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

Predictive value of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and systemic inflammatory index for detection of recurrence of pleomorphic adenoma of the major salivary glands: a multicenter study

OBJECTIVE

The aim of this study was to investigate the correlation among inflammatory biomarkers, such as the systemic immune-inflammation index (SII), the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), and the recurrence of pleomorphic adenomas (PAs).

STUDY DESIGN

This was a retrospective multicenter study. Six hundred eight patients diagnosed with PA and treated by tumor enucleation were included in the analyses. The patients were extracted from a 20-year database of 2 referral centers (January 2000 to January 2020). Data about age, gender, voluntary habits, tumor characteristics, tumor treatment, and values of NLR, PLR, and SII were collected. A receiver operating characteristic (ROC) curve was used to calculate the optimal cutoff values for SII, PLR, and NLR. A linear regression model (LRM) and a nonlinear logistic regression model (NLRM) were implemented for NLR, PLR, and SII.

RESULTS

All 3 inflammatory parameters were statistically significant correlated to the recurrence of the tumor. The best performance was achieved by NLR (cutoff of 2.960) with area under the ROC curve (AUC) = 0.91, accuracy of 96.1%, sensitivity of 78.4% and specificity of 97.2%, PPV = 64.4%, and NPV = 98.6%. LRM and NLRM including all hematological parameters did not improve performance in terms of recurrence detection.

CONCLUSIONS

The use of 3 inflammatory biomarkers could be a useful tool to predict recurrence of tumor in case of PA ≤ 3 cm. NLR in particular could be sensitive with a cutoff of 2.960. The use of NLR, PLR, and SII could be a good reference point for surgical decision making and follow-up in clinical practice. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

Prognostic Significance of Pre-Treatment Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Head and Neck Malignancies

Introduction

Carcinoma is the second most common cause of death worldwide. The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are essential markers of inflammation and tumorigenesis in various cancers including head and neck cancers. Pretreatment platelet- lymphocytic ratio can be used as an independent predictor of mortality whereas neutrophil- lymphocytic ratio is an independent predictor of recurrence. The main aim of this study is to compare the pre-treatment neutrophil lymphocyte ratio and platelet-lymphocyte ratio in the patients of head and neck malignancies with those of the control group.

Material and Method

100 patients with histologically diagnosed cases of head and neck malignancies. Age and sex matched healthy subjects attending Otorhinolaryngology out-patient department for any other complaints (100 control subjects). Complete blood count had been done to calculate absolute neutrophil count and absolute lymphocyte count.

Results

The mean age of the subjects in the study group was 55.73 ± 11.56 years. In control group, the mean age group was 54.11 ± 10.46 years. NLR and PLR significantly increased in cases than controls. NLR associated with T stage, histological type and histological grade but not with site and nodal involvement. PLR associated with T stage, metastasis but not with the histological grade, histological type, site and nodal involvement.

Conclusion

From this study, we conclude that pre-treatment NLR and PLR were closely associated both with the size of primary tumor and also with the stage of malignant disease in patients of head and neck malignancies.

Is the neutrophil-to-lymphocyte ratio a marker for differentiating between benign and malignant submandibular gland masses?

OBJECTIVE

This study aimed to evaluate the effect of the neutrophil-to-lymphocyte ratio on the differentiation of benign and malignant masses in the submandibular triangle.

METHODS

We retrospectively evaluated 48 patients who underwent surgery for submandibular gland masses between January 2013 and February 2023. The patient's age, gender, preoperative complete blood count and imaging findings, postoperative histopathological diagnosis, and hemogram data were analysed. Patients were evaluated according to their postoperative histopathological diagnoses and categorised into four main groups: sialolithiasis, sialadenitis, benign tumours, and malignant tumours. Benign submandibular gland disease formations were evaluated under group B and malignant tumour formations under group M.

RESULTS

A preoperative fine needle aspiration biopsy was performed on 19 patients due to sialadenitis, pleomorphic adenoma, and malignant diseases other than sialolithiasis. One patient died among the patients with malignant disease and the remaining 7 patients were compared with the benign group of 40 patients regarding preoperative and postoperative neutrophil-to-lymphocyte ratio. In the benign group, the neutrophil-to-lymphocyte ratio was 2.64 preoperatively and decreased to 2.34 in the first postoperative year. The preoperative neutrophil-to-lymphocyte ratio decreased from 4.79 to 1.77 postoperatively in the malignant group. A statistically significant difference was observed (p<0.05).

CONCLUSION

This is the first study to demonstrate that the neutrophil-to-lymphocyte ratio can be used as a biomarker in submandibular gland masses and has prognostic significance in malignant masses. In addition to fine needle aspiration biopsy results, neutrophil-to-lymphocyte ratio can be used as a biomarker.

Risk of head and neck cancer in relation to blood inflammatory biomarkers in the Swedish AMORIS cohort

Background

Inflammation is critically involved in the development of human cancer, and blood inflammatory biomarkers have been proposed to indicate the risk of different cancer types.

Methods

Using the Swedish Apolipoprotein-Related Mortality Risk (AMORIS) Cohort (N=812,073), we first performed a time-to-event analysis to evaluate the association of the baseline level of 12 blood inflammatory biomarkers measured during 1985-1996 with the subsequent risk of head and neck cancer (HNC) identified through the nationwide Swedish Cancer Register until end of 2020. A nested case-control study was further conducted to demonstrate the longitudinal trends of the studied biomarkers during the 30-year period prior to diagnosis of HNC.

Results

In the time-to-event analysis, we identified a total of 2,510 newly diagnosed HNC cases. There was an increased risk of HNC per standard deviation (SD) increase of haptoglobin (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.21-1.30), leukocytes (HR: 1.22; 95%CI: 1.17-1.28), sedimentation rate (HR: 1.17; 95%CI: 1.07-1.29), and monocytes (HR: 1.34; 95%CI: 1.07-1.68) at baseline, after adjustment for age, sex, fasting status, occupational status, and country of birth. In contrast, there was a decreased risk of HNC per SD increase of lymphocytes in % (HR: 0.85; 95%CI: 0.73-0.99) and lymphocyte-to-monocyte ratio (LMR) (HR: 0.81; 95%CI: 0.69-0.95) at baseline. In the nested case-control study using repeatedly measured biomarker levels, we found that individuals with HNC had consistently higher levels of haptoglobin, leukocytes, sedimentation rate, and monocytes, as well as consistently lower levels of lymphocytes in % and LMR, during the 30-year period prior to diagnosis, compared to controls.

Conclusion

Based on a cohort of more than half a million participants with up to 35 years of follow-up, our findings provide solid evidence supporting the presence of alterations in blood inflammatory biomarkers during the decades before diagnosis of HNC.

A nomogram for distinguishing benign and malignant parotid gland tumors using clinical data and preoperative blood markers: development and validation

PURPOSE

This study aimed to construct and validate a nomogram that incorporated clinical data and preoperative blood markers to differentiate BPGTs from MPGTs more efficiently and at low cost.

METHODS

We retrospectively analyzed patients who underwent parotidectomy and histopathological diagnosis at the First Affiliated Hospital of Guangxi Medical University from January 2013 to June 2022. Subjects were randomly divided into training and validation sets with a 7:3 ratio. In the training set, the least absolute shrinkage and selection operator (LASSO) regression analysis was performed to select the most relevant features from 19 variables and built a nomogram using logistic regression. We evaluated the model's performance using receiver-operating characteristic (ROC) curves, calibration curves, clinical decision curve analysis (DCA), and clinical impact curve analysis (CICA).

RESULTS

The final sample consisted of 644 patients, of whom 108 (16.77%) had MPGTs. The nomogram included four features: current smoking status, pain/tenderness, peripheral facial paralysis, and lymphocyte-to-monocyte ratio (LMR). The optimal cut-off value for the nomogram was 0.17. The areas under the ROC curves (AUCs) of the nomogram were 0.748 (95% confidence interval [CI] = 0.689-0.807) and 0.754 (95% CI = 0.636-0.872) in the training and validation sets, respectively. The nomogram also showed good calibration, high accuracy, moderate sensitivity, and acceptable specificity in both sets. The DCA and CICA demonstrated that the nomogram had significant net benefits for a wide range of threshold probabilities (0.06-0.88 for the training set; 0.06-0.57 and 0.73-0.95 for the validation set).

CONCLUSION

The nomogram based on clinical characteristics and preoperative blood markers was a reliable tool for discriminating BPGTs from MPGTs preoperatively.

Evaluation of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Mean Platelet Volume in Patients with Branchial Cleft Cyst

Branchial cleft cysts are benign masses of the head and neck. Etiopathogenesis is unclear and many factors such as inflammatory mechanisms can play a role. The aim of our study is to investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV), which are hematologic inflammatory markers, in branchial cleft cyst (BCC). The records of 27 patients who were operated with the diagnosis of BCC in the ENT clinic between January 2011 and March 2020 and 27 healty subjects were retrospectively reviewed. The control group consisted age and sex-matched subjects scheduled for rhinoplasty. Neutrophil, lymphocyte, platelet and MPV values were recorded from the complete blood count samples for all participants. The statistical relationship for NLR, PLR and MPV values between the patient and the control groups was investigated. The NLR values of the patients were significantly lower than the healthy controls (p:0.007). But no statistically significant correlation was found for PLR (p:0.586) and MPV(p:0.676) values between the groups. This is the first study to evaluate the significance of NLR, PLR and MPV in branchial cleft cyst. Decreased NLR may be used as a predictive marker for BCC. But PLR ande MPV should not be used to predict branchial cleft cyst.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-021-02789-1.

Efficacy of the Systemic Immune Inflammation Index in Malignant and Benign Parotid Neoplasms

Objective Several studies have looked at systemic immune-inflammation index (SII) (neutrophil x platelet x lymphocyte) values, which have been shown to be useful in determining tumor aggressivity and prognosis, as well as predicting recurrence risk, particularly in cancer cases. The purpose of the current study was to determine SII values in patients with parotid masses and investigate their utility in distinguishing between malignant and benign parotid tumors. Methods This retrospective study included 237 adult patients-112 women and 125 men-who were followed up on and treated for parotid mass between 2015 and 2021. The SII values determined were compared between the groups. Results The difference between the two groups was statistically significant (p = 0.001). In addition, SII values were higher in malignant tumors with perineural and lymphovascular invasion compared to other malignant tumors, although the difference was not statistically significant. Conclusions Although SII values yielded significant results in differentiating malignant from benign parotid tumors, since no significant cut-off value was determined, we do not think that they represent an effective marker capable of being used to distinguish between these tumors in clinical practice.

Association of low skeletal muscle mass and systemic inflammation with surgical complications and survival after microvascular flap reconstruction in patients with head and neck cancer

BACKGROUND

Skeletal muscle mass (SMM) and chronic inflammation are associated with postoperative complications and survival.

METHODS

Patients with head and neck cancer (HNC) undergoing microvascular free flap reconstruction were included. SMM and neutrophil-to-lymphocyte ratio (NLR) were measured and their association with treatment outcomes analyzed.

RESULTS

Five hundred and fifty-four patients were included. Predictors for complications were elevated NLR in all flaps (OR 1.5), low SMM in radial forearm flap (OR 2.0), and elevated NLR combined with low SMM in fibula flap surgery (OR 4.3). Patients with solely elevated NLR were at risk for flap-related complications (OR 3.0), severe complications (OR 2.2), and when combined with low SMM for increased length of hospital stays (LOS) (+3.9 days). In early-stage HNC, low SMM (HR 2.3), and combined elevated NLR with low SMM (HR 2.6) were prognostics for decreased overall survival.

CONCLUSIONS

SMM and NLR are predictive for poor outcomes in patients with HNC undergoing microvascular reconstruction.

Platelet-to-lymphocyte ratio associated with the clinicopathological features and prognostic value of breast cancer: A meta-analysis

OBJECTIVE

The association of platelet-to-lymphocyte ratio (PLR) with the clinicopathological features and prognosis in patients with breast cancer was evaluated.

METHOD

Related studies were searched from PubMed, Embase, Cochrane Library, and Web of Science up to July 1, 2021. Then, basic characteristic and prognostic data were extracted from the included studies. We synthesized and compared primary outcomes such as overall survival. Subgroups analyses in pathology, geographical area, follow-up time, and sample size were conducted. The pooled hazard ratio (HR), odds ratio (OR), and 95% confidence interval (CI) served as measures to assess the relationship of PLR with prognosis and clinicopathological features of breast cancer patients. After literature retrieval and selection, 20 studies with 7484 patients were included in this meta-analysis.

RESULTS

High PLR was significantly related to poor overall survival (HR = 1.88; 95% CI 1.61, 2.19; P < 0.001) in breast cancer patients. Also, high PLR was associated with lymph node metastasis (LNM) (OR = 1.82; 95% CI 1.32, 2.52; P < 0.001), advanced tumor-node-metastasis (TNM) stage (OR = 1.89; 95% CI 1.25, 2.87; P = 0.003), and distant metastasis (OR = 1.76; 95% CI 1.14, 2.72; P = 0.01) in breast cancer. The stability and reliability of results in this meta-analysis were confirmed by sensitivity analysis.

CONCLUSION

Elevated PLR is related to a poor prognosis and a higher risk of LNM, advanced TNM stage, and distant metastasis in breast cancer patients. Therefore, PLR can be identified as a biomarker with potential prognostic value in breast cancer.

Monocyte-to-high-density lipoprotein ratio and systemic inflammation response index are associated with the risk of metabolic disorders and cardiovascular diseases in general rural population

BACKGROUND

The present study aimed to clarify the effects of four inflammatory indicators (monocyte-to-high-density lipoprotein ratio [MHR], neutrophil-to-lymphocyte ratio [NLR], systematic immune-inflammation index [SII], and systemic inflammation response index [SIRI]) in evaluating the risk of metabolic diseases and cardiovascular disease (CVD), filling the gap of inflammation-metabolism system research in epidemiology.

METHODS

We conducted a cross-sectional study and multivariable logistic regression analysis to elucidate the association between inflammatory indicators and metabolic diseases and CVD risk. Metabolic diseases were defined as metabolic disorders (MetDs) or their components, such as metabolic syndrome (MetS), dyslipidemia, and central obesity. We calculated the Framingham risk score (FRS) to evaluate 10-year CVD risk.

RESULTS

Odds ratios for the third vs. the first tertile of MHR were 2.653 (95% confidence interval [CI], 2.142-3.286) for MetD, 2.091 (95% CI, 1.620-2.698) for MetS, 1.547 (95% CI, 1.287-1.859) for dyslipidemia, and 1.515 (95% CI, 1.389-1.652) for central obesity. Odds ratios for the third vs. the first tertile of SIRI were 2.092 (95% CI, 1.622-2.699) for MetD, 3.441 (95% CI, 2.917-4.058) for MetS, 1.417 (95% CI, 1.218-1.649) for dyslipidemia, and 2.080 (95% CI, 1.613-2.683) for central obesity. The odds ratio of a 10-year CVD risk of >30% for the third vs. the first tertile of MHR was 4.607 (95% CI, 2.648-8.017) and 3.397 (95% CI, 1.958-5.849) for SIRI.

CONCLUSIONS

MHR and SIRI had a significant association with MetD and its components, in which a higher level of MHR or SIRI tended to accompany a higher risk of metabolic diseases. Furthermore, they also correlated with CVD, and the increment of these indicators caused a gradually evaluated risk of 10-year CVD risk.

Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy

Aims

Emerging evidence has related inflammation-based biomarkers to numerous carcinomas, including bladder carcinoma (BC). However, the role of inflammatory biomarkers in the prognosis of BC remains inconclusive. This study aimed to compare preoperative plasma fibrinogen (PF) and other inflammatory biomarkers such as the platelet–lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR), lymphocyte–monocyte ratio (LMR), C-reactive protein (CRP) level, and serum albumin level to predict the prognosis of patients with BC.

Methods

This article focused on a retrospective analysis of 175 patients with newly diagnosed BC who were admitted to our hospital from March 2005 to March 2016. Of these BC patients, 136 had undergone radical cystectomy (RC).

Results

According to multivariate analysis, high PF level was an independent predictor of overall survival (OS) in 136 BC patients receiving RC (HR = 3.759; P = 0.011), but not for all 175 BC patients. Combining the NLR and PF values showed higher predictive accuracy for OS than NLR or PF alone (P < 0.05). Additionally, for 136 BC patients who had undergone RC, a close relationship was found between high PF levels (≥3.39 g/L) and lymph node metastasis (P = 0.011) and clinical T stage (P = 0.015). Furthermore, PF was a superior prognostic factor compared with the LMR, PLR, CRP, and albumin values in 136 BC patients who had undergone RC (P < 0.001).

Conclusions

The preoperative PF level may be a prognostic biomarker; and when combined with the NLR, it can improve the predictive ability of the survival of BC patients, particularly of BC patients who underwent RC.