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Seo BM, Choi J, Chang B, Kim BG, Park TS, Lee H, Moon JY, Kim SH, Kim TH, Yoo SJ, Park HJ, Yoon HJ, Sohn JW, Lee SH, Park DW. Clinical significance of the advanced lung cancer inflammation index in patients with limited-stage small cell lung cancer treated with chemoradiotherapy. Sci Rep 2024; 14:10347. [PMID: 38710892 PMCID: PMC11074130 DOI: 10.1038/s41598-024-61145-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/02/2024] [Indexed: 05/08/2024] Open
Abstract
The aim of the study was to investigate the prognostic significance of the advanced lung cancer inflammation index (ALI) in patients with limited-stage small-cell lung cancer (LS-SCLC) undergoing definite chemo-radiotherapy (CRT). We included 87 patients with LS-SCLC from South Korea, treated between 2005 and 2019 with definite CRT. ALI was calculated using body mass index, serum albumin, and neutrophil-lymphocyte ratio. We categorized 38 patients into the high ALI group (ALI ≥ 44.3) and 48 into the low ALI group (ALI < 44.3). Patients in the high ALI group exhibited longer overall survival (OS) than patients in the low ALI group. In multivariate analysis, prophylactic cranial irradiation (hazard ratio [HR] = 0.366, 95% confidence interval [CI] 0.20-0.66, P = 0.0008), and high ALI (HR = 0.475, 95% CI 0.27-0.84, P = 0.0103) were identified as independent prognostic factors for predicting better OS. Notably, a high ALI score was particularly indicative of longer survival in patients treated with the combination of etoposide and cisplatin. In conclusion, this study demonstrated that a high pretreatment ALI was significantly associated with better OS in patients with LS-SCLC undergoing definite CRT. This suggests that ALI could be a useful tool for predicting prognosis and guiding chemotherapy regimen selections in clinical practice for LS-SCLC.
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Affiliation(s)
- Bo Mi Seo
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jiin Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Boksoon Chang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyungheedae-ro 23, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Bo-Guen Kim
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Tai Sun Park
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Tae-Hyung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Seung-Jin Yoo
- Department of Radiology, Hanyang University College of Medicine, Seoul, South Korea
| | - Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, South Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jang Won Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Seung Hyeun Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyungheedae-ro 23, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Fumagalli RM, Chiarelli M, Cazzaniga M, Bonato C, D'Angelo L, Cavalieri D'Oro L, Cerino M, Terragni S, Lainu E, Lorini C, Scarazzati C, Tazzari SE, Porro F, Aldé S, Burati M, Brambilla W, Nattino S, Locatelli M, Valsecchi D, Spreafico P, Tantardini V, Schiavo G, Zago MP, Fumagalli LAM. Blood cell differential count discretisation modelling to predict survival in adults reporting to the emergency room: a retrospective cohort study. BMJ Open 2023; 13:e071937. [PMID: 37993167 PMCID: PMC10668290 DOI: 10.1136/bmjopen-2023-071937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/02/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVES To assess the survival predictivity of baseline blood cell differential count (BCDC), discretised according to two different methods, in adults visiting an emergency room (ER) for illness or trauma over 1 year. DESIGN Retrospective cohort study of hospital records. SETTING Tertiary care public hospital in northern Italy. PARTICIPANTS 11 052 patients aged >18 years, consecutively admitted to the ER in 1 year, and for whom BCDC collection was indicated by ER medical staff at first presentation. PRIMARY OUTCOME Survival was the referral outcome for explorative model development. Automated BCDC analysis at baseline assessed haemoglobin, mean cell volume (MCV), red cell distribution width (RDW), platelet distribution width (PDW), platelet haematocrit (PCT), absolute red blood cells, white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils and platelets. Discretisation cut-offs were defined by benchmark and tailored methods. Benchmark cut-offs were stated based on laboratory reference values (Clinical and Laboratory Standards Institute). Tailored cut-offs for linear, sigmoid-shaped and U-shaped distributed variables were discretised by maximally selected rank statistics and by optimal-equal HR, respectively. Explanatory variables (age, gender, ER admission during SARS-CoV2 surges and in-hospital admission) were analysed using Cox multivariable regression. Receiver operating curves were drawn by summing the Cox-significant variables for each method. RESULTS Of 11 052 patients (median age 67 years, IQR 51-81, 48% female), 59% (n=6489) were discharged and 41% (n=4563) were admitted to the hospital. After a 306-day median follow-up (IQR 208-417 days), 9455 (86%) patients were alive and 1597 (14%) deceased. Increased HRs were associated with age >73 years (HR=4.6, 95% CI=4.0 to 5.2), in-hospital admission (HR=2.2, 95% CI=1.9 to 2.4), ER admission during SARS-CoV2 surges (Wave I: HR=1.7, 95% CI=1.5 to 1.9; Wave II: HR=1.2, 95% CI=1.0 to 1.3). Gender, haemoglobin, MCV, RDW, PDW, neutrophils, lymphocytes and eosinophil counts were significant overall. Benchmark-BCDC model included basophils and platelet count (area under the ROC (AUROC) 0.74). Tailored-BCDC model included monocyte counts and PCT (AUROC 0.79). CONCLUSIONS Baseline discretised BCDC provides meaningful insight regarding ER patients' survival.
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Affiliation(s)
- Riccardo Mario Fumagalli
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
- Klinik für Angiologie, UniversitätsSpital Zürich, Zurich, Switzerland
| | - Marco Chiarelli
- Dip.Chirurgico, Chirurgia Urgenza, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Massimo Cazzaniga
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Claudio Bonato
- Dipartimento Servizi Clinici, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Luciano D'Angelo
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Luca Cavalieri D'Oro
- UOC Epidemiologia, Agenzia per la Tutela della Salute Brianza, Monza, Lombardia, Italy
| | - Mario Cerino
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Sabina Terragni
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Elisa Lainu
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Cristina Lorini
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Claudio Scarazzati
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Sara Elisabetta Tazzari
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Francesca Porro
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Simone Aldé
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Morena Burati
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - William Brambilla
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Stefano Nattino
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
- Scuola Spec. Medicina Emergenza-Urgenza, Università degli Studi di Milano, Milano, Lombardia, Italy
| | - Matteo Locatelli
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
- Polo formativo, Agenzia per la Tutela della Salute Brianza, Monza, Lombardia, Italy
| | - Daria Valsecchi
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Paolo Spreafico
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Valter Tantardini
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Gianpaolo Schiavo
- Dipartimento Emergenza Accettazione, Pronto Soccorso, Ospedale Alessandro Manzoni, Lecco, LC, Italy
| | - Mauro Pietro Zago
- Dip.Chirurgico, Chirurgia Urgenza, Ospedale Alessandro Manzoni, Lecco, LC, Italy
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Smith D, Raices M, Cayol F, Corvatta F, Caram L, Dietrich A. Is the neutrophil-to-lymphocyte ratio a prognostic factor in non-small cell lung cancer patients who receive adjuvant chemotherapy? Semin Oncol 2022; 49:482-489. [PMID: 36775797 DOI: 10.1053/j.seminoncol.2023.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Abstract
Inflammation plays a key role in malignant tumor progression. Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and, as such, high isolated pretreatment NLR has been shown in some studies to be associated with worse long-term outcomes. We summarize the data regarding the utility of NLR as a prognosis factor and present results of a single institution study assessing the usefulness of high preoperative NLR as a prognosis factor for patients with successfully resected NSCLC who receive adjuvant cisplatin-based chemotherapy. While largely supportive of the value of NLR as a prognostic factor, the literature is not consistent and suggest a more nuanced association. Our single institution study adds to the exiting literature. We conclude preoperative NLR can be used as a reliable, cost-effective biomarker to estimate prognosis in NSCLC patients who have undergone lung lobectomy with curative intent followed by cisplatin-based adjuvant chemotherapy.
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Affiliation(s)
- David Smith
- Department of Thoracic Surgery and Pulmonary Transplantation of Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Micaela Raices
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Federico Cayol
- Department of Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Franco Corvatta
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Lucas Caram
- Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Agustín Dietrich
- Department of Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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4
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Yin LX, Routman DM, Day CN, Harmsen WS, Haller T, Bartemes K, Price DL, Moore EJ, Foote RL, Neben-Wittich M, Chintakuntlawar AV, Ma DJ, Price KA, Van Abel KM. Low postoperative lymphocyte count increases risk of progression in human papillomavirus associated oropharyngeal cancer. Head Neck 2022; 44:2760-2768. [PMID: 36129387 DOI: 10.1002/hed.27198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/04/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We aim to explore the prognostic role of absolute lymphocyte count (ALC) before, during, and after treatment on oncologic outcomes in human papillomavirus associated oropharyngeal cancer (HPV(+)OPSCC). METHODS Retrospective cohort at a tertiary center, 2006-2018. Multivariable Cox regressions were used to determine the effect of ALC on risk of progression. Univariate linear regression was performed to determine clinical factors associated with lower ALC. RESULTS All 197 patients underwent primary surgery. Mean (SD) ALC nadirs (×109 cells/L) were: baseline (N = 149): 1.69 (0.56); postoperative (N = 126): 1.58 (0.59); post-RT (N = 141): 0.68 (0.35) and long-term (N = 105): 0.88 (0.37). Lower baseline ALC nadir was associated with worse overall survival (HR 3.85, 95%CI: 1.03-14.29, p = 0.04). Lower postoperative ALC nadir was associated with higher risk of progression (HR 2.63, 95%CI: 1.04-6.67, p = 0.04). CONCLUSIONS Lower baseline ALC is associated with worse survival, whereas lower postoperative ALC is associated with increased risk of progression in surgically treated HPV(+)OPSCC. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Courtney N Day
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - William S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Travis Haller
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen Bartemes
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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5
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Keskin Z, Yesildag M. The evaluation of the association between the prevalence and patterns of computed tomography findings of cryptogenic organizing pneumonia, and neutrophil/lymphocyte and platelet/lymphocyte ratios. CHINESE JOURNAL OF ACADEMIC RADIOLOGY 2022; 5:61-68. [PMID: 35224446 PMCID: PMC8857733 DOI: 10.1007/s42058-022-00090-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/16/2022] [Accepted: 02/05/2022] [Indexed: 10/25/2022]
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Emile G, Penager S, Levy C, Johnson A, Allouache D, Lequesne J, Hrab I, Segura C, Morel A, Gunzer K, Faveyrial A, Cherifi F, Da Silva A. Baseline lymphopenia as prognostic factor in patients with metastatic breast cancer treated with palbociclib. Oncol Lett 2021; 23:25. [PMID: 34868362 DOI: 10.3892/ol.2021.13143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
Cyclin-dependent-kinase 4-6 inhibitors (CDK4/6i) have improved the management of hormone receptor (HR)+/human epidermal growth factor receptor (HER)2- metastatic breast cancer (mBC). Currently, there are no valid prognostic factors for response to CDK4/6i. Baseline lymphopenia is reported as a prognostic factor in several types of cancer. The present retrospective study aimed to evaluate the effect of baseline absolute lymphocyte count (ALC) on response to palbociclib. Progression-free survival (PFS) was the primary endpoint. Secondary endpoints were overall survival (OS), best response and safety. A total of 114 patients treated for mBC between 2016 and 2019 were included. Median baseline ALC was 1.4 g/l (range, 0.2-4.3 g/l). A total of 65 (57%) and 49 (43%) patients had baseline ALC values of <1.5 and ≥1.5 g/l, respectively. Patients with baseline lymphopenia exhibited significantly shorter PFS (6 vs. 10 months; P=0.004) and OS (20 vs. 33 months; P=0.02). ALC <1.5 g/l independently predicted worse survival, as indicated by multivariate analysis (P=0.04; hazard ratio, 1.76; 95% confidence interval, 1.02-3.02). Patients with baseline ALC <1.5 g/l had significantly less partial response (14 vs. 22%; P=0.016) and more disease progression (46 vs. 20%; P=0.016) than those with ALC ≥1.5 g/l. ALC is a strong and easy-to-use dosage with prognostic factor for patients with HR+/HER2- mBC treated with palbociclib and endocrine therapy. Lymphopenia may also be a predictive factor of early progression. These data need to be verified in a larger prospective study.
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Affiliation(s)
- George Emile
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Sarah Penager
- Clinical Research Department, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Christelle Levy
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Alison Johnson
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Djelila Allouache
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Justine Lequesne
- Clinical Research Department, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Ioana Hrab
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Carine Segura
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Adeline Morel
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Katarina Gunzer
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Audrey Faveyrial
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Francois Cherifi
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Angelique Da Silva
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
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7
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Hannarici Z, Yilmaz A, Buyukbayram ME, Tekin SB, Bilici M. A novel prognostic biomarker for cutaneous malignant melanoma: red cell distribution width (RDW) to lymphocyte ratio. Melanoma Res 2021; 31:566-574. [PMID: 34570023 DOI: 10.1097/cmr.0000000000000785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It is well-known that inflammation plays a significant role in cancer formation and prognosis. Both lymphocyte count and red cell distribution width (RDW) has been used to predict prognosis in various cancers as an indicator of inflammation. Yet, the role of RDW-lymphocyte ratio (RLR) in determining prognosis is still unknown. We aimed to determine the prognostic role of RLR in cutaneous malignant melanoma (MM). One hundred fifteen patients with MM were included in the study retrospectively. The relationship of the clinical-pathological data with overall survival (OS) and progression-free survival (PFS) was analyzed using Kaplan-Meier curves. The cut-off values of neutrophil to lymphocyte ratio, systemic immune-inflammation index (SII), prognostic nutritional index (PNI) and RLR were determined as 2, 487, 51.5 and 6.52, respectively. OS was significantly longer in the low SII, high PNI, low RLR group, while PFS was longer in groups with high PNI and low RLR. In univariate analysis, it was determined that PFS was significantly correlated with Eastern Cooperative Oncology Group (ECOG) performance, TNM stage, PNI and RLR. Moreover, in univariate analysis, a significant correlation was determined between OS and age, ECOG performance, TNM stage, adjuvant interferon, SII, PNI and RLR. In multivariate analysis, ECOG performance, TNM stage and RLR were determined as independent prognostic factors for PFS, while TNM stage and RLR were found to be independent prognostic factors for OS. RLR could be a novel prognostic marker for both PFS and OS in patients with cutaneous MM.
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Affiliation(s)
- Zekeriya Hannarici
- Department of Medical Oncology, Atatürk University Faculty of Medicine, Erzurum, Turkey
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8
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Murray NP, Villalon R, Hartmann D, Rodriguez MP, Aedo S. Improvement in immune dysfunction after FOLFOX chemotherapy for Stage III colon cancer is associated with improved minimal residual disease prognostic subtype and outcome. Colorectal Dis 2021; 23:2879-2893. [PMID: 34473913 DOI: 10.1111/codi.15899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 12/25/2022]
Abstract
AIM Minimal residual disease (MRD) is the net result of the biological properties of disseminated tumour cells and the effect of the immune system and treatment to eliminate them. The aim of this work is to report the changes in MRD status and immune function (lymphocyte count) after FOLFOX chemotherapy, and the outcome in Stage III colon cancer patients. METHOD This study is a prospective, single-centre observational study. Lymphocyte counts were determined prior to and 1, 2 and 3 months after the completion of chemotherapy. Circulating tumour cells (CTCs) and bone marrow micrometastases were determined using immunocytochemistry with anticarcinoembryonic antigen prior to and 1 month after chemotherapy. MRD was classified as negative (Group I), micrometastasis positive only (Group II) and CTC positive (Group III). Changes in lymphocyte counts and MRD subtype following chemotherapy and relapse-free progression were analysed. RESULTS Of the total of 185 patients, 83 (44.9%) relapsed. The risk of relapse significantly increased from Groups I to III (p < 0.001) and with decreasing lymphocyte count (p < 0.01). The lymphocyte count significantly decreased from Groups I to III (p < 0.001). Multivariance Cox regression analysis showed hazard ratios of 3.58 (Group II), 17.43 (Group III) and 0.39 (lymphocyte count) in predicting relapse. Following chemotherapy, improved lymphocyte count was associated with improved MRD subtype (p < 0.0001). Neither baseline lymphocyte count nor MRD subtype predicted response to chemotherapy. Five-year relapse-free survival for combined lymphocyte-MRD subtypes was 95%, 57% and 5% for Groups I to III, respectively (p < 0.001). CONCLUSION Following chemotherapy, improvements in immune function were associated with improved MRD subtype and a better relapse-free survival.
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Affiliation(s)
- Nigel P Murray
- Servicio de Medicina, Hospital de Carabineros de Chile, Santiago, Chile.,Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Ricardo Villalon
- Servicio de Coloproctologia, Hospital de Carabineros de Chile, Santiago, Chile
| | - Dan Hartmann
- Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | | | - Socrates Aedo
- Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
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9
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Homkham N, Muangwong P, Pisprasert V, Traisathit P, Jiratrachu R, Chottaweesak P, Chitapanarux I. Dynamic changes in practical inflammation and immunity markers in cancer patients receiving immune-enhancing nutritional supplementation during concurrent chemoradiotherapy. Cancer Biomark 2021; 32:281-291. [PMID: 34151843 PMCID: PMC8673492 DOI: 10.3233/cbm-210086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immune-enhancing nutrition (IMN) strengthens the systematic inflammatory response and the immune system. Neutrophil to lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) are affected during cancer therapies. OBJECTIVE We carried out an analysis of the dynamic changes in NLR and ALC over time in cancer patients with or without IMN supplementation. METHODS 88 cancer patients receiving concurrent chemoradiotherapy (CCRT) were randomized into regular diet group, and regular diet and IMN group.Generalized estimation equation models were used to assess associations between patient's characteristics, IMN, and dynamic changes in NLR and ALC over time. RESULTS NLR and ALC at preCCRT were significantly associated with dynamic changes in NLR (adjusted β= 1.08, 95% confidence interval [CI]: 0.64-1.52) and ALC (adjusted β= 0.41, 95% CI: 0.36-0.46). The magnitudes of the NLR and ALC changes through CCRT were lower in patients receiving IMN, although the differences were not statistically significant except ALC at the end of CCRT in head and neck cancer patients (P= 0.023). CONCLUSION Dynamic negative changes in both markers were demonstrated throughout CCRT. There were non-significant trend in promising changes in both NLR and ALC values in the whole group in IMN supplementation.
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Affiliation(s)
- Nontiya Homkham
- Faculty of Public Health, Thammasat University, Prathumthani, Thailand
| | - Pooriwat Muangwong
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Veeradej Pisprasert
- Division of Clinical Nutrition, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Center of Excellence in Bioresources for Agriculture, Industry and Medicine, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Rungarun Jiratrachu
- Division of Radiation Oncology, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Pattawee Chottaweesak
- Radiotherapy Unit, Radiology Department, Maharat Nakhonratchasima Hospital, Nakhonratchasima, Thailand
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
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10
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Park SJ, Lee J, Kim H, Shin K, Lee M, Park JM, Choi MG, Park CH, Song KY, Lee HH, Kim IH. Association between absolute lymphocyte count and overall mortality in patients with surgically resected gastric cancer. Korean J Intern Med 2021; 36:679-688. [PMID: 33601866 PMCID: PMC8137401 DOI: 10.3904/kjim.2019.358] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS Lymphocytes are an important component of the cell-mediated immune system. As lymphopenia is reportedly associated with poor prognoses in patients with various cancers, we investigated this notion in patients who underwent curative gastrectomy. METHODS We retrospectively analyzed the association between absolute lymphocyte count (ALC) and prognosis in patients with stage I-III gastric cancer who underwent curative surgical resection. Ever lymphopenic patients were defined as those with ALCs < 1,000/μL at any time post-diagnosis except within 30 days post-surgery. Adjusted multivariable regression models were used to evaluate the associations between lymphopenia and overall mortality, gastric cancer-specific mortality, and disease-free survival. RESULTS We investigated 1,222 patients diagnosed between January 2011 and December 2015. Fifty-six patients (4.6%) were lymphopenic at diagnosis and nearly one-quarter (24.8%) were ever lymphopenic with a mean minimum ALC of 640/μL. Older age (odds ratio [OR], 1.02) and higher stage (stage III vs. I; OR, 3.01) were positively associated with ever lymphopenia. On multivariable analysis, ever lymphopenia predicted higher overall mortality (hazard ratio [HR], 1.83; p = 0.008), higher gastric cancer-specific mortality (HR, 1.58; p = 0.048), and shorter disease-free survival (HR, 1.83; p = 0.006). The 5-year gastric cancer-specific mortality rates for ever- and never lymphopenic patients were 10.9% and 3.7%, respectively; their 5-year cumulative recurrence rates were 15.1% and 4.6%, respectively. CONCLUSION This study demonstrate that ever lymphopenia is independent prognostic factor for overall mortality and recurrence in patients with potentially curable gastric cancer; hence, ALCs may be a biomarker for predicting the prognoses of patients with stage I-III gastric cancer who had curative gastrectomy.
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Affiliation(s)
- Se Jun Park
- Divisions of Medical Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jinsoo Lee
- Divisions of Medical Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyunho Kim
- Divisions of Medical Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kabsoo Shin
- Divisions of Medical Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - MyungAh Lee
- Divisions of Medical Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jae Myung Park
- Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Myung-Gyu Choi
- Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Cho Hyun Park
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Han Hong Lee
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - In-Ho Kim
- Divisions of Medical Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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11
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Upadhyay R, Venkatesulu BP, Giridhar P, Kim BK, Sharma A, Elghazawy H, Dhanireddy B, Elumalai T, Mallick S, Harkenrider M. Risk and impact of radiation related lymphopenia in lung cancer: A systematic review and meta-analysis. Radiother Oncol 2021; 157:225-233. [PMID: 33577865 DOI: 10.1016/j.radonc.2021.01.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/17/2021] [Accepted: 01/24/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite the modern advances in treatment techniques, the survival of locally advanced lung cancer patients continues to remain poor. Circulating lymphocytes have an important role to play in local immune response to RT as well as immune checkpoint inhibitors, and radiation related lymphopenia has been associated with inferior survival in various tumors. METHODS We undertook this systematic review and meta-analysis to evaluate the literature on risk and impact of lymphopenia in thoracic tumors. A systematic methodology search of the PubMed, Embase and Cochrane library was performed and eligible studies selected based on pre-defined inclusion and exclusion criteria. Review Manager Version 5.4.1 was used for the meta-analysis. RESULTS Fourteen studies were included in the final systematic review and 10 in the quantitative analysis. Overall mean incidence of severe lymphopenia (absolute lymphocyte count < 500) was 64.24%. The patients with severe lymphopenia were at increased risk of death with a pooled HR of 1.59 (95% CI: 1.40, 1.81, I2 = 17%, P < 0.001) and progression with a pooled HR of 2.1 (95% CI: 1.57, 2.81, I2 = 59%, P < 0.001) compared to patients with no severe lymphopenia. Dosimetric parameters including gross tumor volume, lung V5 and heart V5 were predictive of lymphopenia, while advanced age, lower baseline lymphocyte counts, higher stage and large tumor size were other risk factors. Models predicting estimated radiation dose to lymphocytes were a good surrogate for treatment outcomes. CONCLUSION Radiation related lymphopenia is associated with increased hazard of progression and death in lung cancer. Minimizing the lung and heart dose, especially in patients with concurrent other risk factors can reduce lymphopenia and potentially improve treatment outcomes in these patients.
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Affiliation(s)
- Rituraj Upadhyay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
| | | | - Prashanth Giridhar
- Department of Radiation Oncology, National Cancer Institute, New Delhi, India
| | - B K Kim
- Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston and The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Amrish Sharma
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Hagar Elghazawy
- Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Thiraviyam Elumalai
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Supriya Mallick
- Department of Radiation Oncology, National Cancer Institute, New Delhi, India
| | - Matthew Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Maywood, United States
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12
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Jiang J, Ahuja S. Addressing Patient to Patient Variability for Autologous CAR T Therapies. J Pharm Sci 2021; 110:1871-1876. [PMID: 33340532 DOI: 10.1016/j.xphs.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
Chimeric Antigen Receptor (CAR) T cell therapy clinical trials have had unprecedented success in the endeavors to cure cancer patients, particularly those having hematological cancers. As researchers learn more about the ways to make CAR T cells more effective to kill tumor cells, equally important will be understanding the differences between T cells from healthy donors and cancer patients and how these differences could affect ex vivo expansion of T cells during CAR T production. This undoubtedly could be a crucial factor in treating solid tumors, where CAR T cells are needed in significantly higher numbers. As the evidence for significant differences between the patients and healthy donors is compelling, an adaptable and robust production process should be designed to allow manufacture of the required CAR T cells for all cancer patients. Improving the fundamental understanding of the cellular metabolism and accompanying epigenetic and phenotypic changes during in vivo and ex vivo expansion of T cells will be just as important. Such discoveries will provide an invaluable tool box from which actionable knowledge could be drawn for designing an adaptable CAR T production process that is able to absorb the patient-to-patient variation.
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Affiliation(s)
- Jinlin Jiang
- Cell Culture and Fermentation Sciences, BioPharmaceutical Development, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD
| | - Sanjeev Ahuja
- Cell Culture and Fermentation Sciences, BioPharmaceutical Development, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD.
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13
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Xu K, Li J, Hu M, Zhang H, Yang J, Gong H, Li B, Wan W, Xiao J. Prognostic Significance of Preoperative Inflammatory Biomarkers and Traditional Clinical Parameters in Patients with Spinal Metastasis from Clear Cell Renal Cell Carcinoma: A Retrospective Study of 95 Patients in a Single Center. Cancer Manag Res 2020; 12:59-70. [PMID: 32021423 PMCID: PMC6954859 DOI: 10.2147/cmar.s228570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/07/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this retrospective study was to identify preoperative inflammatory biomarkers and clinical parameters and evaluate their prognostic significance in patients with spinal metastasis from clear cell renal cell carcinoma (CCRCC). Patients and methods Correlations of overall survival (OS) with traditional clinical parameters and inflammatory indicators including the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), lymphocyte–monocyte ratio (LMR), albumin–globulin ratio (AGR), and C-reactive protein to albumin ratio (CRP/Alb ratio) were analyzed in 95 patients with spinal metastasis from CCRCA using the Kaplan–Meier method to identify potential prognostic factors. Factors with P values ≤ 0.1 were subjected to multivariate analysis by Cox regression analysis. P values ≤ 0.05 were considered statistically significant. Results The 95 patients included in this study were followed up by a mean of 48.8 months (median 51 months; range 6–132 months), during which 21 patients died, with a death rate of 22.1%. The statistical results indicated that patients with total piecemeal spondylectomy (TPS), targeted therapy, NLR < 3.8 and PLR < 206.9 had a significantly longer OS rate. Conclusion TPS and targeted therapy could significantly prolong the OS of patients with spinal metastasis from CCRCC. In addition, NLR and PLR are robust and convenient prognostic indicators that have a discriminatory ability superior to other inflammatory biomarkers.
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Affiliation(s)
- Kehan Xu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Jialin Li
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Mengzi Hu
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, People's Republic of China
| | - Hao Zhang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Jian Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Haiyi Gong
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Bo Li
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Wei Wan
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, People's Republic of China
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14
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Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Maskell NA, Cardillo G. ERS/EACTS statement on the management of malignant pleural effusions. Eur J Cardiothorac Surg 2019; 55:116-132. [PMID: 30060030 DOI: 10.1093/ejcts/ezy258] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 12/26/2022] Open
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS.
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Affiliation(s)
- Anna C Bibby
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Patrick Dorn
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | | | - Jose M Porcel
- Pleural Medicine Unit, Arnau de Vilanova University Hospital, IRB Lleida, Lleida, Spain
| | - Julius Janssen
- Department of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marios Froudarakis
- Department of Respiratory Medicine, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dragan Subotic
- Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Phillippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hospital North Aix-Marseille University, Marseille, France
| | - Peter Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Ralph Schmid
- Division of Thoracic Surgery, University Hospital Bern, Bern, Switzerland
| | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology Department, Hospital of the University (CHU) of Lille, Lille, France
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Oxford Centre for Respiratory Medicine, University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol Medical School Translational Health Sciences, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
- Task force chairperson
| | - Giuseppe Cardillo
- Task force chairperson
- Department of Thoracic Surgery, Carlo Forlanini Hospital, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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15
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Clinical significance of traditional clinical parameters and inflammatory biomarkers for the prognosis of patients with spinal chondrosarcoma: a retrospective study of 150 patients in a single center. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1468-1479. [PMID: 31055664 DOI: 10.1007/s00586-019-05993-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/26/2019] [Accepted: 04/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate the clinical significance of five inflammatory biomarkers and conventional clinical parameters in prognostic prediction of spinal chondrosarcoma. METHODS Univariate and multivariate analyses were performed to investigate independent prognostic factors for recurrence and death of patients with spinal chondrosarcoma. Disease-free survival (DFS) and overall survival (OS) were estimated by Kaplan-Meier curve, and differences were analyzed by log-rank test. The optimal cutoff values for NLR, PLR, LMR, and CAR were determined by X-tile program. RESULTS The optimal cutoff value for NLR, PLR, LMR, AGR, and CAR was 2.7, 200, 3.0, 1.5, and 0.2, respectively. Of the 150 patients included, recurrence was detected in 105 patients, and death occurred in 78 patients. Multivariate analysis indicated that Tomita I-III, total resection, and CAR < 0.2 were significantly associated with longer DFS. Meanwhile, preoperative Frankel score D-E, total resection, and CAR < 0.2 were favorable prognostic factors for OS. Subtype analysis showed that only total resection was an independent prognostic factor for DFS of recurrent spinal chondrosarcoma. CONCLUSION Total resection could significantly reduce the recurrence rate of spinal chondrosarcoma and improve OS of chondrosarcoma patients. Tomita classification I-III was a favorable factor for DFS, and preoperative Frankel score A-C was an adverse prognostic factor for OS. CAR was the most robust prognostic indicator with a discriminatory ability as compared with other inflammatory indicators. These slides can be retrieved under Electronic Supplementary Material.
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16
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Martínez R, Tapia G, De Muga S, Hernández A, Cao MG, Teixidó C, Urrea V, García E, Pedreño-López S, Ibarz L, Blanco J, Clotet B, Cabrera C. Combined assessment of peritumoral Th1/Th2 polarization and peripheral immunity as a new biomarker in the prediction of BCG response in patients with high-risk NMIBC. Oncoimmunology 2019; 8:1602460. [PMID: 31413912 DOI: 10.1080/2162402x.2019.1602460] [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: 11/29/2018] [Revised: 01/17/2019] [Accepted: 03/29/2019] [Indexed: 01/04/2023] Open
Abstract
Intravesical Bacille Calmette-Guérin (BCG) remains the most effective treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), unfortunately there is no validated biomarker to predict clinical outcome. Here we tried to explore the possibility that a combination of the density of peritumoral infiltrating cells (Th1, Th2 and PD-L1) and the composition of peripheral immune cells (neutrophil and lymphocyte counts) could generate a more reliable prognostic biomarker. Twenty-two patients with high-risk NMIBC treated with BCG (10 BCG nonresponders and 12 BCG responders) were selected. BCG responders had significantly lower level of peritumoral T-bet+ cells with an associated higher GATA-3+/T-bet+ ratio (p = 0.04, p = 0.02, respectively). Furthermore, the immune polarization in tissue (GATA-3+/T-bet+ ratio) adjusted for the systemic inflammation (neutrophil-to-lymphocyte ratio) showed a significantly higher association with the BCG response (p = 0.004). A survival analysis demonstrated prolonged recurrence-free survival (RFS) in patients with a lower T-bet+/Lymphocyte ratio and higher GTR/NLR (p = 0.01). No association was observed between peritumoral PD-L1+ expression and the BCG response. In conclusion, alterations in overall immune function, both local and systemic, may influence the therapeutic response to BCG, therefore a combined analysis of tumoral (Th2/Th1 ratio) and peripheral (NLR) immune composition prior to treatment may be a promising approach to predict the BCG response in high-risk NMIBC patients.
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Affiliation(s)
- Roberto Martínez
- Urology Department, Hospital Universitario Germans Trias i Pujol, IGTP, UAB, Badalona, Spain
| | - Gustavo Tapia
- Pathology Department, Hospital Universitario Germans Trias i Pujol, IGTP, UAB, Badalona, Spain
| | - Silvia De Muga
- IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Research Institute (IGTP) UAB, Badalona, Spain
| | - Alba Hernández
- Pathology Department, Hospital Universitario Germans Trias i Pujol, IGTP, UAB, Badalona, Spain
| | - Maria González Cao
- Dr. Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Cristina Teixidó
- Pangaea Biotech, Quirón Dexeus University Hospital, Barcelona, Spain.,Pathology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Victor Urrea
- IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Research Institute (IGTP) UAB, Badalona, Spain
| | - Elisabet García
- IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Research Institute (IGTP) UAB, Badalona, Spain
| | - Sònia Pedreño-López
- IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Research Institute (IGTP) UAB, Badalona, Spain
| | - Luis Ibarz
- Urology Department, Hospital Universitario Germans Trias i Pujol, IGTP, UAB, Badalona, Spain
| | - Julià Blanco
- IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Research Institute (IGTP) UAB, Badalona, Spain.,AIDS and Related Illnesses, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Vic, Barcelona, Spain
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Research Institute (IGTP) UAB, Badalona, Spain.,AIDS and Related Illnesses, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Vic, Barcelona, Spain
| | - Cecilia Cabrera
- IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Research Institute (IGTP) UAB, Badalona, Spain
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17
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Prognostic Importance of Controlling Nutritional Status in Patients Undergoing Curative Thoracoscopic Esophagectomy for Esophageal Cancer. Am J Ther 2019; 25:e524-e532. [PMID: 26866437 PMCID: PMC6133196 DOI: 10.1097/mjt.0000000000000414] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It is now clear that cancer survival is determined not only by tumor pathology but also by host-related factors, in particular, nutritional status and systemic inflammation. It is desirable that the essential properties of any scale designed or intended to be used for the prediction of survival are simple, convenient, and objective. In this study, we retrospectively reviewed the database of patients who underwent curative surgery for esophageal cancer in our department to evaluate controlling nutritional status (CONUT) and neutrophil–lymphocyte ratio (NLR) as predictors of cancer-specific survival (CSS) after esophagectomy. We retrospectively reviewed the database of 148 consecutive patients who underwent potentially curative surgery for histologically verified esophageal squamous cell carcinoma at our institute between January 2002 and December 2014. CONUT and NLR were calculated. On multivariate analysis, pTNM stage (P < 0.0001) and CONUT (P = 0.0291) were independently associated with worse prognosis. Multivariate analysis evaluated the prognostic factors in 2 different patient groups: patients younger than 70 years (nonelderly) and those aged 70 years or more (elderly). Multivariate analysis demonstrated that pTNM stage (P = 0.0083) and CONUT (P = 0.0138) were the independent risk factors for a worse prognosis among the nonelderly group, whereas univariate analysis demonstrated that pTNM stage (P = 0.0002) was the only independent risk factor for a worse prognosis among the elderly group. CONUT was a significant predictor of CSS in patients with esophageal cancer in this study. However, pTNM stage remained a significantly more powerful predictor of CSS. Therefore, the results of this study suggested that CONUT and pTNM stage are the significant and complementary factors predicting survival in patients with esophageal cancer. But, this study failed to confirm the NLR as a significant predictor of CSS after resection for esophageal cancer.
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18
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Oh SY, Heo J, Noh OK, Chun M, Cho O, Oh YT. Absolute Lymphocyte Count in Preoperative Chemoradiotherapy for Rectal Cancer: Changes Over Time and Prognostic Significance. Technol Cancer Res Treat 2018; 17:1533033818780065. [PMID: 29909729 PMCID: PMC6024269 DOI: 10.1177/1533033818780065] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We analyzed the changes in absolute lymphocyte count and its changes over time in 139 patients treated with preoperative chemoradiotherapy for locally advanced rectal cancer. The baseline absolute lymphocyte count was defined as the median of absolute lymphocyte count levels measured during 30 days before preoperative chemoradiotherapy. Absolute lymphocyte count at 1 month, 0.5 to 1 year, 1 to 2 years, and 2 to 3 years were determined by the median values of the absolute lymphocyte counts during the respective periods. Absolute lymphocyte count decreased after delivering preoperative chemoradiotherapy, reached minimum level at 1 month, and then gradually increased after the completion of chemoradiotherapy. Baseline absolute lymphocyte count had significant correlations with the absolute lymphocyte count of every period (range of coefficient, 0.41-0.64, P < .001). The overall survival of the group with high baseline absolute lymphocyte count was significantly higher than that of the group with low baseline absolute lymphocyte count (5-year overall survival: 82.4% vs 62.9%, P = .012). In multivariable analyses, the baseline absolute lymphocyte count remained as a significant prognostic factor for overall survival, favoring the group with a high baseline absolute lymphocyte count (hazard ratio = 0.405, P = .017). This study showed that the level of baseline absolute lymphocyte count was an independent prognostic factor, and it correlated with the absolute lymphocyte counts across varying periods of treatments and follow-up in patients treated with preoperative chemoradiotherapy for rectal adenocarcinoma.
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Affiliation(s)
- Seung Yeop Oh
- 1 Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jaesung Heo
- 2 Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - O Kyu Noh
- 1 Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.,2 Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.,3 Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,4 Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Mison Chun
- 2 Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Oyeon Cho
- 2 Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young-Taek Oh
- 2 Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
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19
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Hirai T, Ogawa R, Yamaga R, Itoh T. Impact of relative dose intensity on bone marrow suppression induced by S-1: retrospective observational study. J Pharm Health Care Sci 2018; 4:30. [PMID: 30524750 PMCID: PMC6276246 DOI: 10.1186/s40780-018-0127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022] Open
Abstract
Background S-1 (a combination of tegafur, gimeracil, and oteracil) is used to treat various cancers. Bone marrow suppression is a dose-limiting toxicity of S-1. The relationship between relative dose intensity (RDI) and bone marrow suppression has not been investigated. Hence, we aimed to elucidate the threshold for RDI to identify bone marrow suppression induced by S-1. Methods In this retrospective cohort study, patients who initiated S-1 treatment at Tokyo Women’s Medical University, Medical Center East between June 2015 and June 2017 were included. Bone marrow suppression induced by S-1 was assessed using Common Terminology Criteria for Adverse Events version 4.0. The relationships between grade 3 or higher bone marrow suppression induced by S-1 and RDIs (i.e., 70, 75, and 80%) were investigated using the multivariate Cox proportional hazard model. Results We identified 143 patients in this study. The median RDI was 78.8%. Bone marrow suppression induced by S-1 developed in 19 (13.3%) patients. The multivariate Cox proportional hazard model revealed that grade ≥ 2 lymphocytopenia was associated with bone marrow suppression induced by S-1 regardless of the threshold for RDI. In addition, RDI > 75% [hazard ratio (HR) = 1.71, p < 0.05] and RDI > 80% (HR = 1.65, p < 0.05) were associated with bone marrow suppression induced by S-1. Conclusions Reduced dose of S-1 still has the risk of developing bone marrow suppression. Clinicians should assess RDI to identify high risk patients with bone marrow suppression induced by S-1.
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Chen J, Zhang L, Yu X, Zhou H, Luo Y, Wang W, Wang L. Clinical application of plasma mitochondrial DNA content in patients with lung cancer. Oncol Lett 2018; 16:7074-7081. [PMID: 30546441 PMCID: PMC6256833 DOI: 10.3892/ol.2018.9515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/29/2018] [Indexed: 12/24/2022] Open
Abstract
Alterations of mitochondrial DNA (mtDNA) have been identified in several types of solid tumor. However, to the best of our knowledge, the clinical significance of plasma mtDNA content in lung cancer remains unknown. Thus, the current study explored the diagnostic and prognostic value of plasma mtDNA quantification in patients with lung cancer. Plasma mtDNA copy numbers of patients with lung cancer (n=128) and healthy individuals (n=107) were quantified by quantitative polymerase chain reaction. Plasma mtDNA copy numbers in patients and healthy controls were 0.89×104 and 1.37×104 copies/µl, respectively (P<0.0001). Furthermore, lower plasma mtDNA content was associated with tumor size, lymph node metastases, distant metastases and serum carcinoembryonic antigen levels (P<0.05), but was not associated with pathological type, age, sex or main driver gene mutation status (P>0.05). Plasma mtDNA facilitated the detection of lung cancer at a threshold of 1.19×104 copies/µl with a sensitivity of 71.1% and specificity of 70.1%, as determined by receiver operating characteristic curve analysis. Advanced stage (III and IV) patients with a lower mtDNA copy number (cutoff: 1.02×104 copies/µl) tended to exhibit poorer prognosis (P<0.05). These results indicated that plasma mtDNA content is a promising and complementary candidate with tissue mtDNA for diagnosis and prognostic prediction for lung cancer.
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Affiliation(s)
- Jianhua Chen
- Thoracic Medicine Department 1, Hunan Cancer Hospital Affiliated to Xiangya Medical School, Central South University, Changsha, Hunan 410013, P.R. China
| | - Lemeng Zhang
- Thoracic Medicine Department 1, Hunan Cancer Hospital Affiliated to Xiangya Medical School, Central South University, Changsha, Hunan 410013, P.R. China
| | - Xun Yu
- Thoracic Medicine Department 1, Hunan Cancer Hospital Affiliated to Xiangya Medical School, Central South University, Changsha, Hunan 410013, P.R. China
| | - Hui Zhou
- Hematology Department, Hunan Cancer Hospital Affiliated to Xiangya Medical School, Central South University, Changsha, Hunan 410013, P.R. China
| | - Yongzhong Luo
- Thoracic Medicine Department 1, Hunan Cancer Hospital Affiliated to Xiangya Medical School, Central South University, Changsha, Hunan 410013, P.R. China
| | - Wei Wang
- Thoracic Medicine Department 1, Hunan Cancer Hospital Affiliated to Xiangya Medical School, Central South University, Changsha, Hunan 410013, P.R. China
| | - Lijing Wang
- Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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Campian JL, Ye X, Sarai G, Herman J, Grossman SA. Severe Treatment-Related Lymphopenia in Patients with Newly Diagnosed Rectal Cancer. Cancer Invest 2018; 36:356-361. [PMID: 30095290 DOI: 10.1080/07357907.2018.1499028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although treatment-related lymphopenia (TRL) is common in many cancers no data exists in rectal cancer. METHODS Serial lymphocyte counts were analyzed retrospectively in patients with newly diagnosed rectal cancer, serial blood counts, and complete records at Johns Hopkins Hospital. RESULTS Fifty-seven patients with normal pretreatment lymphocyte counts were studied. Two months after beginning chemoradiation, 35% of these patients developed grade III-IV lymphopenia [median lymphocyte counts fell from 1590 to 490 cell/mm3 (p < 0.001)] which persisted throughout one year of observation. CONCLUSION Severe and prolonged TRL is common in rectal cancer. Further studies are required to determine TRL's relationship to survival.
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Affiliation(s)
- Jian L Campian
- a Departments of Medicine, Oncology Division , Washington University in St Louis , St Louis , Missouri , USA.,b Departments of Oncology , The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Xiaobu Ye
- b Departments of Oncology , The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Guneet Sarai
- c St. Mary's Hospital , Richmond , Virginia , USA
| | - Joseph Herman
- b Departments of Oncology , The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Stuart A Grossman
- b Departments of Oncology , The Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
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Bibby AC, Dorn P, Psallidas I, Porcel JM, Janssen J, Froudarakis M, Subotic D, Astoul P, Licht P, Schmid R, Scherpereel A, Rahman NM, Cardillo G, Maskell NA. ERS/EACTS statement on the management of malignant pleural effusions. Eur Respir J 2018; 52:13993003.00349-2018. [DOI: 10.1183/13993003.00349-2018] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomised clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature.Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE.The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.
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Garnier M, Zaragoza J, Bénéton N, Bens G, Meurisse V, Samimi M, Maillard H, Machet L. High neutrophil-to-lymphocyte ratio before starting anti-programmed cell death 1 immunotherapy predicts poor outcome in patients with metastatic melanoma. J Am Acad Dermatol 2018; 79:165-167.e2. [DOI: 10.1016/j.jaad.2018.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 12/01/2022]
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Mizuguchi S, Izumi N, Tsukioka T, Komatsu H, Nishiyama N. Neutrophil-lymphocyte ratio predicts recurrence in patients with resected stage 1 non-small cell lung cancer. J Cardiothorac Surg 2018; 13:78. [PMID: 29945635 PMCID: PMC6020444 DOI: 10.1186/s13019-018-0763-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/19/2018] [Indexed: 12/25/2022] Open
Abstract
Background The aim was to determine the prognostic value of the neutrophil-lymphocyte ratio (NLR) in patients with completely resected stage 1 non-small cell lung cancer (NSCLC). Methods The study enrolled 382 NSCLC patients, and an optimal NLR cutoff value was determined by ROC analysis. Patients were divided by preoperative NLR into low (< 1.5, n = 99), intermediate (1.5 ≤ NLR < 3.5, n = 245), and high (NLR ≥ 3.5, n = 38) value groups. Serum diacron-reactive oxygen metabolites (d-ROMs) were assayed in 33 consecutive patients and used as an indicator of oxidative stress. Results The mean NLR in patients with high d-ROMs (> 300 U.CARR, n = 16) was 1.72 ± 0.67, which was significantly higher than that in patients with low d-ROMs (1.41 ± 0.39, n = 17; P = 0.018). The 3-, 5- and 10-year survival rates in the three NLR groups were 92, 77, and 59% (low); 82, 70, and 50% (intermediate); and 76, 58, and 32% (high) (P = 0.034). The 1-, 3- and 5-year recurrence-free survival rates in the three groups were 98, 90, and 86% (low), 91, 77, and 74% (intermediate); and 92, 77, and 68% (high) (P = 0.033). Multivariate analysis found that although NLR was not predictive of overall survival, high NLR was an independent risk factor of recurrence (hazard ratio: 2.03, 95% confidence interval: 1.17–3.79, P = 0.011) as were as age, pathological stage, tumor differentiation, and lymph-vascular invasion. Conclusions A low preoperative NLR predicted good prognosis, and was associated with low systemic inflammation status in patients with stage 1 NSCLC. It may be helpful when considering intervals of routine follow-up or choice of adjuvant therapy.
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Affiliation(s)
- Shinjiro Mizuguchi
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Nobuhiro Izumi
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takuma Tsukioka
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Komatsu
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Noritoshi Nishiyama
- Department of Thoracic Surgery, Osaka City University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Park YM, Oh KH, Cho JG, Baek SK, Kwon SY, Jung KY, Woo JS. A prognostic scoring system using inflammatory response biomarkers in oral cavity squamous cell carcinoma patients who underwent surgery-based treatment. Acta Otolaryngol 2018; 138:422-427. [PMID: 29168424 DOI: 10.1080/00016489.2017.1404640] [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] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness of a scoring system based on the lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio for predicting disease-specific survival of oral cancer patients treated by surgery. METHODS From January 2007 to December 2016, we retrospectively analyzed data from 69 oral cancer patients who received surgery. RESULTS Lymphocyte-to-monocyte ratio was significantly associated with T classification, N classification, and pathologic stage. Neutrophil-to-lymphocyte ratio was significantly associated with T classification and pathologic stage. Platelet-to-lymphocyte ratio was significantly associated with N classification and pathologic stage. In multivariate analysis, only a higher score on this scoring system was significantly associated with poorer disease-specific survival. CONCLUSIONS We found that the prognostic score system based on these three values was significantly associated with disease-specific survival of oral cancer patients who received surgery, indicating that the prognostic scoring system was effective in indirectly predicting systemic inflammatory response.
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Affiliation(s)
- Young Min Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Kyung Ho Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Soon-Young Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Kwang-Yoon Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jeong-Soo Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea
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Prognostic significance of neutrophil-lymphocyteratio/platelet-lymphocyteratioin lung cancers: a meta-analysis. Oncotarget 2018; 7:76769-76778. [PMID: 27732958 PMCID: PMC5363548 DOI: 10.18632/oncotarget.12526] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/10/2016] [Indexed: 01/29/2023] Open
Abstract
Setting For now, hematological markers of inflammatory response have emerged as prognostic factors for patients with cancer. Many articles have confirm that neutrophil to lymphocyte ratio(NLR) and platelet–lymphocyte ratio (PLR) are relate with poor prognosis in various types of tumors. Objective To investigate the association between NLR/PLR and progression free survival (PFS), overall survival (OS) and clinicopathologic parameters in lung cancer patients. Design We performed relevant searches in PubMed database, Google Scholar, Springer Link. We included retrospective cohort studies that reported hazard ratios with 95% confidence intervals for the NLR or PLR and PFS or OS. Results Both high NLR (P < 0.00001) and high PLR (P = 0.01) were significantly predictive of poorer OS. It also demonstrated that elevated NLR predicted poorer PFS (P = 0.0002). High NLR was significantly associated with deeper Invasive of tumor, (P = 0.006) extensive lymph nodetastasis(N2–3) (P = 0.01), poor differentiation (P = 0.0002) and vascular invasion(P = 0.002). There was no evidence of publication bias. Subgroup analysis indicated that little evidence of heterogeneity. However, PLR has no prognostic significance for SCLC. Conclusions We provides further evidence in support of elevated NLR and PLR were predictors of poor OS and PFS in patients with lung cancer. Given this, NLR and PLR may be markers to report treatment outcomes.
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Suzuki R, Lin SH, Wei X, Allen PK, Welsh JW, Byers LA, Komaki R. Prognostic significance of pretreatment total lymphocyte count and neutrophil-to-lymphocyte ratio in extensive-stage small-cell lung cancer. Radiother Oncol 2018; 126:499-505. [PMID: 29398150 DOI: 10.1016/j.radonc.2017.12.030] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/21/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND We evaluated pretreatment total lymphocyte count (TLC, marker of immunosuppression), neutrophil-to-lymphocyte ratio (NLR, marker of inflammation), and overall survival (OS) in patients with extensive-stage small-cell lung cancer (ES-SCLC). METHODS Pretreatment blood characteristics, age, sex, performance status, race, stage (M1a vs. M1b), number and location of metastases, weight loss, smoking status, chemotherapy cycles (<4 vs. ≥4), thoracic radiotherapy dose (<45 vs. ≥45 Gy), and receipt of prophylactic cranial irradiation (PCI) were evaluated in 252 patients with ES-SCLC treated in 1998-2015. Factors significant in univariate analysis were selected as covariates for a multivariate Cox model. RESULTS Pretreatment TLC was below normal (<1.0 × 103/µL) in 58 patients (23%). Median OS time was 11.0 months and was worse for those with TLC ≤ 1.5 × 103/µL (9.8 vs. 12.0 months) and pretreatment NLR > 4.0 (9.4 vs. 13.9 months). Multivariate analysis identified low TLC (hazard ratio [HR] 0.734, 95% confidence interval [CI] 0.565-0.955, P = 0.021) and high NLR (HR 1.521, 95% CI 1.172-1.976, P = 0.002) as predicting inferior survival. Age (>63 y), sex (male), performance status (≥2), chemotherapy cycles (<4), radiation dose (<45 Gy), and no PCI also predicted worse OS (P < 0.05). CONCLUSIONS Pretreatment TLC and NLR may be useful for stratifying patients with ES-SCLC for treatment approaches.
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Affiliation(s)
- Ryoko Suzuki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Xiong Wei
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lauren A Byers
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Veselý P, Touškoví M, Melichar B. Phenotype of Peripheral Blood Leukocytes and Survival of Patients with Metastatic Colorectal Cancer. Int J Biol Markers 2018. [DOI: 10.1177/172460080502000208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Immune dysfunction is prevalent in metastatic cancer. Few patients with colorectal cancer metastases are cured, and among the strategies aimed at improving the therapeutic results in patients with metastatic colorectal cancer, immunotherapy is being increasingly investigated. We evaluated retrospectively the prognostic significance of peripheral blood leukocytes in 59 patients with metastatic colorectal cancer. The relative numbers of CD3+, CD3+CD4+, CD3+CD8+, NK (CD3-CD16+CD56+), CD3+DR+, CD3+CD25+, CD3+CD69+, CD19+, CD19+CD23+, CD8+CD28+, CD8-CD28+, CD8+CD57+, CD14+DR+ and CD14+CD16+ leukocytes were analyzed by two-color flow cytometry. A three-step approach was adopted to identify predictors of prognosis using regression analysis. Based on the results of univariate survival analysis, the absolute number of white blood cells, NK/CD3+CD69+ and NK/white cell count ratios were significant indicators of prognosis. In the multivariate regression analysis a model was obtained using a single parameter, the NK/CD3+CD69+ ratio, predicting the survival with 10–15% power of regression. The present results indicate that the NK/CD3+CD69+ ratio in peripheral blood may be an independent variable in a regression model predicting the overall survival of patients with colorectal cancer metastases to be tested in prospective studies.
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Affiliation(s)
- P. Veselý
- Department of Oncology and Radiotherapy, Charles University Medical School and Teaching Hospital, Hradec Krílové - Czech Republic
- Department of Medicine, Charles University Medical School and Teaching Hospital, Hradec Krílové - Czech Republic
| | - M. Touškoví
- Department of Immunology, Charles University Medical School and Teaching Hospital, Hradec Krílové - Czech Republic
| | - B. Melichar
- Department of Oncology and Radiotherapy, Charles University Medical School and Teaching Hospital, Hradec Krílové - Czech Republic
- Department of Medicine, Charles University Medical School and Teaching Hospital, Hradec Krílové - Czech Republic
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The Prognostic Value of Platelet-to-Lymphocyte Ratio in Urological Cancers: A Meta-Analysis. Sci Rep 2017; 7:15387. [PMID: 29133845 PMCID: PMC5684392 DOI: 10.1038/s41598-017-15673-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022] Open
Abstract
The relationship of platelet-to-lymphocyte ratio (PLR) and survival in urological cancers remained inconsistent in previous studies. Therefore, we performed a meta-analysis to assess the prognostic significance of PLR in patients with urological cancers. A literature search was performed in the PubMed, Embase, and Web of Science up to July, 2017 and study quality was obtained using the Newcastle-Ottawa Scale. To estimate the association of PLR and overall survival (OS) and other survival outcomes in urological cancers, we used pooled hazard ratios (HRs). Subgroup analyses were conducted on different ethnics, sample sizes and cut-off values. 20 high quality studies involving 7562 patients with urological cancers were included in this meta-analysis. High pretreatment PLR was significantly associated with poor OS in patients with urological cancers (pooled HR = 1.58). Elevated PLR was also correlated with other survival outcomes. However, we found that PLR was significantly relevant to the OS of patients with different types of urological cancers except bladder cancer (BCa, HR = 1.16, 95%CI: 0.96–1.41). In conclusion, elevated PLR was negatively related to the OS of patients with urological cancers, except in BCa. However, more large scale prospective studies with high quality are required in the future.
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Li YJ, Yao K, Lu MX, Zhang WB, Xiao C, Tu CQ. Prognostic value of the C-reactive protein to albumin ratio: a novel inflammation-based prognostic indicator in osteosarcoma. Onco Targets Ther 2017; 10:5255-5261. [PMID: 29138578 PMCID: PMC5679688 DOI: 10.2147/ott.s140560] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The prognostic role of the C-reactive protein to albumin ratio (CRP/Alb ratio) in patients with osteosarcoma has not been investigated. A total of 216 osteosarcoma patients were enrolled in the study. Univariate and multivariate survival analyses between the groups were performed and Kaplan-Meier analysis was conducted to plot the survival curves. Receiver operating characteristic curves were generated and areas under the curve (AUCs) were compared to assess the discriminatory ability of the inflammation-based indicators, including CRP/Alb ratio, Glasgow prognostic score (GPS), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). The optimal cutoff value was 0.210 for CRP/Alb ratio with a Youden index of 0.319. Higher values of CRP/Alb ratio were significantly associated with poorer overall survival in univariate (HR =2.62, 95% CI =1.70-4.03; P<0.001) and multivariate (HR =2.21, 95% CI =1.40-3.49; P=0.001) analyses. In addition, the CRP/Alb ratio had significantly higher AUC values compared with GPS (P=0.003), NLR (P<0.001), and PLR (P<0.001). The study demonstrated that the CRP/Alb ratio is an effective inflammation-based prognostic indicator in osteosarcoma, which potentially has a discriminatory ability superior to that of other inflammatory indicators including GPS, NLR, and PLR.
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Affiliation(s)
| | - Kai Yao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Min-Xun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | | | - Cong Xiao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chong-Qi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Pretreatment Neutrophil-to-Lymphocyte Ratio and Lymphocyte Recovery: Independent Prognostic Factors for Survival in Pediatric Sarcomas. J Pediatr Hematol Oncol 2017; 39:538-546. [PMID: 28697168 DOI: 10.1097/mph.0000000000000911] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pretreatment neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) recovery have been shown to be associated with prognosis in several types of cancer in adults. However, evidence in pediatric cancer is scarce. The aim of our study was to evaluate whether pretreatment NLR and lymphocyte recovery are prognostic factors in pediatric sarcomas. MATERIALS AND METHODS Study participants were identified from a retrospective cohort of 100 children with osteosarcoma (n=55), rhabdomyosarcoma (n=22), and Ewing sarcoma (n=23). Data for the hematological variables were obtained from medical records and analyzed with other known prognostic factors in univariate and multivariate analyses. RESULTS In multivariate analysis, NLR>2 was an independent prognostic factor for OS in patients with osteosarcoma (hazard ratio [HR], 2.27, 95% confidence interval [CI], 1.07-5.30; P=0.046) along with metastatic disease and poor histologic response; as well as in patients with rhabdomyosarcoma (HR, 4.76, 95% CI, 1.01-22.24; P=0.0237) along with metastatic disease and risk group. ALC recovery correlated for inferior OS in osteosarcoma (HR, 3.34, 95% CI, 1.37-8.12; P=0.008) and rhabdomyosarcoma (HR, 3.89; 95% CI, 1.01-14.89; P=0.0338). CONCLUSIONS Our study confirms that NLR and ALC recovery are independent prognostic factors for pediatric sarcomas, implying an important role of immune system in survival. Clinical utility of these prognostic biomarkers should be validated in larger pediatric studies.
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Li YJ, Yang X, Zhang WB, Yi C, Wang F, Li P. Clinical implications of six inflammatory biomarkers as prognostic indicators in Ewing sarcoma. Cancer Manag Res 2017; 9:443-451. [PMID: 29033609 PMCID: PMC5628701 DOI: 10.2147/cmar.s146827] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cancer-related systemic inflammation responses have been correlated with cancer development and progression. The prognostic significance of several inflammatory indicators, including neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), Glasgow Prognostic Score (GPS), C-reactive protein to albumin ratio (CRP/Alb ratio), lymphocyte–monocyte ratio (LMR), and neutrophil–platelet score (NPS), were found to be correlated with prognosis in several cancers. However, the prognostic role of these inflammatory biomarkers in Ewing sarcoma has not been evaluated. This study enrolled 122 Ewing patients. Receiver operating characteristic (ROC) analysis was generated to determine optimal cutoff values; areas under the curves (AUCs) were assessed to show the discriminatory ability of the biomarkers; Kaplan–Meier analysis was conducted to plot the survival curves; and Cox multivariate survival analysis was performed to identify independent prognostic factors. The optimal cutoff values of CRP/Alb ratio, NLR, PLR, and LMR were 0.225, 2.38, 131, and 4.41, respectively. CRP/Alb ratio had a significantly larger AUC than NLR, PLR, LMR, and NPS. Higher levels of CRP/Alb ratio (hazard ratio [HR] 2.41, P=0.005), GPS (HR 2.27, P=0.006), NLR (HR 2.07, P=0.013), and PLR (HR 1.85, P=0.032) were significantly correlated with poor prognosis. As the biomarkers had internal correlations, only the CRP/Alb ratio was involved in the multivariate Cox analysis and remained an independent prognostic indicator. The study demonstrated that CRP/Alb ratio, GPS, and NLR were effective prognostic indicators for patients with Ewing sarcoma, and the CRP/Alb ratio was the most robust prognostic indicator with a discriminatory ability superior to that of the other indicators; however, PLR, LMR, and NPS may not be suitable as prognostic indicators in Ewing sarcoma.
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Affiliation(s)
- Yong-Jiang Li
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xi Yang
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wen-Biao Zhang
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Cheng Yi
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Feng Wang
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ping Li
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Liu B, Huang Y, Sun Y, Zhang J, Yao Y, Shen Z, Xiang D, He A. Prognostic value of inflammation-based scores in patients with osteosarcoma. Sci Rep 2016; 6:39862. [PMID: 28008988 PMCID: PMC5180218 DOI: 10.1038/srep39862] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
Abstract
Systemic inflammation responses have been associated with cancer development and progression. C-reactive protein (CRP), Glasgow prognostic score (GPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and neutrophil-platelet score (NPS) have been shown to be independent risk factors in various types of malignant tumors. This retrospective analysis of 162 osteosarcoma cases was performed to estimate their predictive value of survival in osteosarcoma. All statistical analyses were performed by SPSS statistical software. Receiver operating characteristic (ROC) analysis was generated to set optimal thresholds; area under the curve (AUC) was used to show the discriminatory abilities of inflammation-based scores; Kaplan-Meier analysis was performed to plot the survival curve; cox regression models were employed to determine the independent prognostic factors. The optimal cut-off points of NLR, PLR, and LMR were 2.57, 123.5 and 4.73, respectively. GPS and NLR had a markedly larger AUC than CRP, PLR and LMR. High levels of CRP, GPS, NLR, PLR, and low level of LMR were significantly associated with adverse prognosis (P < 0.05). Multivariate Cox regression analyses revealed that GPS, NLR, and occurrence of metastasis were top risk factors associated with death of osteosarcoma patients.
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Affiliation(s)
- Bangjian Liu
- Department of Neurology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, No. 600, Yishan Road, 200233 Shanghai, People's Republic of China
| | - Yujing Huang
- Department of Oncology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, No. 600, Yishan Road, 200233 Shanghai, People's Republic of China
| | - Yuanjue Sun
- Department of Oncology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, No. 600, Yishan Road, 200233 Shanghai, People's Republic of China
| | - Jianjun Zhang
- Department of Oncology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, No. 600, Yishan Road, 200233 Shanghai, People's Republic of China
| | - Yang Yao
- Department of Oncology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, No. 600, Yishan Road, 200233 Shanghai, People's Republic of China
| | - Zan Shen
- Department of Oncology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, No. 600, Yishan Road, 200233 Shanghai, People's Republic of China
| | - Dongxi Xiang
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Aina He
- Department of Oncology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, No. 600, Yishan Road, 200233 Shanghai, People's Republic of China.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Lymphopenia Associated With Adjuvant Chemotherapy After Potentially Curative Surgery for Colorectal Cancer Correlates With Recurrence. Int Surg 2016. [DOI: 10.9738/intsurg-d-14-00236.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this retrospective study was to evaluate the prognostic significance of lymphopenia associated with chemotherapy in patients with colorectal cancer who received adjuvant chemotherapy after undergoing potentially curative surgery. Lymphocyte plays an important role in antitumor immunity. Lymphopenia is sometimes induced during the period of adjuvant chemotherapy after potentially curative surgery for colorectal cancer. However, the prognostic significance of lymphopenia associated with chemotherapy is unknown. One hundred fifteen patients who received adjuvant chemotherapy after potentially curative surgery for stage II/III colorectal cancer were enrolled in this study. All patients were classified into 2 groups, the lymphopenia group and the normal group, according to minimum lymphocyte count during the period of adjuvant chemotherapy. Lymphopenia was defined as a lymphocyte count of less than 1000/μL. Lymphopenia associated with chemotherapy was found in 17 of the 115 patients (14.8%). Lymphopenia was associated with a worse disease-free survival (P = 0.018) and overall survival (P = 0.022). Moreover, in a multivariate analysis, lymphopenia associated with chemotherapy was identified to be an independent prognostic factor for disease-free survival (hazard ratio, 2.296; 95% confidence interval, 1.089–4.840; P = 0.029) and overall survival (hazard ratio, 2.995; 95% confidence interval, 1.021–8.790; P = 0.046). Lymphopenia associated with chemotherapy is an independent prognostic factor in patients with colorectal cancer who receive adjuvant chemotherapy after undergoing potentially curative surgery.
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Predictive value of pretreatment lymphocyte count in stage II colorectal cancer and in high-risk patients treated with adjuvant chemotherapy. Oncotarget 2016; 7:1014-28. [PMID: 26510910 PMCID: PMC4808048 DOI: 10.18632/oncotarget.5835] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/07/2015] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Pretreatment lymphocyte count (LC) has been associated with prognosis and chemotherapy response in several cancers. The predictive value of LC for stage II colorectal cancer (CRC) and for high-risk patients treated with adjuvant chemotherapy (AC) has not been determined. A retrospective review of prospectively collected data from 1332 consecutive stage II CRC patients who underwent curative tumor resection was conducted. A pretreatment LC value <1.3 Giga/L(28.1%, 373/1332) was defined as low LC. A total of 738 patients (55.4%) were considered high-risk, 459 (62.2%) of whom received AC. Patients with low LCs had significantly worse 5-year OS (74.6% vs. 90.2%, p < 0.001) and DFS (61.3% vs. 84.6%, p < 0.001). High-risk patients with low LCs had the poorest DFS (p < 0.001). Multivariate analysis indicated that low LC value or combined with high-risk status were both independent prognostic factors(p <0.001). High-risk, AC-treated patients with high LCs had significantly longer DFS than untreated patients (HR, 0.594; 95% CI, 0.364-0.970; p = 0.035). There was no difference or trend for DFS or OS in patients with low LCs, regardless of the use of AC (DFS, p = 0.692; OS, p = 0.522). Low LC was also independently associated with poorer DFS in high-risk, AC-treated patients (HR, 1.885; 95% CI, 1.112-3.196; p = 0.019). CONCLUSIONS Pretreatment LC is an independent prognostic factor for survival in stage II CRC. Furthermore, pretreatment LC reliably predicts chemotherapeutic efficacy in high-risk patients with stage II CRC.
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The impact of the preoperative peripheral lymphocyte count and lymphocyte percentage in patients with colorectal cancer. Surg Today 2016; 47:743-754. [PMID: 27783149 DOI: 10.1007/s00595-016-1433-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/29/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE We evaluated the prognostic significance of the peripheral lymphocyte count and lymphocyte percentage, which reflect the preoperative immune status, in patients with colorectal cancer (CRC) and then compared their accuracy as predictors of the survival. METHODS We retrospectively reviewed a database of 362 patients. We classified the patients into high lymphocyte count and low lymphocyte count groups. We also classified the patients into high lymphocyte percentage and low lymphocyte percentage groups. RESULTS The 5-year relapse-free survival (RFS) rate in the high lymphocyte count group tended to be higher than that in the low lymphocyte count group. The 5-year overall survival (OS) rate in the high lymphocyte count group was significantly higher than that in the low lymphocyte count group. In contrast, the 5-year RFS and OS rates in the high lymphocyte percentage group were both significantly higher than those in the low lymphocyte percentage group. A multivariate analysis showed that the lymphocyte percentage was independently associated with the OS. CONCLUSIONS These findings suggest that the lymphocyte percentage is a good predictor of the OS and may be a stronger predictor of survival than the lymphocyte count in CRC patients.
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The Prognostic Value of PLR in Lung Cancer, a Meta-analysis Based on Results from a Large Consecutive Cohort. Sci Rep 2016; 6:34823. [PMID: 27703265 PMCID: PMC5050506 DOI: 10.1038/srep34823] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/21/2016] [Indexed: 01/21/2023] Open
Abstract
Recently, many studies have been conducted to explore prognostic value of platelet to lymphocyte ratio (PLR) for patients with lung cancer, while the results remain controversial. We collected pretreatment, clinicopathological and follow-up data of 1388 lung cancer patients receiving surgery between 2006 and 2011 in our hospital, and reviewed relevant articles from Embase, Pubmed, Web of science databases, then performed a meta-analysis to clarify the relationship between PLR and prognosis of lung cancer patients. Finally, 11 articles with our study were included, results indicated elevated PLR was negatively related to overall survival (HR = 1.33, 95% CI: 1.10–1.62), but not related to progress-free survival (HR = 1.21, 95% CI: 0.97–1.49). Subgroup analysis suggested high PLR was correlated with poor survival in non-small cell lung cancer (HR = 1.43, 95% CI: 1.14–1.78), but not in small cell lung cancer (HR = 1.10, 95% CI: 0.76–1.58). Besides, for patients treated by chemotherapy or radiotherapy (HR = 1.66, 95% CI: 1.15–2.38) and patients in late stage (HR = 1.41, 95% CI: 1.19–1.68), PLR had significantly prognostic value. Additionally, the result was significant for patients when cut-off value of PLR was between 150 and 200 (HR = 1.47, 95% CI: 1.18–1.82). In Conclusion, this meta-analysis revealed that elevated PLR was associated with poor prognosis in lung cancer.
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Noble F, Mellows T, McCormick Matthews LH, Bateman AC, Harris S, Underwood TJ, Byrne JP, Bailey IS, Sharland DM, Kelly JJ, Primrose JN, Sahota SS, Bateman AR, Thomas GJ, Ottensmeier CH. Tumour infiltrating lymphocytes correlate with improved survival in patients with oesophageal adenocarcinoma. Cancer Immunol Immunother 2016; 65:651-62. [PMID: 27020682 PMCID: PMC4880639 DOI: 10.1007/s00262-016-1826-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 03/08/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Oesophageal adenocarcinoma (OAC) is increasingly common in the west, and survival remains poor at 10-15 % at 5 years. Immune responses are increasingly implicated as a determining factor of tumour progression. The ability of lymphocytes to recognise tumour antigens provides a mechanism for a host immune attack against cancer providing a potential treatment strategy. MATERIALS AND METHODS Tumour infiltrating lymphocytes (TILs: CD3+, CD4+, CD8+ and FOXp3+) were assessed by immunohistochemistry using tissue microarrays in a contemporary and homogeneous cohort of OAC patients (n = 128) undergoing curative treatment. RESULTS Multivariate analysis identified three independent prognostic factors for improved cancer-specific survival (CSS): increased CD8+ TILs (p = 0.003), completeness of resection (p < 0.0001) and lower pathological N stage (p < 0.0001). Independent prognostic factors for favourable disease-free survival included surgery-only treatment (p = 0.015), completeness of resection (p = 0.001), increased CD8+ TILs (p < 0.0001) and reduced pathological N stage (p < 0.0001). Higher levels of TILs in the pathological specimen were associated with significant pathological response to neoadjuvant chemotherapy (NAC). On multivariate analysis increased levels of CD4+ (p = 0.017) and CD8+ TILs (p = 0.005) were associated with significant local tumour regression and lymph node downstaging, respectively. DISCUSSION Our results establish an association of TILs and survival in OAC, as seen in other solid tumours, and identify particular TIL subsets that are present at higher levels in patients who responded to NAC compared to non-responders. These findings highlight potential therapeutic strategies in EAC based on utilising the host immunological response and highlight the immune responses biomarker potential.
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Affiliation(s)
- Fergus Noble
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building (MP824), Southampton General Hospital, Tremona Road, Southampton, UK.
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Toby Mellows
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building (MP824), Southampton General Hospital, Tremona Road, Southampton, UK
| | - Leo H McCormick Matthews
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building (MP824), Southampton General Hospital, Tremona Road, Southampton, UK
| | - Adrian C Bateman
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Scott Harris
- Public Health Sciences and Medical Statistics, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Timothy J Underwood
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building (MP824), Southampton General Hospital, Tremona Road, Southampton, UK
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James P Byrne
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ian S Bailey
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Donna M Sharland
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jamie J Kelly
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John N Primrose
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building (MP824), Southampton General Hospital, Tremona Road, Southampton, UK
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Surinder S Sahota
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building (MP824), Southampton General Hospital, Tremona Road, Southampton, UK
| | - Andrew R Bateman
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building (MP824), Southampton General Hospital, Tremona Road, Southampton, UK
- Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gareth J Thomas
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building (MP824), Southampton General Hospital, Tremona Road, Southampton, UK
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christian H Ottensmeier
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Somers Cancer Research Building (MP824), Southampton General Hospital, Tremona Road, Southampton, UK
- Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Hyder J, Boggs DH, Hanna A, Suntharalingam M, Chuong MD. Changes in neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios during chemoradiation predict for survival and pathologic complete response in trimodality esophageal cancer patients. J Gastrointest Oncol 2016; 7:189-95. [PMID: 27034785 DOI: 10.3978/j.issn.2078-6891.2015.080] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) predict for survival in cancer patients. In patients receiving multimodality therapy, the effect of therapy on the NLR and PLR is not well understood. We evaluated changes in NLR and PLR among locally advanced esophageal cancer patients who received trimodality therapy. METHODS We performed a retrospective analysis of nonmetastatic patients with esophageal cancer who received neoadjuvant chemoradiation therapy (CRT) followed by esophagectomy at our institution between March 2000 and April 2012. NLR and PLR values were obtained for the following time points (TPs): (I) at diagnosis before CRT; (II) after CRT but prior to surgery; and (III) after surgery. We evaluated changes in NLR and PLR using the difference and ratio between TPs. Overall survival (OS) was evaluated by Kaplan-Meier analysis. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. RESULTS This IRB-approved study included the records of 83 consecutive patients with stage II-IV esophageal cancer. The median age was 60 years, and median follow-up was 29.3 months. Patients were treated to a median prescription dose of 50.4 Gy (range, 50.4-56.4 Gy) in 28-33 fractions. Median NLR and PLR were 3.3 and 157.2, 12 and 645, and 11.5 and 391.7 at TPs 1, 2, and 3, respectively. On multivariate analysis, superior OS was associated with PLR ≥250 at TP3 (P=0.03), PLR decrease ≥609.2 between TP2 and TP3 (P=0.02), and PLR ratio (TP3/TP1) ≥1.08 (P=0.03). Inferior progression-free survival (PFS) was associated with NLR ≥36 at TP2 (P=0.0008), NLR increase ≥28.3 between TP1 and TP2 (P=0.0005), and PLR ratio (TP2/TP3) ≥0.38 (P=0.1). Pathologic complete response (PCR) was less likely for adenocarcinoma (AC) histology (P=0.03), NLR ≥10.6 at TP2 (P=0.04), and NLR increase ≥4.6 from TP1 to TP2 (P=0.03). CONCLUSIONS To our knowledge, this is the first study to examine NLR and PLR values at various time intervals throughout treatment and demonstrate a correlation between OS, PFS, and PCR in patients undergoing trimodality therapy for esophageal cancer.
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Affiliation(s)
- Jalal Hyder
- University of Maryland Medical Center, Baltimore, MD, USA
| | | | - Andrew Hanna
- University of Maryland Medical Center, Baltimore, MD, USA
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Standardized pretreatment inflammatory laboratory markers and calculated ratios in patients with oral squamous cell carcinoma. Eur Arch Otorhinolaryngol 2016; 273:3371-84. [DOI: 10.1007/s00405-016-3950-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/22/2016] [Indexed: 12/18/2022]
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Kou F, Lu Z, Li J, Zhang X, Lu M, Zhou J, Wang X, Gong J, Gao J, Li J, Li Y, Shen L. Pretreatment lymphopenia is an easily detectable predictive and prognostic marker in patients with metastatic esophagus squamous cell carcinoma receiving first-line chemotherapy. Cancer Med 2016; 5:778-86. [PMID: 26814381 PMCID: PMC4864807 DOI: 10.1002/cam4.638] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/22/2015] [Accepted: 12/16/2015] [Indexed: 01/21/2023] Open
Abstract
To explore the influence of pretreatment lymphopenia on the toxicity and efficacy of first‐line chemotherapy in patients with metastatic esophagus squamous cell carcinoma (ESCC). In total, 215 patients were included in this retrospective study. Correlations between pretreatment lymphopenia (lymphocyte count <1 × 109/L) and the occurrence of toxicity and the efficacy of first‐line palliative chemotherapy were investigated. Pretreatment lymphopenia was found in 19.1% of the patients. The overall response rate (ORR) was 35.5% (65 of 183 patients). Patients with pretreatment lymphopenia had a lower ORR to chemotherapy compared with those without lymphopenia (22.2% vs. 38.8%, respectively; P = 0.045). Furthermore, the patients with pretreatment lymphopenia have higher grade 3–4 hematological toxicity than that of patients without pretreatment lymphopenia (19 of 41 patients, 46.3% vs. 54 of 174 patients, 31.0%; P = 0.048). Pretreatment lymphopenia was not correlated with grade 3–4 nonhematological toxicity. Multivariate analysis showed that pretreatment lymphopenia is an independent prognostic factor. Patients with pretreatment lymphopenia had a significantly shorter overall survival time than those without lymphopenia (8.2 months vs. 12.7 months; P = 0.020). This study shows that pretreatment lymphopenia is a good prognostic factor as well as a predictive factor for tumor response and chemotherapy‐related hematological toxicity in metastatic ESCC.
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Affiliation(s)
- Furong Kou
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhihao Lu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jian Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Xiaotian Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Ming Lu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jun Zhou
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Xicheng Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jifang Gong
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jing Gao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jie Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Yan Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Lin Shen
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
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Miljković MD, Grossman SA, Ye X, Ellsworth S, Terezakis S. Patterns of Radiation-Associated Lymphopenia in Children with Cancer. Cancer Invest 2016; 34:32-8. [PMID: 26745229 DOI: 10.3109/07357907.2015.1086366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adults with cancer commonly develop severe lymphopenia two months following chemoradiation therapy, which is an independent predictor of survival. In this retrospective study of 53 children with central nervous system tumors and sarcomas, the frequency, severity, and duration of radiation-associated lymphopenia was similar to that seen in adults. Pretreatment lymphocyte counts were 1,000 cells/mm(3) or greater in all patients, with 66% experiencing grade III-IV lymphopenia two months after chemoradiation. Lymphocyte counts remained significantly lower than baseline 12 months later. Further studies are needed to determine if this is also associated with poorer survival, as seen in adults.
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Affiliation(s)
- Miloš D Miljković
- a Medical Oncology Service , National Cancer Institute , Bethesda , Maryland , USA
| | | | | | - Susannah Ellsworth
- c Department of Radiation Oncology , Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins , Baltimore , Maryland , USA
| | - Stephanie Terezakis
- c Department of Radiation Oncology , Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins , Baltimore , Maryland , USA
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Mendez JS, Govindan A, Leong J, Gao F, Huang J, Campian JL. Association between treatment-related lymphopenia and overall survival in elderly patients with newly diagnosed glioblastoma. J Neurooncol 2016; 127:329-35. [PMID: 26725885 DOI: 10.1007/s11060-015-2037-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/27/2015] [Indexed: 01/05/2023]
Abstract
Management of patients with glioblastoma (GBM) often includes radiation (RT) and temozolomide (TMZ). The association between severe treatment-related lymphopenia (TRL) after the standard chemoradiation and reduced survival has been reported in GBM patients with the median age of 57. Similar findings were described in patients with head and neck, non-small cell lung, and pancreatic cancers. This retrospective study is designed to evaluate whether elderly GBM patients (age ≥65) develop similar TRL after RT/TMZ and whether such TRL is associated with decreased survival. Serial total lymphocyte counts (TLC) were retrospectively reviewed in patients (age ≥65) with newly diagnosed GBM undergoing RT/TMZ and associated with treatment outcomes. Seventy-two patients were eligible: median KPS 70, median age 71 years (range 65-86) with 56 % of patients >70 years, 53% female, 31% received RT ≤45 Gy. Baseline median TLC was 1100 cells/mm(3) which fell by 41% to 650 cells/mm(3) 2 months after initiating RT/TMZ (p < 0.0001). Patients with TLC <500 cells/mm(3) at 2 months had a shorter survival than those with higher TLCs with a median overall survival of 4.6 versus 11.6 months, respectively. Multivariate analysis revealed a significant association between TRL and survival (HR 2.76, 95% CI 1.30-5.86, p = 0.008). Treatment-related lymphopenia is frequent, severe, and an independent predictor for survival in elderly patients with GBM. These findings add to the body of evidence that immunosuppression induced by chemoradiation is associated with inferior clinical outcomes. Prospective studies are needed to confirm these findings suggesting that immune preservation is important in this cancer.
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Affiliation(s)
- Joe S Mendez
- Department of Neurology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Ashwin Govindan
- Department of Medicine, Oncology Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8056, St Louis, MO, 63110, USA
| | - Jacqueline Leong
- Department of Medicine, Oncology Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8056, St Louis, MO, 63110, USA
| | - Feng Gao
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Jiayi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Jian L Campian
- Department of Medicine, Oncology Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8056, St Louis, MO, 63110, USA.
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Wu ES, Oduyebo T, Cobb LP, Cholakian D, Kong X, Fader AN, Levinson KL, Tanner EJ, Stone RL, Piotrowski A, Grossman S, Roche KL. Lymphopenia and its association with survival in patients with locally advanced cervical cancer. Gynecol Oncol 2015; 140:76-82. [PMID: 26571200 DOI: 10.1016/j.ygyno.2015.11.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/06/2015] [Accepted: 11/08/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the association between lymphopenia and survival in women with cervical cancer treated with primary chemoradiation. METHODS A single institution, retrospective analysis of patients with stage IB2-IVA cervical cancer who received upfront chemoradiation from 1998 to 2013 was performed. Complete blood counts from pre-treatment to 36 months post-treatment were analyzed. Lymphopenia and known prognostic factors were evaluated for an association with progression-free (PFS) and overall survival (OS). RESULTS Seventy-one patients met study criteria for whom 47 (66%) had a documented total lymphocyte count (TLC) two months after initiating chemoradiation. FIGO stage distribution was 6% Stage I, 46% Stage II, 45% Stage III and 3% Stage IV. Pre-treatment TLC was abnormal (<1000 cells/mm3) in 15% of patients. The mean reduction in TLC was 70% two months after initiating chemoradiation. Severe post-treatment lymphopenia (TLC <500 cells/mm3) was observed in 53% of patients; they experienced inferior median OS (21.2 vs. 45.0 months, P=0.03) and similar 25th percentile PFS (6.3 vs. 7.7 months, P=0.06) compared to patients without severe lymphopenia. Multivariate analysis demonstrated pre-treatment TLC ≥1000 cells/mm3 and post-treatment TLC >500 cells/mm3 had a 77% (HR: 0.23; 95% CI 0.05-1.03; P=0.053) and 58% decrease in hazards of death (HR: 0.42; 95%CI 0.12-1.46; P=0.17) respectively. CONCLUSION More than half of cervical cancer patients treated with chemoradiation experienced severe and prolonged lymphopenia. Although statistical significance was not reached, the findings suggest that pre- and post-treatment lymphopenia may be associated with decreased survival. Further research is warranted, given that lymphopenia could be a reversible prognostic factor.
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Affiliation(s)
- Emily S Wu
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Titilope Oduyebo
- Department of Epidemiology, Johns Hopkins Hospital School of Public Health, Baltimore, MD, USA
| | - Lauren P Cobb
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Diana Cholakian
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Xiangrong Kong
- Department of Epidemiology, Johns Hopkins Hospital School of Public Health, Baltimore, MD, USA
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kimberly L Levinson
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Edward J Tanner
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Rebecca L Stone
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anna Piotrowski
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Stuart Grossman
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Kara Long Roche
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
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Singab ANB, El-Hefnawy HM, Esmat A, Gad HA, Nazeam JA. A Systemic Review on Aloe arborescens Pharmacological Profile: Biological Activities and Pilot Clinical Trials. Phytother Res 2015; 29:1858-67. [PMID: 26768148 DOI: 10.1002/ptr.5483] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 12/23/2022]
Abstract
Since ancient times, plants and herbal preparations have been used as medicine. Research carried out in the last few decades has verified several such claims. Aloe arborescens Miller, belonging to the Aloe genus (Family Asphodelaceae), is one of the main varieties of Aloe used worldwide. The popularity of the plant in traditional medicine for several ailments (antitumor, immunomodulatory, antiinflammatory, antiulcer, antimicrobial and antifungal activity) focused the investigator's interest on this plant. Most importantly, the reported studies have shown the plant effectiveness on various cancer types such as liver, colon, duodenal, skin, pancreatic, intestinal, lung and kidney types. These multiple biological actions make Aloe an important resource for developing new natural therapies. However, the biological activities of isolated compounds such as glycoprotein, polysaccharides, enzyme and phenolics were insufficient. Considering all these, this contribution provides a systematic review outlining the evidence on the biological efficacy of the plant including the pharmacology and the related mechanisms of action, with specific attention to the various safety precautions, and preclinical and clinical studies, indicating the future research prospects of this plant.
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Affiliation(s)
- Abdel-Naser B Singab
- Pharmacognosy Department, Faculty of Pharmacy, Ain-Shams University, Cairo, Egypt
| | - Hala M El-Hefnawy
- Pharmacognosy Department, Faculty of Pharmacy, Cairo University, Egypt
| | - Ahmed Esmat
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Ain-Shams University, Cairo, Egypt
| | - Haidy A Gad
- Pharmacognosy Department, Faculty of Pharmacy, Ain-Shams University, Cairo, Egypt
| | - Jilan A Nazeam
- Pharmacognosy Department, Faculty of Pharmacy, October 6th University, Egypt
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Shaverdian N, Veruttipong D, Wang J, Schaue D, Kupelian P, Lee P. Pretreatment Immune Parameters Predict for Overall Survival and Toxicity in Early-Stage Non-Small-Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy. Clin Lung Cancer 2015; 17:39-46. [PMID: 26372098 DOI: 10.1016/j.cllc.2015.07.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 01/04/2023]
Abstract
INTRODUCTION We determined whether pretreatment immunologic parameters could predict the outcomes and toxicity in early-stage non-small-cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT). PATIENTS AND METHODS The pretreatment leukocyte, lymphocyte, and neutrophil counts, serum albumin levels, neutrophil-to-lymphocyte ratio (NLR,) and platelet-to-lymphocyte ratio (PLR) were evaluated to determine the association with locoregional control, distant metastasis-free survival (DMFS), disease-specific survival (DSS), overall survival (OS), and treatment-related toxicity. The survival rates were estimated with Kaplan-Meier analysis and multivariate analysis using the Cox proportional hazards model. RESULTS The data from 118 patients with a median follow-up period of 28.9 months were assessed. The 3-year local control, regional control, and DMFS rates were 97%, 87%, and 92%, respectively. The 3-year OS and DSS rates were 77% and 85%, respectively. On univariate analysis, none of the pretreatment immune parameters predicted for disease control. A higher NLR (P = .008), PLR (P = .002), neutrophil count (P = .059), and the presence of lymphocytopenia (P = .032) independently prognosticated for poor OS. Receiver operating characteristic curve analysis found NLRs > 2.18 and PLRs > 187.27 optimally predicted for poor 3-year OS (P = .0262 and P = .0089, respectively). A higher NLR predicted against the development of any symptomatic toxicity and against the development of symptomatic (grade ≥ 2) radiation pneumonitis on univariate analysis, and a higher serum albumin level independently predicted for the development of symptomatic radiation pneumonitis (P = .0491). CONCLUSION In the setting of SBRT, an elevated pretreatment NLR, PLR, and neutrophil count and the presence of lymphocytopenia independently predicted for poor OS. Patients who presented with higher NLRs and lower serum albumin levels experienced less treatment-related symptomatic toxicity.
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Affiliation(s)
- Narek Shaverdian
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Darlene Veruttipong
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Jason Wang
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Dorthe Schaue
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Patrick Kupelian
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Percy Lee
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
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Kim CH, Lee HS, Park JH, Choi JH, Jang SH, Park YB, Lee MG, Hyun IG, Kim KI, Kim HS, Cho SW, Lee WY, Kim EJ, Kim H, Shim JW, Choi YH. Prognostic role of p53 and Ki-67 immunohistochemical expression in patients with surgically resected lung adenocarcinoma: a retrospective study. J Thorac Dis 2015; 7:822-33. [PMID: 26101637 DOI: 10.3978/j.issn.2072-1439.2015.05.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/16/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE p53 mutations and the Ki-67 protein are frequently observed in various types of human cancer; the abnormal expression of p53 and Ki-67 in the tumor is associated with poor survival of lung cancer patients. We aimed to assess the prognostic role of immunohistochemical (IHC) expression of p53 and Ki-67 in lung adenocarcinoma tissue. METHODS Tumor samples from 136 patients who had undergone surgical resection for lung adenocarcinoma were retrospectively evaluated for p53 and Ki-67 expression by immunohistochemistry. Associations of clinical and pathologic variables with p53 and Ki-67 were determined using the χ(2) test. After excluding two patients (follow-up loss), 134 cases were evaluated for associations between p53, Ki-67, clinical and pathologic variables, and survival by using the Cox proportional hazards regression model and Kaplan-Meier method. RESULTS In the 136 patients, p53 was positive in 71.0% (93/131), and Ki-67 showed high in 49.2% (61/124). Unlike p53, Ki-67 was associated with male sex, smoking, and poor tumor differentiation (P=0.004, P=0.001 and P=0.006). Of these, poor tumor differentiation strongly was correlated with high level of Ki-67 expression (P=0.008). Neither p53 nor Ki-67 was associated with increased risk of death (P=0.318, P=0.053); however, age ≥60 years and lymph node involvement were significant predictors of death (P=0.039 and P=0.042). The log-rank test revealed a significant association between Ki-67 and lower survival in all patients (χ(2)=5637; P=0.018); however, the risk was limited to stage III cases (χ(2)=5.939; P=0.015). Unlike p53, patients with high level of Ki-67 expression showed lower 3-year actuarial survival than those without (log-rank test, χ(2)=4.936; P=0.026). CONCLUSIONS IHC expression of Ki-67 in lung adenocarcinoma tissue shows stronger association with poor tumor differentiation, and negatively affects patients' survival in advanced-stage lung cancer; however, the role of p53 on patient outcome needs further study.
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Affiliation(s)
- Cheol-Hong Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Hee Sung Lee
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Ju-Hee Park
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jeong-Hee Choi
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Seung-Hun Jang
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong-Bum Park
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Myung Goo Lee
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - In Gyu Hyun
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Kun Il Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyoung Soo Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung Woo Cho
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Won Yong Lee
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Eung-Joong Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Haeyoung Kim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jung Weon Shim
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Hee Choi
- Departments of 1 Internal Medicine and Lung Research Institute, 2 Thoracic and Cardiovascular Surgery, 3 Radiation Oncology and 4 Pathology, Hallym University College of Medicine, Chuncheon, Korea
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Hudson AL, Weir C, Moon E, Harvie R, Klebe S, Clarke SJ, Pavlakis N, Howell VM. Establishing a panel of chemo-resistant mesothelioma models for investigating chemo-resistance and identifying new treatments for mesothelioma. Sci Rep 2014; 4:6152. [PMID: 25141917 PMCID: PMC4139953 DOI: 10.1038/srep06152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 08/04/2014] [Indexed: 12/13/2022] Open
Abstract
Mesothelioma is inherently chemo-resistant with only 50% of patients responding to the standard of care treatments, and consequently it has a very grim prognosis. The aim of this study was to establish a panel of chemo-resistant mesothelioma models with clinically relevant levels of resistance as tools for investigating chemo-resistance and identifying new treatments for mesothelioma. Chemo-resistant cell lines were established in vitro and characterized in vivo using syngeneic Fischer rats. Tumors derived from all chemo-resistant cell lines were immunohistochemically classified as mesothelioma. Homozygous deletion of p16INK4A/p14ARF and increased expression of several ATP-binding cassette transporters were demonstrated, consistent with findings in human mesothelioma. Further, the acquisition of chemo-resistance in vitro resulted in changes to tumor morphology and overall survival. In conclusion, these models display many features corresponding with the human disease, and provide the first series of matched parental and chemo-resistant models for in vitro and in vivo mesothelioma studies.
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Affiliation(s)
- Amanda L Hudson
- 1] Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St. Leonards, New South Wales, Australia [2] Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales, Australia
| | - Chris Weir
- 1] Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St. Leonards, New South Wales, Australia [2] Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales, Australia
| | - Elizabeth Moon
- 1] Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St. Leonards, New South Wales, Australia [2] Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales, Australia
| | - Rozelle Harvie
- 1] Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St. Leonards, New South Wales, Australia [2] Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales, Australia
| | - Sonja Klebe
- Department of Anatomical Pathology, Flinders University and SA Pathology, Adelaide, Australia
| | - Stephen J Clarke
- 1] Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St. Leonards, New South Wales, Australia [2] Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales, Australia
| | - Nick Pavlakis
- 1] Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St. Leonards, New South Wales, Australia [2] Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales, Australia
| | - Viive M Howell
- 1] Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, University of Sydney, Royal North Shore Hospital, St. Leonards, New South Wales, Australia [2] Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales, Australia
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Zhou X, Du Y, Xu J, Huang Z, Qiu T, Wang X, Qian J, Zhu W, Liu P. The preoperative lymphocyte to monocyte ratio predicts clinical outcomes in patients with stage II/III gastric cancer. Tumour Biol 2014; 35:11659-66. [PMID: 25139101 DOI: 10.1007/s13277-014-2504-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/13/2014] [Indexed: 12/30/2022] Open
Abstract
Recently, lymphocyte to monocyte ratio (LMR) has been reported to be associated with clinical outcomes in some types of cancer but has not been explored in gastric cancer. In this study, we analyzed the association between LMR and clinical outcomes in stage II/III gastric cancer patients. Preoperative LMR calculated from peripheral lymphocyte and monocyte with corresponding clinical features from 426 stage II/III gastric cancer patients was noted. Kaplan-Meier method and Cox regression model were applied for overall survival (OS) and recurrence-free survival (RFS). Related with smaller tumor size (p<0.001), increased LMR could predict better OS [hazard ratio (HR), 0.688; 95% confidence interval (CI), 0.521-0.908, p=0.008] and was borderline significantly associated with better RFS (HR, 0.775; 95% CI, 0.592-1.01, p=0.06) in stage II/III gastric cancer patients through multivariable analysis. Subgroup analyses revealed that except stage III patients for RFS which yielded borderline significance (p=0.052), lower LMR was associated with poor clinical outcomes for patients regardless of different stages or whether the patients received adjuvant chemotherapy. The elevated preoperative LMR level was a significant favorable factor in the prognosis of stage II/III gastric cancer patients, especially for those with stage II. However, further validation of our findings is warranted.
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Affiliation(s)
- Xin Zhou
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
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Yuan D, Zhu K, Li K, Yan R, Jia Y, Dang C. The preoperative neutrophil-lymphocyte ratio predicts recurrence and survival among patients undergoing R0 resections of adenocarcinomas of the esophagogastric junction. J Surg Oncol 2014; 110:333-40. [PMID: 24889121 DOI: 10.1002/jso.23651] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Elevated preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) predict survival rates among patients with several types of cancer. The current study sought to clarify whether NLR and PLR are clinically useful independent prognostic indicators of adenocarcinomas of the esophagogastric junction (AEG) among patients undergoing curative resections (i.e., R0 resections). METHODS A total of 327 patients who underwent R0 resections for AEG were enrolled in the study. Data concerning demographic parameters, laboratory analyses, histopathology, and survival time were collected and analyzed. RESULTS A total of 123 patients (37.6%) had elevated preoperative NLR (≥ 5). The median follow-up duration was 24.7 months (range = 2-39 months). NLR was significantly related to histology (P = 0.035), pTNM stage (P < 0.0001) and tumor recurrence (P = 0.022). Univariate analyses revealed that NLR were significantly associated with disease-free survival (DFS) and overall survival (OS; both P < 0.0001). Multivariable analyses revealed that elevated NLR independently predicted poorer DFS (hazard ratio [HR] = 2.551, P < 0.0001) and OS (HR = 2.743, P < 0.0001). However, PLR did not significantly predict DFS or OS. CONCLUSION The present study indicates that elevated preoperative NLR (≥ 5) is a useful marker of tumor recurrence and independently predicts poorer disease-free and overall survival among patients with AEG undergoing R0 resections.
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Affiliation(s)
- Dawei Yuan
- Department of Surgical Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
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