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Popovici D, Stanisav C, Sima LV, Negru A, Murg SI, Carabineanu A. Influence of Biomarkers on Mortality among Patients with Hepatic Metastasis of Colorectal Cancer Treated with FOLFOX/CAPOX and FOLFIRI/CAPIRI, Including Anti-EGFR and Anti-VEGF Therapies. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1003. [PMID: 38929620 PMCID: PMC11205545 DOI: 10.3390/medicina60061003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Background and objectives: Colorectal cancer is a major global health concern, with a significant increase in morbidity and mortality rates associated with metastatic stages. This study investigates the prognostic significance of various clinical and laboratory parameters in patients with metastatic CRC. Materials and Methods: A retrospective cohort of 188 CRC patients with hepatic metastasis from the OncoHelp Association in Timisoara was analyzed from January 2016 to March 2023. Data on demographics, clinical characteristics, and biomarkers, such as lymphocyte counts, as well as various inflammation indices, were examined. Statistical analyses included univariate and multivariate logistic regression, Kaplan-Meier survival analysis, and ROC curve assessments. Results: Our findings indicate significant associations between survival outcomes and several biomarkers. Higher BMI and lymphocyte counts were linked with better survival rates, while higher values of Neutrophil-Hemoglobin-Lymphocyte (NHL) score, Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII) were predictors of poorer outcomes. Notably, the presence of hepatic metastasis at diagnosis was a critical factor, significantly reducing overall survival. Conclusions: The study has expanded the current understanding of prognostic factors in CRC, advocating for a multi-dimensional approach to prognostic evaluations. This approach should consider not only the traditional metrics such as tumor stage and histological grading but also incorporate a broader spectrum of biomarkers. Future studies should aim to validate these findings and explore the integration of these biomarkers into routine clinical practice, enhancing the precision of prognostic assessments and ultimately guiding more personalized treatment strategies for CRC patients.
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Affiliation(s)
- Dorel Popovici
- Department of Oncology, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Cristian Stanisav
- Departments of Radiology, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Laurentiu V. Sima
- Department of Surgical Semiology, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Alina Negru
- Department of Cardiology, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Sergiu Ioan Murg
- Doctoral School of Medicine, Faculty of Medicine and Pharmacy, University of Oradea, 1 Decembrie Square 10, 410073 Oradea, Romania
| | - Adrian Carabineanu
- Department of Surgical Semiology, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
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Di Rosa M, Sabbatinelli J, Soraci L, Corsonello A, Bonfigli AR, Cherubini A, Sarzani R, Antonicelli R, Pelliccioni G, Galeazzi R, Marchegiani F, Iuorio S, Colombo D, Burattini M, Lattanzio F, Olivieri F. Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study. J Transl Med 2023; 21:835. [PMID: 37990223 PMCID: PMC10664513 DOI: 10.1186/s12967-023-04717-z] [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: 09/26/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The Neutrophil-to-lymphocyte ratio (NLR) is a marker of poor prognosis in hospitalized older patients with different diseases, but there is still no consensus on the optimal cut-off value to identify older patients at high-risk of in-hospital mortality. Therefore, in this study we aimed at both validating NLR as a predictor of death in older hospitalized patients and assess whether the presence of specific acute diseases can modify its predictive value. METHODS This prospective cohort study included 5034 hospitalizations of older patients admitted to acute care units in the context of the ReportAge study. NLR measured at admission was considered as the exposure variable, while in-hospital mortality was the outcome of the study. ROC curves with Youden's method and restricted cubic splines were used to identify the optimal NLR cut-off of increased risk. Cox proportional hazard models, stratified analyses, and Kaplan-Meier survival curves were used to analyse the association between NLR and in-hospital mortality. RESULTS Both continuous and categorical NLR value (cut-off ≥ 7.95) predicted mortality in bivariate and multivariate prognostic models with a good predictive accuracy. The magnitude of this association was even higher in patients without sepsis, congestive heart failure, and pneumonia, and those with higher eGFR, albumin, and hemoglobin (p < 0.001). A negative multiplicative interaction was found between NLR and eGFR < 45 (p = 0.001). CONCLUSIONS NLR at admission is a readily available and cost-effective biomarker that could improve identification of geriatric patients at high risk of death during hospital stay independent of admitting diagnosis, kidney function and hemoglobin levels.
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Affiliation(s)
- Mirko Di Rosa
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, IRCCS INRCA, Ancona, Italy
| | - Jacopo Sabbatinelli
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
- Laboratory Medicine Unit, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | - Luca Soraci
- Unit of Geriatric Medicine, IRCSS INRCA, C.da Muoio Piccolo, 87100, Cosenza, Italy.
| | - Andrea Corsonello
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, IRCCS INRCA, Ancona, Italy
- Unit of Geriatric Medicine, IRCSS INRCA, C.da Muoio Piccolo, 87100, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Riccardo Sarzani
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
| | | | | | - Roberta Galeazzi
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
| | | | | | | | | | | | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
- Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
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Sowannakul A, Rodpenpear N, Ekbhum P, Tantitamit T. Prognostic Value of The Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Platelet Count for Platinum-Sensitive Recurrent Epithelial Ovarian Cancer. Asian Pac J Cancer Prev 2023; 24:3765-3771. [PMID: 38019234 PMCID: PMC10772778 DOI: 10.31557/apjcp.2023.24.11.3765] [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: 05/19/2023] [Accepted: 11/04/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To study the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet count in patients with platinum-sensitive recurrent epithelial ovarian cancer (PS-ROC). METHODS This was a retrospective study on a database of platinum-sensitive recurrent epithelial ovarian cancer patients who received treatment at HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) between January 2010 and December 2020. The patients' demographic data, surgical factors, pathological factors, laboratory findings, and response to treatment were reviewed from the patients' medical records. Survival analysis was conducted using the Kaplan-Meier survival estimate and Cox regression model. RESULTS In total, 56 patients were recruited in this study. The median overall survival (OS) and progression-free survival (PFS) were 33 (95%CI 23-43) and 11 (95%CI 8-16) months, respectively. Survival analysis showed a high PLR was associated with decreased OS compared with low value but no significant difference in PFS. High NLR was associated with poor OS and PFS. There was no association between the platelet count and survival outcome (OS and PFS). In the multivariable Cox regression analysis, the NLR, PLR, and platelet count were not significant prognostic factors for survival outcome. However, low hemoglobin and a decreased disease-free interval were significantly associated with poor PFS. A white blood cell count (WBC) ≥ 8,000 cells/mm3 was a poor prognostic factor for overall survival (Adjusted HR 7.64; 95%CI: 2.21-26.42; p-value = 0.001). CONCLUSIONS The NLR, PLR, and platelet count were not associated with both the OS or PFS in patients with PS-ROC. However, the WBC level is an easy, readily available, and economical way to predict survival outcomes in PS-ROC patients and may help physicians to tailor therapeutic interventions in the future.
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Affiliation(s)
| | | | | | - Tanitra Tantitamit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.
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Kocoglu Barlas U, Akcay N, Talip M, Menentoglu ME, Sevketoglu E. Is the prognosis of traumatic critically ill pediatric patients predictable? : A multicenter retrospective analysis. Wien Klin Wochenschr 2023; 135:639-645. [PMID: 37684531 DOI: 10.1007/s00508-023-02269-2] [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: 01/09/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND In this retrospective study the effects of the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), mean platelet volume to platelet count ratio (MPV/PC) values as well as C‑reactive protein (CRP) and procalcitonin (PCT) levels on the severity and mortality in critically ill child trauma cases were evaluated. METHODS A total of 80 trauma cases aged 31 days to 16 years that were followed-up in the pediatric intensive care unit (PICU) were included in the study. The data of the patients on the first day of hospitalization (T1), the median day of intensive care admission (T2), and before discharge or exitus (T3) were analyzed. The cases were divided into three groups according to the injury severity score (ISS) as minor, moderate, and severe. RESULTS Of the 80 cases 59 (73.75%) were male and 21 (26.25%) were female. The mean age of all the cases was 54.5 ± 47.8 months, and the mean PICU stay was 7.35 ± 6.64 days. Of the cases 19 (23.75%) due to motor vehicle accidents and 61 (76.25%) due to falling from heights were followed-up. The mortality rate was found to be 13.75% (11 cases). The T1, T2 and T3 NLR, MLR, MPV/PC and PCT values did not differ between the groups. The T1 and T2 CRP levels were higher in the moderate trauma group than in the severe trauma group. Also, ISS and pediatric risk of mortality 3 (PRISM-3) scores were higher while the revised injury severity classification version II (RISC II), RISC II survival and Glasgow coma scale (GCS) scores were lower in the nonsurvivors. While the T3 MLR value was lower in nonsurvival cases, the T3 MPV/PC value was found to be higher. CONCLUSION The NLR, MLR, and MPV/PC values do not predict the severity of the trauma in children. In children with severe trauma, low MLR and high MPV/PC values can be used to predict mortality.
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Affiliation(s)
- Ulkem Kocoglu Barlas
- Istanbul Medeniyet University, Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey.
| | - Nihal Akcay
- University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Mey Talip
- University of Health Sciences Turkey, Prof Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Mehmet Emin Menentoglu
- University of Health Sciences Turkey, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Esra Sevketoglu
- University of Health Sciences Turkey, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Stangl-Kremser J, Sun M, Ho B, Thomas J, Nauseef JT, Osborne JR, Molina A, Sternberg CN, Nanus DM, Bander NH, Tagawa S. Prognostic value of neutrophil-to-lymphocyte ratio in patients with metastatic castration-resistant prostate cancer receiving prostate-specific membrane antigen targeted radionuclide therapy. Prostate 2023; 83:1351-1357. [PMID: 37424145 DOI: 10.1002/pros.24597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/23/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Neutrophil count:lymphocyte count ratio (NLR) may be a prognostic factor for men with advanced prostate cancer. We hypothesized that it is associated with prostate-specific antigen (PSA) response and survival in men treated with prostate-specific membrane antigen (PSMA)-targeted radionuclide therapy (TRT). METHODS Data of 180 men with metastatic castration-resistant prostate cancer (mCRPC) who were treated in sequential prospective radionuclide clinical trials from 2002 to 2021 (utilizing 177Lu-J591, 90Y-J591, 177Lu-PSMA-617, or 225Ac-J591) were retrospectively analyzed. We used a logistic regression to determine the association between NLR and ≥50% PSA decline (PSA50) and a Cox proportional hazards model to investigate the association between NLR and overall survival (OS). RESULTS A total of 94 subjects (52.2%) received 177Lu-J591, 51 (28.3%) 177Lu-PSMA-617, 28 (15.6%) 225Ac-J591, and 7 (3.9%) 90Y-J591. The median NLR of 3.75 was used as cut-off (low vs. high NLR; n = 90, respectively). On univariate analysis, NLR was not associated with PSA50 (HR 1.08; 95% confidence interval [CI] 0.99-1.17, p = 0.067). However, it was associated with worse OS (hazard ratio [HR] 1.06, 95% CI 1.02-1.09, p = 0.002), also after controlling for circulating tumor cell count and cancer and leukemia group B risk group (HR 1.05; 95% CI 1.003-1.11, p = 0.036). Men with high NLR were at a higher hazard of death from all causes (HR 1.43, 95% CI 1.05-1.94, p = 0.024). CONCLUSIONS NLR provides prognostic information in the setting of patients with mCRPC receiving treatment with PSMA-TRT.
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Affiliation(s)
| | - Michael Sun
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Benedict Ho
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Joseph Thomas
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Jones T Nauseef
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Joseph R Osborne
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York, USA
- Department of Radiology, Division of Molecular Imaging and Therapeutics, Weill Cornell Medicine, New York, New York, USA
| | - Ana Molina
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Cora N Sternberg
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David M Nanus
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Neil H Bander
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York, USA
| | - Scott Tagawa
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York, USA
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Bezjak M, Kocman B, Jadrijević S, Filipec Kanižaj T, Antonijević M, Dalbelo Bašić B, Mikulić D. Use of machine learning models for identification of predictors of survival and tumour recurrence in liver transplant recipients with hepatocellular carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:345. [PMID: 37675331 PMCID: PMC10477658 DOI: 10.21037/atm-22-6469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/19/2023] [Indexed: 09/08/2023]
Abstract
Background Hepatocellular carcinoma (HCC) is one of the leading indications for liver transplantation (LT) however, selection criteria remain controversial. We aimed to identify survival factors and predictors for tumour recurrence using machine learning (ML) methods. We also compared ML models to the Cox regression model. Methods Thirty pretransplant donor and recipient general and tumour specific parameters were analysed from 170 patients who underwent orthotopic liver transplantation for HCC between March 2013 and December 2019 at the University Hospital Merkur, Zagreb. Survival rates were calculated using the Kaplan-Meier method and multivariate analysis was performed using the Cox proportional hazards regression model. Data was also processed through Coxnet (a regularized Cox regression model), Random Survival Forest (RSF), Survival Support Vector Machine (SVM) and Survival Gradient Boosting models, which included pre-processing, variable selection, imputation of missing data, training and cross-validation of the models. The cross-validated concordance index (CI) was used as an evaluation metric and to determine the best performing model. Results Kaplan-Meier curves for 5-year survival time showed survival probability of 80% for recipient survival and 82% for graft survival. The 5-year HCC recurrence was observed in 19% of patients. The best predictive accuracy was observed in the RSF model with CI of 0.72, followed by the Survival SVM model (CI 0.70). Overall ML models outperform the Cox regression model with respect to their limitations. Random Forest analysis provided several relevant outcome predictors: alpha fetoprotein (AFP), donor C-reactive protein (CRP), recipient age and neutrophil to lymphocyte ratio (NLR). Cox multivariate analysis showed similarities with RSF models in identifying detrimental variables. Some variables such as donor age and number of transarterial chemoembolization treatments (TACE) were pointed out, but these were not influential in our RSF model. Conclusions Using ML methods in addition to classical statistical analysis, it is possible to develop sufficient prognostic models, which, compared to established risk scores, could help us quantify survival probability and make changes in organ utilization.
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Affiliation(s)
- Miran Bezjak
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Branislav Kocman
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Stipislav Jadrijević
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Tajana Filipec Kanižaj
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Merkur, Zagreb, Croatia
| | | | - Bojana Dalbelo Bašić
- Faculty of Electrical Engineering and Computing, Department of Electronics, Microelectronics, Computer and Intelligent Systems, Zagreb, Croatia
| | - Danko Mikulić
- Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb, Croatia
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Alshamsan B, Aseafan M, Badran A, Shaheen A, Elshenawy MA, Bazarbashi S, Aljubran AH. Characteristics and outcomes of small bowel adenocarcinoma: 14 years of experience at a single tertiary hospital in Saudi Arabia. Mol Clin Oncol 2023; 18:17. [PMID: 36798464 PMCID: PMC9926043 DOI: 10.3892/mco.2023.2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/22/2022] [Indexed: 01/28/2023] Open
Abstract
Small bowel adenocarcinoma (SBA) is an extremely rare cancer type. In the present study, the patient characteristics and clinical outcomes of patients diagnosed and treated for SBA at a single tertiary hospital were reported. All patients diagnosed and managed between 2007 and 2020 were reviewed. Regression analysis was used to assess variables associated with the metastatic stage at diagnosis. The Kaplan-Meier method was used to estimate survival and the log-rank test was used to determine factors associated with survival outcomes. Out of 137 cases of small bowel primary tumor, 43 consecutive patients with SBA were diagnosed with a median age of 53 years and the majority (76.7%) were males. The common initial presenting symptoms were abdominal pain (58.8%) and bowel obstruction (30.2%). The most common primary site was the duodenum (60.5%) and the majority (65.1%) were diagnosed with stage III/IV disease. Patients with a high neutrophil-lymphocyte ratio (NLR) (≥0.85) were more likely to be in the metastatic stage at diagnosis (P=0.01). The 3-year overall survival (OS) rates based on stage were 100% (I), 85% (II), 53% (III) and 33.9% (IV) (P=0.001). In addition to the stage, the Eastern Cooperative Oncology Group Performance Status (P<0.001), NLR (P<0.001), hypoalbuminemia (P=0.02) and chemotherapy in a metastatic setting (P=0.02) were prognostic factors for OS. In conclusion, NLR is a potential prognostic biomarker for a metastatic stage at diagnosis. Advanced stage, lower performance status score, low albumin level and high NLR are associated with short OS.
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Affiliation(s)
- Bader Alshamsan
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Department of Medicine, College of Medicine, Qassim University, Buraidah 51432, Saudi Arabia
| | - Mohamed Aseafan
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Section of Medical Oncology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh 11481, Saudi Arabia
| | - Ahmed Badran
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt
| | - Amgad Shaheen
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Medical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Mahmoud A. Elshenawy
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Clinical Oncology Department, Faculty of Medicine, Menoufia University, Shebin El Kom 32511, Egypt
| | - Shouki Bazarbashi
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Ali H. Aljubran
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Correspondence to: Dr Ali H. Aljubran, Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, 7375 Alowantat Mountain Street, King Abdulaziz, Riyadh 11211, Saudi Arabia
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Guven DC, Sahin TK, Erul E, Cakir IY, Ucgul E, Yildirim HC, Aktepe OH, Erman M, Kilickap S, Aksoy S, Yalcin S. The Association between Early Changes in Neutrophil-Lymphocyte Ratio and Survival in Patients Treated with Immunotherapy. J Clin Med 2022; 11:jcm11154523. [PMID: 35956139 PMCID: PMC9369683 DOI: 10.3390/jcm11154523] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/15/2022] [Accepted: 07/24/2022] [Indexed: 02/05/2023] Open
Abstract
Dynamic changes in the blood-based biomarkers could be used as a prognostic biomarker in patients treated with immune checkpoint inhibitors (ICIs), although the data are limited. We evaluated the association between the neutrophil−lymphocyte ratio (NLR) and early NLR changes with survival in ICI-treated patients. We retrospectively evaluated the data of 231 patients with advanced-stage cancer. We recorded baseline clinical characteristics, baseline NLR and fourth-week NLR changes, and survival data. A compound prognostic score, the NLR2-CEL score, was developed with the following parameters: baseline NLR (<5 vs. ≥5), ECOG status (0 vs. ≥1), Charlson Comorbidity Index (CCI, <9 vs. ≥9), LDH (N vs. ≥ULN), and fourth-week NLR change (10% or over NLR increase). In the multivariable analyses, higher NLR (HR: 1.743, p = 0.002), 10% or over NLR increase in the fourth week of treatment (HR: 1.807, p = 0.001), higher ECOG performance score (HR: 1.552, p = 0.006), higher LDH levels (HR: 1.454, p = 0.017), and higher CCI (HR: 1.400, p = 0.041) were associated with decreased OS. Compared to patients with the lowest scores, patients in the highest score group had significantly lower OS (HR: 7.967, 95% CI: 3.531−17.979, p < 0.001) and PFS. The composite score had moderate success for survival prediction, with an AUC of 0.702 (95% CI: 0.626−0.779, p < 0.001). We observed significantly lower survival in patients with higher baseline NLR values and increased NLR values under treatment.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
- Correspondence:
| | - Taha Koray Sahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Enes Erul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Ibrahim Yahya Cakir
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Enes Ucgul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey; (T.K.S.); (E.E.); (I.Y.C.); (E.U.)
| | - Hasan Cagri Yildirim
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Oktay Halit Aktepe
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Mustafa Erman
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Saadettin Kilickap
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
- Department of Medical Oncology, Faculty of Medicine, Istinye University, 34396 Istanbul, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
| | - Suayib Yalcin
- Department of Medical Oncology, Cancer Institute, Hacettepe University, 06100 Ankara, Turkey; (H.C.Y.); (O.H.A.); (M.E.); (S.K.); (S.A.); (S.Y.)
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Razmara AM, Wittenburg LA, Al-Nadaf S, Toedebusch RG, Meyers FJ, Toedebusch CM. Prevalence and Clinicopathologic Features of Canine Metastatic Melanoma Involving the Central Nervous System: A Retrospective Analysis and Comparative Review. Front Oncol 2022; 12:868004. [PMID: 35692802 PMCID: PMC9186031 DOI: 10.3389/fonc.2022.868004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Central nervous system (CNS) involvement is the leading cause of death in malignant melanoma. Rodent models, while vital to mechanistic investigation, have had limited success identifying effective therapies for melanoma brain metastases. The companion dog with de novo melanoma is a promising complementary model for developmental therapeutic investigation, as these tumors occur in an immunologically outbred host that has shared environmental exposures with humans. However, relatively little is known regarding the prevalence and clinicopathological features of canine melanoma metastasis to the CNS. To further validate the dog as an appropriate model for human metastatic melanoma, the aims of this study were to determine the rate of CNS metastasis and associated clinicopathologic features in canine malignant melanoma. Methods Medical records of dogs diagnosed with malignant melanoma from 1985-2019 at the University of California Davis Veterinary Medical Teaching Hospital were assessed retrospectively. Clinicopathologic features were compared between dogs with CNS metastasis (CNS+) and dogs without CNS metastasis (CNS-). Site of CNS involvement and associated neurological signs were analyzed via Wilcoxon-Mann-Whitney rank sum and Fisher’s exact tests. Survival data were analyzed via Kaplan-Meier estimates. Results CNS metastasis was identified in 38% of dogs in this study (20/53). The oral cavity was the most common site of primary melanoma in both groups [CNS+: n=12 (60%) vs. CNS-: n=22 (67%); p>0.99]. The total burden of metastatic disease was higher in the CNS+ group (CNS+: 4, 95% CI 3-5 vs. CNS-: 3, 95% CI 1-3; p<0.001). The cerebrum was the most common site of CNS metastasis (n=15, 75%) and seizures were the most observed neurological sign (n=9, 64%). There was no difference in overall survival between CNS+ and CNS- groups. However, the median survival time following onset of neurological signs was 9.5 days (95% CI 1-43), with 5 dogs euthanized within 24 hours of the onset of neurological signs. Conclusions Canine and human MM patients share similar rates of CNS metastasis and clinical presentation. This study will guide clinical management of canines with malignant melanoma and inform future studies using dogs with spontaneously occurring melanoma as a preclinical model for human melanoma brain metastases.
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Affiliation(s)
- Aryana M. Razmara
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
| | - Luke A. Wittenburg
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
| | - Sami Al-Nadaf
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
| | - Ryan G. Toedebusch
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
| | - Frederick J. Meyers
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
- Department of Internal Medicine, Division of Hematology and Oncology, Center for Precision Medicine, University of California, Davis School of Medicine, Sacramento, CA, United States
| | - Christine M. Toedebusch
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
- UCD Comprehensive Cancer Center, Sacramento, CA, United States
- *Correspondence: Christine M. Toedebusch,
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10
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Outcomes of Patients with Small Intestine Adenocarcinoma in a Canadian Province: A Retrospective Multi-Center Population-Based Cohort Study. Cancers (Basel) 2022; 14:cancers14112581. [PMID: 35681560 PMCID: PMC9252258 DOI: 10.3390/cancers14112581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Small intestine adenocarcinoma is a rare cancer. The current study aims to determine the outcomes of patients with small intestine adenocarcinoma in a Canadian province. Methods: This retrospective population-based cohort study assessed patients with small intestine adenocarcinoma who were diagnosed from 2008 to 2017 in Saskatchewan. A Cox proportional multivariate regression analysis was performed to determine the correlation between survival and exploratory factors. Results: 112 eligible patients with a median age of 73 years and M:F of 47:53 were identified. Overall, 75% had a comorbid illness, and 45% had a WHO performance status >1. Of the 112 patients, 51 (46%) had early-stage disease and 61 (54%) had advanced-stage disease. The median overall survival (mOS) was as follows: stage one, 59 months; stage two, 30 months; stage three, 20 months; and stage four, 3 months (p < 0.001). The median disease-free survival of patients with stage three disease who received adjuvant chemotherapy was 26 months (95% CI:23.1−28.9) vs. 4 months (0.0−9.1) with observation (p = 0.04). Patients who received chemotherapy for advanced disease had a mOS of 10 months (3.5−16.5) vs. 2 months (0.45−3.6) without chemotherapy (p < 0.001). In the multivariate analysis, stage four disease, hazard ratio (HR), 3.20 (1.84−5.40); WHO performance status >1, HR, 2.22 (1.42−3.45); lack of surgery, HR, 2.10 (1.25−3.50); and a neutrophil:lymphocyte ratio of >4.5, HR, 1.72 (1.10−2.71) were significantly correlated with inferior survival. Conclusions: Most patients with small intestine adenocarcinoma were diagnosed with advanced-stage disease. Advanced-stage disease, poor performance status, lack of surgery and a baseline neutrophil:lymphocyte ratio >4.5 were correlated with inferior survival.
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11
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Ronchetti L, Terrenato I, Ferretti M, Corrado G, Goeman F, Donzelli S, Mandoj C, Merola R, Zampa A, Carosi M, Blandino G, Conti L, Lobascio AM, Iacobelli M, Vizza E, Piaggio G, Gurtner A. Circulating cell free DNA and citrullinated histone H3 as useful biomarkers of NETosis in endometrial cancer. J Exp Clin Cancer Res 2022; 41:151. [PMID: 35449078 PMCID: PMC9027343 DOI: 10.1186/s13046-022-02359-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/06/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cancer mortality is mainly caused by organ failure and thrombotic events. It has been demonstrated that NETosis, a chromatin release mechanism implemented by neutrophils, may contribute to these lethal systemic effects. Our aim was to investigate NETosis biomarkers in endometrial cancer (EC). METHODS The experiments were conducted on 21 healthy subjects (HS) with no gynecological conditions, and on 63 EC patients. To assess the presence of NETosis features, IHC and IF was performed using antibodies against citrullinated histone H3 (citH3), neutrophil elastase (NE) and histone 2B. Serum levels of cell free DNA (cfDNA), cell free mitochondrial DNA (cfmtDNA) and citH3 were measured by qPCR using one microliter of deactivated serum, and by ELISA assay respectively. Fragmentation pattern of serum cfDNA was analyzed using the Agilent 2100 Bioanalyzer and High Sensitivity DNA Chips. Receiver operating characteristic (ROC) analysis was used to identify a cut off for cfDNA and cfmtDNA values able to discriminate between ECs and HSs. Correlation analysis and multiple correspondence analysis (MCA) between cfDNA, mtcfDNA, citH3 and blood parameters were used to identify the potential association among serum parameters in EC grades. RESULTS We demonstrated the presence of NETosis features in tissues from all EC grades. Serum cfDNA and cfmtDNA levels discriminate ECs from HSs and a direct correlation between citH3 and cfDNA content and an inverse correlation between cfmtDNA and citH3 in EC sera was observed, not detectable in HSs. MCA indicates cfDNA, cfmtDNA and citH3 as features associated to G1 and G2 grades. A correlation between increased levels of cfDNA, citH3 and inflammation features was found. Finally, serum nucleosomal cfDNA fragmentation pattern varies in EC sera and correlates with increased levels of cfDNA, citH3, lymphocytes and fibrinogen. CONCLUSION Our data highlight the occurrence of NETosis in EC and indicate serum cfDNA and citH3 as noninvasive biomarkers of tumor-induced systemic effects in endometrial cancer.
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Affiliation(s)
- Livia Ronchetti
- SAFU Unit, IRCCS - Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
| | - Irene Terrenato
- Clinical Trial Center - Biostatistics & Bioinformatics, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Margherita Ferretti
- SAFU Unit, IRCCS - Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
| | - Giacomo Corrado
- Department of Women and Children Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Frauke Goeman
- SAFU Unit, IRCCS - Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
| | - Sara Donzelli
- Oncogenomics and Epigenetics Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Chiara Mandoj
- Clinical Pathology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Roberta Merola
- Clinical Pathology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Ashanti Zampa
- Gynecologic Oncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Mariantonia Carosi
- Anatomy Pathology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Blandino
- Oncogenomics and Epigenetics Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Conti
- Clinical Pathology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Maria Lobascio
- Gynecologic Oncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Iacobelli
- Gynecologic Oncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Piaggio
- SAFU Unit, IRCCS - Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
| | - Aymone Gurtner
- SAFU Unit, IRCCS - Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy.
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), Rome, Italy.
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12
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Lecot P, Ardin M, Dussurgey S, Alcazer V, Moudombi L, Pereira Abrantes M, Hubert M, Swalduz A, Hernandez‐Vargas H, Viari A, Caux C, Michallet M. Gene signature of circulating platelet‐bound neutrophils is associated with poor prognosis in cancer patients. Int J Cancer 2022; 151:138-152. [PMID: 35253899 PMCID: PMC9311065 DOI: 10.1002/ijc.33991] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 11/15/2022]
Abstract
Beyond their critical role in hemostasis, platelets physically interact with neutrophils to form neutrophil‐platelet aggregates (NPAs), enhancing neutrophil effector functions during inflammation. NPAs may also promote disease worsening in various inflammatory diseases. However, characterization of NPAs in cancer remains totally unexplored. Using ImageStreamX (ISX) imaging flow cytometer, we were not only allowed able to detect CD15+ CD14− CD36+ ITGA2B+ NPAs in both healthy donors' (HDs) and cancer patients' bloods, but we also showed that NPAs result from the binding of platelets preferentially to low‐density neutrophils (LDNs) as opposed to normal‐density neutrophils (NDNs). By reanalyzing two independent public scRNAseq data of whole blood leukocytes from cancer patients and HDs, we could identify a subset of neutrophils with high platelet gene expression that may correspond to NPAs. Moreover, we showed that cancer patients' derived NPAs possessed a distinct molecular signature compared to the other neutrophil subsets, independently of platelet genes. Gene ontology (GO) term enrichment analysis of this NPAs‐associated neutrophil transcriptomic signature revealed a significant enrichment of neutrophil degranulation, chemotaxis and trans‐endothelial migration GO terms. Lastly, using The Cancer Genome Atlas (TCGA), we could show by multivariate Cox analysis that the NPAs‐associated neutrophil transcriptomic signature was associated with a worse patient prognosis in several cancer types. These results suggest that neutrophils from NPAs are systemically primed by platelets empowering them with cancer progression capacities once at tumor site. NPAs may therefore hold clinical utility as novel noninvasive blood prognostic biomarker in cancer patients with solid tumors.
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Affiliation(s)
- Pacôme Lecot
- TERI (Tumor Escape, Resistance and Immunity) Department, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286 Lyon France
| | - Maude Ardin
- TERI (Tumor Escape, Resistance and Immunity) Department, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286 Lyon France
| | - Sébastien Dussurgey
- Université de Lyon, SFR Biosciences, ENS de Lyon, Inserm US8, CNRS UMS3444, UCBL ‐ 50 Avenue Tony Garnier Lyon France
| | - Vincent Alcazer
- TERI (Tumor Escape, Resistance and Immunity) Department, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286 Lyon France
| | - Lyvia Moudombi
- TERI (Tumor Escape, Resistance and Immunity) Department, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286 Lyon France
| | - Manuela Pereira Abrantes
- TERI (Tumor Escape, Resistance and Immunity) Department, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286 Lyon France
| | - Margaux Hubert
- TERI (Tumor Escape, Resistance and Immunity) Department, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286 Lyon France
| | - Aurélie Swalduz
- Department of Lung and Thoracic Medical Oncology Centre Léon Bérard Lyon France
| | - Hector Hernandez‐Vargas
- TERI (Tumor Escape, Resistance and Immunity) Department, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286 Lyon France
| | - Alain Viari
- Synergie Lyon Cancer, Plateforme de Bio‐informatique ‘Gilles Thomas’ Lyon France
| | - Christophe Caux
- TERI (Tumor Escape, Resistance and Immunity) Department, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286 Lyon France
| | - Marie‐Cécile Michallet
- TERI (Tumor Escape, Resistance and Immunity) Department, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286 Lyon France
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13
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Trommer M, Adams A, Celik E, Fan J, Funken D, Herter JM, Linde P, Morgenthaler J, Wegen S, Mauch C, Franklin C, Galldiks N, Werner JM, Kocher M, Rueß D, Ruge M, Meißner AK, Baues C, Marnitz S. Oncologic Outcome and Immune Responses of Radiotherapy with Anti-PD-1 Treatment for Brain Metastases Regarding Timing and Benefiting Subgroups. Cancers (Basel) 2022; 14:cancers14051240. [PMID: 35267546 PMCID: PMC8909717 DOI: 10.3390/cancers14051240] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/07/2023] Open
Abstract
While immune checkpoint inhibitors (ICIs) in combination with radiotherapy (RT) are widely used for patients with brain metastasis (BM), markers that predict treatment response for combined RT and ICI (RT-ICI) and their optimal dosing and sequence for the best immunogenic effects are still under investigation. The aim of this study was to evaluate prognostic factors for therapeutic outcome and to compare effects of concurrent and non-concurrent RT-ICI. We retrospectively analyzed data of 93 patients with 319 BMs of different cancer types who received PD-1 inhibitors and RT at the University Hospital Cologne between September/2014 and November/2020. Primary study endpoints were overall survival (OS), progression-free survival (PFS), and local control (LC). We included 66.7% melanoma, 22.8% lung, and 5.5% other cancer types with a mean follow-up time of 23.8 months. Median OS time was 12.19 months. LC at 6 months was 95.3% (concurrent) vs. 69.2% (non-concurrent; p = 0.008). Univariate Cox regression analysis detected following prognostic factors for OS: neutrophil-to-lymphocyte ratio NLR favoring <3 (low; HR 2.037 (1.184−3.506), p = 0.010), lactate dehydrogenase (LDH) favoring ≤ULN (HR 1.853 (1.059−3.241), p = 0.031), absence of neurological symptoms (HR 2.114 (1.285−3.478), p = 0.003), RT concept favoring SRS (HR 1.985 (1.112−3.543), p = 0.019), RT dose favoring ≥60 Gy (HR 0.519 (0.309−0.871), p = 0.013), and prior anti-CTLA4 treatment (HR 0.498 (0.271−0.914), p = 0.024). Independent prognostic factors for OS were concurrent RT-ICI application (HR 0.539 (0.299−0.971), p = 0.024) with a median OS of 17.61 vs. 6.83 months (non-concurrent), ECOG performance status favoring 0 (HR 7.756 (1.253−6.061), p = 0.012), cancer type favoring melanoma (HR 0.516 (0.288−0.926), p = 0.026), BM volume (PTV) favoring ≤3 cm3 (HR 1.947 (1.007−3.763), p = 0.048). Subgroups with the following factors showed significantly longer OS when being treated concurrently: RT dose <60 Gy (p = 0.014), PTV > 3 cm3 (p = 0.007), other cancer types than melanoma (p = 0.006), anti-CTLA4-naïve patients (p < 0.001), low NLR (p = 0.039), steroid intake ≤4 mg (p = 0.042). Specific immune responses, such as abscopal effects (AbEs), pseudoprogression (PsP), or immune-related adverse events (IrAEs), occurred more frequently with concurrent RT-ICI and resulted in better OS. Other toxicities, including radionecrosis, were not statistically different in both groups. The concurrent application of RT and ICI, the ECOG-PS, cancer type, and PTV had an independently prognostic impact on OS. In concurrently treated patients, treatment response (LC) was delayed and specific immune responses (AbE, PsP, IrAE) occurred more frequently with longer OS rates. Our results suggest that concurrent RT-ICI application is more beneficial than sequential treatment in patients with low pretreatment inflammatory status, more and larger BMs, and with other cancer types than melanoma.
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Affiliation(s)
- Maike Trommer
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Center for Molecular Medicine Cologne, University of Cologne, 50937 Cologne, Germany
- Correspondence:
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Eren Celik
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
| | - Jiaqi Fan
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
| | - Dominik Funken
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
| | - Jan M. Herter
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Center for Molecular Medicine Cologne, University of Cologne, 50937 Cologne, Germany
| | - Philipp Linde
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
| | - Janis Morgenthaler
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
| | - Simone Wegen
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
| | - Cornelia Mauch
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Department of Dermatology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Cindy Franklin
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Department of Dermatology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Norbert Galldiks
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- Department of Neuroscience and Medicine (INM-3), Research Center Juelich, 52428 Juelich, Germany
| | - Jan-Michael Werner
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Martin Kocher
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Daniel Rueß
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Maximilian Ruge
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Anna-Katharina Meißner
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Department for General Neurosurgery, Centre of Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Christian Baues
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
- Center for Molecular Medicine Cologne, University of Cologne, 50937 Cologne, Germany
| | - Simone Marnitz
- Department of Radiation Oncology, Cyberknife Center, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (E.C.); (J.F.); (D.F.); (J.M.H.); (P.L.); (J.M.); (S.W.); (C.B.); (S.M.)
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, 50937 Cologne, Germany; (C.M.); (C.F.); (N.G.); (J.-M.W.); (M.K.); (D.R.); (M.R.); (A.-K.M.)
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14
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Cross-Sectional and Time-Dependent Analyses on Inflammatory Markers Following Natural Killer Cell Activity. Diagnostics (Basel) 2022; 12:diagnostics12020448. [PMID: 35204539 PMCID: PMC8870889 DOI: 10.3390/diagnostics12020448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 02/01/2023] Open
Abstract
The function of natural killer (NK) cells in inflammation has not been explored enough in large-scale population studies. The cross-sectional and time-dependent relationship between NK cell activity (NKA) and inflammatory markers was examined. Methods: A total of 7031 subjects were involved in the cross-sectional analyses. Non-linear relationship between NKA and inflammatory indices was analyzed using generalized additive models. The time-dependent changes were analyzed in 1005 subjects with repeated measurement in 3–6 months. The changes in inflammatory markers were analyzed based on the changes in NKA. Results: As NKA reduces to a very low level, the white blood cell (WBC) and neutrophil counts increase sharply, and the lymphocyte count exhibits a slow decline. With increasing NKA larger than about 500 pg/mL, WBC and neutrophil-lymphocyte ratio (NLR) reduces in a mild slope. Among the subjects with repeated measurements, the follow-up NKA was increased with advancing baseline NKA levels. The subjects with a reduction in NKA indicated increment in WBC count, neutrophil count, and NLR, and decrease in lymphocyte count. Conclusions: Very low levels of NKA suggest a high inflammatory immune response. The changes in NKA may interact with the balance between neutrophils and lymphocytes.
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15
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Platelet-Lymphocyte and Neutrophil-Lymphocyte Ratio for Prediction of Hospital Outcomes in Patients with Abdominal Trauma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5374419. [PMID: 35178450 PMCID: PMC8844345 DOI: 10.1155/2022/5374419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/26/2022] [Indexed: 12/15/2022]
Abstract
Background The platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) reflect the patient inflammatory and immunity status. We investigated the role of on-admission PLR and NLR in predicting massive transfusion protocol (MTP) activation and mortality following abdominal trauma. Methods A 4-year retrospective analysis of all adult abdominal trauma patients was conducted. Patients were classified into survivors and nonsurvivors and low vs. high PLR. The discriminatory power for PLR and NLR to predict MTP and mortality was determined. Multivariate logistic regression analysis was performed for predictors of mortality. Results A total of 1199 abdominal trauma patients were included (18.7% of all the trauma admissions). Low PLR was associated with more severe injuries and greater rates of hospital complications including mortality in comparison to high PLR. On-admission PLR and NLR were higher in the survivors than in nonsurvivors (149.3 vs. 76.3 (p = 0.001) and 19.1 vs. 13.7 (p = 0.009), respectively). Only PLR significantly correlated with injury severity score, revised trauma score, TRISS, serum lactate, shock index, and FASILA score. Optimal cutoffs of PLR and NLR for predicting mortality were 98.5 and 18.5, respectively. The sensitivity and specificity of PLR were 81.3% and 61.1%, respectively, and 61.3% and 51.3%, respectively, for NLR. The AUROC for predicting MTP was 0.69 (95% CI: 0.655–0.743) for PLR and 0.55 (95% CI: 0.510–0.598) for NLR. To predict hospital mortality, the area under the curve (AUROC) for PLR was 0.77 (95% CI: 0.712–0.825) and 0.59 (95% CI: 0.529–0.650) for the NLR. On multivariate logistic regression analysis, the age, Glasgow Coma Scale, sepsis, injury severity score, and PLR were independent predictors of mortality. Conclusion On-admission PLR but not NLR helps early risk stratification and timely management and predicts mortality in abdominal trauma patients. Further prospective studies are required.
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Magetsari R, Dwianingsih EK, Budhiparama NC, Araneta I, Sakti YM. Expression of Receptor Activator of Nuclear – Kappa β Ligand in Patients with Metastatic Bone Disease. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Bone metastasis is a complication that often occurs due to cancer in solid organs, and more often compared to primary bone tumors. Bone metastasis is associated with excessive osteolytic processes.
AIM: This study was conducted to reveal the correlation between Receptor Activator of Nuclear factor kβ Ligand (RANKL) expression, lactate dehydrogenase (LDH), and neutrophil-lymphocyte ratio (NLR) level in patients with bone metastatic lesions.
METHODS: This cross-sectional study was conducted in 15 subjects with bone metastatic lesions. The specimens were fresh bone tissues obtained by open biopsy. Expression of RANKL in mRNA level was detected quantitatively using reverse transcription-polymerase chain reaction. LDH and NLR were analyzed from the peripheral blood analysis. The correlation of RANKL expression with LDH and NLR was statistically analyzed.
RESULTS: This study enrolled 15 subjects with bone metastasis disease based on the clinical, radiological, and histopathological results. The means of LDH, NLR, and RANKL expression were not significantly different. There was no significant association between the characteristics of metastatic lesion and RANKL expression. The correlation between LDH levels with RANKL expression was positive (p < 0.05), while the correlation between NLR and RANKL expression was negative (p < 0.05).
CONCLUSION: RANKL expression was positively correlated with LDH and negatively correlated with the NLR. Both LDH and NLR can be used as predictive factors of RANKL expression in bone metastasis.
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Meisel A, de Wit R, Oudard S, Sartor O, Stenner-Liewen F, Shun Z, Foster M, Ozatilgan A, Eisenberger M, de Bono JS. Neutropenia, neutrophilia, and neutrophil-lymphocyte ratio as prognostic markers in patients with metastatic castration-resistant prostate cancer. Ther Adv Med Oncol 2022; 14:17588359221100022. [PMID: 35677318 PMCID: PMC9168856 DOI: 10.1177/17588359221100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background and purpose Chemotherapy-induced neutropenia and neutrophil-to-lymphocyte ratio (NLR) are potentially useful prognostic markers in patients with metastatic castration-resistant prostate cancer (mCRPC). This post hoc analysis investigated whether these markers can be utilized for dose considerations and evaluated the prognostic impact of leukocyte subtypes. Patients and methods PROSELICA assessed the non-inferiority of cabazitaxel 20 mg/m2 (C20; n = 598) versus 25 mg/m2 (C25; n = 602) for overall survival (OS) in patients with mCRPC previously treated with docetaxel. The association of grade ⩾ 3 neutropenia, NLR, baseline neutrophilia and lymphopenia with OS, progression-free survival (PFS), and prostate-specific antigen response rate (PSArr) was investigated by an unplanned uni- and multivariate analyses. Results PROSELICA confirmed the negative prognostic value of increased baseline NLR [⩾3, hazard ratio (HR) 1.40; p < 0.0001], but did not identify a subgroup of patients benefiting more from C20 or C25. In this post hoc analysis, patients who developed grade ⩾3 neutropenia (n = 673) had a significantly improved OS [∆OS = 2.7 months, HR = 0.78 (95% CI 0.68-0.89)] with the greatest advantage observed in patients with baseline neutrophilia [n = 85; 5.3 months, 0.60 (0.42-0.84)]. After adjustment for the Halabi criteria, neutropenia grade ⩾ 3 was the only biomarker that remained significantly associated with OS [ (HR 0.86 (0.75-0.98)], PFS [HR 0.78 (0.68-0.88)], and PSArr [odds ratio (OR) 1.82 (1.37-2.41)] while neutrophilia showed the strongest association with OS [1.53 (1.29-1.81)]. Conclusions Grade ⩾ 3 neutropenia was the only leukocyte-based biomarker associated with all key outcome parameters in mCRPC patients receiving cabazitaxel and might be able to overcome the negative prognostic effect of baseline neutrophilia. NCT number NCT01308580.
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Affiliation(s)
| | - Ronald de Wit
- Medical Oncology, Erasmus University Medical
Center, Rotterdam, The Netherlands
| | - Stephane Oudard
- Service d'Oncologie Médicale, Georges Pompidou
European Hospital, Rene Descartes University, Paris, France
| | - Oliver Sartor
- Medicine and Urology, Tulane Cancer Center, New
Orleans, LA, USA
| | | | | | | | - Ayse Ozatilgan
- Global Medical Affairs Oncology, Sanofi,
Cambridge, MA, USA
| | - Mario Eisenberger
- The Sidney Kimmel Comprehensive Cancer Center,
Johns Hopkins Hospital, Baltimore, MD, USA
| | - Johann S. de Bono
- Division of Clinical Studies, Drug Development
Unit, The Royal Marsden NHS Foundation Trust/The Institute of Cancer
Research, London, UK
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Guven DC, Aktepe OH, Aksun MS, Sahin TK, Kavgaci G, Ucgul E, Cakir IY, Yildirim HC, Guner G, Akin S, Kertmen N, Dizdar O, Aksoy S, Erman M, Yalcin S, Kilickap S. The association between albumin-globulin ratio (AGR) and survival in patients treated with immune checkpoint inhibitors. Cancer Biomark 2021; 34:189-199. [PMID: 34958005 DOI: 10.3233/cbm-210349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The albumin-globulin ratio (AGR) could be a prognostic biomarker in patients with cancer, although the data is limited in patients treated with immune-checkpoint inhibitors (ICIs). OBJECTIVES We aimed to evaluate the association between AGR and survival in ICI-treated patients. METHODS The data of 212 advanced-stage patients were retrospectively evaluated in this cohort study. The association between AGR with overall (OS) and progression-free survival (PFS) were evaluated with multivariate analyses. Additionally, receptor operating curve (ROC) analysis was conducted to assess the AGR's predictive power in the very early progression (progression within two months) and long-term benefit (more than twelve months survival). RESULTS The median AGR was calculated as 1.21, and patients were classified into AGR-low and high subgroups according to the median. In the multivariate analyses, patients with lower AGR (< 1.21) had decreased OS (HR: 1.530, 95% CI: 1.100-2.127, p= 0.011) and PFS (HR: 1.390, 95% CI: 1.020-1.895, p= 0.037). The area under curve of AGR to detect early progression and long-term benefit were 0.654 (95% CI: 0.562-0.747, p= 0.001) and 0.671 (95% CI: 0.598-0.744, p< 0.001), respectively. CONCLUSIONS In our experience, survival with ICIs was impaired in patients with lower AGR. Additionally, the AGR values could detect the very early progression and long-term benefit ICIs.
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Affiliation(s)
| | | | - Melek Seren Aksun
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gozde Kavgaci
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Enes Ucgul
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Yahya Cakir
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Gurkan Guner
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Serkan Akin
- Hacettepe University Cancer Institute, Ankara, Turkey
| | | | - Omer Dizdar
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Sercan Aksoy
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Mustafa Erman
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Suayib Yalcin
- Hacettepe University Cancer Institute, Ankara, Turkey
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Saraiva DP, Correia BF, Salvador R, de Sousa N, Jacinto A, Braga S, Cabral MG. Circulating low density neutrophils of breast cancer patients are associated with their worse prognosis due to the impairment of T cell responses. Oncotarget 2021; 12:2388-2403. [PMID: 34853660 PMCID: PMC8629401 DOI: 10.18632/oncotarget.28135] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 01/06/2023] Open
Abstract
Neutrophils are prominent immune components of tumors, having either anti-tumor (N1) or pro-tumor activity (N2). Circulating neutrophils, divided into high density neutrophils (HDN) and low density neutrophils (LDN), functionally mirror those N1 and N2 cells, respectively. LDN are rare in non-pathological conditions, but frequent in cancer, exhibiting a pro-tumor phenotype. These findings have been mainly demonstrated in animal models, thus proper validation in humans is still imperative. Here, we observed that LDN were increased in the blood of breast cancer (BC) patients, particularly with metastatic disease. Within the population of non-metastatic patients, LDN were more prevalent in patients with poor response to neoadjuvant chemotherapy than patients with a good response. The higher incidence of LDN in BC patients with severe disease or resistance to treatment can be explained by their pro-tumor/immunosuppressive characteristics. Moreover, the percentage of LDN in BC patients’ blood was negatively correlated with activated cytotoxic T lymphocytes and positively correlated with immunosuppressive regulatory T cells. The ability of LDN to spoil anti-tumor immune responses was further demonstrated ex vivo. Hence, this study reveals the potential of LDN as a biomarker of BC response to treatment and opens new avenues for developing new immunotherapies.
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Affiliation(s)
- Diana P Saraiva
- iNOVA4Health, CEDOC, NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisbon, Portugal.,These authors contributed equally to this work
| | - Bruna F Correia
- iNOVA4Health, CEDOC, NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisbon, Portugal.,These authors contributed equally to this work
| | - Rute Salvador
- iNOVA4Health, CEDOC, NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nídia de Sousa
- iNOVA4Health, CEDOC, NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisbon, Portugal
| | - António Jacinto
- iNOVA4Health, CEDOC, NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sofia Braga
- iNOVA4Health, CEDOC, NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisbon, Portugal.,Instituto CUF de Oncologia, Lisbon, Portugal
| | - M Guadalupe Cabral
- iNOVA4Health, CEDOC, NOVA Medical School (NMS), Universidade Nova de Lisboa, Lisbon, Portugal
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20
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Cordeiro MD, Ilario EN, Abe DK, Carvalho PAD, Muniz DQB, Sarkis AS, Coelho RF, Guimarães RM, Haddad MV, Nahas WC. Neutrophil-to-Lymphocyte Ratio Predicts Cancer Outcome in Locally Advanced Clear Renal Cell Carcinoma. Clin Genitourin Cancer 2021; 20:102-106. [PMID: 34969630 DOI: 10.1016/j.clgc.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND To evaluate the association of neutrophil-to-lymphocyte ratio (NLR) with recurrence-free survival (RFS) and overall survival (OS) in patients with locally advanced nonmetastatic clear cell renal cell carcinoma (ccRCC) undergoing radical nephrectomy. MATERIAL AND METHODS We retrospectively identified 880 nephrectomies performed between January 2009 and December 2016 in a single center, reviewed data from 478 radical nephrectomies for kidney tumors and identified 187 patients with locally advanced nonmetastatic ccRCC (pT3-T4 N0M0). NLR was obtained preoperatively and calculated by dividing absolute neutrophil count by absolute lymphocyte count. OS and RFS were evaluated by the Kaplan-Meier method. Cox proportional-hazards regression models were used to evaluate predictors of RFS and OS. RESULTS Among 187 patients with ccRCC (mean age 63.4 ± 11.5 years; 118 [63.1%] male), the median follow-up was 48.7 months. On univariate analysis, in patients with Fuhrman nuclear grade of differentiation 3-4, the median time to recurrence was significantly shorter with NLR ≥ 4 than < 4 (24 vs. 55 months, P = .045). On multivariable analysis adjusted for NLR ≥ 4, among all variables analyzed (NLR, microvascular invasion, sarcomatoid differentiation, tumor size and body mass index), only nuclear grade of differentiation was an independent predictor of recurrence (hazard ratio 2.18; 95% confidence interval 1.07-4.92, P = .03). The 3-year OS had no statistically significant difference between patients with NLR ≥ 4 or < 4. CONCLUSION For patients with locally advanced, nonmetastatic ccRCC, RFS was reduced with high nuclear grade of differentiation and high preoperative NLR. These findings suggest an association between higher NLR and worse outcomes in locally advanced ccRCC.
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Affiliation(s)
- Mauricio Dener Cordeiro
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil.
| | - Eder Nisi Ilario
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Daniel Kanda Abe
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Paulo Afonso de Carvalho
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | | | - Alvaro Sadek Sarkis
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Rafael Ferreira Coelho
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Ronaldo Morales Guimarães
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Michel Vitor Haddad
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - William Carlos Nahas
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
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Salah S, Abu‐Hijlih R, Abuhijla F, Tamimi F, Al‐Tell A, Shahait M. Pretreatment neutrophil-to-lymphocyte ratio as a potential prognostic biomarker for newly diagnosed patients with metastatic castration-sensitive prostate cancer. Cancer Rep (Hoboken) 2021; 4:e1392. [PMID: 34159754 PMCID: PMC8551990 DOI: 10.1002/cnr2.1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although the prognostic role of neutrophil-to-lymphocyte ratio (NLR) has been assessed in patients with metastatic castration-resistant prostate cancer, data on its impact on oncological outcomes of patients with metastatic castration-sensitive prostate cancer (mCSPC) are scarce. AIM This study aims to examine the influence of elevated pretreatment NLR on time to prostatic-specific antigen (PSA) progression and overall survival (OS) of patients with mCSPC. METHODS We retrospectively reviewed patients presenting between June 2007 and June 2019 with mCSPC. Survival was estimated by the Kaplan-Meier method and compared by the log-rank test. Multivariate analyses were used to assess the factors influencing time to PSA progression and OS. RESULTS A total of 189 patients were included; median age = 69 years, median PSA = 155 ng/mL, 41(22%) had visceral metastasis. Median time to PSA progression was shorter for patients with NLR ≥4 (n = 37) compared to patients with NLR < 4 (n = 146); 11.3 and 18.3 months, respectively, P = .015. Patients with NLR ≥4 also had inferior median OS (23.9 vs 49.5 months, P = .001). On multivariate analysis, NLR ≥4 was not an independent factor for time to PSA progression. However, NLR ≥4 was an independent factor of inferior OS (HR: 2.75, 95% CI: 1.01-7.87, P = .047). Other independent factors predicting inferior OS included Eastern Cooperative Oncology Group Performance Status ≥1, high-volume status, and Hb < 12. CONCLUSION Elevated pretreatment NLR independently predicts inferior OS in newly diagnosed patients with mCSPC. However, NLR was not a predictor of time to PSA progression.
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Affiliation(s)
- Samer Salah
- Department of Medical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Ramiz Abu‐Hijlih
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Fawzi Abuhijla
- Department of Radiation OncologyKing Hussein Cancer CenterAmmanJordan
| | - Faris Tamimi
- Department of Medical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Abdallah Al‐Tell
- Department of Medical OncologyKing Hussein Cancer CenterAmmanJordan
| | - Mohammed Shahait
- Department of Surgery, Division of UrologyKing Hussein Cancer CenterAmmanJordan
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22
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Johnson PJ, Dhanaraj S, Berhane S, Bonnett L, Ma YT. The prognostic and diagnostic significance of the neutrophil-to-lymphocyte ratio in hepatocellular carcinoma: a prospective controlled study. Br J Cancer 2021; 125:714-716. [PMID: 34127809 PMCID: PMC8405698 DOI: 10.1038/s41416-021-01445-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/13/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR), a presumed measure of the balance between neutrophil-associated pro-tumour inflammation and lymphocyte-dependent antitumour immune function, has been suggested as a prognostic factor for several cancers, including hepatocellular carcinoma (HCC). METHODS In this study, a prospectively accrued cohort of 781 patients (493 HCC and 288 chronic liver disease (CLD) without HCC) were followed-up for more than 6 years. NLR levels between HCC and CLD patients were compared, and the effect of baseline NLR on overall survival amongst HCC patients was assessed via multivariable Cox regression analysis. RESULTS On entry into the study ('baseline'), there was no clinically significant difference in the NLR values between CLD and HCC patients. Amongst HCC patients, NLR levels closest to last visit/death were significantly higher compared to baseline. Multivariable Cox regression analysis showed that NLR was an independent prognostic factor, even after adjustment for the HCC stage. CONCLUSION NLR is a significant independent factor influencing survival in HCC patients, hence offering an additional dimension in prognostic models.
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Affiliation(s)
- Philip J. Johnson
- grid.10025.360000 0004 1936 8470Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Sofi Dhanaraj
- Liver Services, University Hospitals NHS Foundation Trust, Birmingham, UK
| | - Sarah Berhane
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Bonnett
- grid.10025.360000 0004 1936 8470Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Yuk Ting Ma
- grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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23
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Konopka K, Micek A, Ochenduszko S, Streb J, Potocki P, Kwinta Ł, Wysocki PJ. Combined Neutrophil-to-Lymphocyte and Platelet-Volume-to-Platelet Ratio (NLR and PVPR Score) Represents a Novel Prognostic Factor in Advanced Gastric Cancer Patients. J Clin Med 2021; 10:3902. [PMID: 34501353 PMCID: PMC8432226 DOI: 10.3390/jcm10173902] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Chemotherapy is a cornerstone of treatment in advanced gastric cancer (GC) with a proven impact on overall survival, however, reliable predictive markers are missing. The role of various inflammatory markers has been tested in gastric cancer patients, but there is still no general consensus on their true clinical applicability. High neutrophil-to-lymphocyte (NLR) and low (medium)-platelets-volume-to-platelet ratio (PVPR) are known markers of unspecific immune system activation, correlating significantly with outcomes in advanced GC patients. METHODS Metastatic GC patients (N:155) treated with chemotherapy +/- trastuzumab were enrolled in this retrospective study. Pre-treatment NLR and PVPR, as well as other inflammatory markers were measured in peripheral blood. Univariate Cox regression was conducted to find markers with a significant impact on overall survival (OS) and progression-free survival (PFS). Spearman correlation and Cohen's kappa was used to analyze multicollinearity. Multiple multivariable Cox regression models were built to study the combined impact of NLR and PVPR, as well as other known prognostic factors on OS. RESULTS Elevated NLR was significantly associated with increased risk of death (HR = 1.95; 95% CI: 1.17-3.24), and lower PVPR was significantly associated with improved outcomes (HR = 0.53; 95% CI: 0.32-0.90). A novel inflammatory marker, based on a combination of NLR and PVPR, allows for the classification of GC patients into three prognostic groups, characterized by median OS of 8.4 months (95% CI 5.8-11.1), 10.5 months (95% CI 8.8-12.1), and 15.9 months (95% CI 13.5-18.3). CONCLUSION The NLR and PVPR score (elevated NLR and decreased PVPR) is a marker of detrimental outcome of advanced GC patients treated with chemotherapy.
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Affiliation(s)
- Kamil Konopka
- Department of Oncology, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.S.); (P.P.); (Ł.K.); (P.J.W.)
| | - Agnieszka Micek
- Department of Nursing Management and Epidemiology Nursing, Jagiellonian University Medical College, 31-007 Cracow, Poland;
| | | | - Joanna Streb
- Department of Oncology, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.S.); (P.P.); (Ł.K.); (P.J.W.)
| | - Paweł Potocki
- Department of Oncology, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.S.); (P.P.); (Ł.K.); (P.J.W.)
| | - Łukasz Kwinta
- Department of Oncology, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.S.); (P.P.); (Ł.K.); (P.J.W.)
| | - Piotr J. Wysocki
- Department of Oncology, Jagiellonian University Medical College, 31-007 Cracow, Poland; (J.S.); (P.P.); (Ł.K.); (P.J.W.)
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Grieshober L, Graw S, Barnett MJ, Goodman GE, Chen C, Koestler DC, Marsit CJ, Doherty JA. Pre-diagnosis neutrophil-to-lymphocyte ratio and mortality in individuals who develop lung cancer. Cancer Causes Control 2021; 32:1227-1236. [PMID: 34236573 PMCID: PMC8492578 DOI: 10.1007/s10552-021-01469-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/21/2021] [Indexed: 01/04/2023]
Abstract
Purpose The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been reported to be associated with survival after chronic disease diagnoses, including lung cancer. We hypothesized that the inflammatory profile reflected by pre-diagnosis NLR, rather than the well-studied pre-treatment NLR at diagnosis, may be associated with increased mortality after lung cancer is diagnosed in high-risk heavy smokers. Methods We examined associations between pre-diagnosis methylation-derived NLR (mdNLR) and lung cancer-specific and all-cause mortality in 279 non-small lung cancer (NSCLC) and 81 small cell lung cancer (SCLC) cases from the β-Carotene and Retinol Efficacy Trial (CARET). Cox proportional hazards models were adjusted for age, sex, smoking status, pack years, and time between blood draw and diagnosis, and stratified by stage of disease. Models were run separately by histotype. Results Among SCLC cases, those with pre-diagnosis mdNLR in the highest quartile had 2.5-fold increased mortality compared to those in the lowest quartile. For each unit increase in pre-diagnosis mdNLR, we observed 22–23% increased mortality (SCLC-specific hazard ratio [HR] = 1.23, 95% confidence interval [CI]: 1.02, 1.48; all-cause HR = 1.22, 95% CI 1.01, 1.46). SCLC associations were strongest for current smokers at blood draw (Interaction Ps = 0.03). Increasing mdNLR was not associated with mortality among NSCLC overall, nor within adenocarcinoma (N = 148) or squamous cell carcinoma (N = 115) case groups. Conclusion Our findings suggest that increased mdNLR, representing a systemic inflammatory profile on average 4.5 years before a SCLC diagnosis, may be associated with mortality in heavy smokers who go on to develop SCLC but not NSCLC. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01469-3.
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Affiliation(s)
- Laurie Grieshober
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Room 4746, Salt Lake City, UT 84112 USA
| | - Stefan Graw
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Matt J. Barnett
- Program in Biostatistics, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Gary E. Goodman
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Chu Chen
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA
- Department of Otolaryngology: Head and Neck Surgery, School of Medicine, University of Washington, Seattle, WA USA
| | - Devin C. Koestler
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS USA
| | - Carmen J. Marsit
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Jennifer A. Doherty
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
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The authors respond: Anticipating Covid prognosis from white blood cell count. Am J Emerg Med 2021; 47:297-298. [PMID: 33966924 PMCID: PMC8087572 DOI: 10.1016/j.ajem.2021.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022] Open
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Chantharakhit C, Sujaritvanichpong N. Prognostic Impact of the Advanced Lung Cancer Inflammation Index (ALI) in Metastatic Non-Small Cell Lung Cancer Treated with First Line Chemotherapy. Asian Pac J Cancer Prev 2021; 22:1149-1156. [PMID: 33906307 PMCID: PMC8325112 DOI: 10.31557/apjcp.2021.22.4.1149] [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] [Received: 12/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The advanced lung cancer inflammation index (ALI) has been reported to predict the overall survival in patients with advanced non-small cell lung cancer (NSCLC). However, no previous studies have examined the prognostic significance of ALI in metastatic NSCLC treated with first line chemotherapy. The objective of this study was to explore the relationship between ALI and the prognosis of metastatic NSCLC treated with first line chemotherapy. Materials and Methods: Data of 109 metastatic NSCLC patients who had completed first line treatment with chemotherapy was collected. A multivariate flexible parametric proportional-hazards model with restricted cubic splines (RCS) was used to explore and identify the independent prognostic factors, including clinical potential factors and ALI for the overall survival. Multivariate regression analysis was used to evaluate the potential prognostic factors associated with short survival less than 6 months. The analysis of the restricted mean survival time (RMST) method was used to estimate the event-free time from zero to 18 months. Results: The median OS was 10.9 months (95%CI 9.57-13.18) and median PFS was 7.5 months (95%CI 6.85-8.00).The multivariate survival analyses revealed two prognostic factors for worse survival: Poor ECOG PS (HR46.90; 95%CI 2.90-758.73; p=0.007) and progressive disease after completing the first line chemotherapy treatment (HR 2.85; 95%CI1.18-6.88; p=0.02),whereas a low ALI <11 referred to a non-significant prognostic factor (HR 1.42; 95%CI 0.67-3.01; p=0.364).The results of the multivariate regression analysis revealed that the low ALI and progressive disease status were significantly associated with the short survival outcome (OR 5.12; 95%CI 1.11-23.65; p=0.037; OR 12.57; 95%CI 3.00-52.73; p=0.001). Conclusions: A low ALI was associated with the short survival in metastatic NSCLC treated with chemotherapy. However, using ALI as a prognostic factor only was still too limited. Other considerable clinical prognostic factors should also be used simultaneously, which would have strong significant prognostic impacts.
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Affiliation(s)
- Chaichana Chantharakhit
- Division of Medical Oncology, Department of Internal Medicine, Buddhasothorn Hospital, Chachoengsao, Thailand
| | - Nantapa Sujaritvanichpong
- Division of Medical Oncology, Department of Internal Medicine, Buddhasothorn Hospital, Chachoengsao, Thailand
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Shusterman M, Jou E, Kaubisch A, Chuy JW, Rajdev L, Aparo S, Tang J, Ohri N, Negassa A, Goel S. The Neutrophil-to-Lymphocyte Ratio is a Prognostic Biomarker in An Ethnically Diverse Patient Population with Advanced Pancreatic Cancer. J Gastrointest Cancer 2021; 51:868-876. [PMID: 31677056 DOI: 10.1007/s12029-019-00316-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The neutrophil-to-lymphocyte ratio (NLR) is associated with decreased overall survival in patients with pancreatic adenocarcinoma (PAC) in studies including few minority patients. We investigated the association between NLR and survival in patients with advanced PAC in an ethnically diverse population. METHODS We retrospectively evaluated 226 patients with advanced PAC treated at Montefiore Medical Center between 2006 and 2015. Adjusted Cox proportion hazard regression models were utilized to derive effect estimates for survival duration. RESULTS Patients with a NLR ≤ 5 (126 patients, median age 66 years) were more likely to be non-Hispanic Black (30.8% vs. 20%), while patients with a NLR > 5 (70 patients, median age 66 years) were more likely to be non-Hispanic White (21.4% vs. 12.2%) or Hispanic (44.3% vs. 34%). A NLR > 5 compared with a NLR ≤ 5 was significantly associated with a worse overall survival when adjusted for a priori and exploratory variables from the univariate analysis (median survival 7.4 vs. 12 months, HR 1.650, 95% CI 1.139, 2.390). CONCLUSIONS In an ethnically diverse population, elevated NLR is an independent marker of poor prognosis and a potentially valuable factor in driving therapeutic decisions and defining prognosis for patients in the locally advanced or metastatic for PAC setting, meriting investigation in prospective clinical trials.
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Affiliation(s)
- Michael Shusterman
- Department of Medical Oncology, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY, USA
| | - Erin Jou
- Department of Medical Oncology, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY, USA
| | - Andreas Kaubisch
- Department of Medical Oncology, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Jennifer W Chuy
- Department of Medical Oncology, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Lakshmi Rajdev
- Department of Medical Oncology, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Santiago Aparo
- Department of Medical Oncology, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Justin Tang
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Abdissa Negassa
- Department of Epidemiology and Population Health, Bronx, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Sanjay Goel
- Department of Medical Oncology, Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY, USA. .,Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
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Chae YJ, Lee J, Park JH, Han DG, Ha E, Yi IK. Late Mortality Prediction of Neutrophil-to-lymphocyte and Platelet Ratio in Patients With Trauma Who Underwent Emergency Surgery: A Retrospective Study. J Surg Res 2021; 267:755-761. [PMID: 33583601 DOI: 10.1016/j.jss.2020.11.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/28/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to evaluate the usefulness of neutrophil-to-lymphocyte (N/L) and neutrophil-to-lymphocyte platelet (N/LP) ratios in predicting late mortality of patients with trauma who underwent emergency surgery. MATERIALS AND METHODS We retrospectively evaluated patients with trauma older than 19 y who underwent emergency surgery at our level I trauma center. Blood count-based ratios (N/L and N/LP at days 1, 3, and 7 of hospitalization) and trauma scores were analyzed. Statistical analysis was performed using univariable logistic regression and receiver operating curves. RESULTS A total of 209 patients were evaluated. N/LP at day 7, N/L at day 7, Trauma Injury Severity Score, Revised Trauma Score, and Injury Severity Score were significantly associated with late mortality. Area under the receiver operating characteristic curves for predicting mortality was highest for N/LP at day 7 (0.867 [95% confidence interval 0.798-0.936], P < 0.001). The group with N/LP greater than the cutoff value (9.3, sensitivity 77.3%, specificity 83.1%) at day 7 showed higher mortality than the group with N/LP less than the cutoff value (35.4% versus 3.2%, P < 0.001, respectively) at day 7. CONCLUSIONS N/LP at day 7 may be a superior predictor of late mortality compared with preexisting trauma scores in patients with major trauma undergoing emergency surgery, by better reflecting the systemic inflammation status.
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Affiliation(s)
- Yun Jeong Chae
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Jiyoung Lee
- Department of Anesthesiology and Pain Medicine CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Ji Hyun Park
- Office of Biostatistics, Ajou Research Institute for Innovation Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Do-Gyun Han
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Eunji Ha
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - In Kyong Yi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea.
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Alamsyah F, Pratiwi R, Firdausi N, Irene Mesak Pello J, Evi Dwi Nugraheni S, Ghitha Fadhlurrahman A, Nurhidayat L, Purwo Taruno W. Cytotoxic T cells response with decreased CD4/CD8 ratio during mammary tumors inhibition in rats induced by non-contact electric fields. F1000Res 2021; 10:35. [PMID: 34164110 PMCID: PMC8142601 DOI: 10.12688/f1000research.27952.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 04/03/2024] Open
Abstract
Background: Breast cancer is the most common cancer in women worldwide and is the leading cause of death in women with cancer. One novel therapy used for breast cancer treatment is non-contact electric fields called electro-capacitive cancer therapy (ECCT) with intermediate frequency (100 kHz) and low intensity (18 Vpp). The objective of this study was to examine the effect of ECCT on mammary tumors growth in rats and observing the immune responses that play a role in fighting the tumor. Methods: Female SD rats were used and divided into four groups, namely control (NINT), placebo (NIT), non- therapy (INT), and therapy (IT) groups with 6 biological replicates in each group. Rats in INT and IT groups were treated with 7,12-dimethylbenz[a]anthracene for mammary tumor induction. Only rats in NIT and IT groups were exposed to ECCT individually for 10 hours per day for 21 days. The size of all tumors was measured with a digital caliper. The distributions of PCNA, ErbB2, caspase-3, CD68, CD4 and CD8-positive cells were observed with immunohistochemistry and scoring with ImageJ. Results: The growth rate of mammary tumors in IT group was significantly lower (p<0.05) than that in the INT group. The number of mitotic figures and the percentage of PCNA, caspase-3, and CD68- positive cells in IT group were significantly lower (p<0.05) than those in INT group. Conversely, the percentage of CD8-positive T cells in IT group was significantly higher (p<0.05) than that in INT group. Moreover, the CD4/CD8 ratio in IT group was decreased. Some tumor tissues were blackened and detached from the surrounding tissue, resulting in an open wound which then healed up upon exposure. Conclusions: Non-contact electric fields exposure showed inhibition on mammary tumor growth in rats while inducing CD8+ T cells that lead to tumor cells death and potentially helps wound healing.
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Affiliation(s)
- Firman Alamsyah
- Center for Medical Physics and Cancer Research, Ctech Labs Edwar Technology, Tangerang, Banten, 15143, Indonesia
| | - Rarastoeti Pratiwi
- Faculty of Biology, Universitas Gadjah Mada, Sleman, DI Yogyakarta, 55281, Indonesia
| | - Nisrina Firdausi
- Faculty of Biology, Universitas Gadjah Mada, Sleman, DI Yogyakarta, 55281, Indonesia
| | | | | | | | - Luthfi Nurhidayat
- Faculty of Biology, Universitas Gadjah Mada, Sleman, DI Yogyakarta, 55281, Indonesia
| | - Warsito Purwo Taruno
- Center for Medical Physics and Cancer Research, Ctech Labs Edwar Technology, Tangerang, Banten, 15143, Indonesia
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30
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Alamsyah F, Pratiwi R, Firdausi N, Irene Mesak Pello J, Evi Dwi Nugraheni S, Ghitha Fadhlurrahman A, Nurhidayat L, Purwo Taruno W. Cytotoxic T cells response with decreased CD4/CD8 ratio during mammary tumors inhibition in rats induced by non-contact electric fields. F1000Res 2021; 10:35. [PMID: 34164110 PMCID: PMC8142601 DOI: 10.12688/f1000research.27952.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Breast cancer is the most common cancer in women worldwide and is the leading cause of death amongst women with cancer. One novel therapy used for breast cancer treatment constitutes non-contact electric fields and is called electro-capacitive cancer therapy (ECCT) with intermediate frequency and low intensity. The objective of this study was to examine the effect of ECCT on mammary tumors growth in rats and observing the immune responses that play a role in fighting the tumor. Methods: Female SD rats were used and divided into four groups, namely control (NINT), placebo (NIT), non- therapy (INT), and therapy (IT) groups with 6 biological replicates in each group. Rats in INT and IT groups were treated with 7,12-dimethylbenz[a]anthracene for mammary tumor induction. Only rats in NIT and IT groups were exposed to ECCT individually for 10 hours per day for 21 days. The size of all tumors was measured with a digital caliper. The distributions of PCNA, ErbB2, caspase-3, CD68, CD4, and CD8-positive cells were observed with immunohistochemistry and scoring with ImageJ. Results: The growth rate of mammary tumors in IT group was significantly lower (p<0.05) than that in INT group. The number of mitotic figures and the percentage of PCNA, caspase-3, and CD68-positive cells in IT group were significantly lower (p<0.05) than those in INT group. Conversely, the percentage of CD8-positive T cells in IT group was significantly higher (p<0.05) than that in INT group. Moreover, the CD4/CD8 ratio in IT group was found to have decreased. Some tumor tissues were blackened and detached from the surrounding tissue, resulting in an open wound which then healed upon exposure. Conclusions: Non-contact electric fields exposure showed inhibition on mammary tumor growth in rats while inducing CD8+ T cells, leading to tumor cell death and potentially helping wounds heal.
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Affiliation(s)
- Firman Alamsyah
- Center for Medical Physics and Cancer Research, Ctech Labs Edwar Technology, Tangerang, Banten, 15143, Indonesia
| | - Rarastoeti Pratiwi
- Faculty of Biology, Universitas Gadjah Mada, Sleman, DI Yogyakarta, 55281, Indonesia
| | - Nisrina Firdausi
- Faculty of Biology, Universitas Gadjah Mada, Sleman, DI Yogyakarta, 55281, Indonesia
| | | | | | | | - Luthfi Nurhidayat
- Faculty of Biology, Universitas Gadjah Mada, Sleman, DI Yogyakarta, 55281, Indonesia
| | - Warsito Purwo Taruno
- Center for Medical Physics and Cancer Research, Ctech Labs Edwar Technology, Tangerang, Banten, 15143, Indonesia
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Pourmir I, Noel J, Simonaggio A, Oudard S, Vano YA. Update on the most promising biomarkers of response to immune checkpoint inhibitors in clear cell renal cell carcinoma. World J Urol 2021; 39:1377-1385. [PMID: 33386948 DOI: 10.1007/s00345-020-03528-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/13/2020] [Indexed: 12/21/2022] Open
Abstract
In the last few years, the standard of care for metastatic clear cell renal cell carcinoma (mccRCC) has changed dramatically with the emergence of the immune checkpoint inhibitors (ICI): anti-PD(L)-1 used as a monotherapy or as in combination either with an anti CTLA-4 or with an anti-angiogenic molecule (VEGFR tyrosine kinase inhibitor (TKI)). These combinations are now recommended in first line setting for mccRCC, according to the last European recommendations. In the face of these new therapeutic options, the question of selecting the best treatment arises as well as the optimal sequence. Predictive biomarkers are required to guide the therapeutic choice and provide a personalized treatment for each patient. This narrative review will provide an overview of the main predictive biomarkers assessed in mccRCC treatment, with a particular focus on mRNA panel signatures.
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Affiliation(s)
- Ivan Pourmir
- Medical Oncology Department, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Johanna Noel
- Medical Oncology Department, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Audrey Simonaggio
- Medical Oncology Department, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France
| | - Stéphane Oudard
- Medical Oncology Department, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.,UMR-S1147, INSERM, 75006, Paris, France
| | - Yann-Alexandre Vano
- Medical Oncology Department, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France. .,Centre de Recherche Des Cordeliers, Sorbonne Université, Inserm, Université de Paris, 75006, Paris, France.
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Amonchaisakda N, Aiempanakit K. Clinical characteristics, mortality, and prognostic factors for bullous pemphigoid in a Thai population. Medicine (Baltimore) 2020; 99:e22850. [PMID: 33120819 PMCID: PMC7581062 DOI: 10.1097/md.0000000000022850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Bullous pemphigoid is an uncommon, autoimmune, blistering disease. Clinical features, associated conditions, and outcomes differ according to country. We aimed to determine the mortality rate and clinical characteristics of Thai patients and to evaluate the risk factors associated with survival.A retrospective analysis was conducted on 119 patients, over a ten-year period, at Songklanagarind Hospital, the largest tertiary university hospital in Southern Thailand.The median age of onset was 82 years [interquartile range 72, 90], and 60 (50.4%) patients were men. The underlying diseases were hypertension (53.8%), neurological disease (42.8%), and diabetes mellitus (31.9%). Fifty-eight patients (48.7%) experienced pruritus, and 61.3% of patients had mild cutaneous lesions (less than 10% of the body surface area) on the day of diagnosis. Nine percent of patients presented with mucosal involvement. Complete blood counts showed anemia (32.8%), neutrophilia (30.3%), and eosinophilia (42.9%). The 1-, 3- and 5-year overall mortality rates were 28.1% [95% confidence interval (CI), 7.8-36.6], 55.7% (95% CI, 44.4-64.7) and 71.9% (95% CI 59.9-80.2), respectively. On multivariate analysis, high neutrophil/lymphocyte ratio [odds ratio (OR) 5.55, P < .001] and anemia (OR 2.93, P = .025) were found to be independently associated with mortality rate, whereas disease remission (OR 0.25, P = .003) was demonstrated to be a good prognostic factor.This is the first study to analyze the mortality rate of Bullous pemphigoid in Thailand. Mortality was associated with high neutrophil/lymphocyte ratio and anemia.
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Neutrophil-Lymphocyte Ratio (NLR) Reflects Myocardial Inhomogeneities in Hemodialyzed Patients. Mediators Inflamm 2020; 2020:6027405. [PMID: 32963494 PMCID: PMC7486637 DOI: 10.1155/2020/6027405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Cardiovascular diseases (CVDs) are a leading cause of death in chronically hemodialyzed (HD) patients. In this group, inflammation exerts significant impact on the prevalence of CVD morbidity and mortality. Spatial QRS-T angle is an independent and strong predictor of CV events, including sudden cardiac death (SCD), both in general population and HD patients. Pathogenesis of widened QRS-T angle is complicated and is not well established. Objectives The study is aimed at evaluating whether inflammation process can contribute to the wide QRS-T angle. Patients and Methods. The retrospective study was performed on 183 HD patients. The control group consisted of 38 patients. Demographic, biochemical, vectorcardiographic, and echocardiographic data were evaluated in all patients. Inflammation process was expressed as neutrophil-lymphocyte ratio (NLR), as well as C-reactive protein (CRP). Results Both NLR (3.40 vs. 1.95 (p < 0.0001)) and spatial QRS-T angle (50.76 vs. 93.56 (p < 0.001)) were higher in the examined group, compared to the control group. Similarly, CRP was higher in the examined group than in the control group (8.35 vs. 4.06 (p < 0.001), respectively). The QRS-T angle correlated with NLR, CRP, some structural echocardiographic parameters, parathormone (PTH), and calcium (Ca) concentrations. Multiple regression analysis showed that NLR is an independent QRS-T angle predictor (r = 0.498, p = 0.0027). The ROC curve analysis indicated the cut-off point of NLR equaled 4.59, where the sensitivity and specificity were the highest for predicting myocardial inhomogeneities expressed as widened QRS-T angle. Conclusion The NLR, as an inflammation marker, may indicate myocardial inhomogeneities in HD patients.
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Jaillon S, Ponzetta A, Di Mitri D, Santoni A, Bonecchi R, Mantovani A. Neutrophil diversity and plasticity in tumour progression and therapy. Nat Rev Cancer 2020; 20:485-503. [PMID: 32694624 DOI: 10.1038/s41568-020-0281-y] [Citation(s) in RCA: 528] [Impact Index Per Article: 132.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 12/11/2022]
Abstract
Neutrophils play a key role in defence against infection and in the activation and regulation of innate and adaptive immunity. In cancer, tumour-associated neutrophils (TANs) have emerged as an important component of the tumour microenvironment. Here, they can exert dual functions. TANs can be part of tumour-promoting inflammation by driving angiogenesis, extracellular matrix remodelling, metastasis and immunosuppression. Conversely, neutrophils can also mediate antitumour responses by direct killing of tumour cells and by participating in cellular networks that mediate antitumour resistance. Neutrophil diversity and plasticity underlie the dual potential of TANs in the tumour microenvironment. Myeloid checkpoints as well as the tumour and tissue contexture shape neutrophil function in response to conventional therapies and immunotherapy. We surmise that neutrophils can provide tools to tailor current immunotherapy strategies and pave the way to myeloid cell-centred therapeutic strategies, which would be complementary to current approaches.
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Affiliation(s)
- Sebastien Jaillon
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.
- Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy.
| | - Andrea Ponzetta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy
| | - Diletta Di Mitri
- Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy
| | - Angela Santoni
- Dipartimento di Medicina Molecolare Istituto Pasteur-Fondazione Cenci Bolognetti, Università di Roma 'La Sapienza', Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| | - Raffaella Bonecchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy
| | - Alberto Mantovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy.
- Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy.
- The William Harvey Research Institute, Queen Mary University of London, London, UK.
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Van Berckelaer C, Van Geyt M, Linders S, Rypens C, Trinh XB, Tjalma WAA, Van Laere S, Colpaert C, Dirix L, van Dam PA. A high neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are associated with a worse outcome in inflammatory breast cancer. Breast 2020; 53:212-220. [PMID: 32890963 PMCID: PMC7481565 DOI: 10.1016/j.breast.2020.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/05/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Inflammatory breast cancer (IBC) is an uncommon, but aggressive form of breast cancer that accounts for a disproportionally high fraction of breast cancer related mortality. The aim of this study was to explore the peripheral immune response and the prognostic value of blood-based biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), in a large IBC cohort. Patients & methods We retrospectively identified 127 IBC patients and collected lab results from in-hospital medical records. The differential count of leukocytes was determined at the moment of diagnosis, before any therapeutic intervention. A cohort of early stage (n = 108), locally advanced (n = 74) and metastatic breast cancer patients (n = 41) served as a control population. Results The NLR was significantly higher in IBC compared to an early stage breast cancer cohort, but no difference between IBC patients and locally advanced breast cancer patients was noted. In the metastatic setting, there was also no significant difference between IBC and nIBC. However, a high NLR (>4.0) remained a significant predictor of worse outcome in IBC patients (HR: 0.49; 95% CI: 0.24–1.00; P = .05) and a lower platelet-lymphocyte ratio (PLR) (≤210) correlated with a better disease-free survival (DFS) (HR: 0.51; 95% CI: 0.28–0.93; P = .03). Conclusion Patients with a high NLR (>4.0) have a worse overall prognosis in IBC, while the PLR correlated with relapse free survival (RFS). Since NLR and PLR were not specifically associated with IBC disease, they can be seen as markers of more extensive disease. There is no association between NLR or PLR and inflammatory breast cancer (IBC). IBC and non-inflammatory breast cancer elicit a similar peripheral immune response. A high neutrophil-to-lymphocyte ratio (NLR) is associated with a worse overall survival in IBC. A high platelet-lymphocyte ratio (PLR) correlates with a worse disease-free survival in IBC. An elevated PLR or NLR should be seen as a marker of more extensive disease in IBC.
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Affiliation(s)
- C Van Berckelaer
- Translational Cancer Research Unit, GZA Hospitals & CORE, MIPRO, University of Antwerp, Antwerp, Belgium; Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
| | - M Van Geyt
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - S Linders
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - C Rypens
- Translational Cancer Research Unit, GZA Hospitals & CORE, MIPRO, University of Antwerp, Antwerp, Belgium
| | - X B Trinh
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - W A A Tjalma
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - S Van Laere
- Translational Cancer Research Unit, GZA Hospitals & CORE, MIPRO, University of Antwerp, Antwerp, Belgium
| | - C Colpaert
- Department of Pathology, UZA, Antwerp University Hospital, Edegem, Belgium
| | - L Dirix
- Translational Cancer Research Unit, GZA Hospitals & CORE, MIPRO, University of Antwerp, Antwerp, Belgium; Department of Oncology, GZA Hospitals Sint-Augustinus, Antwerp, Belgium
| | - P A van Dam
- Multidisciplinary Breast Clinic, Unit Gynaecologic Oncology, Antwerp University Hospital (UZA) (Belgium), Molecular Imaging, Pathology, Radiotherapy, Oncology (MIPRO), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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Knight K, Choong JX, McKee RF, Anderson JH, Horgan PG, McMillan DC, McDonald A, Roxburgh CS. The Influence of Systemic Inflammation on Treatment Response and Survival in Anal Squamous Cell Cancer. Clin Oncol (R Coll Radiol) 2020; 33:e22-e30. [PMID: 32709540 DOI: 10.1016/j.clon.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/19/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
AIMS The incidence of anal squamous cell cancer (SCCA) is rising. Although chemoradiotherapy (CRT) provides a chance of cure, a proportion of patients have an incomplete response or develop recurrence. This study assessed the value of inflammation-based prognostic indicators, including the modified Glasgow Prognostic Score (mGPS) and neutrophil:lymphocyte ratio (NLR), in patients with SCCA treated by CRT with curative intent. MATERIAL AND METHODS Patients with histologically confirmed SCCA were identified from pathology records. Medical records were retrospectively reviewed and clinical, pathological and treatment characteristics were abstracted. The mGPS (0 = normal C-reactive protein [CRP] and albumin, 1 = CRP >10 mg/l and 2 = CRP >10 mg/l and albumin <35 mg/l) and NLR were calculated from routine blood tests obtained prior to CRT. RESULTS In total, 118 patients underwent CRT for SCCA between December 2007 and February 2018. Of these, 99 patients had appropriate pretreatment blood results available. Systemic inflammation as indicated by NLR >3 and mGPS >0 was present in 41% and 39% of patients, respectively. Most patients had T2 or larger tumours (n = 85, 86%) without nodal involvement (n = 64, 65%). An elevated mGPS was associated with more advanced T-stage (56% versus 35%, P = 0.036). NLR >5 was associated with nodal positivity (56% versus 31%, P = 0.047). On multivariate analysis, more advanced T-stage (odds ratio 7.49, 95% confidence interval 1.51-37.20, P = 0.014) and a raised mGPS (odds ratio 5.13, 95% confidence interval 1.25-21.14, P = 0.024) were independently related to incomplete CRT response. An elevated mGPS was prognostic of inferior survival (hazard ratio 3.09, 95% confidence interval 1.47-6.50, P = 0.003) and cancer-specific survival (hazard ratio 4.32, 95% confidence interval 1.54-12.15, P = 0.006), independent of TNM stage. CONCLUSION Systemic inflammation, as measured by the mGPS, is associated with an incomplete CRT response and is independently prognostic of inferior survival in patients with SCCA. The mGPS may offer a simple marker of inferior outcome that could be used to identify high-risk patients.
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Affiliation(s)
- K Knight
- Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, UK.
| | - J X Choong
- School of Medicine, University of Glasgow, Glasgow, UK
| | - R F McKee
- Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - J H Anderson
- Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - P G Horgan
- Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - D C McMillan
- Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - A McDonald
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C S Roxburgh
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Gao X, Coull B, Lin X, Vokonas P, Sparrow D, Hou L, DeMeo DL, Litonjua AA, Schwartz J, Baccarelli AA. Association of Neutrophil to Lymphocyte Ratio With Pulmonary Function in a 30-Year Longitudinal Study of US Veterans. JAMA Netw Open 2020; 3:e2010350. [PMID: 32658288 PMCID: PMC7358911 DOI: 10.1001/jamanetworkopen.2020.10350] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Chronic obstructive pulmonary disease (COPD) is a critical public health burden. The neutrophil to lymphocyte ratio (NLR), an inflammation biomarker, has been associated with COPD morbidity and mortality; however, its associations with lung function decline and COPD development are poorly understood. OBJECTIVE To explore the associations of NLR with lung function decline and COPD risks. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study included white male veterans in the US with more than 30 years of follow-up to investigate the associations of NLR with lung function, COPD, and hypomethylation of cg05575921, the top DNA methylation marker of lung function changes in response to tobacco smoking. This study included 7466 visits from 1549 participants, each examined up to 13 times between 1982 and 2018. A subgroup of 1411 participants without COPD at baseline were selected to analyze the association of NLR with incident COPD. Data were analyzed from September 2019 to January 2020. EXPOSURES The primary exposure was NLR, which was estimated using automated whole blood cell counts based on a blood sample collected at each visit. The methylation level of cg05575921 was measured in blood DNA from a subgroup of 1228 visits. MAIN OUTCOMES AND MEASURES The outcomes of interest were lung function, measured as forced respiratory volume in the first second (FEV1) in liters, forced vital capacity (FVC) in liters, percentage of FVC exhaled in the first second (FEV1/FVC), and maximal midexpiratory flow rate (MMEF) in liters per minute and COPD status, defined as meeting the Global Initiative for Chronic Obstructive Lung Diseases stage II (or higher) criteria. Both outcomes were measured as each visit. RESULTS Among 1549 included men (mean [SD] age, 68.3 [9.3] years) with 7466 visits from 1982 to 2018, a 1-unit increase in NLR was associated with statistically significant mean (SE) decreases of 0.021 (0.004) L in FEV1, 0.016 (0.005) L in FVC, 0.290% (0.005) L in FVC, 0.290% (0.065%) in FEV1/FVC, and 3.65 (0.916) L/min MMEF. Changes in NLR up to approximately 10 years were associated with corresponding longitudinal changes in lung function. Furthermore, this increase in NLR was associated with 9% higher odds of COPD (odds ratio, 1.09 [95% CI, 1.03-1.15]) for all visits and 27% higher risk of incident COPD (odds ratio, 1.07 [95% CI, 1.07-1.51]) for participants without COPD at baseline. Additionally, a 1-unit increase in NLR was associated with a mean (SE) decrease of 0.0048 (0.0021 in cg05575921 hypomethylation, which may mediate the adverse association of NLR-related inflammation on lung function. CONCLUSIONS AND RELEVANCE These findings suggest that NLR may be a clinically relevant biomarker associated with high risk of lung function impairment and COPD alone or in combination with DNA methylation profiles.
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Affiliation(s)
- Xu Gao
- Laboratory of Environmental Precision Biosciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Pantel Vokonas
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - David Sparrow
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dawn L. DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, New York
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Andrea A. Baccarelli
- Laboratory of Environmental Precision Biosciences, Mailman School of Public Health, Columbia University, New York, New York
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Simonaggio A, Elaidi R, Fournier L, Fabre E, Ferrari V, Borchiellini D, Thouvenin J, Barthelemy P, Thibault C, Tartour E, Oudard S, Vano YA. Variation in neutrophil to lymphocyte ratio (NLR) as predictor of outcomes in metastatic renal cell carcinoma (mRCC) and non-small cell lung cancer (mNSCLC) patients treated with nivolumab. Cancer Immunol Immunother 2020; 69:2513-2522. [PMID: 32561968 DOI: 10.1007/s00262-020-02637-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND An elevated pre-treatment neutrophil to lymphocytes ratio (NLR) is associated with poor prognosis in various malignancies. Optimal cut-off is highly variable across studies and could not be determined individually for a patient to inform his prognosis. We hypothesize that NLR variations could be more useful than baseline NLR to predict progression-free survival (PFS) and overall survival (OS) in patients (pts) receiving anti-PD1 treatment. PATIENTS AND METHODS All pts with metastatic renal cell carcinoma (mRCC) and metastatic non-small cell lung cancer (mNSCLC) who received anti-PD1 nivolumab monotherapy in second-line setting or later were included in this French multicentric retrospective study. NLR values were prospectively collected prior to each nivolumab administration. Clinical characteristics were recorded. Associations between baseline NLR, NLR variations and survival outcomes were determined using Kaplan-Meier's method and multivariable Cox regression models. RESULTS 161 pts (86 mRCC and 75 mNSCLC) were included with a median follow-up of 18 months. On the whole cohort, any NLR increase at week 6 was significantly associated with worse outcomes compared to NLR decrease, with a median PFS of 11 months vs 3.7 months (p < 0.0001), and a median OS of 28.5 months vs. 18 months (p = 0.013), respectively. In multivariate analysis, NLR increase was significantly associated with worse PFS (HR 2.2; p = 6.10-5) and OS (HR 2.1; p = 0.005). Consistent results were observed in each cohort when analyzed separately. CONCLUSION Any NLR increase at week 6 was associated with worse PFS and OS outcomes. NLR variation is an inexpensive and dynamic marker easily obtained to monitor anti-PD1 efficacy.
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Affiliation(s)
- A Simonaggio
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - R Elaidi
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - L Fournier
- Department of Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - E Fabre
- Medical Thoracic Oncology Department, Hopital Européen Georges Pompidou, Paris, France
- U970, Université Paris Descartes Sorbonne Paris-Cité, 75006, Paris, France
| | - V Ferrari
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - D Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - J Thouvenin
- Department of Medical Oncology, University Hospital of Strasbourg, Strasbourg, France
| | - P Barthelemy
- Department of Medical Oncology, University Hospital of Strasbourg, Strasbourg, France
| | - C Thibault
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - E Tartour
- Department of Immunology, Hôpital Européen Georges Pompidou, 75015, Paris, France
- U970, Université Paris Descartes Sorbonne Paris-Cité, 75006, Paris, France
| | - S Oudard
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France
| | - Y A Vano
- Medical Oncology Department, Hôpital Européen Georges Pompidou, Paris, France.
- INSERM, UMR-S 1138, Centre de Recherche des Cordeliers, Team "Cancer, Immune Control and Escape", University Paris Descartes Sorbonne, 75006, Paris, France.
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Balboul Y, Gurshumov A, Azar A, Stav K, Efrati S, Beberashvili I. Biological basis of lymphocyte ratios for survival prediction in hemodialysis patients: a longitudinal study. Int Urol Nephrol 2020; 52:1345-1356. [PMID: 32333319 DOI: 10.1007/s11255-020-02471-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/13/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE The neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios have been proposed as emerging markers of inflammation and prognosis in maintenance hemodialysis (MHD) patients. However, to date, no longitudinal performance of these indices is known. The study's purpose was to examine the longitudinal relationship between NLR, PLR, inflammatory and nutritional parameters in MHD patients and how their changes over time associate with adverse clinical outcomes. METHODS A historical longitudinal cohort study was conducted using a clinical database which included 554 patients (mean age, 67.6 ± 14.2 years; 34% women) from a single center receiving MHD from November 2007 to July 2018. NLR, PLR, C-reactive protein (CRP) and nutritional parameters were recorded at 0, 6, 12, 18, 24, 30 and 36 months, followed by 58 additional months of clinical observations. RESULTS In a linear mixed-effects model adjusted for baseline demographics and clinical parameters, including white blood cell count, NLR and PLR were both associated with CRP levels at any given time point observation (linear estimates (95% CI): 1.53, (0.11-2.95) and 1.55 (0.15-2.93), respectively). For each 1.0-unit increase in NLR over time, the fully adjusted all-cause mortality hazard ratio using Cox models with the time-varying risk effect was 1.04 (95% CI 1.01-1.07, P = 0.006). However, when CRP was included in this model, the relationship was no longer significant. PLR's performance did not match the prognostic marker. CONCLUSION Longitudinal changes in NLR mimic CRP changes and predict all-cause mortality risk in MHD patients.
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Affiliation(s)
- Yoni Balboul
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aliona Gurshumov
- Internal Department E, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ada Azar
- Nutrition Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kobi Stav
- Urology Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Efrati
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Beberashvili
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Nunno VD, Mollica V, Gatto L, Santoni M, Cosmai L, Porta C, Massari F. Prognostic impact of neutrophil-to-lymphocyte ratio in renal cell carcinoma: a systematic review and meta-analysis. Immunotherapy 2020; 11:631-643. [PMID: 30943858 DOI: 10.2217/imt-2018-0175] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIM Estimate prognosis and clinical outcome of patients with localized or metastatic renal cell carcinoma (RCC) is an important issue which drive our medical decisions. METHODS We carried out a meta-analysis of available clinical studies exploring neutrophil-to-lymphocyte ratio (NLR) in RCC in order to evaluate if this ratio could be correlated to overall survival (OS) and progression-free survival (PFS) of patients with localized/metastatic RCC. RESULTS In overall population higher NLR resulted in worst OS and PFS (OS pooled hazard ratio of 1.80; 95% CI: 1.61-2.00; I2 45%; PFS pooled hazard ratio of 1.69; 95% CI: 1.42-2.01; I2 81%), this negative correlation was also confirmed in both metastatic and nonmetastatic patients. CONCLUSION The NLR ratio is a variable correlated to prognosis in RCC patients.
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Affiliation(s)
| | - Veronica Mollica
- Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Lidia Gatto
- Division of Oncology, S.Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Laura Cosmai
- Onco-Nephrology Outpatient Clinic, Division of Nephrology & Dialysis, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Camillo Porta
- Department of Internal Medicine, University of Pavia & Division of Traslational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
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Bruno V, Corrado G, Baci D, Chiofalo B, Carosi MA, Ronchetti L, Piccione E, Albini A, Noonan DM, Piaggio G, Vizza E. Endometrial Cancer Immune Escape Mechanisms: Let Us Learn From the Fetal-Maternal Interface. Front Oncol 2020; 10:156. [PMID: 32226771 PMCID: PMC7080858 DOI: 10.3389/fonc.2020.00156] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/29/2020] [Indexed: 12/14/2022] Open
Abstract
The immune escape mechanisms at the base of tumor progression in endometrial cancer mimic immune tolerance mechanisms occurring at the maternal-fetal interface. The biological and immunological processes behind the maternal-fetal interface are finely tuned in time and space during embryo implantation and subsequent pregnancy stages; conversely, those behind cancer progression are often aberrant. The environment composition at the maternal-fetal interface parallels the pro-tumor microenvironment identified in many cancers, pointing to the possibility for the use of the maternal-fetal interface as a model to depict immune therapeutic targets in cancer. The framework of cancer environment signatures involved in immune adaptations, precisely timed in cancer progression, could reveal a specific "immune clock" in endometrial cancer, which might guide clinicians in patient risk class assessment, diagnostic workup, management, surgical and therapeutic approach, and surveillance strategies. Here, we review studies approaching this hypothesis, focusing on what is known so far about oncofetal similarities in immunity with the idea to individualize personalized immunotherapy targets, through the downregulation of the immune escape stage or the reactivation of the pro-inflammatory processes suppressed by the tumor.
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Affiliation(s)
- Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Giacomo Corrado
- Gynecologic Oncology Unit, Department of Women and Children Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Denisa Baci
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Antonia Carosi
- Anatomy Pathology Unit, Department of Research, Diagnosis and Innovative Technologies, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Livia Ronchetti
- Anatomy Pathology Unit, Department of Research, Diagnosis and Innovative Technologies, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Emilio Piccione
- Section of Gynecology, Academic Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome "Tor Vergata", Rome, Italy
| | - Adriana Albini
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Vascular Biology and Angiogenesis Laboratory, Science and Technology Pole (PST), IRCCS MultiMedica, Milan, Italy
| | - Douglas M Noonan
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Vascular Biology and Angiogenesis Laboratory, Science and Technology Pole (PST), IRCCS MultiMedica, Milan, Italy
| | - Giulia Piaggio
- Department of Research, Diagnosis and Innovative Technologies, UOSD SAFU, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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Preoperative Neutrophil-to-Lymphocyte Ratio Was a Predictor of Overall Survival in Small Renal Cell Carcinoma: An Analysis of 384 Consecutive Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8051210. [PMID: 32219142 PMCID: PMC7079219 DOI: 10.1155/2020/8051210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/07/2019] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
Objective The aim of this study was to investigate the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) in small renal cell carcinoma (sRCC, ≤4 cm). Methods This study was approved by the review board (NO.XYFY2019-KL032-01). Between 2007 and 2016, a total of 384 consecutive patients who underwent curative surgery for sRCC at our institution were evaluated. Patients were divided into high NLR and low NLR groups by plotting the NLR receiver operating characteristic curve. The Kaplan–Meier method was utilized to graphically display survivor functions. Univariate and multivariate Cox proportional hazards regression analysis addressed time to overall survival (OS) and cancer-specific survival (CSS). Results Of the 384 patients, 264 (68.8%) were males and 120 (31.2%) were females. Median follow-up time after surgical resection was 54 months. One hundred and eighty-seven (48.7%) patients had a high NLR (≥1.97), and the remaining 197 (51.3%) had a low NLR (<1.97). Patients with high NLR were more likely to be aged compared with patients with low NLR (P=0.028). High NLR was associated with decreased OS and CSS compared with low NLR (P=0.028). High NLR was associated with decreased OS and CSS compared with low NLR (P=0.028). High NLR was associated with decreased OS and CSS compared with low NLR (P=0.028). High NLR was associated with decreased OS and CSS compared with low NLR ( Conclusions Elevated preoperative NLR is an independent adverse prognostic factor for OS after surgery with curative intent for sRCC.
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Hizal M, Sendur MA, Yasar HA, Bir Yucel K, Arslan C, Ucar G, Karakaya S, Taban H, Kucukarda A, Erturk I, Bilgin B, Yıldırım N, Demirci U, Kılıckap S, Cicin I, Karadurmus N, Yalcin B, Ürün Y. Neutrophil-lymphocyte ratio as a prognostic factor for survival in patients with advanced renal cell carcinoma (Turkish Oncology Group Study). J Oncol Pharm Pract 2020; 26:1583-1589. [PMID: 32054412 DOI: 10.1177/1078155219900908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND To describe the prognostic value of neutrophil-lymphocyte ratio and its effect on survival in in patients with advanced renal cell carcinoma. METHODS We retrospectively analyzed 331 patients. The cut-off value of neutrophil-lymphocyte ratio was specified as "3" which is mostly close-and also clinically easily applicable-to the median neutrophil-lymphocyte ratio level of our study group. High group is identified as neutrophil-lymphocyte ratio >3 (n = 160) and low group is identified as neutrophil-lymphocyte ratio ≤3 (n = 163). RESULTS A total of 331 (with 211 male and 120 female) patients were enrolled to study. The median age of the patients was 58. The International Metastatic RCC Database Consortium risk score is calculated for the 72.8% (n = 241) of the study group and among these patients, favorable, intermediate, and poor risk rates were 22, 45.2, and 32.8%. The total usage of tyrosine kinase inhibitors reached 78% of the patients. The median overall survival was 32 months versus 11 months in the neutrophil-lymphocyte ratio low and high groups, respectively (HR: 0.49 (95% CI 0.37-0.65), p < 0.001). CONCLUSION In conclusion, the pre-treatment value of elevated neutrophil-lymphocyte ratio might be a predictor of poor overall survival in advanced renal cell carcinoma patients.
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Affiliation(s)
- Mutlu Hizal
- Department of Medical Oncology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Mehmet An Sendur
- Department of Medical Oncology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Hatime Arzu Yasar
- Medical Oncology Department, Ankara University School of Medicine, Ankara, Turkey.,Ankara University Cancer Research Institute, Ankara, Turkey
| | - Kadriye Bir Yucel
- Internal Medicine Department, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Cagatay Arslan
- Department of Internal Medicine and Medical Oncology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey
| | - Gokhan Ucar
- Medical Oncology Department, University of Health Sciences, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Serdar Karakaya
- Medical Oncology Department, University of Health Sciences, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Hakan Taban
- Medical Oncology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kucukarda
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Ismail Erturk
- Medical Oncology Department, University of Health Sciences, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Burak Bilgin
- Department of Medical Oncology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Nuriye Yıldırım
- Department of Medical Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Umut Demirci
- Medical Oncology Department, University of Health Sciences, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Ankara, Turkey
| | - Saadettin Kılıckap
- Medical Oncology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Irfan Cicin
- Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Nuri Karadurmus
- Medical Oncology Department, University of Health Sciences, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Bulent Yalcin
- Department of Medical Oncology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Yüksel Ürün
- Medical Oncology Department, Ankara University School of Medicine, Ankara, Turkey.,Ankara University Cancer Research Institute, Ankara, Turkey
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Güneş M, Büyükgöl H. Relationship between generalized epileptic seizure and neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and neutrophil mediated inflammation. Int J Neurosci 2020; 130:1095-1100. [PMID: 31983256 DOI: 10.1080/00207454.2020.1722662] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aim: There is a close relationship between systemic inflammation and epileptic seizure. Recently, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been defined as significant inflammation biomarkers. In the present study, it was aimed to determine levels of NLR, PLR, and mean platelet volume (MPV) during generalized tonic clonic epileptic seizures, and to investigate their relationships with epileptic seizures.Methods: The present study was conducted on 72 patients with epilepsy who applied with primary and secondary generalized tonic clonic epileptic seizures according to classification of the International League Against Epilepsy (ILAE), and 72 healthy individuals as the control group. Neutrophil and lymphocyte counts, NLR, PLR, and MPV values of patients were evaluated both in acute (in the first hour of epileptic seizure) and subacute (in hour 72 of epileptic seizure) phases by biochemical analysis.Results: Statistically significant differences were determined in laboratory values of white blood cell (WBC) (p < 0.001), neutrophil (p < 0.001), lymphocyte (p < 0.001), NLR (p < 0.001), MPV (p < 0.05), platelet (p < 0.001), C-reactive protein (CRP) (p < 0.05) in acute phase; and in lymphocyte (p < 0.05), NLR (p < 0.05), platelet (p < 0.001), and CRP (p < 0.001) in subacute phase between patients and healthy controls. Statistically significant differences were determined in laboratory values of WBC (p < 0.001), neutrophil (p < 0.001), lymphocyte (p < 0.05), NLR (p < 0.001), CRP (p < 0.001), and PLR (p < 0.05) in patient group between acute and subacute phases. In patient group, mean lymphocyte count was determined lower in acute phase than subacute phase (p < 0.05).Conclusion: The most striking finding of the present study is determination of 1 unit increase in NLR results in 1.95 folds increase in epileptic seizure risk in binary logistic regression analysis. Additionally, it indicates that epileptic seizure is correlated with NLR, PLR, and neutrophil mediated inflammation. To the best of authors knowledge, this is the first report indicating that there is a relationship between epileptic seizure and PLR, neutrophil mediated inflammation, and that 1 unit increase in NLR increases epileptic seizure risk by 1.95 folds.
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Affiliation(s)
- Muzaffer Güneş
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Hüseyin Büyükgöl
- Department of Neurology, Medicana Medical Faculty, KTO Karatay University, Konya, Turkey
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Hua X, Chen J, Wu Y, Sha J, Han S, Zhu X. Prognostic role of the advanced lung cancer inflammation index in cancer patients: a meta-analysis. World J Surg Oncol 2019; 17:177. [PMID: 31677642 PMCID: PMC6825711 DOI: 10.1186/s12957-019-1725-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Inflammation plays a critical role in the development and progression of cancers. The advanced lung cancer inflammation index (ALI) is thought to be able to reflect systemic inflammation better than current biomarkers. However, the prognostic significance of the ALI in various types of cancer remains unclear. Our meta-analysis aimed to comprehensively investigate the relationship between the ALI and oncologic outcomes to help physicians better assess the prognosis of cancer patients. Methods The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched for relevant studies. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated and pooled from the included studies. Furthermore, a sensitivity analysis was performed to evaluate the reliability of the articles. Finally, Begg’s test, Egger’s test, and the funnel plot were applied to assess the significance of publication bias. Results In total, 1736 patients from nine studies were included in our meta-analysis. The median cutoff value for the ALI was 23.2 (range, 15.5–37.66) in the analyzed studies. The meta-analysis showed that there was a statistically significant relationship between a low ALI and worse overall survival (OS) in various types of cancer (HR = 1.70, 95% CI = 1.41–1.99, P < 0.001). Moreover, results from subgroup meta-analysis showed that the ALI had a significant prognostic value in non-small cell lung cancer, small cell lung cancer, colorectal cancer, head and neck squamous cell carcinoma, and diffuse large B cell lymphoma (P < 0.05 for all). Conclusions These results showed that a low ALI was associated with poor OS in various types of cancer, and the ALI could act as an effective prognostic biomarker in cancer patients.
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Affiliation(s)
- Xin Hua
- Medical School of Southeast University, Nanjing, 210009, China
| | - Jing Chen
- Department of Respiratory, Zhongda Hospital of Southeast University, Dingjiaqiao 87, Gulou District, Nanjing, 210009, China
| | - Ying Wu
- Department of Respiratory, Zhongda Hospital of Southeast University, Dingjiaqiao 87, Gulou District, Nanjing, 210009, China
| | - Jun Sha
- Medical School of Southeast University, Nanjing, 210009, China
| | - Shuhua Han
- Department of Respiratory, Zhongda Hospital of Southeast University, Dingjiaqiao 87, Gulou District, Nanjing, 210009, China
| | - Xiaoli Zhu
- Medical School of Southeast University, Nanjing, 210009, China. .,Department of Respiratory, Zhongda Hospital of Southeast University, Dingjiaqiao 87, Gulou District, Nanjing, 210009, China.
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Bayram S, Özmen E, Birişik F, Kıral D, Salduz A, Erşen A. Prognostic factors affecting survival of patients with pathologic humerus shaft fractures treated with intramedullary nailing without tumor removal. J Orthop Sci 2019; 24:1068-1073. [PMID: 31543425 DOI: 10.1016/j.jos.2019.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intramedullary nailing is the procedure of choice for pathologic fractures in humeral shaft because it allows early pain relief and mobilization. The aim of this study was to analyze the prognostic factors affecting survival of patients with pathologic humeral shaft fractures treated with intramedullary nailing without tumor removal. METHODS We performed a retrospective study by evaluating the records of patients treated in our clinic between 2003 and 2018 for pathologic humerus shaft fractures with a minimum follow-up of one year. Kaplan-Meier methods were applied to estimate overall survival. A multivariate Cox algorithm was applied to recognize factors independently associated with survival. RESULTS 52 patients (56 humeral fractures) were operated. The average age at the time of surgery was 58.9 years. There were 28 women and 24 men. In our series, multiple myeloma accounted for 52% of the cases. At the time of this study, 34 (65.3%) patients had deceased. Survival rates at first month, 6 months and 1 year after surgery were 96.2%, 67.4% and 59.6%, respectively. The median survival after surgery was 7.5 (6 days-84 months) months for deceased patients and 18 (34.7%) surviving patients with a median survival of 68.6 months. Rapid growth tumor, presence of pathological fracture in other extremities and, Eastern Cooperative Oncology Group performance status (ECOG-PS) were independently associated with a worse overall survival. CONCLUSION More than 50% of patients with pathological humerus shaft fractures were diagnosed with multiple myeloma. Rapid growth tumors such as lung cancer and renal cell cancer increased mortality by a factor of 1 while presence of operative metastases in other extremities increased mortality by a factor of 3.1 and ECOG-PS increased mortality by a factor 6.8. Rapid growth tumors, ECOG-PS and presence of pathological fracture in other extremities were important prognostic factors influencing overall survival.
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Affiliation(s)
- Serkan Bayram
- Department of Orthopaedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey.
| | - Emre Özmen
- Department of Orthopaedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Fevzi Birişik
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Doğan Kıral
- Department of Orthopaedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Salduz
- Department of Orthopaedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ali Erşen
- Department of Orthopaedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Lecot P, Sarabi M, Pereira Abrantes M, Mussard J, Koenderman L, Caux C, Bendriss-Vermare N, Michallet MC. Neutrophil Heterogeneity in Cancer: From Biology to Therapies. Front Immunol 2019; 10:2155. [PMID: 31616408 PMCID: PMC6764113 DOI: 10.3389/fimmu.2019.02155] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/28/2019] [Indexed: 12/12/2022] Open
Abstract
Neutrophils have been extensively described in the pathophysiology of autoimmune and infectious diseases. Accumulating evidence also suggests the important role of neutrophils in cancer progression through their interaction with cancer and immune cells in blood and in the tumor microenvironment (TME). Most studies have described neutrophils as key drivers of cancer progression, due to their involvement in various tumor promoting functions including proliferation, aggressiveness, and dissemination, as well as in immune suppression. However, such studies were focusing on late-stages of tumorigenesis, in which chronic inflammation had already developed. The role of tumor-associated neutrophils (TANs) at early stages of tumor development remains poorly described, though recent findings indicate that early-stage TANs may display anti-tumor properties. Beyond their role at tumor site, evidence supported by NLR retrospective studies and functional analyses suggest that blood neutrophils could also actively contribute to tumorigenesis. Hence, it appears that the phenotype and functions of neutrophils vary greatly during tumor progression, highlighting their heterogeneity. The origin of pro- or anti-tumor neutrophils is generally believed to arise following a change in cell state, from resting to activated. Moreover, the fate of neutrophils may also involve distinct differentiation programs yielding various subsets of pro or anti-tumor neutrophils. In this review, we will discuss the current knowledge on neutrophils heterogeneity across different tissues and their impact on tumorigenesis, as well as neutrophil-based therapeutic strategies that have shown promising results in pre-clinical studies, paving the way for the design of neutrophil-based next generation immunotherapy.
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Affiliation(s)
- Pacôme Lecot
- Department of Immunity, Virus, and Inflammation (IVI), Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Matthieu Sarabi
- Department of Immunity, Virus, and Inflammation (IVI), Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Manuela Pereira Abrantes
- Department of Immunity, Virus, and Inflammation (IVI), Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Julie Mussard
- Department of Immunity, Virus, and Inflammation (IVI), Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Leo Koenderman
- Department of Respiratory Medicine and Center of Translational Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Christophe Caux
- Department of Immunity, Virus, and Inflammation (IVI), Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Nathalie Bendriss-Vermare
- Department of Immunity, Virus, and Inflammation (IVI), Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
| | - Marie-Cécile Michallet
- Department of Immunity, Virus, and Inflammation (IVI), Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, University of Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Lyon, France
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Çekici Y, Yılmaz M, Seçen Ö. New inflammatory indicators: association of high eosinophil-to-lymphocyte ratio and low lymphocyte-to-monocyte ratio with smoking. J Int Med Res 2019; 47:4292-4303. [PMID: 31319727 PMCID: PMC6753567 DOI: 10.1177/0300060519862077] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective Smoking has been proven to increase systemic inflammation in previous studies
using different biomarkers. The eosinophil-to-lymphocyte ratio (ELR),
neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR)
are new indicators of systemic inflammation that are used as predictors of
systemic inflammation, morbidity, and mortality associated with many
diseases. We investigated the effects of smoking on these inflammatory
indicators. Methods In total, 616 consecutive smoking healthy subjects and 387 age-matched
nonsmoking healthy subjects were enrolled. White blood cell counts
(neutrophils, lymphocytes, basophils, eosinophils, and monocytes) were
determined by electrical impedance with an automatic blood cell counting
device. The ELR, LMR, and NLR were calculated based on these cell counts.
Smoking habits of participants were calculated as pack/year. Results The NLR and ELR were significantly higher and the LMR was significantly lower
in smokers than nonsmokers. The pack-years were positively correlated with
the NLR and ELR and negatively correlated with the LMR. Conclusion A high NLR and ELR and low LMR are associated with cigarette smoking and may
be useful indicators of systemic inflammation activity, even in healthy
smokers. Smokers with a high NLR and ELR and low LMR can easily be
identified during routine blood analysis and might benefit from preventive
treatment.
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Affiliation(s)
- Yusuf Çekici
- Department of Cardiology, Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Mücahid Yılmaz
- Department of Cardiology, Elazığ Education and Research Hospital, Elazığ, Turkey
| | - Özlem Seçen
- Department of Cardiology, Elazığ Education and Research Hospital, Elazığ, Turkey
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Çolak M, Eravcı FC, Karakurt SE, Karakuş MF, İkincioğulları A, Özcan KM. The Predictive Value of Neutrophil-to-Lymphocyte Ratio for Hodgkin's Lymphoma Diagnosis in Patients with Asymptomatic Cervical Lymphadenopathy. Indian J Otolaryngol Head Neck Surg 2019; 71:986-991. [PMID: 31742107 DOI: 10.1007/s12070-019-01676-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/27/2019] [Indexed: 12/31/2022] Open
Abstract
In patients with asymptomatic cervical lymphadenopathy, the physician often has to choose between evaluation via follow-up or open biopsy. Follow-up evaluation may lead to a delayed diagnosis of lymphoma, while an open biopsy is associated with surgical risks and costs. This dilemma can be avoided using predictive parameters. In the present study, we aimed to investigate whether neutrophil-to-lymphocyte ratio (NLR), a parameter which can be assessed quickly with ease and at low cost, has predictive value for Hodgkin's lymphoma diagnosis in patients with asymptomatic cervical lymphadenopathy. A total of 46 patients with asymptomatic cervical lymphadenopathy who underwent open biopsy were included in the study. Based on the biopsy results, the patients were divided into two groups, Hodgkin lymphoma (26 patients) and reactive lymphadenopathy (20 patients). The mean NLR in the groups was calculated and compared based on the results of complete blood count performed before biopsy. We found that mean NLR (P = 0.022) and mean neutrophil count (P = 0.046) were higher and mean lymphocyte count was lower (P = 0.054) in patients with Hodgkin's lymphoma compared to those in patients with reactive lymphadenopathy. Our results indicate that a high NLR may have predictive value for Hodgkin's lymphoma diagnosis in patients with asymptomatic cervical lymphadenopathy.
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Affiliation(s)
- Mustafa Çolak
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Fakih Cihat Eravcı
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Süleyman Emre Karakurt
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Mehmet Fatih Karakuş
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Aykut İkincioğulları
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
| | - Kürşat Murat Özcan
- Department of Otorhinolaryngology, Health Sciences University, Ankara Numune Training and Research Hospital, Talatpaşa Blv. No: 44, 06230 Ankara, Turkey
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50
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Arroyo VM, Lupo PJ, Scheurer ME, Rednam SP, Murray J, Okcu MF, Chintagumpala MM, Brown AL. Pilot study of DNA methylation-derived neutrophil-to-lymphocyte ratio and survival in pediatric medulloblastoma. Cancer Epidemiol 2019; 59:71-74. [PMID: 30703618 DOI: 10.1016/j.canep.2019.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/07/2019] [Accepted: 01/15/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Methylation-derived neutrophil-to-lymphocyte ratio (mdNLR) has been identified as a potential prognostic biomarker of outcomes in various cancers. We evaluated the prognostic value of blood-derived mdNLR within a retrospective cohort of pediatric medulloblastoma patients. MATERIALS AND METHODS DNA methylation was measured in archival peripheral blood samples collected on 56 pediatric medulloblastoma patients. Hazard ratios (HR) and 95% confidence intervals (CI) for the association between mdNLR and survival were evaluated using Cox proportional hazard models. RESULTS Compared to patients who were alive at last follow-up (n = 43), the mean mdNLR value was slightly higher in deceased patients (n = 13) (12.3 vs. 5.2,P = 0.163). Elevated log-transformed mdNLR was suggestively associated with an increased likelihood of death in unadjusted models (HR=1.43, 95%CI: 0.92-2.22) and significantly associated with mortality in adjusted models (HR=1.61, 95%CI: 1.01-2.58). DISCUSSION Future work is warranted to investigate the relationship between mdNLR outcomes in specific pediatric medulloblastoma molecular subgroups.
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Affiliation(s)
- Vidal M Arroyo
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA
| | - Philip J Lupo
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA; Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Michael E Scheurer
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA; Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Surya P Rednam
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA; Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | | | - M Fatih Okcu
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA; Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Murali M Chintagumpala
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA; Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Austin L Brown
- Baylor College of Medicine, One Baylor Plaza, Houston, TX, USA; Texas Children's Cancer and Hematology Centers, Houston, TX, USA.
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