Prognostic significance of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in patients with metastatic gastric cancer

Prognostic relevance of platelet lymphocyte ratio (PLR) in gastric cancer patients receiving immune checkpoint inhibitors: a systematic review and meta-analysis

Objectives

The prognostic relevance of the platelet-to-lymphocyte ratio (PLR) in gastric cancer (GC) patients undergoing immune checkpoint inhibitor (ICI) treatment remains unclear. This meta-analysis aimed to determine the prognostic impact of PLR in this specific patient cohort.

Methods

We searched the PubMed, Cochrane Library, CNKI, and EMBASE databases, including literature published up to September 2023, to investigate the prognostic implications of PLR in patients with gastric cancer undergoing immune checkpoint inhibitor therapy. Outcome measures encompassed overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rates (DCR).

Results

Nine studies from seven articles comprising 948 eligible patients were selected. The results revealed a significant correlation between elevated PLR and poorer OS and progression-free survival (PFS) (OS: HR 1.67, 95% CI 1.39-2.00, p < 0.001; PFS: HR 1.51, 95% CI 1.29-1.76, p < 0.001). Subgroup analyses were performed to validate the robustness of the results. Moreover, a meta-analysis of four studies investigating the correlation between the PLR in gastric cancer (GC) patients and the objective response rate/disease control rate (ORR/DCR), showed no significant association between the PLR and ORR/DCR (ORR: RR = 1.01, p = 0.960; DCR: RR = 0.96, p = 0.319).

Conclusions

This meta-analysis indicates that elevated PLR in GC patients undergoing ICI treatment is significantly linked to worse OS and PFS. Therefore, PLR can serve as a prognostic indicator of post-treatment outcomes in patients with GC receiving ICIs. Further prospective studies are required to assess the reliability of these findings.

Systematic review registration

https://inplasy.com/, identifier INPLASY2023120103.

Development and validation of a nomogram to predict cancer-specific survival of elderly patients with unresected gastric cancer who received chemotherapy

This investigation aimed to explore the prognostic factors in elderly patients with unresected gastric cancer (GC) who have received chemotherapy and to develop a nomogram for predicting their cancer-specific survival (CSS). Elderly gastric cancer patients who have received chemotherapy but no surgery in the Surveillance, Epidemiology, and End Results Database between 2004 and 2015 were included in this study. Cox analyses were conducted to identify prognostic factors, leading to the formulation of a nomogram. The nomogram was validated using receiver operating characteristic (ROC) and calibration curves. The findings elucidated six prognostic factors encompassing grade, histology, M stage, radiotherapy, tumor size, and T stage, culminating in the development of a nomogram. The ROC curve indicated that the area under curve of the nomogram used to predict CSS for 3, 4, and 5 years in the training queue as 0.689, 0.708, and 0.731, and in the validation queue, as 0.666, 0.693, and 0.708. The calibration curve indicated a high degree of consistency between actual and predicted CSS for 3, 4, and 5 years. This nomogram created to predict the CSS of elderly patients with unresected GC who have received chemotherapy could significantly enhance treatment accuracy.

Platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with gastric cancer undergoing radical resection

Background

Amounting literatures have reported the significance of systemic inflammatory markers for evaluating tumor prognosis. But few studies have systematically compared their superiority and their impact on adjuvant chemotherapy.

Aims

We aimed to investigate the ability of inflammatory markers to predict the efficacy of chemotherapy in GC patients undergoing radical therapy and to identify an effective methodology based on the study's findings that would enable clinicians to differentiate between chemotherapy-responsive populations.

Methods

We retrospectively enrolled 730 GC patients who underwent radical gastrectomy. Fibrinogen (FIB), platelet-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR) and lymph node ratio (LNR) were grouped according to cutoff values. Their clinical significance for GC prognosis was determined by multivariate COX regression analysis in the 730 GC patients and high/low PLR status subgroups. Cases were divided into four groups according to PLR status and adjuvant chemotherapy status and survival was compared among groups.

Results

Multivariate analysis showed that PLR was an independent prognostic factor for overall survival (OS) and disease-free survival (DFS) of GC patients. Adjuvant chemotherapy improved survival more significantly in patients with low PLR than that with high PLR. Among patients receiving adjuvant chemotherapy, low PLR was significantly associated with prolonged survival in TNM stage II, but not in TNM stage III.

Conclusion

Preoperative high PLR is an independent risk factor for GC patients undergoing radical gastrectomy and adversely affects the postoperative chemotherapy effect.

Pretreatment lymphocyte-monocyte ratio (LMR) as a superior predictor of short-term progression outcomes in patients with gastric cancer receiving second- and later-line apatinib regimens

PURPOSE

Lymphocyte-monocyte ratio (LMR) has previously been used as a prognostic predictor in various solid tumors. This research aims in comparing the prognostic predictive Please check and conability of several inflammatory parameters and clinical parameters to validate further the excellent prognostic value of LMR in patients with gastric cancer treated with apatinib.

METHODS

Monitor inflammatory, nutritional parameters and tumor markers. Cutoff values of the parameters concerned were identified with the X-tile program. Subgroup analysis was made via Kaplan-Meier curves, and univariate and multivariate Cox regression analyses were used to find independent prognostic factors. The nomogram of logistic regression models was constructed according to the results.

RESULTS

A total of 192 patients (115 divided into training group and 77 into validation group) who received the second- or later-line regimen of apatinib were retrospectively analyzed. The optimal cutoff value for LMR was 1.33. Patients with high LMR (LMR-H) were significantly longer than those with low LMR (LMR-L) in progression-free survival (median 121.0 days vs. median 44.5 days, P < 0.001). The predictive value of LMR was generally uniform across subgroups. Meanwhile, LMR and CA19-9 were the only hematological parameters with significant prognostic value in multivariate analysis. The area under the LMR curve (0.60) was greatest for all inflammatory indices. Adding LMR to the base model significantly enhanced the predictive power of the 6-month probability of disease progression (PD). The LMR-based nomogram showed good predictive power and discrimination in external validation.

CONCLUSION

LMR is a simple but effective predictor of prognosis for patients treated with apatinib.

CANCER-ASSOCIATED ADIPOCYTES AND PROGNOSTIC VALUE OF PREOPERATIVE NEUTROPHIL-LYMPHOCYTE RATIO IN GASTRIC CANCER

BACKGROUND

The neutrophil-to-lymphocyte ratio (NLR) turned out to be a routinely available marker capable to reflect the systemic inflammatory response created by a tumor. Gastric cancer (GC) grows in the anatomical vicinity of adipose tissue, which is also associated with low-grade inflammation.

AIM

To investigate the usefulness of the combined use of preoperative NLR and density of intratumoral cancer-associated adipocytes (CAAs) for predicting the disease outcome in GC patients.

MATERIALS AND METHODS

A total of 151 patients with GC were eligible for retrospective analysis between 2009 and 2015.NLR preoperative values were calculated. Perilipin expression in tumor tissue was examined immunohistochemically.

RESULTS

Low preoperative NLR is the most reliable prognostic factor for the favorable outcome for patients with low density of intratumoral CAAs. Patients with a high density of CCAs are at high risk of lethal outcomes independently of the value of preoperative NLR.

CONCLUSION

The results have clearly shown an association between preoperative NLR and the density of CAAs in the primary tumor of GC patients. The prognostic value of NLR is essentially modified by means of the individual density of intratumoral CAAs in GC patients.The elevated NLR could be of significant predictive potential for a negative prognosis for patients with tumors characterized by the high density of CAAs independently of BMI.

Development and validation of nomogram of peritoneal metastasis in gastric cancer based on simplified clinicopathological features and serum tumor markers

BACKGROUND

Peritoneal metastasis (PM) is not uncommon in patients with gastric cancer(GC), which affects clinical treatment decisions, but the relevant examination measures are not efficiently detected. Our goal was to develop a clinical radiomics nomogram to better predict peritoneal metastases.

METHODS

A total of 3480 patients from 2 centers were divided into 1 training, 1 internal validation, and 1 external validation cohort(1949 in the internal training set, 704 in the validation set, and 827 in the external validation cohort) with clinicopathologically confirmed GC. We recruited 11 clinical factors, including age, sex, smoking status, tumor size, differentiation, Borrmann type, location, clinical T stage, and serum tumor markers (STMs) comprising carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 72-4 (CA72-4), and carcinoembryonic antigen (CEA), to develop the radiomics nomogram. For clinical predictive feature selection and the establishment of clinical models, statistical methods of analysis of variance (ANOVA), relief and recursive feature elimination (RFE) and logistic regression analysis were used. To develop combined predictive models, tumor diameter, type, and location, clinical T stage and STMs were finally selected. The discriminatory ability of the nomogram to predict PM was evaluated by the area under the receiver operating characteristic curve(AUC), and decision curve analysis (DCA) was conducted to evaluate the clinical usefulness of the nomogram.

RESULTS

The AUC of the clinical models was 0.762 in the training cohorts, 0.772 in the internal validation cohort, and 0.758 in the external validation cohort. However, when combined with STMs, the AUC was improved to 0.806, 0.839 and 0.801, respectively. DCA showed that the combined nomogram was of good clinical evaluation value to predict PM in GC.

CONCLUSIONS

The present study proposed a clinical nomogram with a combination of clinical risk factors and radiomics features that can potentially be applied in the individualized preoperative prediction of PM in GC patients.

Prognostic significance of pretreatment systemic immune-inflammation index in patients with prostate cancer: a meta-analysis

BACKGROUND

The SII (systemic immune-inflammation index) has been extensively reported to have a prognostic value in prostate cancer (PCa), despite the unconformable results. The purpose of this meta-analysis is to quantify the effect of pretreatment SII on survival outcomes in patients with PCa.

METHODS

The following databases were searched: Web of Science, Cochrane Library, PubMed, Embase, and China National Knowledge Infrastructure (CNKI). For exploration of the SII's correlations with the overall survival (OS) and the progression-free survival/biochemical recurrence-free survival (PFS/bRFS) in PCa, the pooled hazard ratios (HRs) were assessed within 95% confidence intervals (CIs).

RESULTS

The present meta-analysis covered 10 studies with 8133 patients. Among the PCa population, a high SII was linked significantly to poor OS (HR = 2.63, 95% CI = 1.87-3.70, p < 0.001), and worse PFS/bRFS (HR = 2.49, 95% CI = 1.30-4.77, p = 0.006). However, a high SII was not linked significantly to T stage (OR = 1.69, 95% CI = 0.86-3.33, p = 0.128), the metastasis to lymph node (OR = 1.69, 95% CI = 0.69-4.16, p = 0.251), age (OR = 1.41, 95% CI = 0.88-2.23, p = 0.150), or the Gleason score (OR = 1.32, 95% CI = 0.88-1.96, p = 0.178).

CONCLUSIONS

For the PCa sufferers, the SII might be a promising prognostic biomarker, which is applicable to the high-risk subgroup identification, and provide personalized therapeutic strategies.

The prognostic impact of the lymphocyte-to-C-reactive protein ratio in patients with unresectable or recurrent advanced gastric cancer treated with first- and second-line treatment

PURPOSE

The goal of this study was to determine which markers are the most useful as first- and second-line pre-treatment markers in patients with unresectable or recurrent gastric cancer (URGC).

METHODS

This study included 101 URGC patients who were treated with first- and second-line chemotherapy. Several prognostic scores based on nutrition and inflammation were analyzed using a receiver operating characteristic (ROC) analysis to determine the most useful prognostic marker.

RESULTS

The lymphocyte-to-C-reactive protein ratio (LCR) had the highest area under the curve for both first- and second-line chemotherapy, according to an ROC analysis. An ROC analysis was used to determine the optimal LCR cut-off for the median survival time before first- and second-line chemotherapy, and patients were divided into high- and low-LCR groups. Patients with a high LCR had a significantly longer survival than those with a low LCR before first- and second-line chemotherapy (p = 0.004, p < 0.001, respectively). A low LCR before both first- and second-line chemotherapy was an independent poor prognostic factor in a multivariate analysis.

CONCLUSIONS

URGC patients with a low LCR before both first- and second-line chemotherapy had a significantly worse prognosis than those with a high LCR in this study. Nutritional intervention during chemotherapy induction may lead to a better prognosis.

Evaluation of multiple biological indicators for combined diagnosis of gastric cancer: A retrospective analysis

To assess carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) for gastric cancer's (GC) diagnostic efficiency, and the use of receiver operating characteristic curves (ROC) combined with logistic regression to evaluate multi-index combination's diagnostic value of GC. 773 GC patients' clinical data were retrospectively collected in the Weihai Municipal Hospital, affiliated hospital of Shandong University from April 2018 to May 2021, and selected 2368 healthy physical examination patients during the same period as the control group. A total of 3141 samples was included in this study, including 773 cases in the GC group and 2368 cases in the healthy physical examination group. The results of the overall comparison between groups showed that apart from gender, the age differences, CEA, CA19-9, PDW, NLR, and PLR were statistically significant (P < .001). Spearman ranks correlation analysis's results showed that CA19-9, CEA, PLR, and NLR were correlated with GC patients' clinical-stage positively, and the correlation coefficients r was 0.249, 0.280, 0.252, 0.262 (all P < .001), and PDW was correlated with the clinical stage negatively (r = -0.186, P < .001). The ROC curve analysis results of CEA, CA19-9, PDW, NLR and PLR showed that CEA's diagnostic cutoff value for GC was 3.175 (area under the curve [AUC] = 0.631, 95% CI: 0.606-0.655, P < .001), the CA19-9's diagnostic cutoff value is 19.640 (AUC = 0.589, 95% CI: 0.563-0.615, P < .001), PDW's diagnostic cutoff value is 15.750 (AUC = 0.799, 95% CI: 0.778-0.820, P < .001), NLR's diagnostic cutoff value was 2.162 (AUC = 0.699, 95% CI: 0.675-0.721, P < .001), and PLR's diagnostic cutoff value was 149.540 (AUC = 0.709, 95% CI: 0.688-0.732, P < .001). The area under the ROC curve for the combined diagnosis of GC with 5 indicators was 0.877 (95% CI: 0.860-0.894, P < .001), which was better than a single indicator (P < .05). The diagnostic efficiency of combined detection of CEA, CA19-9, PDW, NLR, and PLR is better than that of single index detection alone, which can reduce the misdiagnosis rate of GC effectively.

New validation of a well-known marker in cochlear implant infections: A retrospective, case-controlled, observational study

Objectives

Cochlear implant (CI) infection is the most common complication after CI surgery. We investigated whether the preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) values could predict the CI infection and the NLR and PLR values obtained at the first admission to the hospital with an CI infection could help the clinician in the diagnosis.

Methods

This retrospective case-controlled study included 26 patients with postsurgical CI infection. To prevent age-related incompatibility in the blood analysis of the infected group, the patients were divided into three age groups: 0-4 years, 5-18 years, and over 18 years old. To compare the infected group, 29 patients who did not have implant infection after CI surgery and whose age ranges were compatible with the infected group were randomly selected from the hospital records as the control group. The infected group preimplantation (PREs) and postinfection (POSTi) NLR and PLR values were compared with each other and the control group values. The area under the curve, sensitivity, specificity, and cutoff values were calculated by ROC analysis.

Results

The POSTi NLR values of the infected group patients aged 0-4 years and over 18 years were significantly greater than the PREs NLR values (p = .038 and p = .008, respectively). Significant differences were found between the POSTi NLR values of the infected group patients aged 0-4 years and over 18 years and those of PREs in the control group (p = .011 and p = .015, respectively).

Conclusions

Preoperative NLR and PLR values cannot predict postoperative CI infection. However, NLR and PLR values increased significantly after CI infection, even if systemic symptoms did not occur. At the first admission to the hospital, NLR values can guide the clinician in diagnosing the CI infection in patients between 0 and 4 years and over 18 years.Trial Registration Clinical Trials.gov Identifier: NCT04120181.

Relationship between PLR and Clinicopathological Characteristics of Patients with Advanced NSCLC and Its Predictive Value for the Efficacy of Chemotherapy and Prognosis

Objective

To investigate the relationship between blood platelet-to-lymphocyte ratio (PLR) and clinicopathological characteristics of patients with advanced non-small cell lung cancer (NSCLC) and evaluate the value of PLR for predicting the efficacy of chemotherapy and prognosis.

Methods

The clinical data of 175 patients with advanced NSCLC diagnosed from March 2017 to December 2018 in our hospital were retrospectively analyzed, and the data of 175 healthy subjects from our hospital physical examinations were included. The platelet was detected by using a blood cell analyzer to calculate PLR. According to the average PLR value (197) before chemotherapy, 175 patients were divided into the low PLR group (=78) and the high PLR group (=97). The relationship between the expression levels of PLR and clinicopathologic features was analyzed, and the Kaplan-Meier survival curve was used to analyze the relationship between the expression levels of PLR and prognosis.

Results

The results showed that prechemotherapy PLR levels were significantly higher in NSCLC compared with the healthy subjects (P < 0.05). After 4 cycles of chemotherapy, the PLR levels were significantly lower than those during prechemotherapy (P < 0.05). The proportion of TNM (IV) stage cases in the low PLR group was lower than that in the high PLR group (P < 0.05). The total effective rate of the first-line chemotherapy was 46.9% (82/175). The effective rate of IIIb staging was higher than that in IV staging (P < 0.05), and the effective rate of the low PLR group was higher than that in the high PLR group (P < 0.05). Multivariate logistic analysis showed that TNM stage 4 and high PLR level were the independent risk factors for the efficacy of the first-line chemotherapy in patients with advanced NSCLC (P < 0.05), and the high PLR level was an independent risk factor affecting the prognosis of patients with advanced NSCLC. The median overall survival (OS) of patients with the low PLR group was 20.8 months, higher than the 12.0 months of patients with the high PLR group (P < 0.05).

Conclusion

PLR might have a certain clinical significance for predicting the TNM staging of NSCLC and can provide important diagnostic and prognostic results for patients.

Prognostic Value of Preoperative Systemic Inflammatory Parameters in Advanced Gastric Cancer

Background: The predictive value of various systemic inflammatory parameters has been reported. However, it is still unclear which inflammatory parameters are the best predictors of prognosis in advanced gastric cancer and what are their mechanisms of action. The aim of this study was to evaluate the association between preoperative systemic inflammatory parameters and overall survival (OS) in patients with advanced gastric cancer. Methods: This retrospective study included 489 patients with stage II/III advanced gastric cancer treated at the National Cancer Center, Republic of Korea, between January 2012 and December 2015. We divided the patients into survivors and non-survivors and compared their clinicopathological characteristics. Univariate and multivariate analyses using the Cox proportional hazards model were performed to evaluate the prognostic value of inflammatory parameters. Results: The absolute lymphocyte count was significantly higher in survivors (2.07 ± 0.62 × 10³/µL vs. 1.88 ± 0.63 × 10³/µL, p = 0.001). The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were marginally lower in survivors. Survival analysis revealed that the NLR and PLR were independent prognostic factors for OS. Survival was significantly different depending on NLR and PLR in the same pathologic stages. Conclusions: NLR and PLR were independent prognostic factors for OS in patients with advanced gastric cancer. Regarding single inflammatory parameters, an elevated lymphocyte count was the only factor associated with a favorable prognosis. These results suggest that the enhanced immune function of patients affects their prognosis more than the increased systemic inflammatory response.

Outcomes and Prognostic Factors of Metastatic Gastric Cancer: A Single-Center Experience

Background

Gastric cancer (GC) carries a poor survival outcome despite the availability of many therapeutic agents active in treatment. In this study, we aimed to evaluate the survival outcomes of metastatic GC treatment from a single center in Saudi Arabia and identify possible prognostic factors.

Methodology

Data on patients diagnosed with metastatic GC between December 2009 and November 2013 were collected and analyzed.

Results

During this period, 41 patients were diagnosed with a median age at diagnosis of 52 years, and 56.1% of patients were males. Only four (9.2%) patients had human epidermal growth factor receptor 2 overexpression. Overall, 83% were treated with oxaliplatin-based chemotherapy. The median progression-free survival (PFS) and overall survival (OS) were 4.1 and 15.4 months, respectively. Female sex was an independent prognostic factor for better PFS and OS. Normal lymphocyte count was associated with improved PFS.

Conclusions

Our study highlights poor outcomes in patients with metastatic GC and the need for further research in this field.

Prognostic Value of Preclinical Markers after Radiotherapy of Metastatic Spinal Cord Compression-An Additional Analysis of Patients from Two Prospective Trials

For optimal personalization of treatment for metastatic spinal cord compression (MSCC), the patient’s survival prognosis should be considered. Estimation of survival can be facilitated by prognostic factors. This study investigated the prognostic value of pre-treatment preclinical markers, namely hemoglobin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lactate dehydrogenase (LDH), and c-reactive protein (CRP), in 190 patients from two prospective trials who had poor or intermediate survival prognoses and were irradiated for MSCC with motor deficits. In addition, clinical factors including radiation regimen, age, gender, tumor type, interval from tumor diagnosis to MSCC, number of affected vertebrae, visceral metastases, other bone metastases, time developing motor deficits, ambulatory status, sensory function, and sphincter function were evaluated. On univariate analyses, NLR (p = 0.033), LDH (p < 0.001), CRP (p < 0.001), tumor type (p < 0.001), pre-radiotherapy ambulatory status (p < 0.001), and sphincter function (p = 0.011) were significant. In the subsequent Cox regression analysis, LDH (p = 0.007), CRP (p = 0.047), tumor type (p = 0.003), and ambulatory status (p = 0.010) maintained significance. In addition to clinical factors, preclinical markers may help in estimating the survival of patients irradiated for MSCC. Additional prospective trials are warranted.

Elevated baseline circulating platelet-to-lymphocyte ratio and survival in initial stage Ⅳ gastric cancer patients: A meta-analysis

Background

Systemic inflammatory response (SIR) plays important roles in initiation, promotion and progression of tumor. However, the prognostic role of baseline circulating platelet–to–lymphocyte ratio (PLR) (known as a marker of SIR) in human initial stage Ⅳ gastric cancer (GC) remains controversial. Hence, we performed this meta-analysis to assess the value of it in prognosis prediction for these patients.

Materials and methods

We searched PubMed, Embase and EBSCO to identify the studies and computed extracted data with STATA 12.0.

Results

A total of 3025 patients with initial stage Ⅳ GC from 13 published studies were incorporated into this meta-analysis. We found that elevated baseline circulating PLR was significantly associated with decreased overall survival (OS), but not with progression–free survival (PFS) in stage Ⅳ GC patients. However, in stratified analyses, high PLR was only associated with worse 1-year and 2-year OS, but not with 3-year or 4-year OS; In addition, it was considerably related with reduced 6-month PFS, but not with 1-year or 2-year PFS. Moreover, high PLR markedly correlated with peritoneal metastasis of GC.

Conclusion

Elevated baseline circulating PLR decreased 1-year OS and 6-month PFS in initial stage Ⅳ GC patients, implicating that it is a valuable prognostic index for these patients and modifying the inflammatory responses may have a potential for effective treatment.

Systemic inflammation response index (SIRI) as a novel biomarker in patients with rheumatoid arthritis: a multi-center retrospective study

OBJECTIVES

To evaluate the potential ability of systemic inflammation response index (SIRI) as a novel biomarker in patients with rheumatoid arthritis (RA) and explore the mechanisms.

METHOD

Patients fulfilling the 2010 ACR/EULAR classification criteria for RA were enrolled in this study. Demographic, clinical, and laboratory characteristics of all subjects were collected. Neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), and SIRI were calculated. Statistical analysis was performed, and P-values < 0.05 were considered statistically significant.

RESULTS

One thousand four hundred ninety-nine RA patients from five hospitals were included, with 366 healthy volunteers served as controls. The NLR, MLR, PLR, and SIRI significantly increased in RA patients. Receiver operating characteristics (ROC) curve analysis showed SIRI, and NLR could distinguish RA from healthy controls. Correlation analysis and multiple linear regression analysis indicated that SIRI and PLR positively correlated with disease activity in RA. The NLR, MLR, and SIRI increased significantly in patients with RA-associated interstitial lung disease (ILD). There was a good accuracy of SIRI in differentiating RA-ILD from RA patients without ILD. SIRI was also found to be higher in RA patients with tumor and could differentiate them from RA patients without tumor.

CONCLUSIONS

SIRI could be evaluated as a novel, non-invasive, and suitable biomarker for assisting in the diagnosis process and demonstrating the disease activity of RA, as well as predicting RA-ILD and tumor development of RA patients. Key Points • As a novel biomarker, systemic inflammation response index (SIRI) may assist in the diagnosis process and indicate the disease activity of RA patients • SIRI may predict the development of RA-associated interstitial lung disease (RA-ILD) and tumor in RA patients • SIRI is more satisfactory than other blood cells-based indexes in the assessment of RA patients.

Positive H. pylori status predicts better prognosis of non-cardiac gastric cancer patients: results from cohort study and meta-analysis

BACKGROUND

Previous researches have associated Helicobacter pylori (H. pylori) with a prognosis of gastric cancer (GC), however, without a concert conclusion. This study aimed to study this issue further by a prospective cohort study and a meta-analysis.

METHODS

Histologically diagnosed gastric cancer (GC) patients were recruited into the primary prospective cohort study between January 2009 to December 2013. All the patients were followed-up periodically to record information on post-surgery therapy and overall survival status. The pre-surgery status of H. pylori was measured by enzyme-linked immunosorbent assay. A meta-analysis was conducted after retrieving related researches in the databases of PubMed and Embase up to April 2020. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were summarized to validate the relationship between H. pylori infection and the survival time of GC patients. I² statistics and Q test were used to assess the heterogeneity. Sensitivity analyses were performed using Galbraith's plot, leave-one-out analysis, subgroup analyses and meta-regression to explore the sources of heterogeneity and the stability of the summary results.

RESULTS

A total of 743 GC patients with radical tumorectomy were included prospectively and 516 (69.4%) were positive on H. pylori. H. pylori-positive patients tended to survive longer than -negative ones (HR 0.92, 95%CI: 0.74-1.15), though the tendency was not statistically significant. Cohort studies on the prognosis of GC were retrieved comprehensively by assessing the full-text and 59 published studies, together with the result of our study, were included in the further meta-analysis. The summarized results related the positive status of H. pylori to better overall survival (HR 0.81, 95%CI: 0.72-0.90) and disease-free survival (HR 0.83, 95%CI: 0.67-0.99). Results from subgroup analyses indicated that the pooled magnitude of this association was relatively lower in studies not referring to H. pylori in title and abstract.

CONCLUSIONS

In conclusion, gastric cancer patients with H. pylori have a better prognosis than patients of H. pylori negative. More stringent surveillance strategies may be necessary for patients with H. pylori negative at cancer diagnosis.

Utility of Pretreatment Blood Platelet-To-Lymphocyte Ratio in Prediction of Clinical Outcomes and Chemosensitivity in Patients with Advanced Gastric Cancer: A Meta-Analysis

Background

The results of previous studies that evaluated the association between pretreatment blood platelet-to-lymphocyte ratio (PLR) and clinical outcomes and chemosensitivity in patients with advanced gastric cancer are inconsistent. Therefore, this study was designed to investigate the association between pretreatment blood PLR and clinical outcomes and chemosensitivity in advanced gastric cancer patients.

Material/Methods

We performed a systematic literature search in PubMed, Web of Science, EMBASE, and the Cochrane Library up to Mar 9, 2021. Hazard ratios (HRs) for overall survival (OS) and disease-free survival (DFS) were pooled for meta-analysis. The quality of the included studies was measured by the Newcastle-Ottawa Quality Assessment Scale.

Results

We included 17 studies comprising 3499 patients with advanced GC in this meta-analysis. Pooled results demonstrated that high PLR was correlated with poor OS (HR=1.429, 95% CI=1.246–1.639, P<0.001) and DFS (HR=1.47, 95% CI=1.14–1.88, P=0.003) compared with low PLR in patients with advanced GC. Moreover, high PLR was associated with a lower response to chemotherapy in patients with advanced GC (OR=1.395, 95% CI=1.056–1.841, P=0.019). However, there was no significant correlation between PLR and clinicopathological features.

Conclusions

This meta-analysis suggests that high PLR is a risk factor for unfavorable OS, DFS, and chemosensitivity in patients with advanced GC.

Preoperative Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and CEA as the Potential Prognostic Biomarkers for Colorectal Cancer

BACKGROUND

This study was to evaluate the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA) in colorectal cancer (CRC) patients and to identify the potential and easily accessible prognostic biomarkers for CRC.

METHODS

We retrospectively reviewed altogether the records of 330 CRC patients according to inclusion criteria. The clinical characteristics include age at diagnosis, body mass index (BMI), preoperative CEA level, neutrophil , lymphocyte, and platelet count, tumor primary site and size, clinical pathological TNM stage, and survival status were recorded through the review of medical records. The overall survival (OS) was calculated using the Kaplan-Meier method. The Cox proportional hazards model was used for the univariate and multivariate analysis to evaluate the prognostic factors of CRC.

RESULTS

A total of 330 patients were finally included in the current study. The mean follow-up duration was 32.8 ± 19.1 months (range, 0.1-67.7). Compared with the median OS, preoperative high NLR, PLR, and CEA, and low BMI had lower median OS. The NLR and PLR value rise indicates lower median OS in stage I-II CRC; however, the NLR value and CEA level rise indicates lower median OS in stage III-IV CRC. Preoperative high NLR, PLR, and CEA level and low BMI have poorer OS by univariate analysis. By multivariate analysis, the age, sex, N, M stage, and BMI demonstrated independently influence the OS of CRC. NLR was an independent predictor of stage I-II CRC, and the CEA level was an independent predictor of stage III-IV CRC.

CONCLUSIONS

Our results show that preoperative high NLR, PLR, CEA, and low BMI had poorer OS, NLR was an independent predictor of stage I-II CRC, and the CEA level was an independent predictor of stage III-IV CRC.

Prediction of survival after eribulin chemotherapy for breast cancer by absolute lymphocyte counts and progression types

Background

In the Response Evaluation Criteria for Solid Tumors (RECIST) diagnostic criteria, the concepts of progression by preexisting disease (PPL) and progression by new metastases (PNM) have been proposed to distinguish between the progression types of cancer refractory to treatment. According to the tumor biology of cancer progression forms, the “PPL” form indicates invasion, and the “PNM” form indicates metastasis. On the other hand, recent studies have focused on the clinical importance of inflammatory markers as indicators of the systemic tumor immune response. In particular, absolute lymphocyte count (ALC) is an indicator of the host’s immune response. Thus, we developed a new measure that combined progression form with ALC. In this study, we clinically validated the combined assessment of progression form and ALC in eribulin chemotherapy.

Methods

From August 2011 to April 2019, a total of 486 patients with locally advanced or metastatic breast cancer (MBC) underwent treatment. In this study, only 88 patients who underwent chemotherapy using eribulin were included. The antitumor effect was evaluated based on the RECIST criteria, version 1.1. To measure ALC, peripheral blood samples collected before eribulin treatment were used. The cut-off value for ALC in this study was 1500/μl, based on previous studies.

Results

The PPL group (71 patients, 80.7%) had significantly longer progression-free survival (PFS) (p = 0.022, log-rank) and overall survival (OS) (p < 0.001, log-rank) than the PNM group (17 patients, 19.3%). In the 51 patients with ALC < 1500/μl, the PPL group had a significantly better prognosis than the PNM group (PFS: p = 0.035, OS: p < 0.001, log-rank, respectively). On the other hand, in the 37 patients with ALC ≥ 1500/μl, the PPL group had a better OS compared with the PNM group (p = 0.055, log-rank), but there was no significant difference in PFS between the two groups (p = 0.541, log-rank). Furthermore, multivariate analysis that validated the effect of OS showed that high ORR and “high-ALC and PPL” were factors for a good prognosis (p < 0.001, HR = 0.321; p = 0.036, HR = 0.290).

Conclusions

The progression form of PNM had a worse prognosis than PPL in patients treated with eribulin. In breast cancer patients with eribulin chemotherapy, good systemic immune status, such as ALC ≥ 1500/μl, was associated with less progression, particularly metastasis, and better prognosis. Furthermore, the biomarker “high-ALC (ALC ≥ 1500/μl) and PPL” was particularly useful as a prognostic marker following eribulin chemotherapy.

Pretreatment neutrophil-to-lymphocyte ratio predicts the benefit of gastric cancer patients with systemic therapy

Pretreatment neutrophil-to-lymphocyte ratio (NLR) has been reported to be associated with the prognosis of inoperable gastric cancer patients with systemic therapy. However, no consensus on the association has been reached. In this study, we mainly evaluated whether pretreatment NLR predicted the benefit of inoperable gastric cancer patients with systemic therapy, including chemotherapy, targeted therapy and immunotherapy. PubMed, Embase and Cochrane Library databases were systematically searched from inception up to September 16th, 2020. A total of 36 studies including 8614 patients were involved in the meta-analysis. Pooled data revealed that high pretreatment NLR was significantly associated with poor outcomes of OS (HR = 1.78, 95% CI = [1.59, 1.99]) and PFS (HR = 1.63, 95% CI = [1.39, 1.91]) in gastric cancer. Subgroup analyses stratified by country, study type, case load, analysis of HR, cutoff of pretreatment NLR, or treatment types arrived at the same conclusion. Pooled data based on different effect models and sensitivity analyses did not change the conclusion. Overall, high pretreatment NLR predicts the poor prognosis of inoperable gastric cancer patients with systemic therapy. Measurement of pretreatment NLR will assist clinicians with patient counseling and clinical treatment guiding accordingly.

Platelet-to-lymphocyte ratio and C-reactive protein as markers for colorectal polyp histological type

Background

The platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP) level are markers that have been reported to predict the histological type of various tumors, and here, we evaluated their utility in predicting colorectal polyp histological types.

Methods

We retrospectively reviewed 172 patients with colorectal polyps who underwent endoscopic polypectomy. The associations between histological type and clinicopathologic parameters were assessed by multivariate analysis.

Results

The optimal PLR and CRP cut-off values were 113.32 and 0.39, respectively. The PLR (P = 0.002) and CRP (P = 0.009) values were associated with the histological type according to the univariate analysis, whereas low PLR (P ≤ 0.001) and CRP (P = 0.017) values were independent risk factors in the multivariate analysis together with maximum tumor diameter (P ≤ 0.001) and tumor number (P = 0.0014).

Conclusions

Preoperative PLR and CRP are correlated with the colorectal polyp histological type.

Neutrophils as Orchestrators in Tumor Development and Metastasis Formation

Several lines of clinical and experimental evidence suggest that immune cell plasticity is a central player in tumorigenesis, tumor progression, and metastasis formation. Neutrophils are able to promote or inhibit tumor growth. Through their interaction with tumor cells or their crosstalk with other immune cell subsets in the tumor microenvironment, they modulate tumor cell survival. Here, we summarize current knowledge with regards to the mechanisms that underlie neutrophil–mediated effects on tumor establishment and metastasis development. We also discuss the tumor-mediated effects on granulopoiesis and neutrophil precursors in the bone marrow and the involvement of neutrophils in anti-tumor therapeutic modalities.

The Neutrophil: The Underdog That Packs a Punch in the Fight against Cancer

The advent of immunotherapy has had a major impact on the outcome and overall survival in many types of cancer. Current immunotherapeutic strategies typically aim to (re)activate anticancer T cell immunity, although the targeting of macrophage-mediated anticancer innate immunity has also emerged in recent years. Neutrophils, although comprising ≈ 60% of all white blood cells in the circulation, are still largely overlooked in this respect. Nevertheless, neutrophils have evident anticancer activity and can induce phagocytosis, trogocytosis, as well as the direct cytotoxic elimination of cancer cells. Furthermore, therapeutic tumor-targeting monoclonal antibodies trigger anticancer immune responses through all innate Fc-receptor expressing cells, including neutrophils. Indeed, the depletion of neutrophils strongly reduced the efficacy of monoclonal antibody treatment and increased tumor progression in various preclinical studies. In addition, the infusion of neutrophils in murine cancer models reduced tumor progression. However, evidence on the anticancer effects of neutrophils is fragmentary and mostly obtained in in vitro assays or murine models with reports on anticancer neutrophil activity in humans lagging behind. In this review, we aim to give an overview of the available knowledge of anticancer activity by neutrophils. Furthermore, we will describe strategies being explored for the therapeutic activation of anticancer neutrophil activity.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Blood to Distinguish Lung Cancer Patients from Healthy Subjects

Objective

Inflammation-driven markers play a crucial role in tumorigenesis and tumor progression. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in blood are systemic inflammatory response markers. Some reports have showed that NLR and PLR are related to a poor prognosis in patients with lung cancer. However, little studies have reported whether NLR and PLR can be diagnostic markers for lung cancer. The aim of the current study is to investigate the roles of NLR and PLR in diagnosing lung cancer.

Methods

This study analyzed data from lung cancer patients and healthy individuals in Wuxi People's Hospital Affiliated with Nanjing Medical University. The Mann-Whitney U test was performed to compare differences between the lung cancer group and the control group. Based on white blood cell (WBC) counts, both lung cancer patients and healthy individuals were divided into the low-level group, moderate-level group, and high-level group. The Kruskal-Wallis test was applied to compare differences of NLR and PLR among those groups with different WBC counts. Spearman correlation analysis was used to assess correlations. Receiver operating characteristic (ROC) curves were performed to determine diagnostic accuracy.

Results

210 patients diagnosed with lung cancer and 261 healthy subjects were enrolled in this study. Levels of NLR and PLR increased in the lung cancer group compared with the control group (P < 0.001). For the lung cancer group, NLR levels could rise with the increasing of WBC levels (P < 0.001) while PLR levels had no significant variation with the increasing of WBC levels (P = 0.206). For the control group, NLR levels could rise with the increasing of WBC levels (P < 0.001) while PLR levels would decline with the increasing of WBC levels (P < 0.001). In the lung cancer group, both NLR and PLR had no significant correlations with aspartate transaminase, urea, and glucose. The area under the curve (AUC) with 95% confidence interval (95% CI) of NLR and PLR to distinguish lung cancer patients from healthy subjects was, respectively, 0.684 (0.634-0.735) and 0.623 (0.571-0.674). When NLR and PLR were combined, AUC (95% CI) increased to 0.691 (0.642-0.740).

Conclusions

NLR and PLR alone have moderate ability to distinguish lung cancer patients from healthy subjects. Furthermore, combination forms of NLR and PLR can improve diagnostic ability.

Clinicopathological and prognostic significance of platelet-lymphocyte ratio (PLR) in gastric cancer: an updated meta-analysis

BACKGROUND

Pre-treatment PLR (platelet-lymphocyte ratio) was reported to be associated with the prognosis in gastric cancer (GC), but the results remain inconclusive. This meta-analysis aimed to investigate the prognostic potential of the pre-treatment PLR in gastric cancer.

METHODS

We performed a systematic literature search in PubMed, Embase, and the Cochrane Library to identify eligible publications. The hazard ratio (HR)/odds ratio (OR) and its 95% confidence (CI) of survival outcomes and clinicopathological parameters were calculated.

RESULTS

A total of 49 studies (51 cohorts), collecting data from 28,929 GC patients, were included in the final analysis. The pooled results demonstrated that the elevated pre-treatment PLR was significantly associated with poor overall survival (OS) (HR 1.37, 95% CI 1.26-1.49, p < 0.001; I² = 79.90%, P_h < 0.001) and disease-free survival (DFS) (HR 1.52, 95% CI 1.22-1.90, p < 0.001, I² = 88.6%, P_h < 0.001). Furthermore, the patients with the elevated PLR had a higher risk of lymph node metastasis (OR = 1.17, 95% CI 1.02-1.33, p = 0.023), serosal invasion (T3+T4) (OR = 1.34, 95% CI 1.10-1.64, p = 0.003), and increased advanced stage (III+IV) (OR = 1.20, 95% CI 1.06-1.37, p = 0.004).

CONCLUSIONS

An elevated pre-treatment PLR was a prognostic factor for poor OS and DFS and associated with poor clinicopathological parameters in GC patients.

Profiles Combining Muscle Atrophy and Neutrophil-to-Lymphocyte Ratio Are Associated with Prognosis of Patients with Stage IV Gastric Cancer

We aimed to investigate the impact of muscle atrophy and the neutrophil-to-lymphocyte ratio (NLR), a sub-clinical biomarker of inflammation and nutrition, on the prognosis of patients with unresectable advanced gastric cancer. We retrospectively enrolled 109 patients with stage IV gastric cancer (median age 69 years; female/male 22%/78%; median observational period 261 days). Independent factors and profiles for overall survival (OS) were determined by Cox regression analysis and decision-tree analysis, respectively. OS was calculated using the Kaplan–Meier method. The prevalence of muscle atrophy was 82.6% and the median NLR was 3.15. In Cox regression analysis, none of factors were identified as an independent factor for survival. The decision-tree analysis revealed that the most favorable prognostic profile was non-muscle atrophy (OS rate 36.8%). The most unfavorable prognostic profile was the combination of muscle atrophy and high NLR (OS rate 19.6%). The OS rate was significantly lower in patients with muscle atrophy and high NLR than in patients with non-muscle atrophy (1-year survival rate 28.5% vs. 54.7%; log-rank test p = 0.0014). In conclusion, “muscle atrophy and high NLR” was a prognostic profile for patients with stage IV gastric cancer. Thus, the assessment of muscle mass, subclinical inflammation, and malnutrition may be important for the management of patients with stage IV gastric cancer.