRP level(s) and OC prognostic outcomes was analyzed by computing the combined hazard ratio (HR) and corresponding 95% confidence interval (CI). Thereafter, the association between CRP level(s) and clinicopathological factors was evaluated using a combined odds ratio (OR) and corresponding 95% CI.

RESULTS

The present meta-analysis included 15 studies comprising 3202 subjects. According to the combined data, higher CRP levels were markedly associated with unfavorable overall survival (OS) (HR 1.23 [95% CI 1.11-1.37]; p < 0.001) and progression-free survival (PFS) (HR 1.55 [95% CI 1.30-1.84]; p < 0.001) in patients with OC. Furthermore, the results indicated that high CRP levels were significantly correlated with International Federation of Gynecology and Obstetrics (FIGO) stages III-IV (p < 0.001), residual tumor size ≥ 1 cm (p < 0.001), histological grade 3 (p = 0.040), and ascites volume ≥ 500 mL (p < 0.001).

CONCLUSION

The results of this meta-analysis demonstrated that higher serum CRP levels were strongly associated with dismal OS and PFS in subjects with OC. High CRP levels were also significantly associated with clinical factors implicated in tumor aggressiveness and the development of OC.

The Intraoperative Administration of Dexmedetomidine Alleviates Postoperative Inflammatory Response in Patients Undergoing Laparoscopy-Assisted Gastrectomy: A Double-Blind Randomized Controlled Trial

Surgical stress can compromise the immune system of patients with cancer, affecting susceptibility to perioperative infections, tumor progression, treatment responses, and postoperative recovery. Perioperatively reducing inflammatory responses could improve outcomes. We determined the impact of intraoperative dexmedetomidine administration on the inflammatory response and postoperative recovery in patients undergoing elective laparoscopy-assisted gastrectomy. These patients were randomly assigned to the dexmedetomidine or control group (n = 42 each). The primary endpoint was the C-reactive protein (CRP) level on postoperative day 1. The secondary endpoints included the perioperative interleukin (IL)-6 levels, postoperative numerical rating scale (NRS) scores, and rescue analgesic doses. There were no significant between-group differences in terms of CRP levels. The IL-6 levels at the end of the surgery, NRS scores in the post-anesthesia care unit, and rescue pethidine requirements within the first hour postoperatively were significantly lower in the dexmedetomidine group than in the control group. The bolus deliveries-to-attempts ratio (via patient-controlled analgesia) at 2 h differed significantly between the two groups. However, IL-6 reduction was confined to a single timepoint, and the postoperative analgesic effects lasted for the first 2 h postoperatively. Low-dose dexmedetomidine infusion (0.4 µg kg-1 h-1) during laparoscopy-assisted gastrectomy exerts minimal anti-inflammatory effects.

The preoperative platelet to neutrophil ratio and lymphocyte to monocyte ratio are superior prognostic indicators compared with other inflammatory biomarkers in ovarian cancer

Background

Previous studies have suggested that the ratios of immune-inflammatory cells could serve as prognostic indicators in ovarian cancer. However, which of these is the superior prognostic indicator in ovarian cancer remains unknown. In addition, studies on the prognostic value of the platelet to neutrophil ratio (PNR) in ovarian cancer are still limited.

Methods

A cohort of 991 ovarian cancer patients was analyzed in the present study. Receiver operator characteristic (ROC) curves were utilized to choose the optimal cut-off values of inflammatory biomarkers such as neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and PNR. The correlation of inflammatory biomarkers with overall survival (OS) and relapse-free survival (RFS) was investigated by Kaplan-Meier methods and log-rank test, followed by Cox regression analyses.

Results

Kaplan-Meier curves suggested that LMR<3.39, PLR≥181.46, and PNR≥49.20 had obvious associations with worse RFS (P<0.001, P=0.018, P<0.001). Multivariate analysis suggested that LMR (≥3.39 vs. <3.39) (P=0.042, HR=0.810, 95% CI=0.661-0.992) and PNR (≥49.20 vs. <49.20) (P=0.004, HR=1.351, 95% CI=1.103-1.656) were independent prognostic indicators of poor RFS. In addition, Kaplan-Meier curves indicated that PLR≥182.23 was significantly correlated with worse OS (P=0.039).

Conclusion

Taken together, PNR and LMR are superior prognostic indicators compared with NLR, PLR, and SII in patients with ovarian cancer.

Independent predictive value of blood inflammatory composite markers in ovarian cancer: recent clinical evidence and perspective focusing on NLR and PLR

Ovarian cancer (OC) is one of the deadliest malignant tumors affecting women worldwide. The predictive value of some blood inflammatory composite markers in OC has been extensively reported. They can be used for early detection and differential diagnosis of OC and can be used for predicting survival, treatment response, and recurrence in the affected patients. Here, we reviewed the predictive values of composite inflammatory markers based on complete blood count, namely neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, and systemic inflammation index and markers based on blood protein, namely C-reactive protein-to-albumin ratio and prognostic nutritional index in OC, with a focus on NLR and PLR. We referred to the clinical studies on these six markers, reviewed the patient population, and summarized the marker cut-off values, significance, and limitations of these studies. All these studies were retrospective and most of them were single-center clinical studies with small sample sizes. We found that the cut-off values of these markers have not been unified, and methods used to determine these values varied among studies. The predictive value of these markers on survival was mainly reflected in the postoperative patients of multiple subtypes of ovarian cancer including epithelial OC, high-grade serous ovarian carcinoma, and ovarian clear cell carcinoma. We focused on NLR and PLR and calculated their pooled hazard ratios. NLR and PLR were reliable in predicting overall and progression-free survivals in patients with OC. Therefore, it is necessary to adjust important confounding factors and conduct a long-term follow-up prospective cohort study to further clarify the cut-off values of NLR and PLR and their clinical applications.

C-Reactive Protein as a Prognostic Biomarker for Gynecologic Cancers: A Meta-Analysis

Background

The prognostic role of CRP (C-reactive protein) in gynecological tumors has been previously reported in individual studies, but whether CRP can be used as a separate potential prognostic factor has not been systematically reviewed. The purpose of this research is to determine if there is a link between CRP levels and the prognosis of gynecological cancer patients.

Methods

A systematic search was carried out to find the literature evaluating the predictive role of CRP in the prognosis of gynecological cancer patients. For the purpose of determining the relationship between CRP and clinicopathological characteristics, the pooled odds ratio (OR) was calculated. A hazard ratio (HR) with a 95% confidence interval (CI) was used to determine differences in overall survival (OS), disease-free survival (DFS), or progression-free survival (PFS) between patients with low and high CRP levels.

Results

A total of 19 studies, including 4062 patients, were analyzed retrospectively. The FIGO stage was related to the CRP level (OR = 0.43, 95% CI: 0.19-1.00). Age, lymph node metastasis, and histological grade were not associated with CRP level (OR = 0.93, 95% CI: 0.69-1.25; OR = 0.91, 95% CI: 0.65-1.28; OR = 0.74, 95% CI: 0.52-1.05). Worse OS (HR = 1.40, 95% CI: 1.23-1.57), DFS (HR = 1.20, 95% CI: 1.12-1.28), and PFS (HR = 1.57, 95%CI: 1.23-1.91) were associated with elevated CRP levels, as shown by the pooled results. Subgroup analysis was performed according to cancer type (endometrial cancer: HR = 1.15, 95% CI: 1.02-1.28; ovarian cancer: HR = 1.67, 95% CI: 1.03-2.31; cervical cancer: HR = 1.42, 95% CI: 1.19-1.64), multivariate value (HR = 1.22, 95% CI: 1.10-1.33), and age (HR = 1.50, 95% CI: 1.28-1.72). Significant correlations were observed between CRP and OS.

Conclusions

CRP may be utilized as a prognostic indicator for a variety of gynecologic malignancies, including cervical cancer, ovarian cancer, endometrial cancer, and vulvar cancer.

Progress in Applicability of Scoring Systems Based on Nutritional and Inflammatory Parameters for Ovarian Cancer

Ovarian cancer is a malignancy that seriously endangers women’s health; its case fatality rate ranks first among the gynecological malignancies. The status of nutrition of ovarian cancer patients is related to their prognoses. Thus, it is important to evaluate, monitor, and improve the nutritional status of ovarian cancer patients during their treatment. Currently, there are several tools for examining malnutrition and nutritional assessment, including NRI (nutrition risk index), PG-SGA (patient-generated subjective global assessment), and NRS 2002 (nutritional risk screening 2002). In addition to malnutrition risk examination and related assessment tools, the evaluation of muscle mass, C-reactive protein, lymphocytes, and other inflammation status indicators, such as neutrophils to lymphocytes ratio, lymphocyte-to-monocyte ratio, and C-reactive protein-albumin ratio, is of great importance. The nutritional status of ovarian cancer patients undergoing surgery affects their postoperative complications and survival rates. Accurate evaluation of perioperative nutrition in ovarian cancer patients is crucial in clinical settings. An intelligent nutritional diagnosis can be developed based on the results of its systematic and comprehensive assessment, which would lay a foundation for the implementation of personalized and precise nutritional therapy.

Prognostic and Clinicopathologic Significance of Neutrophil-to-Lymphocyte Ratio in Esophageal Cancer: An Update Meta-Analysis

Background: Esophageal cancer is one of the most common cancers with significant morbidity and mortality. It is important to predict the prognosis of patients. The purpose of this study was to comprehensively assess the prognostic and clinicopathologic significance of NLR in patients with esophageal cancer. Methods: A systematic literature search was performed using PubMed, Cochrane Library, Embase, Web of Science, MEDLINE, and CNKI. This meta-analysis was conducted in accordance with PRISMA guidelines. Hazard ratio (HR) with 95% confidence interval (CI) was used as the effect estimation to evaluate the prognostic role of NLR. Odds ratio (OR) was used to evaluate the relation between NLR and clinicopathologic characteristics. Results: A total of 8431 patients from 32 studies were included in this meta-analysis. The pooled results showed that elevated NLR might predict poor prognosis: The factors considered included overall survival (OS) (HR, 1.57; 95% CI, 1.40-1.75; P < .001), cancer-specific survival (CSS) (HR, 1.28; 95% CI, 1.09-1.49; P < .001), progression-free survival (PFS) (HR, 1.45; 95% CI, 1.29-1.72; P < .001), and disease-free survival (DFS) (HR,1.58; 95% CI, 1.27-1.97; P < .001). High NLR was also associated with tumor differentiation, tumor length, tumor invasion depth, lymph node metastasis, and clinical stage. No significant association was observed between NLR and metastasis stage (OR, 1.69; 95% CI, 0.98-2.98; P = .058). Conclusions: The results of this meta-analysis suggest that elevated NLR value might predict poor prognosis (OS, CSS, PFS, and DFS), according to abnormal clinicopathologic parameters.

Prognostic Value of Platelet-to-Lymphocyte Ratio, Neutrophil-to-Lymphocyte Ratio, and Lymphocyte-to-White Blood Cell Ratio in Colorectal Cancer Patients Who Received Neoadjuvant Chemotherapy

Background:

The objective of this study was to assess the prognostic value of pretreatment platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-white blood cell ratio (LWR) of CRC patients who received neoadjuvant chemotherapy.

Methods:

We analyzed the peripheral blood routine parameters and other clinical data of 145 patients with colorectal cancer who had undergone neoadjuvant chemotherapy between January 2011 and February 2014. Pretreatment blood parameters of 145 patients were collected, and PLR, NLR, and LWR were calculated. The utility of PLR, NLR, and LWR in predicting treatment efficacy and patient survival was statistically evaluated using the chi-square test, log-rank test, Kaplan-Meier curves and logistic regression models, and Cox regression models.

Results:

Receiver operating characteristic curve showed that the best cutoff values of PLR, NLR, and LWR were 154.31, 3.01, and 0.22, respectively. In univariate analysis, tumor location (P = 0.044), differentiation degree (P = 0.001), lymph node metastasis (P = 0.020), and high PLR (P = 0.042) were significantly correlated with a lower overall response rate (ORR). In addition, clinical stage, lymph node metastasis, and high PLR were correlated with short OS (P < 0.01) and DFS (P < 0.01). Moreover, WBC count was correlated with a short OS. Multivariate analysis showed that tumor location (P = 0.013), differentiation degree (P = 0.001), and lymph node metastasis (P = 0.033) were independent predictors of ORR. In addition, lymph node metastasis independently predicted a shorter OS (P = 0.011). Lymph node metastasis (P = 0.013) and high PLR (P = 0.022) were independent prognostic factors for short DFS.

Conclusions:

For CRC patients who received NAC, clinical pathological stage and lymph node metastasis were correlated with lower ORR and survival, while a high PLR that may be of prognostic relevance in CRC patients receiving NAC.

Maternal serum calprotectin level in intrahepatic cholestasis of pregnancy

AIM

This study aimed to investigate maternal serum levels of calprotectin in patients with intrahepatic cholestasis of pregnancy (ICP) and to compare these with serum calprotectin levels in healthy pregnant women.

METHODS

Ninety pregnant women (ICP group, n = 45; healthy control group, n = 45) were included in the study. The gestational age and body mass index of the participants in the two groups were similar. This prospective cross-sectional study was conducted between November 2019 and May 2020 in the perinatology department of University of Health Sciences Doctor Zekai Tahir Burak Women's Education Hospital, Ankara, Turkey. Patients were recruited from those attending the perinatology outpatient and inpatient clinics. Biochemical (alanine aminotransferase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), total bilirubin), fasting bile acid, hemogram, and calprotectin parameters of maternal blood were evaluated.

RESULTS

The mean fasting bile acid value in the ICP group was 30.3 ± 27.3 μmol, with severe ICP present in 11 (24.4%) patients. ALT, AST, LDH, total bilirubin, and mean platelet volume (MPV) values in the ICP group were higher and the red cell distribution width (RDW) value was lower than those in the control group (p < 0.001). The mean serum calprotectin levels in the control group and ICP group were 48.0 ± 10.4 and 765.4 ± 126.8 μg, respectively (p < 0.001). There was no significant correlation between serum fasting bile acid levels and serum calprotectin levels in the ICP group (p > 0.005).

CONCLUSION

Serum levels of calprotectin in patients with ICP were higher than those in healthy pregnant women. The serum calprotectin level may be an important diagnostic marker of ICP.

Platelet/lymphocyte ratio is a significant prognostic factor for targeted therapy in patients with EGFR-mutated non-small-cell lung cancer

Objective

To analyze the prognostic significance of the pretreatment platelet/lymphocyte ratio (PLR) for targeted therapy in patients with epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC).

Methods

We conducted a retrospective study of 96 patients with EGFR-mutated advanced NSCLC who were treated at Dongguan People’s Hospital, Southern Medical University from May 2014 to December 2017. All patients received EGFR-targeted therapy until disease progression, unacceptable toxicity, or other factors. Approximately 3 days before the initial treatment, data including a detailed clinical history, physical examination, radiographic results, pathological diagnosis, and laboratory parameters including complete blood cell counts and albumin levels were evaluated.

Results

Patients in the PLR ≥ 190 group had shorter progression-free survival (PFS) than those in the PLR < 190 group. Furthermore, the 1-year PFS rate was worse in the PLR ≥ 190 group than in the PLR< 190 group. Multivariate analysis indicated the possible role of PLR as a prognostic factor for patients with advanced NSCLC who received EGFR-targeted therapy.

Conclusions

Pretreatment PLR may be an independent prognostic factor for patients with NSCLC receiving EGFR tyrosine kinase inhibitor treatment. Further studies are needed to identify the impact of PLR on EGFR-mutated NSCLC.

Development and Validation of a Nomogram for Preoperative Prediction of Central Compartment Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma and Type 2 Diabetes Mellitus

Purpose

To develop and validate a nomogram to predict central compartment lymph node metastasis in PTC patients with Type 2 Diabetes.

Patients and Methods

The total number of enrolled patients was 456. The optimal cut-off values of continuous variables were obtained by ROC curve analysis. Significant risk factors in univariate analysis were further identified to be independent variables in multivariable logistic regression analysis, which were then incorporated and presented in a nomogram. The ROC curve analysis was performed to evaluate the discrimination of the nomogram, calibration curves and Hosmer-Lemeshow test were used to visualize and quantify the consistency. Decision curve analysis (DCA) was performed to evaluate the net clinical benefit patients could get by applying this nomogram.

Results

ROC curve analysis showed the optimal cutoff values of NLR, PLR, and tumor size were 2.9204, 154.7003, and 0.95 (cm), respectively. Multivariate logistic regression analysis indicated that age, multifocality, largest tumor size, and neutrophil-to-lymphocyte ratio were independent prognostic factors of CLNM. The C-index of this nomogram in the training data set was 0.728, and 0.618 in the external validation data set. When we defined the predicted possibility (>0.5273) as high-risk of CLNM, we could get a sensitivity of 0.535, a specificity of 0.797, a PPV(%) of 67.7, and an NPV(%) of 68.7. Great consistencies were represented in the calibration curves. DCA showed that applying this nomogram will help patients get more clinical net benefit than having all of the patients or none of the patients treated with central compartment lymph node dissection (CLND).

Conclusion

A high level of preoperative NLR was an independent predictor for CLNM in PTC patients with T2DM. And the verified optimal cutoff value of NLR in this study was 2.9204. Applying this nomogram will help stratify high-risk CLNM patients, consequently enabling these patients to be treated with appropriate measures. What is more, we hope to find more sensitive indicators in the near future to further improve the sensitivity and specificity of our nomogram.

Elevated neutrophil-to-lymphocyte ratio in children and adolescents with attention-deficit/hyperactivity disorder

OBJECTIVE

Inflammation is reported to play a substantial role in the pathophysiology of attention-deficit/hyperactivity disorder (ADHD). Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are inexpensive and potentially interesting biomarkers of inflammation. In this cross-sectional and retrospective study, we investigated the relationship between NLR, PLR and ADHD.

METHODS

This study consisted of 100 children and adolescents with ADHD (85 of those receiving psychopharmacological treatment), and 99 physically and mentally healthy children.

RESULTS

The mean NLR and PLR were significantly higher in patients than in controls. There was no significant difference between patients who received psychopharmacological treatment for ADHD and patient that did not with regard to NLR and PLR. No associations were found between NLR and PLR and ADHD symptom severity. The significance of NLR is not influenced by medication use, age and sex.

CONCLUSIONS

Our findings suggest that NLR and PLR may be inflammation biomarkers in children and adolescents with ADHD. Moreover, the significance of NLR is not influenced by medication use, age and sex. Prospective studies that address alterations in NLR and PLR and other pro-inflammatory cytokines following ADHD treatment may provide additional information about the inflammatory mechanisms in ADHD.Key pointsThe mean NLR and PLR were significantly higher in patients than in controls.The significance of NLR is not influenced by medication use, age and sex.No associations were found between NLR and PLR and ADHD symptom severity.Prospective studies that address alterations in NLR and PLR and other pro-inflammatory cytokines following psychopharmacological treatment of ADHD may provide additional information about the inflammatory mechanisms in ADHD.

Association Between Complete Blood Count Components and Intrahepatic Cholestasis of Pregnancy

Objective

Some components of the routine complete blood count (CBC) and their ratios, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been found to be sensitive biomarkers of preeclampsia and other inflammatory obstetric conditions. We wanted to evaluate whether they can be associated with intrahepatic cholestasis of pregnancy (ICP).

Materials and Methods

We conducted a retrospective case-control study between May 1, 2015 and July 1, 2018. Cases were considered pregnancies with ICP and control healthy pregnancies. Cases and controls were matched for age, parity, and race.

We compared the levels of white blood cells (WBC), hemoglobin, neutrophils, lymphocytes, NLR, PLR, platelets, red cell distribution width (RDW), and mean platelet volume (MPV) in the first and third trimesters between cases and controls. In addition, we compared the same components in the third trimester between patients with mild (serum total bile acid (TBA) of 10 - 40 µmols/L) and severe (TBA > 40 µmols/L) ICP. 

Results

There were 33 patients with ICP and 33 controls. There were no significant differences between the two groups in the first trimester. WBC, neutrophil count, and NLR were decreased in women with ICP in the third trimester compared to controls. MPV was significantly higher in the third trimester of patients with ICP compared to controls. RDW was lower in mild ICP compared to severe ICP in the third trimester.

Conclusion

Decreased WBC, neutrophil, NLR, and MPV values are associated with ICP and may be useful additions to the diagnostic algorithm for ICP. Larger studies are needed to assess the responsible underlying molecular pathogenic mechanisms.

Prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer

Aims

This study was aimed at investigating the prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer (EOC) patients in Lagos, Nigeria.

Methods

This was a retrospective cohort study involving the review of the clinical record of 72 patients with histologically confirmed EOC who were managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. Information on the sociodemographic data and platelet counts at diagnosis of EOC were retrieved from the patients' medical records. Descriptive statistics were then computed for all baseline patients' characteristics. Survival analyses were carried out using the Kaplan-Meier estimates. Multivariate analysis of these data was performed with the Cox proportional hazards model.

Results

This study revealed that the prevalence of pretreatment thrombocytosis was 41.7% among the women with EOC. Fifty-three (73.6%) of the women had the advanced-stage disease (FIGO stage III-IV) while 52 (72.2%) had high-grade disease (II-III). The majority (66.7%) of the women had a serous histological type of EOC while 76.4% had documented recurrence. Pretreatment thrombocytosis was significantly associated with the women's parity (P = 0.009), serum carbohydrate antigen 125 levels (P = 0.018), median progression-free survival (PFS) (P < 0.001), 3-year median overall survival (OS) (P < 0.001), type of primary treatment (P = 0.002), extent of cytoreduction (P < 0.001), presence of ascites (P = 0.002), International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.008), and histological type (P = 0.011). Pretreatment thrombocytosis was negatively associated with PFS (hazard ratio [HR] = 0.25; 95% CI 0.83, 0.75; P = 0.014) and 3-year OS (HR = 0.03; 95% CI 0.03, 0.27; P = 0.002).

Conclusions

The study suggests that pretreatment thrombocytosis may be a useful predictor of survivals in EOC patients.

Early predictors of small-for-gestational-age neonates using non-invasive, low-cost, and readily available hematological markers

OBJECTIVE

To evaluate whether neutrophil-to-lymphocyte ratio (NLR), a well-established inflammatory marker, can be used as an early predictor for small-for-gestational-age (SGA) neonates and other adverse pregnancy outcomes.

METHODS

A case-control study compared first-trimester hematological biomarkers in pregnancies of patients with and without SGA (n=149, n=151, respectively). Demographic, clinical, and obstetrical characteristics and first-trimester complete blood count were retrieved. Woman with singleton pregnancies who delivered at Soroka University Medical Center between January 2015 and December 2016 were included. Patients with known maternal infections, relevant medications, hematological conditions, and chronic diseases that may alter the blood count, those with multiple pregnancies, and those with congenital or chromosomal abnormalities were excluded. After univariate analysis, a linear regression model was constructed to assess the association between hematological indices and SGA. Receiver operating curves were constructed to evaluate the sensitivity and specificity of NLR.

RESULTS

First-trimester NLR values of the SGA group were significantly higher compared to controls (3.03 ± 1.68 vs 2.63 ± 1.2, P=0.016). Significantly higher levels of NLR were noted among the severely (<3%) SGA neonates (3.12 ± 1.62 vs 2.62 ± 1.2; P=0.034).

CONCLUSION

NLR may be an early, clinically useful marker in the prediction of SGA. As blood samples are routinely collected, correct implication of this result may serve as a valuable non-invasive, low-cost, readily available predicting tool.

Differential blood count as triage tool in evaluation of pelvic masses

OBJECTIVE

Triaging patients with presumptive ovarian cancer to the appropriate specialist may improve survival. Therefore, there is increasing interest in complementary diagnostic markers to the standard serum CA125. In patients with pelvic masses, we examined the ability of epidemiologic variables and preoperative differential blood counts to improve detection of ovarian cancer over CA125 alone.

METHODS

From pathology reports, patients were classified as having: epithelial ovarian cancer (n=743), including fallopian tube and primary peritoneal cancer, non-epithelial ovarian cancers (n=46), non-ovarian cancers (n=122), or benign disease (1,129). From women with epithelial ovarian cancer, we excluded those who received prior neoadjuvant chemotherapy (n=19). Women were also excluded if they did not have a serum CA125 or complete blood count measured within 180 days prior to surgery (n=1099) or did not have both tests within 90 days of each other (n=13). Categorizing patients by menopausal status, we calculated Pearson correlations between differential counts or ratios and CA125, and used t tests to identity univariate predictors of malignancy and stepwise logistic regression and likelihood ratio tests to create models best distinguishing epithelial ovarian cancer from benign disease.

RESULTS

337 women with epithelial ovarian cancer and 365 with benign disease were included in the analysis. Compared with cancers, women with benign disease had lower average: age, 52.5 versus 58.4 years (p<0.0001); serum CA125, 20 versus 239 U/mL (p<0.0001), neutrophil-to-lymphocyte ratio, 2.4 versus 3.5 (p<0.0001); and platelet-to-lymphocyte ratio, 158 versus 222 (p<0.0001); but greater average body mass index, 28.5 versus 26.8 kg/m² (p=0.004), and lymphocyte-to-monocyte ratio, 5.6 versus 3.9 (p<0.0001). Correlations between counts and ratios and serum CA125 were seen in both epithelial ovarian cancer and benign disease groups and differed by menopausal status. In premenopausal women, a multivariate model including serum CA125, smoking, family history, lymphocytes, and monocytes performed similarly to the model with lymphocyte-to-monocyte ratio replacing counts. In postmenopausal women, a model including body mass index, parity, monocytes, and basophils performed similarly to the model replacing counts with platelet-to-lymphocyte ratio and lymphocyte-to-monocyte ratio. Models including epidemiologic variables and either counts or ratios were better at fitting data than models with serum CA125 and menopausal status alone. A single model applying to all women overstated performance for premenopausal women and understated performance for postmenopausal women.

CONCLUSIONS

Epidemiologic variables and differential counts or ratios better distinguished between benign and malignant disease when compared with serum CA125 alone using separate models for pre- and postmenopausal women.

Laboratory predictors of survival in ovarian cancer

OBJECTIVE

To relate disease-free survival and overall survival with type I and type II ovarian cancer and preoperative laboratory parameters biomarkers.

METHODS

A retrospective study was carried out based on the collection of data from medical records of patients with ovarian tumors. Kaplan-Mayer curves were drawn based on the statistical analysis of the data and were compared using the Log-rank test.

RESULTS

Disease-free survival in type I ovarian cancer was significantly higher than in type II (p=0.0013), as well as in those with normal levels of CA-125 (p=0.0243) and with a platelet-lymphocyte ratio (PLR) lower than 200 (p=0.0038). The overall survival of patients with type I ovarian cancer was significantly higher than in patients with type II, as well as in patients with normal CA-125 serum levels (p=0.0039) and those with a preoperative fasting glucose of less than 100 mg/dL.

CONCLUSION

CA-125 levels may predict greater overall and disease-free survival. PLR < 200 may suggest greater disease-free survival, whereas normal fasting glucose may suggest greater overall survival.

Systemic inflammatory response markers in preeclampsia

PURPOSE

Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), platelet distribution width (PDW), red cell distribution width (RDW), mean platelet volume (MPV), and plateletcrit (PCT) are known as systemic inflammatory response markers. In this study, we aimed to evaluate changes in NLR, PLR, PDW, RDW, MPV, and PCT in preeclampsia (PE) and their use in predicting its severity.

MATERIALS AND METHODS

This is a retrospective case-control study. The study comprised 64 control group (healthy pregnant females), 51 females with mild PE, and 13 with severe PE. These three groups were compared with demographic data and inflammation markers.

RESULTS

There were no statistically significant differences between healthy pregnant females and preeclaptic females in terms of median age, hemoglobin, lymphocyte, neutrophil, platelet, NLR, PLR, PDV, RDW, MPV, PCT (P > 0.05). The control group has a higher number of gravity and parity than the PE group (P < 0.001). MPV value is a lower PE group than the control group (P < 0.001). Both gravity and parity were significantly higher in the patients with mild PE than in the control group (P < 0.001). MPV value was statistically higher in the control group compared both mild and severe PE (P < 0.001), however, no statistical difference between mild and severe PE (P = 0.305).

CONCLUSIONS

MPV may be clinically useful markers in the prediction of PE. Further, prospective multicenter studies are needed to reveal the association between these markers and PE.

Prognostic significance of neutrophil-lymphocyte ratio (NLR) in patients with ovarian cancer: A systematic review and meta-analysis

The prognostic role of neutrophil to lymphocyte ratio (NLR) in patients with ovarian cancer remains inconsistent. This meta-analysis was conducted to evaluate the predictive value of this biomarker for prognoses in ovarian cancer patients.We systematically searched PubMed, Web of Science, and Embase for eligible studies embracing multivariate results. The Newcastle-Ottawa Scale were used to assess the study quality. Pooled hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated.Ten studies involving 2919 patients were included in this meta-analysis. In multivariate analysis, the group with higher NLR had worse overall survival (OS) (HR = 1.34, 95% CI = 1.16-1.54) and shorter PFS (HR = 1.36, 95% CI = 1.17-1.57) than the control group. Furthermore, PLR values higher than the cut-off were associated with not only poorer OS (HR = 1.97, 95% CI = 1.61-2.40) but also more unfavorable PFS (HR = 1.79, 95% CI = 1.46-2.20). Univariate analysis also indicated the same results. Additionally, subgroup analysis showed that when the cut-off values for NLR and PLR were higher, their predictive effects became stronger.This comprehensive meta-analysis suggested that the values of inflammatory marker of NLR was associated with ovarian cancer survival. Therefore, inflammatory markers can potentially serve as prognostic biomarkers.

Platelet-lymphocyte ratio as a potential prognostic factor in gynecologic cancers: a meta-analysis

PURPOSE

Cancer-related inflammation plays an important role in tumor development and progression. Platelet-lymphocyte ratio (PLR) has been studied as a biomarker for prognosis in gynecologic cancers. But, the results of previous studies were controversial, so we performed this meta-analysis.

METHODS

We searched the scientific database of PubMed, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure (CNKI) using free text and MeSH keywords. Crude HR (hazard ratio) with 95% confidence interval was used to evaluate the risk association between PLR and overall survival (OS) or progression-free survival (PFS) in gynecologic neoplasms.

RESULTS

There totally 23 studies, including 6869 patients who were eligible, most of which are published after 2015 or later. PLR greater than the cut-off was associated with poorer survival prognosis in ovarian cancer [OS: HR 1.80 (95% CI 1.37-2.37), p = 0.000; PFS: HR 1.63 (95% CI 1.38-1.91), p = 0.000] and cervical cancer [OS: HR 1.36 (95% CI 1.10-1.68), p = 0.005; PFS: HR 1.40 (95% CI 1.16-1.70), p = 0.002], but not in endometrial cancer [OS: HR 1.95 (95% CI 0.65-5.84), p = 0.234].

CONCLUSIONS

The current meta-analysis revealed that pretreatment PLR was a simple, promising prognostic indicator for OS and PFS in ovarian and cervical cancers. But, its significance of prognosis did not agree with endometrial neoplasm. However, due to the limited number of original studies, future large-scale studies with more well-designed, high-quality studies are still needed.

Red cell distribution width and preeclampsia: a systematic review and meta-analysis

BACKGROUND

Preeclampsia is a serious pregnancy-related disease which may lead to adverse health effects to the mother and fetus. Besides many publications on the association of red cell distribution width (RDW) and preeclampsia, there has been no published meta-analysis. This necessitated the present systemic review and met-analysis to assess the RDW in relation to preeclampsia.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Relevant published studies were searched in PubMed, Cochrane library, Google scholar, Scopus, Embase and CINAHL using the term "Preeclampsia OR eclampsia AND red cell distribution width OR red blood cells). Modified Newcastle - Ottawa quality assessment scale was used for critical appraisal of retrieved studies. Pooled Meta logistic regression was computed using OpenMeta Analyst software. Subgroup and meta-regression methods were performed to analyse the heterogeneity.

RESULTS

Eleven case control studies were included in the met-analyses with a total of 951 cases (preeclampsia) and 2024 controls. The mean (SD) of the RDW level was significantly higher in women with preeclampsia compared to controls [15.10 (2.48) % vs. 14.26(1.71) %, P < 0.001]. The mean difference was 0.85, 95% CI = 0.26-1.43. Due to a high heterogeneity (I2 = 90.45, P < 0.001), the continuous random effect model was used.Eight studies compared RDW level in the mild (N = 360) with severe cases (N = 354) of preeclampsia. The RDW level was significantly higher in women with severe preeclampsia compared to those with mild preeclampsia [15.37 (2.48) % vs. 14.037(1.79) %, P < 0.001]. The mean difference was 1.07, 95% CI = 0.45-1.70. Since there is a high heterogeneity [I2 = 76.67, P < 0.001], the continuous random effect model was used.Through the met-regression model, except for the region of the study (P < 0.001), none of investigated variables (age, parity, quality of the study) was significantly associated with the investigated heterogeneity. The outliers (3studies) were removed to reduce the heterogeneity. The pooled meta-analysis of the remaining 8 studies showed a significant difference in the RDW between preeclamptic women compared with the controls. The mean difference was 0.93, 95% CI = 0.56-1.31, P < 0.001. Because of heterogeneity [I2 = 69.6, P = 0.002], the continuous random effect model was used.

CONCLUSION

RDW level was significantly higher in women with preeclampsia compared to controls. Similarly, women with severe preeclampsia had significantly higher RDW than those with the mild form.

Prognostic Value of Systemic Inflammatory Indices, NLR, PLR, and MPV, for Predicting 1-Year Survival of Patients Undergoing Cytoreductive Surgery with HIPEC

The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and mean platelet volume (MPV) have been reported to be associated with the prognosis of various types of tumors. This study evaluated the prognostic value and clinical use of inflammatory markers for predicting 1-year survival in patients undergoing cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). This retrospective study included 160 patients who underwent CRS with HIPEC between July 2014 and April 2017. Data on NLR, PLR, and MPV were collected preoperatively and on postoperative days (POD) 1, 2, 3, 4, and 5. In a multivariate analysis using a cox proportional hazard regression model, higher values of preoperative NLR and MPV, PLR, and MPV on POD 2, 3, and 5 were associated with reduced 1-year survival after CRS with HIPEC. Patients with increased MPV showed lower rates of 1-year survival following CRS with HIPEC. In addition, elevated preoperative NLR and postoperative PLR were correlated with poor survival. These markers are able to stratify patients by risk profile, which may ultimately improve perioperative management and be helpful in improving outcomes following CRS with HIPEC.

Influence of obesity on surgical complications of patients with ovarian tumors

Influence of obesity on surgical complications and survival of patients with ovarian tumors were investigated. In total, 362 patients who were diagnosed with ovarian cancer by biopsy in the Department of Pathology of Shanxi Dayi Hospital Affiliated to Shanxi Medical University from April 2012 to July 2017 were selected as research subjects for retrospective analysis. The patients were divided into the obesity group [body mass index (BMI) ≥28] (n=64), the overweight group (≥24 BMI <28) (n=124), the normal body weight group (≥18.5 BMI <24) (n=108) and the low body weight group (BMI <18.5) (n=66). The surgical conditions and postoperative complications of patients in the 4 groups were compared, and the patients were followed up for prognosis for one year, and their mortality rates were recorded. The surgical time, intraoperative blood loss amount and blood transfusion amount of the patients in the obesity group were the highest, followed by the overweight group (P<0.05). Among the 4 groups, the prognosis of patients in the obesity group was also the worst. The incidence rates of complications among all groups were compared, and the incidence rate of complications in the obesity group was the highest (50.00%), followed by the overweight group (30.65%), the low body weight group (13.64%) and the normal body weight group (4.63%), (P<0.05). The prognosis follow-up results showed that the 1-year mortality rate in the obesity group was the highest (35.94%), followed by the overweight group (28.23%). For patients with ovarian cancer, obesity raises the risks of postoperative complications and worsens their prognosis. Therefore, indexes of patients with tumors associated with high BMI should be monitored more strictly after surgeries.

Can complete blood count inflammatory parameters in epithelial ovarian cancer contribute to prognosis? - a survival analysis

Subjective

The aim of the present study was to investigate the prognostic significance of preoperative complete blood count inflammatory markers in women operated for invasive Epithelial Ovarian Cancer (EOC).

Method

Two hundred forty four patients that underwent operation with the diagnosis of invasive EOC between 2006 and 2014 were included in the study. The date of operation, date of recurrence and final mortality evaluations were performed for survival analysis. The sensitivity, specificity, PPV and NPV were separately calculated with ROC analysis. Survival analysis was carried out with Kaplan Meier-Log Rank Method.

Results

Five-years overall survival rate was 56, 9% and 5-year disease-free survival (DFS) rate was 45,5%. Advanced disease stage, moderate-poor tumor differentiation, and the presence of recurrence were determined to have significant inverse relation at mean survival and 5-year survival rates. Neutrophil/lymphocyte ratio (NLR) and Platelet lymphocyte ratio (PLR) had prognostic effect on both DFS and overall survival based upon the cut-off values determined in the study (PLR = 231, s36, NLR = 3,83). Histopathological subtypes were not found to have any prognostic value. In correlation analysis, PLR and NLR had positive correlation with each other and negative correlation with overall survival.

Conclusions

Inflammatory markers such as NLR and PLR have independent prognostic value for women who undergo surgery for invasive EOC.

Systemic immune-inflammation index predicts prognosis in patients with epithelial ovarian cancer: A retrospective study

OBJECTIVE

The study aimed to investigate the prognostic value of the systemic immune-inflammation index (SII) in patients with epithelial ovarian cancer (EOC).

METHODS

A total of 553 EOC patients were retrospectively analyzed. 250 patients from West China Second University Hospital were assigned into the discovery cohort and 283 patients from The Affiliated Hospital of Southwest Medical University were assigned into the validation cohort. The correlation between SII and survival were analyzed using Cox regression analyses and Kaplan-Meier method. Prediction accuracy was evaluated with the receiver operating characteristics (ROC) curve.

RESULTS

The high SII (≥612) was correlated with advanced FIGO stage, lymph node metastasis, and tumor recurrence. In univariate Cox regression, patients with high SII (≥612) had a significantly shorter progression-free survival (PFS) and overall survival (OS) compared to low SII patients (<612) in both cohorts. In multivariate Cox regression analysis, SII was an independent prognostic indicator for PFS (HR = 7.61, 95% CI 3.34-17.35, P < 0.001) and OS (HR = 6.36, 95% CI 2.64-15.33, P < 0.001) in the discovery cohort. These results were verified in the validation cohort.

CONCLUSION

High SII was correlated with poor survival in patients with EOC. The SII was an independent prognostic factor for patients with EOC.

Prognostic role of inflammatory biomarkers in HIV-infected patients with a first diagnosis of hepatocellular carcinoma: A single-center study

OBJECTIVES

To assess hepatocellular carcinoma (HCC) survival and to investigate the prognostic role of immunonutritional biomarkers, as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI), in a cohort of human immunodeficiency virus (HIV)-infected patients.

METHODS

All HIV-positive patients diagnosed with HCC at our Department from January 2000 to December 2013 were included. The outcomes were overall survival (OS), recurrence-free survival (RFS), and liver-related death (LRD). To examine the role of inflammatory biomarkers on the outcomes, univariate and multivariable Cox regression models were used. Receiver operating characteristic (ROC) curves were implemented to evaluate the prediction role of NLR, PLR, and PNI.

RESULTS

A total of 40 patients (90% males) with a mean age of 48.3 years (SD = 5.6) were recruited. NLR ≥ 2.9 was associated with all causes mortality, as well as, PLR ≥ 126. NLR and PLR were predictors of OS, RFS, and LRD, while PNI did not emerge as a prognostic marker. According to the multivariate analysis, no HCC treatment was the only risk factor associated with risk of death. The areas under the ROC curves were 68.3 (95% confidence interval [CI], 54.5-82.1) for PLR and 66.3 (95% CI, 54.3-78.2) for NLR at 3 years; similar results were found at 5 years of follow-up.

CONCLUSIONS

Although, if examined singularly, NLR and PLR are prognostic factors for HCC recurrence and survival in HIV-infected patients, at the multivariate analysis, "no HCC treatment" remains the only independent risk factor associated with fatal outcome.

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

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

Malnutrition and the Development of Periprosthetic Joint Infection in Patients Undergoing Primary Elective Total Joint Arthroplasty

BACKGROUND

Although an abundance of literature exists linking malnutrition with infectious complications in surgical patients, there is little specifically examining the link between malnutrition and periprosthetic joint infection (PJI). This study evaluated the relationship between abnormal nutritional parameters and development of PJI in patients undergoing primary total joint arthroplasty (TJA).

METHODS

We retrospectively reviewed TJA patients from 2000 to 2016 with preoperative nutritional screening at a single institution. Any development of PJI at 2 years was assessed as the primary outcome. The Musculoskeletal Infection society criteria were used to define PJI. The association between the aforementioned nutritional markers and PJI was evaluated in a bivariate analysis followed by multivariate logistic regression. Performance for markers was assessed using receiver operator characteristic curves. Sensitivity and specificity were also compared.

RESULTS

Multivariate analysis demonstrated that low albumin (adjusted odds ratio [OR], 4.69; 95% confidence interval [CI], 2.428-9.085; P < .001) and low hemoglobin (adjusted OR, 2.718; 95% CI, 1.100-2.718; P = .018) were significantly associated with PJI. Albumin had the highest specificity and (95% CI, 97.8%-98.4%) and positive predictive value compared to all other markers. Platelet-to-white blood cell ratio had the highest sensitivity (95% CI, 29.5%-40.3%). The area under the curve was greatest for albumin (0.61; 95% CI, 0.55-0.67) followed by hemoglobin (0.57; 95% CI, 0.51-0.63), platelets (0.56; 95% CI, 0.50-0.62), and platelet-to-white blood cell ratio (0.54; 95% CI, 0.49-0.60).

CONCLUSION

The most valuable predictor of PJI following primary TJA, among nutritional parameters examined, was preoperative albumin with a very high specificity and positive predictive value.

The association between the inflammatory potential of diet and risk of developing, and survival following, a diagnosis of ovarian cancer

PURPOSE

Inflammation has been implicated in ovarian carcinogenesis. This study evaluated two dietary indices: the Dietary Inflammatory Index (DII®) and the Empirical Dietary Inflammatory Pattern (EDIP), in relation to risk of developing, and survival following, a diagnosis of ovarian cancer.

METHODS

Data came from the Australian Ovarian Cancer Study (1375 cases, 1415 population controls). DII and EDIP scores were computed from dietary information obtained using a semiquantitative food-frequency questionnaire. Logistic regression was used to assess the association between DII and EDIP scores and risk of ovarian cancer and proportional hazards models were used for survival analysis.

RESULTS

A high DII score, reflecting a more pro-inflammatory diet, was associated with a modest increased risk of ovarian cancer [odds ratio (OR) DII score_{Q4 vs.Q1} = 1.31, 95% CI 1.06-1.63, p_trend = 0.014]. Likewise a high EDIP score was associated with an increase in risk of ovarian cancer [OR EDIP score_{Q4 vs.Q1} = 1.39, 95% confidence interval (CI) 1.12-1.73, p_trend = 0.002]. We found no association between DII or EDIP score and overall or ovarian cancer-specific survival.

CONCLUSION

In conclusion, our results suggest that a pro-inflammatory diet modestly increases the risk of developing ovarian cancer.

Prognostic significance of platelet-to-lymphocyte ratio in patients with ovarian cancer: A meta-analysis

BACKGROUND

The platelet-to-lymphocyte ratio (PLR) has been found to predict clinical outcomes in borderline ovarian tumours and the other genital neoplasms. However, its prognostic value in patients with ovarian cancer remains controversial. The aim of this study was to assess its prognostic value in ovarian cancer.

METHODS

We searched MEDLINE, EMBASE and the Cochrane databases to identify studies evaluating the prognostic significance of pretreatment PLR in ovarian cancer. The end points were overall survival (OS) and progression-free survival (PFS). Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed-effects/random-effects models.

RESULTS

A total of 11 studies comprising 3574 patients with ovarian cancer were included. The random-effects meta-analysis demonstrated that patients with elevated PLR had shorter OS (HR: 1.48, 95% CI: 1.24-1.76, P < .001) and PFS (HR: 1.38, 95% CI: 1.17-1.63, P < .001). The negative prognostic impact of high PLR on OS and PFS remained substantial in Asian populations, patients with PLR ≥ 200 and studies with NOS score ≥ 7.

CONCLUSIONS

Elevated pretreatment PLR could be an unfavourable prognostic factor for clinical outcomes in patients with ovarian cancer.

Prognostic value of systemic inflammatory markers in ovarian Cancer: a PRISMA-compliant meta-analysis and systematic review

BACKGROUND

The prognostic effect of elevated systemic inflammatory markers, including neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), remains controversial in cancer patients. This meta-analysis was conducted to evaluate the predictive values of these markers for prognoses in ovarian cancer patients.

METHODS

Potentially relevant publications in PubMed, ISI Web of Science, and EBSCO were searched. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) for overall survival (OS) and progression-free survival (PFS) were determined using a fixed or random effects model.

RESULTS

Ten studies involving 2919 patients were included in this meta-analysis. In multivariate analysis, the group with higher NLR had worse OS (HR = 1.34, 95% CI = 1.16-1.54) and shorter PFS (HR = 1.36, 95% CI = 1.17-1.57) than the control group. Furthermore, PLR values higher than the cut-off were associated with not only poorer OS (HR = 1.97, 95% CI = 1.61-2.40) but also more unfavorable PFS (HR = 1.79, 95% CI = 1.46-2.20). Univariate analysis also indicated the same results. Additionally, subgroup analysis showed that when the cut-off values for NLR and PLR were higher, their predictive effects became stronger.

CONCLUSION

This comprehensive meta-analysis suggested that the values of inflammatory markers such as NLR and PLR were associated with ovarian cancer survival. Therefore, inflammatory markers can potentially serve as prognostic biomarkers.

Prognostic significance of preoperative serum albumin in epithelial ovarian cancer patients: a systematic review and dose-response meta-analysis of observational studies

Purpose

To comprehensively assess the impact of preoperative serum albumin levels on survival of patients with epithelial ovarian cancer (EOC).

Materials and methods

Two independent researchers searched the PubMed, Embase, and Web of Science databases to identify relevant studies from inception to October 20, 2017. The studies were independently reviewed and those deemed eligible were selected based on predetermined selection criteria. Summarized HRs and 95% CIs were calculated for overall survival (OS) with a profile likelihood random-effects model.

Results

Twelve cohort studies comprising 3884 EOC patients were included for analysis. Comparison of the highest vs the lowest categories of preoperative serum albumin yielded a summarized HR of 0.63 (95% CI=0.45–0.88, I²=88.8%). Although the results were robust in all subgroup analyses stratified by International Federation of Gynecology and Obstetrics (FIGO) stage, cutoff definition, geographical location, quality of study, number of EOC cases, followup time, and adjustments made for potential confounders, not all were statistically significant. Of note, dose–response analysis showed that for each 10 g/L increment in preoperative serum albumin level, the summary HR was 0.56 (95% CI=0.35–0.92, I²=78.6%). No evidence of publication bias was detected by funnel plot analysis and formal statistical tests. Sensitivity analyses showed no important differences in the estimates of effects.

Conclusion

The present meta-analysis suggests that preoperative serum albumin can be used as an independent prognostic predictor of OS in EOC patients. Since the included studies had high heterogeneity and retrospective designs, these results require further validation with prospective cohort trials enrolling larger patient populations with longer follow-up examinations.

Preoperative neutrophil-to-lymphocyte ratio is a predictor of survival of epithelial ovarian cancer: a systematic review and meta-analysis of observational studies

Inflammation plays an important role in the development and progression of epithelial ovarian cancer (EOC). However, no meta-analysis has comprehensively and quantitatively investigated the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in EOC patients. Therefore, we performed a meta-analysis to quantify the prognostic impact of this biomarker. We searched the PubMed and Web of Science databases from their inception through December 31, 2016, and examined observational studies evaluating the association of preoperative NLR with progression-free survival (PFS) and overall survival (OS) of EOC patients. A random-effects model was used to summarize hazard ratios (HRs) with 95% confidence intervals (CIs). Twelve retrospective cohort studies including 3,154 EOC patients were identified. Elevated NLR in EOC patients was associated with worse PFS (summarized HR=1.80; 95% CI = 1.22–2.65; I² = 79.1%) and OS (summarized HR = 1.72; 95% CI = 1.18–2.51; I² = 73.5%) compared with low NLR. No evidence of publication bias was detected by funnel plot analysis and formal statistical tests. Although the results were robust in all subgroup analyses, not all results were statistically significant. We determined that adjustments for CA-125 level and performance status might be sources of heterogeneity. These combined results indicate that preoperative NLR is an important predictor of prognosis in EOC patients. Since the high heterogeneity and retrospective study design of included studies, these results require further validation with prospective cohort and trials enrolling larger patient populations and conducting longer follow-up examinations.

Prognostic roles of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in ovarian cancer: a meta-analysis of retrospective studies

PURPOSE

The systemic inflammatory response markers have been reported to be associated with the prognosis of various cancers. We conducted this meta-analysis of retrospective studies to evaluate and identify the prognostic impact of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) on ovarian cancer.

METHODS

PubMed, EMBASE, and China National Knowledge Infrastructure databases were included to search for eligible studies. The following terms were used: "neutrophil to lymphocyte ratio", "NLR", "platelet to lymphocyte ratio", "PLR", "ovarian cancer", "ovary cancer", "ovarian carcinoma", "ovary carcinoma", "ovarian neoplasm", "ovary neoplasm", "ovarian tumor", and "ovary tumor". The random-effects model was chosen to estimate the pooled HR with 95% CI. Heterogeneity between studies was assessed by Higgins I² value. The stability and heterogeneity of studies were analyzed by sensitivity analysis. Publication bias was examined by Egger's test and Begg's test with the funnel plots.

RESULTS

13 studies consisting of 3467 patients were considered for meta-analysis. We found that the high NLR had a poor prognostic impact on OS and PFS in ovarian cancer, with a pooled HR 1.70, 95% CI 1.35-2.15 and HR 1.77, 95% CI 1.48-2.12, respectively. Similarly, the results showed the high PLR adversely affected OS and PFS in ovarian cancer, with a pooled HR 2.05, 95% CI 1.70-2.48 and HR 1.85, 95% CI 1.53-2.25, respectively.

CONCLUSION

In conclusion, we found that both NLR and PLR had an unfavorable impact on PFS and OS of patients with ovarian cancer. Our meta-analysis supported that NLR/PLR could be effective prognostic predictors of ovarian cancer.

An inflammation-based cumulative prognostic score system in patients with diffuse large B cell lymphoma in rituximab era

Background

Systemic inflammatory parameters are associated with poor outcomes in malignant patients. Several inflammation-based cumulative prognostic score systems were established for various solid tumors. However, there is few inflammation based cumulative prognostic score system for patients with diffuse large B cell lymphoma (DLBCL).

Methods

We retrospectively reviewed 564 adult DLBCL patients who had received rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) therapy between Nov 1 2006 and Dec 30 2013 and assessed the prognostic significance of six systemic inflammatory parameters evaluated in previous studies by univariate and multivariate analysis:C-reactive protein(CRP), albumin levels, the lymphocyte-monocyte ratio (LMR), the neutrophil-lymphocyte ratio(NLR), the platelet-lymphocyte ratio(PLR)and fibrinogen levels.

Results

Multivariate analysis identified CRP, albumin levels and the LMR are three independent prognostic parameters for overall survival (OS). Based on these three factors, we constructed a novel inflammation-based cumulative prognostic score (ICPS) system. Four risk groups were formed: group ICPS = 0, ICPS = 1, ICPS = 2 and ICPS = 3. Advanced multivariate analysis indicated that the ICPS model is a prognostic score system independent of International Prognostic Index (IPI) for both progression-free survival (PFS) (p < 0.001) and OS (p < 0.001). The 3-year OS for patients with ICPS =0, ICPS =1, ICPS =2 and ICPS =3 were 95.6, 88.2, 76.0 and 62.2%, respectively (p < 0.001). The 3-year PFS for patients with ICPS = 0–1, ICPS = 2 and ICPS = 3 were 84.8, 71.6 and 54.5%, respectively (p < 0.001).

Conclusions

The prognostic value of the ICPS model indicated that the degree of systemic inflammatory status was associated with clinical outcomes of patients with DLBCL in rituximab era. The ICPS model was shown to classify risk groups more accurately than any single inflammatory prognostic parameters. These findings may be useful for identifying candidates for further inflammation-related mechanism research or novel anti-inflammation target therapies.

Prognostic Role of Neutrophil to Lymphocyte Ratio in Ovarian Cancer: A Meta-Analysis

OBJECTIVE

The aim of the study was to investigate the prognostic role of neutrophil to lymphocyte ratio in ovarian cancer. Growing number of articles reported the relationship between neutrophil to lymphocyte ratio and prognosis in ovarian cancer, but the results remains inconclusive. The meta-analysis was conducted to analyze the association of pretreatment neutrophil to lymphocyte ratio with overall survival and progression-free survival.

METHODS

We performed a systematic literature research of PubMed, EMBASE, Medline, and Cochrane library for relevant studies up to October 8, 2017. The quality of included studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. The hazard ratio and corresponding 95% confidence intervals were calculated. We checked the heterogeneity by the Q test and Higgins I-squared statistic. Begg funnel plot and Egger linear regression test were also applied for ascertain publication bias. All of the statistical analyses were performed using STATA version 12.0.

RESULTS

A total of 12 studies with 4046 patients were included in our study. The results indicated that depressed neutrophil to lymphocyte ratio was significantly correlated with higher overall survival (hazard ratio = 1.409, 95% confidence intervals = 1.112-1.786, P = .005) and progression-free survival (hazard ratio = 1.523, 95% confidence intervals = 1.187-1.955, P = .001) in ovarian cancer. Subgroup analysis by ethnicity of overall survival and progression-free survival showed that the prognostic effect of neutrophil to lymphocyte ratio was found both in Asians and Caucasians.

CONCLUSION

Patients with depressed neutrophil to lymphocyte ratio had a higher overall survival and progression-free survival in ovarian cancer. This meta-analysis provided neutrophil to lymphocyte ratio as an available predictor of overall survival and progression-free survival for patients with ovarian cancer.

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.

Can we predict severity of intrahepatic cholestasis of pregnancy using inflammatory markers?

Objective:

To investigate the association of inflammatory markers with severity of intrahepatic cholestasis of pregnancy (ICP).

Materials and Methods:

This retrospective case-control study was conducted with 229 pregnant women, 84 with ICP, and 145 age-matched healthy pregnant women. Patients were categorized as mild ICP (<40 µmol/L) and severe ICP (≥40 µmol/L) with regard to serum bile acids. Inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), platelet-to- lymphocyte ratio (PLR) and mean platelet volume (MPV), and red blood cell distribution width (RDW) were compared between the groups.

Results:

Patients with ICP had significantly decreased RDW and increased white blood cell counts (WBC), MPV and PLR, but no significant changes in NLR. The comparison of mild and severe cases with regard to NLR, PLR, WBC, and RDW was similar (p>0.05). MPV levels were significantly increased in severe group (p<0.05).

Conclusion:

WBC, MPV, and PLR were the inflammatory markers significantly increased, and RDW was signifantly reduced in ICP. MPV was the marker that significantly increased with the severity of disease. The use of inflammatory markers in the assessment of perinatal outcomes needs further studies.

Prognostic role of platelet to lymphocyte ratio in hepatocellular carcinoma: a systematic review and meta-analysis

BACKGROUND AND AIMS

Several studies were conducted to explore the prognostic significance of platelet to lymphocyte ratio (PLR) in hepatocellular carcinoma (HCC), however, contradictory results across most reports were documented. To this end, we present a systematic review that aims to summarize the prognostic significance of PLR in patients with HCC.

RESULTS

A total of 10 studies involving a total of 2,315 patients were identified. The Newcastle-Ottawa Quality Assessment Scale (NOS) of each included study was greater than or equal to 5. The results indicated that high PLR was significantly associated with a worse OS when compared to the low PLR (HR = 1.60, 95% CI = 1.23-2.08, p = 0.0005; I2 = 88%, p < 0.00001). Similar results were detected in the subgroup analysis of the analysis model, cut-off value, ethnicity, sample size and therapy. However, no obvious correlation between the PLR and DFS/RFS in patients with HCC was observed (HR = 1.21, 95% CI = 0.87-1.67, p = 0.26; I2 = 61%, p = 0.07).

MATERIALS AND METHODS

A complete literature search in the PubMed, Cochrane Library and Embase database was performed. Retrospective and prospective studies focusing on the role of PLR on the prognosis in HCC were all deemed as "suitable" for our scope. The endpoints determined were: the overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS) and the progress free survival (PFS).

CONCLUSIONS

The study revealed that high PLR is an unfavorable predictor of OS in patients with HCC, and high PLR is a promising prognostic biomarker for HCC, especially for patients in Asia.

Preoperative prognostic nutritional index is a powerful predictor of prognosis in patients with stage III ovarian cancer

Many established inflammation- and nutrition-related factors have been investigated as potential independent prognostic factors in various cancers, including the C-reactive protein/albumin ratio (CAR), lymphocyte/monocyte ratio (LMR), modified Glasgow prognostic score (mGPS), body mass index (BMI), and prognostic nutritional index (PNI). This study was performed to estimate the prognostic value of these factors in predicting survival and platinum resistance in ovarian cancer (OC), especially according to stage. Kaplan-Meier and multivariate analyses were performed to plot the survival curve and determine the independent prognostic factors. Additionally, the area under the receiver operating characteristic curve (AUC) was used to predict platinum resistance and prognosis by comparing the predictive ability of PNI and cancer antigen (CA)-125. In all patients, decreased PNI was significantly associated with platinum resistance and poor overall survival (OS) and progression-free survival (PFS). Regarding tumor stage, decreased PNI was significantly associated with poor PFS and OS only in stage III OC. Furthermore, the PNI also showed a significantly higher AUC value than CA-125 for predicting mortality and platinum resistance in all OC patients, but not in stage III patients. In conclusion, decreased PNI is a powerful predictor of a poor prognosis in OC, and especially for stage III cases.

Prognostic significance of neutrophil to lymphocyte ratio in ovarian cancer: evidence from 4,910 patients

Increasing evidence indicates that elevated neutrophil to lymphocyte ratio (NLR) are related with poor prognosis in various types of tumors. However, the prognostic role of NLR in patients with ovarian cancer (OC) remains controversial. Thus, the current meta-analysis aimed to investigate the prognostic role of NLR in patients with OC. A total of 16 studies with 4,910 patients were included. By pooling hazard ratios (HRs) with 95% confidence intervals (CIs) and odds ratios (ORs) with 95% CIs from each study. The results demonstrated that elevated pretreatment NLR was significantly related to poor OS (HR: 1.50, 95% CI: 1.27-1.77) and PFS (HR: 1.53, 95% CI: 1.28-1.84) in patients with OC. Subgroup analyses was divided by ethnicity, sample size, histologic types, cut-off value of NLR, analysis method and NOS score, but the results did not showed any significant change the main results. This meta-analysis revealed that elevated pretreatment NLR might be a predicative factor of poor prognosis in OC patients.

Neutrophil-to-Lymphocyte Ratio Is a Potential Prognostic Biomarker in Patients with Ovarian Cancer: A Meta-Analysis

Background and Aims

Plenty of studies were conducted to explore the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in ovarian cancer with contradictory results. This study aims to summarize the prognostic significance of NLR in patients with ovarian cancer.

Methods

A literature search in PubMed, Cochrane Library, and Embase was conducted. The endpoints were progression-free survival (PFS) and overall survival (OS).

Results

Eleven studies involving a total of 2,892 patients were identified. The results indicated that patients with high NLR had shorter PFS compared to patients with low NLR in ovarian cancer (HR = 1.55, 95% CI = 1.15–2.08, p = 0.004, and I² = 61%). Similarly, high NLR was related to shorter OS (HR = 1.51, 95% CI = 1.03–2.23, p = 0.04, and I² = 85%). Moreover, high NLR was significantly associated with shorter PFS when the NLR cut-off was less than 3.3 (p = 0.03) or when treatment is operation (p = 0.002). In addition, high NLR was distinctly related to worse OS in Asian people (p = 0.04) or operation (p = 0.04).

Conclusion

High NLR was associated with shorter PFS and shorter OS in ovarian cancer. NLR is potentially a promising prognostic biomarker in patients with ovarian cancer.

The Prognostic Value of Pre-Treatment Leukocytosis in Patients with Previously Treated, Stage IIIB/IV Non-Small Cell Lung Cancer Treated with the IGF-1R Pathway Modulator AXL1717 or Docetaxel; a Retrospective Analysis of a Phase II Trial

Background: The aim of the present study was to investigate any prognostic value of pre-treatment anemia, leukocytosis and thrombocytosis in patients with advanced pretreated NSCLC. Methods: A randomized, multicenter phase II study comparing the IGF-1R modulator AXL with standard docetaxel in the treatment of previously treated stage IIIB or IV NSCLC patients was conducted in 2011-2013. Clinical and laboratory data were collected, including serum values for hemoglobin (Hgb), white blood cells (WBC) and platelets (Plt) at baseline. These hematological parameters were studied in relation to overall survival using Kaplan–Meier product-limit estimates and multivariate Cox proportional hazards regression models. Results: The median overall survival for all patients was 8.9 months. Patients with leukocytosis (WBC > 9 x 109/L) had a significantly shorter median overall survival (4.2 months) as compared with those with a WBC ≤ 9 x 109/L at baseline (12.3 months) with a corresponding of HR 2.10 (95% CI: 1.29-3.43). Patients with anemia (Hgb < 110 g/L) had a non-significant (p = 0.097) shorter median overall survival (6.1 months) as compared with their counterparts with Hgb ≥ 110 g/L at baseline (9.4 months). As for thrombocytosis (Plt > 350 x 109/L), there was no statistically significant impact on overall survival. Leukocytosis retained its prognostic significance in a multivariate model where other clinical factors such as age, sex and WHO performance status were taken into consideration (HR: 1.83, 95% CI: 1.06-3.13, p = 0.029). Conclusion: Pre-treatment leukocytosis is a strong and independent prognostic marker for shorter overall survival in previously treated stage IIIB or IV NSCLC patients receiving docetaxel or AXL1717. Combined use of pre-treatment leukocytosis assessments together with established prognostic factors such as performance status could be of help when making treatment decisions in this clinical setting.