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Garcia-Ortega DY, Ponce-Herrera D, Alvarez-Cano A, Caro-Sanchez C, Luna-Ortiz K. Preoperative Neutrophil to Lymphocyte Ratio (NLR), Lymphocyte to Monocyte Ratio (LMR), and Platelet to Lymphocyte Ratio (PLR) as Prognostic Markers in Patients With Retroperitoneal Liposarcoma. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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2
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Neutrophil-to-Lymphocyte ratio as a prognostic biomarker in extremities undifferentiated pleomorphic sarcoma. Surg Oncol 2022; 42:101746. [DOI: 10.1016/j.suronc.2022.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/03/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
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Kobayashi H, Okuma T, Okajima K, Ishibashi Y, Zhang L, Hirai T, Ohki T, Ikegami M, Sawada R, Shinoda Y, Akiyama T, Goto T, Tanaka S. Systemic inflammation response index (SIRI) as a predictive factor for overall survival in advanced soft tissue sarcoma treated with eribulin. J Orthop Sci 2022; 27:222-228. [PMID: 33384219 DOI: 10.1016/j.jos.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Eribulin is a tubulin and microtubule-targeting drug that has clinical benefit in overall survival (OS) for patients with advanced soft tissue sarcoma. Eribulin's efficacy has been confirmed in several clinical trials, although no clinically useful biomarkers have been identified. We therefore sought to clarify the predictive factor of eribulin treatment, while focusing on systemic inflammation and immune response values. METHODS This study included 33 advanced STS patients treated with eribulin between March 2016 and September 2019. We evaluated the associations of clinical factors influencing the efficacy of eribulin treatment and systemic inflammatory and immune response, including the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the lymphocyte-to-monocyte ratio (LMR), the systemic inflammation response index (SIRI), and the prognostic nutrition index (PNI), with progression-free survival (PFS) and OS using the Kaplan-Meier method and log-rank test. RESULTS NLR, LMR, PLR, SIRI, and PNI were unassociated with PFS. Compared with patients with SIRI <1.5, those with an SIRI ≥1.5 had a significantly shorter OS [median OS 15 months (95% confidence interval [CI] 8-not reached) vs. 7 months (95% CI 3-14), P = 0.04]. Moreover, the PFS tended to be shorter for patients with SIRI ≥1.5 who received chemotherapy after eribulin treatment than in those with SIRI >1.5 [median PFS 92.5 days (95% CI 27-204) vs. 133 days (95% CI 36-507), P = 0.08]. CONCLUSIONS High SIRI values may predict poorer overall survival and the efficacy of subsequent drugs after eribulin treatment among patients with advanced soft tissue sarcoma.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tomotake Okuma
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Koichi Okajima
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yuki Ishibashi
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Liuzhe Zhang
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University
| | - Toshihide Hirai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takahiro Ohki
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Masachika Ikegami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryoko Sawada
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yusuke Shinoda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University
| | - Takahiro Goto
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Griffiths TT, Arango MWF, Smith IM, Wade RG. The baseline neutrophil lymphocyte ratio predicts survival in soft-tissue sarcoma: A 17-year cohort study. J Plast Reconstr Aesthet Surg 2021; 75:1372-1379. [PMID: 34955395 DOI: 10.1016/j.bjps.2021.11.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/07/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Abnormal ratios of peripheral blood cells, e.g. neutrophil-lymphocyte ratio (NLR), are strongly associated with poor outcomes in numerous cancers. In soft-tissue sarcoma (STS), the NLR has been studied in populations outside the UK although many have major methodological flaws, which represents the rationale for this study. METHODS Over 17 years old (2002-2019) adults with extremity STS were included. The baseline NLR (at the time of diagnosis) was calculated. The association between NLR, disease recurrence and survival was explored using cubic splines and a threshold of 3 selected, which is in keeping with the literature. Multivariable Cox regression was used to estimate overall survival, disease-free survival and recurrence with Hazard Ratios (HR) and 95% confidence intervals (CI). RESULTS Overall, 401 patients were included. The median follow-up was 3 years 8 months (interquartile range 1 years 7 months to 5 years 2 months). During surveillance 148 died (37%), of which 123 (76%) were attributable to sarcoma. At the time of diagnosis, an NLR≥3 was independently associated with worse overall survival (adjusted HR 1.44 [95% 1.01, 2.03]). However, the baseline NLR was not associated with the risk of recurrence (adjusted HR 0.98 [95% CI 0.62, 1.57]) or disease-free survival (adjusted HR 1.11 [95% CI 0.79, 1.56]). CONCLUSIONS At the time of diagnosis of STS, the NLR is strongly associated with survival and may serve as a cheap and readily available biomarker to personalise treatment plans for patients.
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Affiliation(s)
| | | | - Ian M Smith
- Academic Plastic Surgery Office, Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds LS1 3EX, UK
| | - Ryckie G Wade
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK; Academic Plastic Surgery Office, Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds LS1 3EX, UK.
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5
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Offi C, Romano RM, Cangiano A, Candela G, Docimo G. Clinical significance of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio and prognostic nutritional index in low-risk differentiated thyroid carcinoma. ACTA ACUST UNITED AC 2021; 41:31-38. [PMID: 33746220 PMCID: PMC7982751 DOI: 10.14639/0392-100x-n1089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/26/2020] [Indexed: 01/06/2023]
Abstract
Objective Inflammation and nutritional status play an important role in the prognosis of cancer. Lymphocyte-to monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and prognostic nutritional index (PNI) are independent prognostic scores in numerous cancers. However, any study showed their prognostic role in low-risk differentiated thyroid carcinoma (DTC). We aimed to clarify and identify the prognostic value of inflammation indices in low-risk DTC patients. Methods We analysed data from 116 patients, dividing the population into two groups, according to AJCC staging system (8th edition). The LMR, NLR, PLR and PNI cut-off value were determined using receiver operating characteristic (ROC) curve. Disease-free survival (DFS) was calculated with Kaplan-Meyer and Log-Rank tests and the risk of recurrence was calculated with univariate and multivariate Cox regression. Statistical significance was p < 0.05. Results We found a baseline NLR value ≥ 1.750 (75% sensitivity, 40.2% specificity) and a baseline LMR value of 3.83 (66.7% sensitivity, 48.9% specificity). Overall DFS was 74.995 ± 3.236 with a p value of 0.678. NLR showed a hazard ratio for recurrence with almost twice the risk of recurrence (Adjusted Hazard Ratio /HRA): 1.828, p-value = 0.019). Conclusions NLR can be considered a prognostic score with twice the risk of recurrence in low-risk DTC patients with NLR < 1.750.
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Affiliation(s)
- Chiara Offi
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Roberto Maria Romano
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Angelo Cangiano
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Giancarlo Candela
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Giovanni Docimo
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
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Chiti LE, Ferrari R, Boracchi P, Morello E, Marconato L, Roccabianca P, Avallone G, Iussich S, Giordano A, Ferraris EI, Agnoli C, Dondi F, Giacobino D, Godizzi F, Stefanello D. Prognostic impact of clinical, haematological, and histopathological variables in 102 canine cutaneous perivascular wall tumours. Vet Comp Oncol 2021; 19:275-283. [PMID: 33386693 DOI: 10.1111/vco.12673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 12/21/2022]
Abstract
Identification of prognostic factors for perivascular wall tumours (PWTs) is desirable to accurately predict prognosis and guide treatment. 100 and two dogs with surgically excised PWTs without distant metastasis were retrospectively enrolled in this multi-institutional study, and the impact of pre-treatment leukocyte parameters, clinical and histopathological variables on local recurrence (LR) and overall-survival time (OST) were evaluated. Increasing values of white blood cell count (WBCC), neutrophil count (NC) and neutrophil-to-lymphocyte ratio (NLR) were significantly correlated with the hazard of LR in univariate analysis. WBCC and NC remained prognostic when adjusted for margins, grade, tumour size, location and skin ulceration, but lost their significance when adjusted for mitotic index and necrosis, whilst NLR remained prognostic only when close margins where categorised as infiltrated. Castrated males had a higher hazard of LR than intact males in univariate analysis, but significance was lost in multivariate models. Ulcerated PWTs and those located on the distal extremities had a higher hazard of LR both in univariate and multivariate analysis. Histological grade, necrosis, mitotic count, and infiltrated margins were all associated with LR both in univariate and multivariate analysis. Boxer breed, older age, ulceration, grade III, necrosis >50% and higher mitotic count were correlated with shorter OST, although breed and age lost their significance in multivariate analysis. Prognostication of surgically excised PWTs should be based on both clinical and histopathological variables. If validated in further studies, leukocyte counts and NLR may aid the clinician in identifying dogs at higher risk of LR before treatment.
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Affiliation(s)
- Lavinia E Chiti
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Roberta Ferrari
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Patrizia Boracchi
- Dipartimento di Scienze Cliniche e di Comunità, Laboratorio di Statistica Medica, Biometria ed Epidemiologia "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Emanuela Morello
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Turin, Italy
| | - Laura Marconato
- Dipartimento di Scienze Mediche Veterinarie (DIMEVET), Università degli Studi di Bologna, Ozzano dell'Emilia, Italy
| | - Paola Roccabianca
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Giancarlo Avallone
- Dipartimento di Scienze Mediche Veterinarie (DIMEVET), Università degli Studi di Bologna, Ozzano dell'Emilia, Italy
| | - Selina Iussich
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Turin, Italy
| | - Alessia Giordano
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Erica I Ferraris
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Turin, Italy
| | - Chiara Agnoli
- Dipartimento di Scienze Mediche Veterinarie (DIMEVET), Università degli Studi di Bologna, Ozzano dell'Emilia, Italy
| | - Francesco Dondi
- Dipartimento di Scienze Mediche Veterinarie (DIMEVET), Università degli Studi di Bologna, Ozzano dell'Emilia, Italy
| | - Davide Giacobino
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Turin, Italy
| | - Francesco Godizzi
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Damiano Stefanello
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
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Liu C, Xing Y, Jiao Q, Yang Q, Yu W, Li Y, Tao X, Yao W. Association of Preoperative Neutrophil/Lymphocyte Ratio with Clinical Outcomes in Dedifferentiated Chondrosarcoma Patients. Cancer Manag Res 2020; 12:6719-6726. [PMID: 32848454 PMCID: PMC7425651 DOI: 10.2147/cmar.s266671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Dedifferentiated chondrosarcoma (DC) is an extremely uncommon malignant bone tumor with dismal survival outcomes. The purpose of this study was to investigate whether the preoperative neutrophil/lymphocyte ratio (NLR) has the ability to predict overall survival (OS) in DC patients. Materials and Methods Twenty-three DC patients with surgical resection were retrospectively reviewed between 2008 and 2015. The clinical pathological information and survival data were collected for analysis. The cut-off point for NLR was defined by receiver operating curve (ROC). The impact of NLR level on OS between two groups was compared using Kaplan–Meier curves with the Log-rank test. The association between NLR and OS was calculated by univariate and multivariate Cox proportional models. Results From the ROC analysis, the optimal NLR cut-off point was 3.11. Patients with high NLR had a worse OS than low NLR (p = 0.003, Log-rank test). In univariate analysis, a significant association was observed between high NLR and poor OS (Hazard ratio (HR) 4.62, 95% confidence interval (CI) 1.48–14.34, p = 0.008). After adjustment of co-variables, high NLR had more than 4 times the risk of mortality (HR 4.01, 95% CI 1.12–14.26, p = 0.032). Conclusion Preoperative NLR in peripheral blood is an easily accessible and cost-effective prognostic biomarker in DC patients. A prospective study with large sample size is warranted.
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Affiliation(s)
- Chenglei Liu
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yue Xing
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Qingcheng Yang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Wenbin Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yuncheng Li
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Weiwu Yao
- Department of Radiology, Shanghai Tongren Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China
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8
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Teck Seo S, Singh VA, Yasin NF. Preoperative lymphocyte count in relation to sarcoma prognosis. J Orthop Surg (Hong Kong) 2020; 27:2309499019854957. [PMID: 31221016 DOI: 10.1177/2309499019854957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Inflammation plays a major role in tumour development, progression and metastasis. Multiple inflammatory markers such as absolute lymphocyte count, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and platelet-lymphocyte ratio have been discovered as prognostic markers for various malignancies. We investigate preoperative lymphocyte count and other cell count ratios and their relation to survival and prognosis of sarcoma patients after surgery. METHODS A total of 142 patients from the Orthopaedics Oncology Database were included into this retrospective study. Kaplan-Meier curve and multivariate Cox proportional models were used to calculate the overall survival of patients with sarcoma who underwent radical excision surgery. RESULTS High preoperative LMR is significantly associated with better overall survival and prognosis in sarcoma patients, whereas high preoperative NLR is significantly associated with shorter overall survival and poorer prognosis. Multivariate analysis shows that LMR and NLR are good predictors for overall survival at 3 and 5 years after surgery, respectively. Patients with high preoperative lymphocytes count are associated with longer overall survival, but this association is not statistically significant. Our findings suggest that preoperative NLR and LMR are good predictive markers for survival of sarcoma patients. CONCLUSION LMR and NLR can be used to identify patients at risk for poor clinical outcome, so that a more aggressive course of treatment can be applied to improve outcome. These are cost-effective prognostic tools as they are calculated from routine preoperative peripheral blood counts. In conclusion, preoperative NLR and LMR are good prognostic markers for predicting the clinical outcome of patients with sarcoma.
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Affiliation(s)
- Soon Teck Seo
- Orthopaedic Oncology Unit, Department of Orthopaedics (Noceral), University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Vivek Ajit Singh
- Orthopaedic Oncology Unit, Department of Orthopaedics (Noceral), University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Nor Faissal Yasin
- Orthopaedic Oncology Unit, Department of Orthopaedics (Noceral), University Malaya Medical Center, Kuala Lumpur, Malaysia
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Prognostic value of neutrophil-to-lymphocyte ratio and other inflammatory markers in patients with high-risk soft tissue sarcomas. Clin Transl Oncol 2020; 22:1849-1856. [PMID: 32125644 DOI: 10.1007/s12094-020-02324-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) have a high risk of relapse in spite of the use of (neo)adjuvant chemotherapy. In this context, looking for new prognostic biomarkers is an interesting field of research. Our aim is to analyze the prognostic impact of neutrophil-to-lymphocyte ratio (NLR) and other serum markers in patients with STS who received chemotherapy with curative intent. MATERIALS AND METHODS This is a retrospective observational study. We included all patients with STS (primary tumor, local recurrence or resected metastatic disease) treated with high-dose ifosfamide and epirubicin with curative intent from January 2007 to December 2018. The pretreatment NLR and other serum markers were calculated, selecting the median as the cut-off value for the survival and multivariate analysis. RESULTS Seventy-nine patients were included. Median NLR, platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) were 2.83, 174.05 and 3.25, respectively. Median progression-free survival (PFS) was significantly longer in patients with low NLR [not reached (NR) vs 21, 92 months, P < 0.01]. No significant differences were found for PFS regarding PLR or LMR. For overall survival (OS), a significant survival advantage was also found for patients with low NLR (NR vs 65.45 months, P = 0.01), without differences for PLR or LMR. In multivariate analysis, NLR remains an independent prognostic factor for PFS. CONCLUSION In our cohort, low NLR was significantly associated with a longer PFS and OS, and is consolidated as an independent prognostic factor.
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10
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Chiti LE, Martano M, Ferrari R, Boracchi P, Giordano A, Grieco V, Buracco P, Iussich S, Giudice C, Miniscalco B, Zani DD, Proverbio D, Morello E, Stefanello D. Evaluation of leukocyte counts and neutrophil-to-lymphocyte ratio as predictors of local recurrence of feline injection site sarcoma after curative intent surgery. Vet Comp Oncol 2019; 18:105-116. [PMID: 31441996 DOI: 10.1111/vco.12534] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/30/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022]
Abstract
Local recurrence (LR) is the major concern in the treatment of feline injection-site sarcoma (FISS). Pretreatment leukocyte counts and ratios have been reported as diagnostic and/or prognostic markers in human and canine oncology. The aim of this retrospective study was to explore the prognostic impact on LR and overall survival time (OST) of pretreatment neutrophil-to-lymphocyte ratio (NLR), white blood cell count (WBCC), neutrophil count (NC) and lymphocyte count (LC) in cats with surgically excised FISS. Eighty-two cats with histologically confirmed FISS at first presentation, without distant metastases, and with available pretreatment haematological analyses were retrospectively enrolled. The correlation of NLR, WBCC, NC, LC with tumour variables and patient variables was explored. NLR was correlated with tumour size (P = .004), histological pattern of tumour growth (P = .024) and histotype (P = .029), while WBCC and NC were associated with ulceration (P = .007, P = .011) and pattern of growth (P = .028, P = .004). No significant relationships emerged between LC and any of the considered variables. The impact of NLR, WBCC, NC, LC on LR and OST was then estimated in univariate and multivariate analysis. In univariate analysis, NLR, WBCC and NC were significant prognostic factors for both LR and OST. NLR, WBCC and NC remained prognostic in multivariate analysis for LR but not for OST. When NLR, WBCC and NC were jointly analysed, WBCC was the marker with the greater impact on LR. Preoperative NLR, WBCC and NC may aid in identifying cats at higher risk of LR.
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Affiliation(s)
- L E Chiti
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - M Martano
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Turin, Italy
| | - R Ferrari
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - P Boracchi
- Dipartimento di Scienze Cliniche e di Comunità, Laboratorio di Statistica Medica, Biometria ed Epidemiologia "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - A Giordano
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - V Grieco
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - P Buracco
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Turin, Italy
| | - S Iussich
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Turin, Italy
| | - C Giudice
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - B Miniscalco
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Turin, Italy
| | - D D Zani
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - D Proverbio
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - E Morello
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Turin, Italy
| | - D Stefanello
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
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11
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Ozmen S, Timur O, Calik I, Altinkaynak K, Simsek E, Gozcu H, Arslan A, Carlioglu A. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be superior to C-reactive protein (CRP) for predicting the occurrence of differentiated thyroid cancer. Endocr Regul 2019; 51:131-136. [PMID: 28858848 DOI: 10.1515/enr-2017-0013] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES NLR (neutrophil-lymphocyte ratio) and PLR (platelet-lymphocyte ratio) are prognostic markers of differentiated thyroid cancers. In our study, we evaluated NLR, PLR and C-reactive protein (CRP) for predicting the occurence of differentiated thyroid cancer. This is the first study that compares NLR and PLR to C-reactive protein indifferantiated thyroid cancer not only papillary cancer but also folliculer cancer. METHODS This study includes 51 papillary carcinoma, 42 papillary microcarcinoma and 31 folliculer carcinoma patients attending to our outpatient Endocrinology Clinic at Erzurum Region Training and Research Hospital between 2009 and 2014. The control group include 50 age, sex and body mass index matched healty subjects. Blood counts and CRP were measured at the day before surgery. Thyroglobulin was measured after 6 months of operation. RESULTS There were positive correlations between tumor diameter, age, white blood cell (WBC) and thyroglobulin levels. There were also positive correlation between NLR, PLR and CRP levels. CONCLUSION In our study, we found out that higher NLR and PLR was associated with higher levels of thyroglobulin which indicates worse survival. CRP levels were also associated with poorer tumor profile but the determining rate was lower according to ROC analysis.
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12
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Chen S, Luo P, Yang L, Zheng B, Sun Z, Yan W, Wang C. Prognostic analysis of surgically treated clear cell sarcoma: an analysis of a rare tumor from a single center. Int J Clin Oncol 2019; 24:1605-1611. [PMID: 31243628 PMCID: PMC6861539 DOI: 10.1007/s10147-019-01487-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this retrospective study was to evaluate the prognostic value of various factors in clear cell sarcoma patients after radical surgery. METHODS Forty-two clear cell sarcoma patients from August 2006 to March 2018 were included in the study. Curves of disease-free survival and overall survival were calculated using the Kaplan-Meier method, and univariate and multivariate analyses of various prognostic factors were performed using a Cox proportional hazard regression model. Laboratory test of peripheral blood was recorded before surgery. The optimal cutoff value of systemic inflammatory markers was defined by receiver-operating curve analysis. RESULTS The 5-year DFS and 5-year OS rate were 22% and 46%, respectively. The median DFS and OS times were 12 and 41.5 months, respectively. In univariate analysis, there was a significant association between shorter DFS and tumor size larger than 5 cm (p = 0.0043), positive surgical margin (p = 0.0233), and the neutrophil-to-lymphocyte ratio (NLR) higher than 2.73 (p = 0.0009). Furthermore, we observed a significant association between shorter OS and tumor size larger than 5 cm (p = 0.0075), positive surgical margin (p = 0.0101), NLR higher than 2.73 (p = 0.0126), the platelet-to-lymphocyte ratio (PLR) higher than 103.89 (p = 0.0147) and the lymphocyte-to-monocyte ratio (LMR) lower than 4.2 (p = 0.0445). A multivariate analysis demonstrated that the surgical margin (p = 0.013) and NLR (p = 0.001) were significantly associated with DFS. Tumor size (p = 0.010) and NLR (p = 0.013) were independent prognostic factors for OS. CONCLUSIONS This study had the second largest sample around the world and preoperative NLR may be a useful prognostic factor in CCS patients after radical surgery.
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Affiliation(s)
- Shiqi Chen
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Peng Luo
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Lingge Yang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Biqiang Zheng
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhengwang Sun
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wangjun Yan
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Chunmeng Wang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Xuhui District, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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13
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Mirili C, Paydaş S, Guney IB, Ogul A, Gokcay S, Buyuksimsek M, Yetisir AE, Karaalioglu B, Tohumcuoglu M, Seydaoglu G. Assessment of potential predictive value of peripheral blood inflammatory indexes in 26 cases with soft tissue sarcoma treated by pazopanib: a retrospective study. Cancer Manag Res 2019; 11:3445-3453. [PMID: 31114378 PMCID: PMC6485039 DOI: 10.2147/cmar.s191199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose The aim of this study was to evaluate the prognostic and predictive value of neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (DNLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in soft tissue sarcoma (STS) cases treated with pazopanib. Materials and methods The study population included 26 STS cases treated with pazopanib for at least 3 months. NLR, DNLR, LMR, and PLR were evaluated at baseline, and at third month of therapy and also compared with response to pazopanib. Median measurements were taken as cutoff for NLR (4.8), DNLR (3.1), LMR (3.6), and PLR (195). The associations between these cutoff values and survival times (progression-free survival [PFS] and overall survival [OS]) were assessed by Kaplan–Meier curves and Cox proportional models. Results Patients with low pretreatment NLR and DNLR had longer OS (P=0.022, P=0.018), but low PLR was found to be associated only with longer OS. Additionally, decrease in NLR and DNLR after 3 months of therapy as compared with pretreatment measurements was found to be associated with an advantage for OS (P=0.021, P=0.010, respectively) and PFS (P=0.005, P=0.001, respectively). Response to pazopanib; changes in NLR, DNLR, LMR, and PLR; and >3 metastatic sites were found to be independent risk factors in univariate analysis, but NLR was the only independent risk factor in multivariate analysis. Conclusion Low pretreatment and decrease in NLR and DNLR values, and regression/stable disease after 3 months of pazopanib are predictive factors for longer OS and PFS.
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Affiliation(s)
- Cem Mirili
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey,
| | - Semra Paydaş
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey,
| | - Isa B Guney
- Department of Nuclear Medicine, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Ali Ogul
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey,
| | - Serkan Gokcay
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey,
| | - Mahmut Buyuksimsek
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey,
| | - Abdullah E Yetisir
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey,
| | - Bilgin Karaalioglu
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey,
| | - Mert Tohumcuoglu
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey,
| | - Gulsah Seydaoglu
- Department of Bioistatistics, Çukurova University Faculty of Medicine, Adana, Turkey
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14
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Sun Y, Li W, Li AJ, Su H, Yue J, Yu J. Increased systemic immune-inflammation index independently predicts poor survival for hormone receptor-negative, HER2-positive breast cancer patients. Cancer Manag Res 2019; 11:3153-3162. [PMID: 31114357 PMCID: PMC6489660 DOI: 10.2147/cmar.s190335] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/07/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose: We sought to examine the role of pretreatment systemic immune-inflammation index (SII) in hormone receptor-negative, human epidermal growth factor receptor 2+ (HER2+) breast cancer patients. Patients and methods: 155 HER2+ patients treated in our hospital from September 3, 2002, to September 21, 2012, were retrospectively enrolled. SII was established as neutrophil x platelet/lymphocyte counts. The median value of SII was used as cut-off value. We used the Kaplan-Meier method to evaluate the overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS). To comparatively evaluate the survival rates between patients from two groups, we used the log-rank test. For identifying independent factors of prognosis, we used the Cox regression model, applying multivariate statistics. Results: Analyses show that HER2+ patients with high and low SII had median DFS of 15.1 and 31.5 months, respectively (P<0.001), while the median DMFS in HER2+ patients with high SII was 18.4 and in patients with low SII was 33.0 months (P=0.001), and the median OS were 54.5 and 71.1 months respectively in high and low SII patients, respectively (P=0.002). Multivariate analysis had revealed increased SII independently linked to poor DFS (HR =1.46, 95% CI: 1.01–2.11, P=0.045). The difference between SII and DMFS bore no statistical significance. (HR =1.40, 95% CI: 0.96–2.03, P=0.078), while high SII independently predicted short OS (HR =1.51, 95% CI: 1.02–2.25, P=0.038). Conclusion: Our findings suggest that increased SII independently predicts poor survival for hormone receptor-negative, HER2+ breast cancer patients. Prospective studies are, however, required to confirm the role of SII in the prognosis of patients with HER2+ before clinical use.
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Affiliation(s)
- Yi Sun
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, People's Republic of China
| | - Wenqiang Li
- Department of Radiation Oncology, Weifang Medical University, Weifang, Shandong, 261053, People's Republic of China
| | - Ai-Jie Li
- Department of Radiation Oncology, Weifang Medical University, Weifang, Shandong, 261053, People's Republic of China
| | - Huichao Su
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, People's Republic of China
| | - Jinbo Yue
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, People's Republic of China.,School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, Jinan, Shandong, 250000, People's Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, People's Republic of China.,School of Medicine and Life Sciences, Shandong Academy of Medical Sciences, Jinan, Shandong, 250000, People's Republic of China
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15
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Wu YY, Qin YY, Qin JQ, Zhang X, Lin FQ. Diagnostic value of derived neutrophil-to-lymphocyte ratio in patients with ovarian cancer. J Clin Lab Anal 2019; 33:e22833. [PMID: 30666724 PMCID: PMC6528614 DOI: 10.1002/jcla.22833] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/26/2022] Open
Abstract
Background Inflammation plays an important role in the occurrence and development of cancer. Numerous studies have used the derived neutrophil‐to‐lymphocyte ratio (dNLR) to evaluate prognosis in many types of cancer. However, the relationship between dNLR and ovarian cancer and its value in the differential diagnosis of benign and malignant ovarian tumors remain unknown. Methods A total of 262 patients with ovarian cancer, 258 with benign ovarian disease, and 232 healthy controls were included in this study. dNLR was calculated using whole blood cell parameters. Receiver operating characteristic curves were generated to obtain sensitivity, specificity, and area under the ROC curve (AUC) to evaluate the diagnostic values of dNLR. Results dNLR was significantly different among the ovarian cancer, benign ovarian disease, and healthy control groups (all P < 0.001). Moreover, there were significant differences in dNLR between patients with early‐stage (I and II) and advanced‐stage (III and IV) disease (P < 0.001). dNLR was positively correlated with stage and carbohydrate antigen‐125 in ovarian cancer. A cutoff value of dNLR ≤2.11 was diagnostic in distinguishing ovarian cancer from benign ovarian disease with AUC of 0.729 (95% confidence interval [CI], 0.689‐0.767; P = 0.0001). A cutoff value of dNLR ≤1.9 was diagnostic in distinguishing ovarian cancer from healthy controls with an AUC of 0.821 (95% CI, 0.784‐0.854; P = 0.0001). Conclusion dNLR may be a useful indicator for distinguishing between ovarian cancer and benign ovarian disease and for identifying early and advanced ovarian cancer.
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Affiliation(s)
- Yang-Yang Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuan-Yuan Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jin-Qiu Qin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xuan Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fa-Quan Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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16
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Luo P, Cai W, Yang L, Chen S, Wu Z, Chen Y, Zhang R, Shi Y, Yan W, Wang C. Prognostic significance of pretreatment lymphocyte/monocyte ratio in retroperitoneal liposarcoma patients after radical resection. Cancer Manag Res 2018; 10:4727-4734. [PMID: 30425569 PMCID: PMC6201845 DOI: 10.2147/cmar.s171602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study was to evaluate the prognostic value of pretreatment inflammatory biomarkers in retroperitoneal liposarcoma (RPLS) patients after radical resection. Patients and methods One hundred patients with RPLS who underwent radical resection between September 2004 and October 2010 at Fudan University Shanghai Cancer Center were included in this study. Laboratory tests of peripheral blood were sampled before surgery. The optimal cutoff values of systemic inflammatory markers were defined by receiver-operating curve analyses. Curves of disease-free survival (DFS) and overall survival (OS) were obtained by the Kaplan-Meier method. Cox proportional hazards regression modeling was used to perform univariate and multivariate analyses. Results The median follow-up time was 53 months. The median DFS and OS were 27 and 86 months, respectively. On the basis of the optimal cutoff value of 3, 24 patients were classified into low lymphocyte/monocyte ratio (LMR) group and 76 patients into high LMR group. In univariate analysis, low LMR group had significantly shorter DFS (P<0.001) and OS (P<0.001) compared to high LMR group. In multivariate analysis, low LMR was demonstrated as an independent negative prognostic factor for both DFS (HR=2.854, 95% CI=1.392-5.851, P=0.004) and OS (HR=3.897, 95% CI=1.681-9.033, P=0.002). Conclusion Pretreatment LMR is a useful prognostic marker in RPLS patients after radical resection.
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Affiliation(s)
- Peng Luo
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Weiluo Cai
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Lingge Yang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Shiqi Chen
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Zhiqiang Wu
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Yong Chen
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Ruming Zhang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Yingqiang Shi
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Wangjun Yan
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
| | - Chunmeng Wang
- Department of Bone and Soft Tissue Sarcomas, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China, , .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China, ,
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17
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Liu G, Ke LC, Sun SR. Prognostic value of pretreatment neutrophil-to-lymphocyte ratio in patients with soft tissue sarcoma: A meta-analysis. Medicine (Baltimore) 2018; 97:e12176. [PMID: 30200120 PMCID: PMC6133428 DOI: 10.1097/md.0000000000012176] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) has been reported to possess significant prognostic value in multiple types of cancer. We conducted a meta-analysis to evaluate the prognostic value of pretreatment NLR in soft tissue sarcoma (STS). METHODS A systematic literature search through April 2018 was conducted to identify studies evaluating the prognostic value of the pretreatment NLR in STS patients. The end points were overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and clinicopathological parameters. All statistical analyses were conducted with Stata 13.0. RESULTS Fourteen cohorts with 2820 patients were analyzed. Elevated NLR was significantly correlated with worse OS [hazard ratio (HR): 1.59, 95% confidence interval (95% CI): 1.28-1.97, P < .001] and DFS/PFS (HR = 1.28; 95% CI = 1.12-1.47; P < .001). In addition, elevated NLR was highly correlated with age (≥ 65 years), tumor size (>5 cm), tumor depth (deep), Grade (G3), and TNM stage (III-IV). CONCLUSION Overall, pretreatment NLR could be an adverse prognostic biomarker for STS.
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Affiliation(s)
- Gang Liu
- Department of Breast Surgery, Thyroid Surgery, Pancreatic Surgery, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University, Huangshi
| | - Li-chi Ke
- Department of Breast Surgery, Thyroid Surgery, Pancreatic Surgery, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University, Huangshi
| | - Sheng-rong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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18
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García-Ortega DY, Álvarez-Cano A, Sánchez-Llamas LA, Caro-Sanchez CHS, Martínez-Said H, Luna-Ortiz K, Cuéllar-Hübbe M. Neutrophil/lymphocyte ratio is associated with survival in synovial sarcoma. Surg Oncol 2018; 27:551-555. [PMID: 30217318 DOI: 10.1016/j.suronc.2018.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/01/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Synovial sarcoma is a rare malignant soft tissue tumor, more common in adolescents and young adults and entails a poor prognosis. Several good prognostic factors have been well established such as age less than 25, size less than 5 cm and absence of a poorly differentiated component. Inflammation has a well-established role in tumor proliferation and survival. The aim of this study was to investigate the prognostic significance of the neutrophil/lymphocyte ratio (NLR) in a large cohort of synovial sarcoma patients. METHODS Retrospective study of 169 consecutive patients. We analyzed the relation of preoperative NLR on disease-free survival (DFS) and overall survival (OS) using Kaplan-Meier curves and Cox proportional models. RESULTS Of the 169 patients included, there were 90(53.3%) females and 79(46.7%) males. Median age was 32yo (11-73). Median survival was 34.1 and mean disease-free survival was 21.4 months. Mean tumor size was 12.5 cm (1.2-77 cm). Applying receiver operating curve analysis, we determined a cut-off value of 3.5. In univariate and multivariate analysis, increased NLR was significantly associated with poor OS. A <3.5 NLR was an independent prognostic factor in all stages (p = 0.002). CONCLUSIONS NLR >3.5 was found to be a reliable prognostic factor in this cohort. Given its widespread availability, we believe it's use in clinical practice and further clinical trials should be considered.
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Affiliation(s)
| | | | | | | | | | | | - Mario Cuéllar-Hübbe
- Departent of Surgical Oncology, National Cancer Institute Mexico City, Mexico
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19
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Wang Y, Qu X, Kam NW, Wang K, Shen H, Liu Q, Du J. An inflammation-related nomogram for predicting the survival of patients with non-small cell lung cancer after pulmonary lobectomy. BMC Cancer 2018; 18:692. [PMID: 29940884 PMCID: PMC6019648 DOI: 10.1186/s12885-018-4513-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 05/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background Emerging inflammatory response biomarkers are developed to predict the survival of patients with cancer, the aim of our study is to establish an inflammation-related nomogram based on the classical predictive biomarkers to predict the survivals of patients with non-small cell lung cancer (NSCLC). Methods Nine hundred and fifty-two NSCLC patients with lung cancer surgery performed were enrolled into this study. The cutoffs of inflammatory response biomarkers were determined by Receiver operating curve (ROC). Univariate and multivariate analysis were conducted to select independent prognostic factors to develop the nomogram. Results The median follow-up time was 40.0 months (range, 1 to 92 months). The neutrophil to lymphocyte ratio (cut-off: 3.10, HR:1.648, P = 0.045) was selected to establish the nomogram which could predict the 5-year OS probability. The C-index of nomogram was 0.72 and the 5-year OS calibration curve displayed an optimal agreement between the actual observed outcomes and the predictive results. Conclusions Neutrophil to lymphocyte ratio was shown to be a valuable biomarker for predicting survival of patients with NSCLC. The addition of neutrophil to lymphocyte ratio could improve the accuracy and predictability of the nomogram in order to provide reference for clinicians to assess patient outcomes.
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Affiliation(s)
- Ying Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China.,Department of Clinical Oncology, The University of Hong Kong, Laboratory block, 21 Sassoon, Pokfulam, Hong Kong, People's Republic of China
| | - Xiao Qu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Ngar-Woon Kam
- Department of Clinical Oncology, The University of Hong Kong, Laboratory block, 21 Sassoon, Pokfulam, Hong Kong, People's Republic of China
| | - Kai Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Hongchang Shen
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Qi Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China.
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China. .,Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China.
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20
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Validation of Different Nutritional Assessment Tools in Predicting Prognosis of Patients with Soft Tissue Spindle-Cell Sarcomas. Nutrients 2018; 10:nu10060765. [PMID: 29899304 PMCID: PMC6024570 DOI: 10.3390/nu10060765] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/26/2018] [Accepted: 06/07/2018] [Indexed: 01/10/2023] Open
Abstract
Predicting outcomes in patients with soft tissue sarcoma (STS) is challenging. To improve these predictions, we retrospectively analyzed common nutritional assessment systems, including Glasgow prognostic score (GPS), Geriatric Nutritional Risk Index (GNRI), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and controlling nutritional (CONUT) score against outcomes in 103 patients with STS, of whom 15 (14.6%) died within 1 year of diagnosis. GPS, GNRI, NLR, PLR, and CONUT scores significantly differed between patients who died within one year and patients who lived longer. Binomial logistic regression analysis showed that male sex, older age at diagnosis, higher GPS, higher stage, and unresectable STS were risk factors for death within a year of diagnosis. Overall survival was evaluated by Cox proportional hazards models, which correlated higher NLR, higher PLR, larger maximum diameter of tumor, higher stage, and unresectable STS with poor prognosis. We next examined prognostic factors in the 93 patients with resectable STS, and found male sex, higher GPS, and higher stage were correlated with poor prognosis in these patients. Our findings suggest that GPS, NLR, and PLR are simple predictors of outcome in patients with STS. Nutritional therapies might improve their GPS and prognosis.
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21
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Rutkowski P, Teterycz P, Klimczak A, Bylina E, Szamotulska K, Lugowska I. Blood neutrophil-to-lymphocyte ratio is associated with prognosis in advanced gastrointestinal stromal tumors treated with imatinib. TUMORI JOURNAL 2018; 104:415-422. [PMID: 29714669 DOI: 10.1177/0300891618765543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Neutrophil-to-lymphocyte ratio (NLR) was shown to be prognostic in several solid malignancies. There are limited data about predictive/prognostic value of NLR during targeted therapy of patients with advanced gastrointestinal stromal tumors (GIST). The aim of this study was to asses a clinical value of this ratio in patients with advanced GIST. METHODS Between 2001 and 2016, 385 patients with metastatic/unresectable GIST treated initially with imatinib were included in the analysis. In all patients, the NLR was assessed at the baseline, after 3 months of treatment, and upon disease progression (or last observation). The cutoff values for NLR were set at 2.7 and 5.4. Kaplan-Meier survival probability estimation with log-rank test and Cox proportional hazards model were used for analysis. RESULTS Median progression-free survival (PFS) on imatinib treatment was 44.8 months, 5-year rate 43%; median overall survival (OS) 87.2 months, 10-year rate 36.3%. NLR >2.7 at baseline was significantly associated with poorer OS and PFS: median OS was 89.3 months (95% confidence interval [CI] 80.2-115) for NLR ratio ≤2.7 vs 59.4 months (95% CI 48.6-82) for NLR >2.7 (p < .001); median PFS was 59.4 vs 32.7 (p < .001), respectively. In multivariate model adjusted for mitotic index and driver mutation in the tumor (KIT exon 11 mutation versus other), NLR ratio was proven to be statistically significant (hazard ratio 1.09; 95% CI 1.01-1.19; p = .030). Among patients with disease progression, NLR >2.7 assessed at the third month of treatment was linked with significantly shorter median time to progression (7.5 vs 19 months). CONCLUSIONS Our results demonstrate the usefulness of NLR as a prognostic and predictive marker as well as a marker for treatment monitoring in patients with advanced GIST treated with imatinib.
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Affiliation(s)
- Piotr Rutkowski
- 1 Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Paweł Teterycz
- 1 Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Anna Klimczak
- 1 Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Elżbieta Bylina
- 1 Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland.,2 Early Phase Clinical Trial Unit, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland.,3 Clinical Trial Administrative Unit, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | | | - Iwona Lugowska
- 1 Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland.,2 Early Phase Clinical Trial Unit, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland.,4 Department of Biostatistics, Institute of Mother and Child, Warsaw, Poland
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22
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The role of the systemic inflammatory response in predicting outcomes in patients with operable cancer: Systematic review and meta-analysis. Sci Rep 2017; 7:16717. [PMID: 29196718 PMCID: PMC5711862 DOI: 10.1038/s41598-017-16955-5] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/17/2017] [Indexed: 02/06/2023] Open
Abstract
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.
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23
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Kobayashi H, Okuma T, Oka H, Hirai T, Ohki T, Ikegami M, Sawada R, Shinoda Y, Akiyama T, Sato K, Abe S, Kawano H, Goto T, Tanaka S. Neutrophil-to-lymphocyte ratio after pazopanib treatment predicts response in patients with advanced soft-tissue sarcoma. Int J Clin Oncol 2017; 23:368-374. [PMID: 29086877 DOI: 10.1007/s10147-017-1199-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/04/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pazopanib is a multi-tyrosine kinase inhibitor that is used to treat advanced soft-tissue sarcoma, and its efficacy has been confirmed in several clinical trials, although no clinically useful biomarkers have been identified. In other cancers, the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the lymphocyte-to-monocyte ratio (LMR) are associated with chemotherapy response and prognosis. Therefore, we aimed to evaluate the associations of pazopanib response with NLR, PLR, and LMR among patients with advanced soft-tissue sarcoma. METHODS Data regarding NLR, PLR, and LMR were obtained for 25 patients who received pazopanib for soft-tissue sarcoma. The patients were categorized according to their values for NLR (≥3.8 vs. <3.8), PLR (≥230 vs. <230), and LMR (≥2.4 vs. <2.4), and we evaluated the associations of these markers with progression-free survival and overall survival using Kaplan-Meier curves and Cox proportional models. RESULTS No significant differences in progression-free survival or overall survival were observed based on the pre-treatment NLR, PLR, and LMR values. However, decreased NLR values after treatment using pazopanib were independently associated with significantly prolonged progression-free survival (hazard ratio: 0.07, p = 0.001) and overall survival (hazard ratio: 0.17, p = 0.0006). CONCLUSIONS Decreased NLR values after treatment using pazopanib may predict high efficacy and favorable outcomes among patients with advanced soft-tissue sarcoma.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tomotake Okuma
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshihide Hirai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takahiro Ohki
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Masachika Ikegami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryoko Sawada
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yusuke Shinoda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Kenji Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Teikyo, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Satoshi Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Teikyo, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Teikyo, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Takahiro Goto
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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24
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Posch F, Partl R, Döller C, Riedl JM, Smolle M, Leitner L, Bergovec M, Liegl-Atzwanger B, Stotz M, Bezan A, Gerger A, Pichler M, Kapp KS, Stöger H, Leithner A, Szkandera J. Benefit of Adjuvant Radiotherapy for Local Control, Distant Metastasis, and Survival Outcomes in Patients with Localized Soft Tissue Sarcoma: Comparative Effectiveness Analysis of an Observational Cohort Study. Ann Surg Oncol 2017; 25:776-783. [PMID: 28895087 PMCID: PMC5814515 DOI: 10.1245/s10434-017-6080-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Indexed: 11/23/2022]
Abstract
Background This study aimed to quantify the benefit of adjuvant radiotherapy (AXRT) for local control, distant metastasis, and long-term survival outcomes in patients with localized soft tissue sarcoma (STS). Methods This single-center retrospective observational study enrolled 433 STS patients who underwent surgery with curative intent. An inverse probability of treatment-weighted (IPTW) analysis was implemented to account rigorously for imbalances in prognostic variables between the adjuvant treatment groups. Results During a median follow-up period of 5.5 years, the study observed 38 local recurrences (9%), 73 occurrences of distant metastasis (17%), 63 STS-related deaths (15%), and 57 deaths from other causes (13%). As expected, patients receiving AXRT (n = 258, 60%) were more likely to have high-grade G3 tumors (p < 0.0001) than patients not receiving AXRT. A crude analysis showed that AXRT was not associated with improved recurrence-free survival [hazard ratio (HR) 1.00; 95% confidence interval (CI) 0.72–1.38; p = 0.98]. However, after IPTW, AXRT was associated with a 38% relative reduction in the risk of recurrence or death (HR 0.62; 95% CI 0.39–1.00; p = 0.05). This benefit was driven by a strong reduction in the risk of local recurrence (HR 0.42; 95% CI 0.19–0.91; p = 0.03), whereas the relative risk of distant metastasis (HR 0.69; 95% CI 0.39–1.25; p = 0.22) and overall survival (HR 0.76; 95% CI 0.44–1.30; p = 0.32) were only nonsignificantly in favor of AXRT. An exploratory analysis showed an overall survival benefit of AXRT for patients with high-grade G3 tumors (HR 0.51; 95% CI 0.33–0.78; p = 0.002). However, this finding may have been attributable to residual confounding. Conclusion In this observational cohort, AXRT was associated with a 58% reduction in the relative risk of local recurrence. No consistent association between AXRT and lower risks of distant metastasis or death was observed. Electronic supplementary material The online version of this article (doi:10.1245/s10434-017-6080-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Richard Partl
- Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria
| | - Carmen Döller
- Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria
| | - Jakob M Riedl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Maria Smolle
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Lukas Leitner
- Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Marko Bergovec
- Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Bernadette Liegl-Atzwanger
- Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Michael Stotz
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Angelika Bezan
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Armin Gerger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Experimental Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karin S Kapp
- Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Therapeutic Radiology and Oncology, Medical University of Graz, Graz, Austria
| | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.,Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Joanna Szkandera
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. .,Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria.
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25
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Posch F, Leitner L, Bergovec M, Bezan A, Stotz M, Gerger A, Pichler M, Stöger H, Liegl-Atzwanger B, Leithner A, Szkandera J. Can Multistate Modeling of Local Recurrence, Distant Metastasis, and Death Improve the Prediction of Outcome in Patients With Soft Tissue Sarcomas? Clin Orthop Relat Res 2017; 475:1427-1435. [PMID: 28083752 PMCID: PMC5384928 DOI: 10.1007/s11999-017-5232-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exploration of the complex relationship between prognostic indicators such as tumor grade and size and clinical outcomes such as local recurrence and distant metastasis in patients with cancer is crucial to guide treatment decisions. However, in patients with soft tissue sarcoma, there are many gaps in our understanding of this relationship. Multistate analysis may help us in gaining a comprehensive understanding of risk factor-outcome relationships in soft tissue sarcoma, because this methodology can integrate multiple risk factors and clinical endpoints into a single statistical model. To our knowledge, no study of this kind has been performed before in patients with soft tissue sarcoma. QUESTIONS/PURPOSES We implemented a multistate model of localized soft tissue sarcoma to statistically evaluate the relationship among baseline risk factors, recurrence, and death in patients with localized soft tissue sarcoma undergoing curative surgery. METHODS Between 1998 and 2015, our center treated 539 patients for localized soft tissue sarcoma with surgery as curative intent. Of those, 96 patients (18%) were not included in this single-center retrospective study owing to missing baseline histopathology data (n = 3), not yet observed followup (n = 80), or because a neoadjuvant treatment approach in the presence of synchronous distant metastasis was used (n = 13), leaving 443 patients (82%) for the current analysis, of which 40 were lost to followup during the first year after surgery. All patients had tumors of the stages I to III according to the American Joint Committee on Cancer Stages. The median age of the patients was 62 years (range, 16-96 years), and 217 patients (49%) were female. Three hundred-forty-six patients (78%) had tumors of high grade (Grades 2 and 3), and 310 (70%) tumors were greater than 5 cm in maximum diameter. Patients who had died during the first year of followup were included in this analysis. Median followup for the 443 study patients was 6 years, with 84%, 52%, and 23% of patients being followed for more than 1, 5, and 10 years, respectively. The 15-year cumulative incidences of local recurrence, distant metastasis, and death from any cause, using a competing risk analysis, were 16% (95% CI, 11%-22%), 21% (95% CI, 17%-26%), and 55% (95% CI, 44%-67%), respectively. Wide resection with a margin of 1 mm was the preferred treatment for all patients, except for those with Grade 1 liposarcoma where a marginal resection was considered adequate. Multistate models were implemented with the mstate library in R. RESULTS In multistate analysis, patients who experienced a local recurrence were more likely to have distant metastasis develop (hazard ratio [HR] = 8.4; 95% CI, 4.3-16.5; p < 0.001), and to die (HR = 3.4; 95% CI, 2.1-5.6; p < 0.001). The occurrence of distant metastasis was associated with a strong increase in the risk of death (HR = 12.6; 95% CI, 8.7-18.3; p < 0.001). Distant metastasis occurring after a long tumor-free interval was not associated with a more-favorable prognosis with respect to mortality than distant metastasis occurring early after surgery (estimated relative decrease in the adverse effect of distant metastasis on mortality for 1-year delay in the occurrence of distant metastasis = 0.9; 95% CI, 0.7-1.1; p = 0.28). High-grade histology (Grades 2 and 3) was associated with a higher risk of overall recurrence (defined as a composite of local recurrence and distant metastasis, HR = 3.8; 95% CI, 1.8-7.8; p = 0.0003) and a higher risk of death after recurrence developed (HR = 4.4; 95% CI, 1.1-18.2; p = 0.04). Finally, the multistate model predicted distinct outcome patterns depending on baseline covariates and how long a patient has remained free from recurrence after surgery. CONCLUSIONS In patients with localized soft tissue sarcoma undergoing resection, the occurrence of local recurrence and distant metastasis contributes to a dramatically impaired long-term survival outcome. Local recurrences are a substantial risk factor for distant metastasis. Multistate modeling is a very powerful approach for analysis of sarcoma cohorts, and may be used in the future to obtain highly personalized, dynamic predictions of outcomes in patients with localized soft tissue sarcoma. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Florian Posch
- Clinical Division of Medical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Lukas Leitner
- Department of Orthopedic Surgery, Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Marko Bergovec
- Department of Orthopedic Surgery, Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Angelika Bezan
- Clinical Division of Medical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Michael Stotz
- Clinical Division of Medical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Armin Gerger
- Clinical Division of Medical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Martin Pichler
- Clinical Division of Medical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Herbert Stöger
- Clinical Division of Medical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Bernadette Liegl-Atzwanger
- Center for Biomarker Research in Medicine, Medical University of Graz, Graz, Austria ,Institute of Pathology, Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedic Surgery, Comprehensive Cancer Center Graz, Medical University of Graz, Graz, Austria
| | - Joanna Szkandera
- Clinical Division of Medical Oncology, Department of Medicine, Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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26
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The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients. J Trauma Acute Care Surg 2016; 81:882-888. [DOI: 10.1097/ta.0000000000000980] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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27
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Camacho Limas CP, Gerson Cwilich R, Góngora Jurado MDÁ, López Naveda M. Asociación del índice neutrófilo-linfocito y el estadio clínico en el diagnóstico inicial de melanoma. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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28
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Stotz M, Liegl-Atzwanger B, Posch F, Mrsic E, Thalhammer M, Stojakovic T, Bezan A, Pichler M, Gerger A, Szkandera J. Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection. PLoS One 2016; 11:e0159448. [PMID: 27454486 PMCID: PMC4959723 DOI: 10.1371/journal.pone.0159448] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022] Open
Abstract
Background Inflammatory blood count biomarkers may improve recurrence risk stratification and inform long-term prognosis of cancer patients. Here, we quantify the prognostic impact of blood-based biomarkers on recurrence risk and long-term survival in a large cohort of gastrointestinal stroma tumor (GIST) patients after curative surgery. Methods One-hundred-forty-nine consecutive GIST patients were followed-up for a median period of 4.8 years. Local recurrence, distant metastasis, and death occurred in 9, 21, and 31 patients, respectively. Time-to-event and competing risk analysis were applied to study the association between haemoglobin (Hb) level, white blood cell count (WBC), neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), lymphocyte/monocyte ratio (LMR), and platelet/lymphocyte ratio (PLR) with risk of local or distant recurrence (RR), recurrence free survival (RFS), and overall survival (OS). Results A low Hb (p = 0.029), and elevations in the parameters WBC (p = 0.004), NLR (p = 0.015) and dNLR (p = 0.037) were associated with a poor OS in GIST patients in multivariate analysis. Moreover, a low Hb (p = 0.049) and an elevated WBC (p = 0.001), NLR (p = 0.007), dNLR (p = 0.043) and PLR (p = 0.024) were independently associated with decreased RFS after adjusting for Miettinen score. However, only an increase of dNLR/NLR showed a significant association to higher RR (p = 0.048). Inclusion of NLR or PLR to Miettinen risk score did not reasonably improve the clinical risk prediction of 2-year RFS. Conclusion Low Hb, elevated WBC, elevated dNLR, and elevated PLR are independent prognostic factors for a worse clinical outcome in GIST patients after curative resection.
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Affiliation(s)
- Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
| | | | - Florian Posch
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Edvin Mrsic
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Michael Thalhammer
- Division of General Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Angelika Bezan
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit for non-coding RNAs and genome editing in cancer, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Medical University of Graz, Graz, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
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29
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Lee BS, Lee SH, Son JH, Jang DK, Chung KH, Lee YS, Paik WH, Ryu JK, Kim YT. Neutrophil-lymphocyte ratio predicts survival in patients with advanced cholangiocarcinoma on chemotherapy. Cancer Immunol Immunother 2016; 65:141-50. [PMID: 26728479 PMCID: PMC11028491 DOI: 10.1007/s00262-015-1780-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 12/05/2015] [Indexed: 12/13/2022]
Abstract
The blood neutrophil-to-lymphocyte ratio (NLR) is reported to be a prognostic marker in several cancers. However, the prognostic role of NLR in patients with advanced cholangiocarcinoma on chemotherapy is unknown. A total of 221 patients with pathologically confirmed locally advanced or metastatic cholangiocarcinoma receiving first-line palliative chemotherapy were enrolled. Associations between baseline clinical and laboratory variables including NLR and survival were investigated. Patients were classified into two groups according to the NLR level (≤ 5 vs. >5). Median overall survival (OS) and time to progression (TTP) in patients with NLR ≤ 5 were 10.9 and 6.7 months, respectively, and 6.8 and 4.1 months in patients with NLR > 5 (P < 0.001, P = 0.002, respectively). In multivariate analysis, number of cycles of chemotherapy was a significant predictor of longer OS (HR 0.86, P < 0.001), whereas adverse prognostic factors for OS were CA 19-9 > 300 (HR 1.43, P = 0.025), CEA > 5 (HR 1.44, P = 0.029), higher stage (HR 1.69, P = 0.004), and NLR > 5 (HR 1.87, P < 0.001). NLR > 5 was also associated with reduced TTP (HR 1.66, P = 0.007). Among 50 patients with initial NLR > 5, 33 patients had NLR ≤ 5 after two cycles of chemotherapy and they had significantly better survival than the others (HR 0.48, P = 0.015). NLR independently predicts survival in patients with advanced cholangiocarcinoma undergoing chemotherapy. Considering cost-effectiveness and easy availability, NLR may be a useful biomarker for prognosis prediction.
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Affiliation(s)
- Ban Seok Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, South Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Jun Hyuk Son
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Dong Kee Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kwang Hyun Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Yoon Suk Lee
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Koyang, South Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Yong-Tae Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
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30
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Fu Y, Liu W, OuYang D, Yang A, Zhang Q. Preoperative Neutrophil-to-lymphocyte Ratio Predicts Long-term Survival in Patients Undergoing Total Laryngectomy With Advanced Laryngeal Squamous Cell Carcinoma: A Single-center Retrospective Study. Medicine (Baltimore) 2016; 95:e2689. [PMID: 26871799 PMCID: PMC4753894 DOI: 10.1097/md.0000000000002689] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
There is increasing evidence that the neutrophil-to-lymphocyte ratio (NLR) is a stage-independent predictor of poor outcome in patients with cancer. The purpose of this study was to investigate the association between cancer-specific survival (CSS), overall survival (OS), and the preoperative NLR in patients with advanced laryngeal squamous cell carcinoma (LSCC) undergoing total laryngectomy (TL).All patients with a new diagnosis of advanced laryngeal cancer (stages III and IV) presenting at the Department of Head and Neck Oncology, Sun Yat-sen University Cancer Center between January 1990 and July 2010 (n = 420) were included. To evaluate the independent prognostic relevance of the NLR, univariate and multivariate Cox regression models were used. CSS and OS were estimated using the Kaplan-Meier method.Four-hundred twenty patients were enrolled in this study. Patients with an NLR ≥2.59 showed a significantly lower CSS (P = .014) and OS (P = .032) than patients with an NLR <2.59. The Cox proportional multivariate hazard model showed that a higher preoperative NLR was independently correlated with a poor CSS and OS, with hazard ratios of 1.42 (95% confidence interval [CI] 1.06-1.91, P = .018) and 1.31 (95% CI 1.00-1.71, P = .046), respectively.The NLR may be an independent prognostic marker for CSS and OS in patients with advanced LSCC undergoing TL.
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Affiliation(s)
- Yan Fu
- From the Department of Head and Neck Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Chen Q, Yang LX, Li XD, Yin D, Shi SM, Chen EB, Yu L, Zhou ZJ, Zhou SL, Shi YH, Fan J, Zhou J, Dai Z. The elevated preoperative neutrophil-to-lymphocyte ratio predicts poor prognosis in intrahepatic cholangiocarcinoma patients undergoing hepatectomy. Tumour Biol 2015; 36:5283-9. [PMID: 25672606 DOI: 10.1007/s13277-015-3188-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/30/2015] [Indexed: 12/30/2022] Open
Abstract
A high preoperative peripheral blood neutrophil-to-lymphocyte ratio (NLR) has been reported to be a predictor of poor survival in patients with various cancers. The aim of this study was to evaluate the predictive significance of the NLR in patients undergoing hepatectomy for intrahepatic cholangiocarcinoma (ICC). From 2005 to 2011, 322 patients who underwent hepatectomy for ICC were enrolled in this retrospective study. Clinicopathological parameters, including NLR, were evaluated to identify predictors of overall and recurrence-free survival after hepatectomy. The best cutoff for NLR was 2.49, and 177 of 322 patients (54.9 %) had an NLR ≥ 2.49. The 5-year survival rate after hepatectomy was 51.1 % in patients with NLR < 2.49 and 24.8 % in those with NLR ≥ 2.49 (P = 0.0001). Univariate analyses revealed that NLR was significantly associated with recurrence-free survival (RFS) and overall survival (OS; both P < 0.05). Multivariable analyses revealed that elevated NLR independently predicted poorer OS (P = 0.003, hazard ratio [HR] = 1.600). In summary, our results indicate that elevated NLR is a promising independent predictor of poor survival after hepatectomy in patients with ICC.
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Affiliation(s)
- Qing Chen
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China
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