Exploring the value of new preoperative inflammation prognostic score: white blood cell to hemoglobin for gastric adenocarcinoma patients

Predictive Value of the Total Bilirubin and CA50 Screened Based on Machine Learning for Recurrence of Bladder Cancer Patients

Purpose

Recurrence is the main factor for poor prognosis of bladder cancer. Therefore, it is necessary to develop new biomarkers to predict the prognosis of bladder cancer. In this study, we used machine learning (ML) methods based on a variety of clinical variables to screen prognostic biomarkers of bladder cancer.

Patients and Methods

A total of 345 bladder cancer patients were participated in this retrospective study and randomly divided into training and testing group. We used five supervised clustering ML algorithms: decision tree (DT), random forest (RF), adaptive boosting (AdaBoost), gradient boosting machine (GBM), and extreme gradient boosting (XGBoost) to obtained prediction information through 34 clinical parameters.

Results

By comparing five ML algorithms, we found that total bilirubin (TBIL) and CA50 had the best performance in predicting the recurrence of bladder cancer. In addition, the combined predictive performance of the two is superior to the performance of any single indicator prediction.

Conclusion

ML technology can evaluate the recurrence of bladder cancer. This study shows that the combination of TBIL and CA50 can improve the prognosis prediction of bladder cancer recurrence, which can help clinicians make decisions and develop personalized treatment strategies.

Association between white blood cell-to-haemoglobin ratio and 30 day mortality in heart failure in intensive care unit

AIMS

The short-term mortality of heart failure (HF) patients admitted to the intensive care unit (ICU) is reported to be high. This study aims to explore the association between white blood cell-to-haemoglobin ratio (WHR) and 30 day mortality from the admission to the ICU.

METHODS AND RESULTS

This retrospective cohort study was performed based on the Medical Information Mart for Intensive Care III (MIMIC-III) database (2001-12) and MIMIC-IV database (2008-19). Covariables were selected using the least absolute shrinkage and selection operator regression. Based on the optimal cutoff point selected using the survminer package, WHR was divided into high-ratio group (≥1.6) and low-ratio group (<1.6). The association between WHR and the risk of 30 day mortality was explored using univariate and multivariable Cox regression models. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the prediction performance of WHR. A total of 13 702 patients were included. After adjusting the potential covariates, high WHR was associated with a greater risk of 30 day mortality compared with low WHR [hazard ratio = 1.16, 95% confidence interval (CI): 1.07-1.27, P < 0.001]. WHR also showed a good performance for the prediction of risk of 30 day mortality (AUC = 0.751, 95% CI: 0.746-0.756).

CONCLUSIONS

WHR was positively associated with and performed well to predict 30 day mortality, indicating that WHR may be a reliable index to assess the prognosis of HF patients admitted to the ICU.

Prognostic value of preoperative white blood cell to hemoglobin ratio and fibrinogen to albumin ratio in patients with colorectal cancer

The prognostic value of preoperative white blood cell to hemoglobin ratio (WHR) and fibrinogen to albumin ratio (FAR) in colorectal cancer (CRC) is unknown. The purpose of this study was to analyze the correlation between preoperative WHR and FAR and the prognosis of CRC patients. The retrospective study analyzed the medical records of 207 patients with colorectal cancer who were admitted to Linyi People's Hospital between June 1, 2017 and June 1, 2021. The receiver operator curve was used to determine the cutoff value of 4.604 for WHR and 0.086 for FAR, and the patients were divided into high and low groups for comparative analysis of clinical data. Cox proportional hazards regression models were used to assess independent risk factors for disease-free survival (DFS) and overall survival (OS) in univariate and multifactorial analyses. Kaplan-Meier methods were used for survival analysis and logrank tests were used to assess survival differences. Multifactorial Cox analysis showed that tumor pathological stage (HR = 6.224, 95% CI:3.063-12.647, P < .001), and WHR (HR = 3.681, 95% CI:1.768-7.401, P < .001) were the independent risk factors for DFS in CRC patients. Tumor pathological stage (HR = 4.080, 95% CI:1.992-8.360, P < .001), and WHR (HR = 3.397, 95% CI:1.662-6.940, P = .001) were independent risk factors for OS. High levels of WHR and high levels of FAR were associated with lower DFS (P < .001) and OS (P < .001).CRC patients with both higher WHR and FAR had significantly lower DFS (P < .001) and OS (P < .001). DFS and OS may be shorter in CRC patients with high WHR and high FAR, perhaps associated with poor prognosis in CRC patients, and WHR and FAR may be potential CRC prognostic markers.

Predictive value of white blood cell to hemoglobin ratio for 30-day mortality in patients with severe intracerebral hemorrhage

Aim

To explore the predictive value of white blood cell to hemoglobin ratio (WHR) for 30-day mortality in patients with intracerebral hemorrhage (ICH).

Methods

In this cohort study, 2,848 patients with ICH were identified in the Medical Information Mart for Intensive Care (MIMIC)-III and MIMIC-IV. Least absolute shrinkage and selection operator (LASSO) regression screened covariates of 30-day mortality of ICH patients. COX regression analysis was used to study the association of different levels of WHR, white blood cell (WBC), and hemoglobin (Hb) with 30-day mortality. The median follow-up time was 30 (20.28, 30.00) days.

Results

In total, 2,068 participants survived at the end of the follow-up. WHR was negatively correlated with the Glasgow Coma Score (GCS) (spearman correlation coefficient = -0.143, p < 0.001), and positively associated with the Sepsis-related Organ Failure Assessment (SOFA) score (spearman correlation coefficient = 0.156, p < 0.001), quick SOFA (qSOFA) score (spearman correlation coefficient = 0.156, p < 0.001), and Simplified Acute Physiology Score II (SAPS-II) (spearman correlation coefficient = 0.213, p < 0.001). After adjusting for confounders, WHR >0.833 (HR = 1.64, 95%CI: 1.39-1.92) and WBC >10.9 K/uL (HR = 1.49, 95%CI: 1.28-1.73) were associated with increased risk of 30-day mortality of patients with ICH. The area under the curve (AUC) value of the prediction model based on WHR and other predictors was 0.78 (95%CI: 0.77-0.79), which was higher than SAPSII (AUC = 0.75, 95%CI: 0.74-0.76), SOFA score (AUC = 0.69, 95%CI: 0.68-0.70) and GCS (AUC = 0.59, 95%CI: 0.57-0.60).

Conclusion

The level of WHR was associated with 30-day mortality in patients with severe ICH, and the WHR-based prediction model might provide a tool to quickly predict 30-day mortality in patients with ICH.

Association between white blood cell count to hemoglobin ratio and risk of in-hospital mortality in patients with lung cancer

BACKGROUND

The objective of this study was to investigate the association between white blood cell count to hemoglobin ratio (WHR) and risk of in-hospital mortality in patients with lung cancer.

METHODS

In this retrospective cohort study, the medical records of patients with lung cancer were retrieved from the electronic ICU (eICU) Collaborative Research Database between 2014 and 2015. The primary outcome was in-hospital mortality. The secondary outcome was the length of stay in intensive care unit (ICU). The cut-off value for the WHR was calculated by the X-tile software. The Cox model was applied to assess the association between WHR and in-hospital mortality among patients with lung cancer and the linear regression model was used to investigate the association between WHR and length of ICU stay. Subgroup analyses of age (< 65 years or >  = 65 years), Acute Physiology and Chronic Health Evaluation (APACHE) score (< 59 or >  = 59), gender, ventilation (yes or no), and vasopressor (yes or no) in patients with lung cancer were conducted.

RESULTS

Of the 768 included patients with lung cancer, 153 patients (19.92%) died in the hospital. The median total follow-up time was 6.88 (4.17, 11.23) days. The optimal cut-off value for WHR was 1.4. ICU lung cancer patients with WHR >  = 1.4 had a significantly higher risk of in-hospital mortality [Hazard ratio: (HR): 1.65, 95% confidence interval (CI): 1.15 to 2.38, P = 0.007) and length of stay in ICU (HR: 0.63, 0.01, 95% CI: 1.24 to 0.045, P = 0.045). According to the subgroup analysis, WHR was found to be associated with in-hospital mortality in patients with higher APACHE score (HR: 1.60, 95% CI: 1.06 to 2.41, P = 0.024), in male patients (HR: 1.87, 95% CI: 1.15 to 3.04, P = 0.012), and in patients with the treatment of ventilation (HR: 2.33, 95% CI: 1.49 to 3.64, P < 0.001).

CONCLUSION

This study suggests the association between WHR and risk of in-hospital mortality in patients with lung cancer and length of stay, which indicates the importance of attention to WHR for patients with lung cancer.

The potential of high-order features of routine blood test in predicting the prognosis of non-small cell lung cancer

BACKGROUND

Numerous studies have demonstrated that the high-order features (HOFs) of blood test data can be used to predict the prognosis of patients with different types of cancer. Although the majority of blood HOFs can be divided into inflammatory or nutritional markers, there are still numerous that have not been classified correctly, with the same feature being named differently. It is an urgent need to reclassify the blood HOFs and comprehensively assess their potential for cancer prognosis.

METHODS

Initially, a review of existing literature was conducted to identify the high-order features (HOFs) and classify them based on their calculation method. Subsequently, a cohort of patients diagnosed with non-small cell lung cancer (NSCLC) was established, and their clinical information prior to treatment was collected, including low-order features (LOFs) obtained from routine blood tests. The HOFs were then computed and their associations with clinical features were examined. Using the LOF and HOF data sets, a deep learning algorithm called DeepSurv was utilized to predict the prognostic risk values. The effectiveness of each data set's prediction was evaluated using the decision curve analysis (DCA). Finally, a prognostic model in the form of a nomogram was developed, and its accuracy was assessed using the calibration curve.

RESULTS

From 1210 documents, over 160 blood HOFs were obtained, arranged into 110, and divided into three distinct categories: 76 proportional features, 6 composition features, and 28 scoring features. Correlation analysis did not reveal a strong association between blood features and clinical features; however, the risk value predicted by the DeepSurv LOF- and HOF-models is significantly linked to the stage. Results from DCA showed that the HOF model was superior to the LOF model in terms of prediction, and that the risk value predicted by the blood data model could be employed as a complementary factor to enhance the prognosis of patients. A nomograph was created with a C-index value of 0.74, which is capable of providing a reasonably accurate prediction of 1-year and 3-year overall survival for patients.

CONCLUSIONS

This research initially explored the categorization and nomenclature of blood HOF, and proved its potential in lung cancer prognosis.

Preoperative White Blood Cell-Related Indicators Can Predict the Prognosis of Patients with Transurethral Resection of Bladder Cancer

Introduction

Numerous studies, including bladder cancer (BLCA), have confirmed the relationship between conventional systemic inflammatory biomarkers and the prognosis of tumors. Leukocytes, as the most common factor in inflammatory indicators, have been reported to predict prognosis in other tumors. However, we have not seen this research in BLCA. Therefore, we aim to find new blood markers to predict the prognosis of patients with transurethral resection of bladder tumor (TURBT).

Methods

Two cohorts from the two different hospitals were used for the specific study. The best cutoff values of leukocytes-related indicators were determined according to the ROC curve. Univariate and multivariate Cox regression analysis were used to explore the impact of indicators and clinical features on prognosis for patients with TURBT. The KM curve was used to show the impact of indicators on the prognosis. According to the consequence of multivariate method, a risk model was established to evaluate the prognosis of patients with bladder cancer.

Results

The white blood cell-to-lymphocyte ratio (WLR), the white blood cell-to-hemoglobin ratio (WHR), the white blood cell-to-neutrophil ratio (WNR), the white blood cell-to-monocyte ratio (WMR) and the white blood cell-to-erythrocyte ratio (WRR) are related to the prognosis of BLCA. The new risk model consisted of WHR, WMR and platelet-to-lymphocyte ratio (PLR), and patients with TURBT in the high-risk group had a worse prognosis.

Conclusions

Leukocyte-related preoperative indicators could predict the prognosis of the patients with TURBT and provided some guidance for clinical workers.

NLR, PLR, LMR and MWR as diagnostic and prognostic markers for laryngeal carcinoma

OBJECTIVE

To evaluate whether neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and monocyte-to-white blood cell ratio (MWR) can be used as diagnostic and prognostic markers for laryngeal carcinoma (LC).

METHODS

In this retrospective study, 50 patients with LC treated in the Department of Otolaryngology, Head and Neck Surgery of Beijing Tongren Hospital from August 2014 to August 2015 were enrolled in research group. In addition, 40 healthy volunteers from the same period were selected as control group. The counts of white blood cells, neutrophils, lymphocytes, monocytes and platelets in the peripheral blood of participants were measured with a blood counting instrument (Sysmex XE-2100, Sysmex Corporation, Japan), and the NLR, PLR, LMR and MWR were calculated. After that, the survival rate of patients was observed through a 5-year follow-up. The prognostic value of the above four indexes and their combination was discussed in patients with different clinical characteristics.

RESULTS

Compared with the control group, the NLR, PLR and MWR were higher and the LMR was lower in the research group. In terms of survival, patients with higher NLR, PLR and MWR and lower LMR showed a higher 5-year mortality than those with lower NLR, PLR and MWR and higher LMR, indicating that NLR, PLR and MWR were higher and LMR was lower in the survival group than in the death group. Subsequent analysis identified that NLR, PLR, LMR and MWR were closely correlated with age, alcohol drinking, smoking, clinical staging and T-staging. Clinical staging, T-staging, NLR, PLR, LMR, and MWR were confirmed as influencing factors for LC.

CONCLUSIONS

NLR, PLR, LMR, and MWR can be used as diagnostic and prognostic markers for LC and their combination has a superior diagnostic performance.

Neutrophil Lymphocyte Ratio to Albumin Ratio and White Blood Cell to Hemoglobin Ratio as Prognostic Markers for Hepatocellular Carcinoma Patients Who Underwent Curative Hepatectomy

Purpose

Inflammation factors affect the prognosis of hepatocellular carcinoma (HCC). However, it is not clear if the preoperative neutrophil lymphocyte ratio to albumin ratio (NLRAR) and white blood cell to hemoglobin ratio (WHR) affect the prognosis of HCC post curative hepatectomy. We assessed the prognostic values of NLRAR and WHR in patients suffering from HCC who underwent curative resection.

Materials and Methods

A total of 169 eligible HCC cases were reviewed. The optimal cut-off values for NLRAR and WHR were selected using the X-tile software. The overall survival (OS) rate was assessed following the Kaplan–Meier analysis method. The Log rank test and Cox proportional hazard regression model were also used to analyze the data. The prognostic values of NLRAR and WHR were calculated by analyzing the area under the receiver operating characteristic curve (AUC). The decision curve analysis (DCA) was performed for clinical benefits.

Results

The OS rate recorded for the high NLRAR group was poorer than the OS rate recorded for the low NLRAR group. Similar trends were observed for WHR. The NLRAR and WHR were the independent predictors of OS. The results were based on the multivariate Cox analyses method. Results obtained by analyzing the subgroups revealed that NLRAR and WHR could be used for the prognosis of HCC in tumor stage I-patients. The NLRAR–WHR scoring system (NWS) could be used to classify HCC patients into two cohorts with different prognoses. This scoring system was more efficient than NLRAR or WHR in predicting OS.

Conclusion

The preoperative NLRAR and WHR are effective prognostic indicators for HCC in patients who underwent curative hepatectomy.

Preoperative lymphocyte-to-monocyte ratio is the most predictive inflammatory response marker of survival in gastric cancer

PURPOSE

Systemic inflammatory responses play a key role in cancer progression, and detecting the predictive inflammatory response markers is needed. The present study explored inflammatory response markers capable of predicting survival in patients with gastric cancer.

METHODS

We enrolled 264 patients, who underwent curative gastrectomy for clinical stage (cStage) I-III gastric cancer between 2012 and 2015. The cut-off point of eight preoperative inflammatory response markers was determined by receiver operating characteristic (ROC) curve analysis. The marker with the highest Harrell's concordance index (C-index) was adopted for subsequent univariate and multivariate analyses using the Cox proportional-hazards model.

RESULTS

Among eight representative inflammatory response markers, lymphocyte-to-monocyte ratio (LMR; cut-off point, 4.60) achieved the highest C-index (0.633). The 5-year survival rate was significantly worse in patients with LMR < 4.60 than in those with LMR ≥ 4.60 (67.5% versus 89.0%, P < 0.001). In multivariate analysis, LMR < 4.60 was identified as an independent prognostic factor (hazard ratio: 2.372; 95% confidence interval: 1.266-4.442; P = 0.007).

CONCLUSION

In this study, LMR had the strongest ability to predict the survival of patients with gastric cancer among other inflammatory response markers, with lower LMRs being associated with poor survival following curative gastrectomy.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Prognostic Value of Neutrophil-to-lymphocyte Ratio and Monocyte-to-lymphocyte Ratio in Metastatic Gastric Cancer Treated with Systemic Chemotherapy

Background: The prognostic value of neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) in metastatic gastric cancer (mGC) treated with systemic chemotherapy is largely unknown, especially second-line chemotherapy. We retrospectively investigated the prognostic value of baseline NLR and MLR in the progression of mGC with systemic chemotherapy.

Methods: Patients with mGC diagnosed by pathology from January 2010 to December 2018 were identified. Baseline NLR and MLR were collected before treatment. The time to progression during or after first-line therapy from diagnosis (PFS1), and during or after second-line chemotherapy (PFS2) were primary endpoint. Overall survival (OS) was calculated from diagnosis to the date of death or final follow-up.

Results: 537 patients with first-line chemotherapy were included in the retrospective study. The cutoff values of NLR and MLR were 2.610 and 0.285, respectively. Pretreatment NLR and MLR were significantly independent prognostic factors for PFS1 (hazard ratio [HR]=1.597, 95% CI 1.261-2.022, P<0.001 and HR=1.574, 95% CI 1.239-1.999, P<0.001) and OS (HR=1.448, 95% CI 1.030-2.034, P=0.033 and HR=1.622, 95% CI 1.148-2.291, P=0.006). For 172 patients treated with second-line chemotherapy, the cutoff value of MLR was 0.355 and MLR maintained a significant association with PFS2 (HR=1.589, 95% CI 1.073-2.354, P=0.021) in multivariate analysis.

Conclusions: Elevated NLR and MLR were markedly related to the worse PFS1 and OS in mGC performed with first-line chemotherapy. In patients with second-line therapy, MLR was more closely connected to prognosis and was a significantly independent prognostic factor for PFS2.