1
|
Sun M, Zhu S, Wang Y, Zhao Y, Yan K, Li X, Wang X, He C, Ding C, Chen Y, Sun Z, Hu S. Effect of inflammation on association between cancer and coronary artery disease. BMC Cardiovasc Disord 2024; 24:72. [PMID: 38267838 PMCID: PMC10809766 DOI: 10.1186/s12872-023-03613-0] [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: 06/16/2023] [Accepted: 11/14/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Cancer and coronary artery disease (CAD) is reported to often co-exist in same individuals, however, whether cancer is directly associated with anatomical severity of CAD is rarely studied. The present study aimed to observe the relationship between newly diagnosed cancer and anatomical severity of CAD, moreover, to investigate effect of inflammation on the relationship of cancer with CAD. METHODS 374 patients with newly diagnosed cancer who underwent coronary angiography (CAG) were enrolled. Through 1:3 propensity score matching (PSM) to cancer patients based on the age and gender among 51,106 non-cancer patients who underwent CAG, 1122 non-cancer patients were selected as control patients. Anatomical severity of CAD was assessed using SYNTAX score (SXscore) based on coronary angiographic image. SXscore ≤ 22 (highest quartile) was defined as SX-low, and SXscore > 22 as SX-high. The ratio of neutrophil to lymphocyte count (NLR) was used to describe inflammation level. Association between cancer and the anatomical severity of CAD was investigated using logistic regression. RESULTS Univariate logistic regression analysis showed a correlation between cancer and anatomical severity of CAD (OR: 1.419, 95% CI: 1.083-1.859; P = 0.011). Cancer was associated with increased risk of SX-high after adjusted for common risk factors of CAD (OR: 1.598, 95% CI: 1.172-2.179, P = 0.003). Significant association between cancer and SX-high was revealed among patients with high inflammation (OR: 1.656, 95% CI: 1.099-2.497, P = 0.016), but not among patients with low inflammation (OR: 1.530, 95% CI: 0.973-2.498, P = 0.089). CONCLUSIONS Cancer was associated with severity of CAD, however, the association between the two diseases was significant among patients with high inflammation rather than among patients with low inflammation.
Collapse
Affiliation(s)
- Mingzhuang Sun
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China
- Cardiac Department, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Shaoning Zhu
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China
| | - Yihao Wang
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China
| | - Yawei Zhao
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China
| | - Kaixin Yan
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China
| | - Xiaolong Li
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China
| | - Xueting Wang
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China
| | - Changjian He
- Cardiac Department, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Chunhua Ding
- Cardiac Department, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China
| | - Zhijun Sun
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China.
| | - Shunying Hu
- Department of Cardiology, Chinese PLA General Hospital, #28 Fuxing Rd, Beijing, 100853, China.
| |
Collapse
|
2
|
Colloca G, Venturino A, Guarneri D. Neutrophil-to-lymphocyte ratio predict survival of patients with rectal cancer receiving neo-adjuvant chemoradiation followed by radical resection: a meta-analysis. Expert Rev Anticancer Ther 2023; 23:421-429. [PMID: 36970998 DOI: 10.1080/14737140.2023.2194635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio is suggested as a prognostic and predictive factor for patients with rectal cancer. The purpose of the current meta-analysis is to evaluate the relationship between neutrophil-lymphocyte ratio (NLR) and the outcome of patients, with rectal cancer receiving chemoradiation and surgery. METHODS A systematic review on two databases and a selection of studies were done. Thereafter, two meta-analyses were performed, evaluating the relationship of baseline NLR with overall survival (OS) and disease-free survival (DFS). RESULTS Thirty-one retrospective studies were selected. Twenty-six studies have documented a significant relationship of NLR to OS (HR 2.05, CI 1.66-2.53), whereas 23 studies have reported a weaker but significant relationship of NLR to DFS (HR 1.78, CI 1.49-2.12). Among the moderator variables, a possible effect for age and sex on the relationship of NLR with DFS is suggested. CONCLUSIONS Baseline NLR >3 is a simple and reproducible prognostic factor, with a more consistent effect in the elderly. It could be a reliable variable to support clinicians in defining personalized treatment strategies, even though a standardization of the cutoff and a better characterization among microsatellite unstable rectal tumors are necessary.
Collapse
|
3
|
Lee JH, Kang BH, Song C, Kang SB, Lee HS, Lee KW, Chie EK, Kim JS. Microsatellite Instability Correlated Inflammatory Markers and their Prognostic Value in the Rectal Cancer Following Neoadjuvant Chemoradiotherapy: A Hypothesis-generating Study. In Vivo 2021; 34:2119-2126. [PMID: 32606192 DOI: 10.21873/invivo.12017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM This study aimed to analyze the correlation between microsatellite instability (MSI) and inflammatory markers during neoadjuvant CRT in rectal cancer and its influence on prognosis. PATIENTS AND METHODS A total of 549 patients with locally advanced rectal cancer underwent neoadjuvant CRT. Complete blood counts before CRT, and 4-8 weeks after CRT were used to measure neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). RESULTS MSI was significantly associated with elevated NLR and PLR after CRT as well as with a change in NLR and PLR during CRT. Neither inflammatory markers nor MSI significantly related to survival. However, in patients with MSI, an increase in NLR and PLR before CRT was significantly correlated with poor overall survival and disease-free survival. CONCLUSION There is correlation between inflammatory markers and MSI during CRT and it influences prognosis. Therefore, inflammatory markers might have a role in assessing the microenvironment related to MSI and the immunologic response in rectal cancer.
Collapse
Affiliation(s)
- Joo Ho Lee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Hee Kang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Changhoon Song
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| |
Collapse
|
4
|
Can Pre-Treatment Inflammatory Parameters Predict the Probability of Sphincter-Preserving Surgery in Patients with Locally Advanced Low-Lying Rectal Cancer? Diagnostics (Basel) 2021; 11:diagnostics11060946. [PMID: 34070592 PMCID: PMC8226544 DOI: 10.3390/diagnostics11060946] [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: 03/25/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022] Open
Abstract
There is evidence suggesting that pre-treatment clinical parameters can predict the probability of sphincter-preserving surgery in rectal cancer; however, to date, data on the predictive role of inflammatory parameters on the sphincter-preservation rate are not available. The aim of the present cohort study was to investigate the association between inflammation-based parameters and the sphincter-preserving surgery rate in patients with low-lying locally advanced rectal cancer (LARC). A total of 848 patients with LARC undergoing radiotherapy from 2004 to 2019 were retrospectively reviewed in order to identify patients with rectal cancer localized ≤6 cm from the anal verge, treated with neo-adjuvant radiochemotherapy (nRCT) and subsequent surgery. Univariable and multivariable analyses were used to investigate the role of pre-treatment inflammatory parameters, including the C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for the prediction of sphincter preservation. A total of 363 patients met the inclusion criteria; among them, 210 patients (57.9%) underwent sphincter-preserving surgery, and in 153 patients (42.1%), an abdominoperineal rectum resection was performed. Univariable analysis showed a significant association of the pre-treatment CRP value (OR = 2.548, 95% CI: 1.584–4.097, p < 0.001) with sphincter preservation, whereas the pre-treatment NLR (OR = 1.098, 95% CI: 0.976–1.235, p = 0.120) and PLR (OR = 1.002, 95% CI: 1.000–1.005, p = 0.062) were not significantly associated with the type of surgery. In multivariable analysis, the pre-treatment CRP value (OR = 2.544; 95% CI: 1.314–4.926; p = 0.006) was identified as an independent predictive factor for sphincter-preserving surgery. The findings of the present study suggest that the pre-treatment CRP value represents an independent parameter predicting the probability of sphincter-preserving surgery in patients with low-lying LARC.
Collapse
|
5
|
Cupp MA, Cariolou M, Tzoulaki I, Aune D, Evangelou E, Berlanga-Taylor AJ. Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies. BMC Med 2020; 18:360. [PMID: 33213430 PMCID: PMC7678319 DOI: 10.1186/s12916-020-01817-1] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although neutrophils have been linked to the progression of cancer, uncertainty exists around their association with cancer outcomes, depending on the site, outcome and treatments considered. We aimed to evaluate the strength and validity of evidence on the association between either the neutrophil to lymphocyte ratio (NLR) or tumour-associated neutrophils (TAN) and cancer prognosis. METHODS We searched MEDLINE, Embase and Cochrane Database of Systematic Reviews from inception to 29 May 2020 for systematic reviews and meta-analyses of observational studies on neutrophil counts (here NLR or TAN) and specific cancer outcomes related to disease progression or survival. The available evidence was graded as strong, highly suggestive, suggestive, weak or uncertain through the application of pre-set GRADE criteria. RESULTS A total of 204 meta-analyses from 86 studies investigating the association between either NLR or TAN and cancer outcomes met the criteria for inclusion. All but one meta-analyses found a hazard ratio (HR) which increased risk (HR > 1). We did not find sufficient meta-analyses to evaluate TAN and cancer outcomes (N = 9). When assessed for magnitude of effect, significance and bias related to heterogeneity and small study effects, 18 (9%) associations between NLR and outcomes in composite cancer endpoints (combined analysis), cancers treated with immunotherapy and some site specific cancers (urinary, nasopharyngeal, gastric, breast, endometrial, soft tissue sarcoma and hepatocellular cancers) were supported by strong evidence. CONCLUSION In total, 60 (29%) meta-analyses presented strong or highly suggestive evidence. Although the NLR and TAN hold clinical promise in their association with poor cancer prognosis, further research is required to provide robust evidence, assess causality and test clinical utility. TRIAL REGISTRATION PROSPERO CRD42017069131 .
Collapse
Affiliation(s)
- Meghan A Cupp
- Department of Epidemiology & Biostatistics, MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W21PG, UK
| | - Margarita Cariolou
- Department of Epidemiology & Biostatistics, MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W21PG, UK
| | - Ioanna Tzoulaki
- Department of Epidemiology & Biostatistics, MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W21PG, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Dagfinn Aune
- Department of Epidemiology & Biostatistics, MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W21PG, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Evangelos Evangelou
- Department of Epidemiology & Biostatistics, MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W21PG, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Antonio J Berlanga-Taylor
- Department of Epidemiology & Biostatistics, MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W21PG, UK.
| |
Collapse
|
6
|
Fülöp ZZ, Fülöp RL, Gurzu S, Bara T, Tímár J, Drágus E, Jung I. Prognostic Impact of the Neutrophil-to-Lymphocyte and Lymphocyte-to-Monocyte Ratio, in Patients with Rectal Cancer: A Retrospective Study of 1052 Patients. J Pers Med 2020; 10:jpm10040173. [PMID: 33081102 PMCID: PMC7712240 DOI: 10.3390/jpm10040173] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 02/05/2023] Open
Abstract
Despite the description of several new prognostic markers, colorectal cancer still represents the third most frequent cause of cancer-related death. As immunotherapy is considered a therapeutic alternative in such patients, neutrophil-to-lymphocyte (NLR) and lymphocyte-to-monocyte ratio (LMR) are hypothesized to provide reliable prognostic information. A retrospective study was conducted on 1052 patients operated on during 2013-2019 in two clinical hospitals from Hungary and Romania. Inclusion criteria targeted patients over 18 years old, diagnosed with rectal cancer, with preoperatively defined NLR and LMR. The overall survival rate, along with clinical and histopathological data, was evaluated. Overall survival was significantly associated with increased NLR (p = 0.03) and decreased LMR (p = 0.04), with cut-off values of 3.11 and 3.39, respectively. The two parameters were inversely correlated (p < 0.0001). There was no statistically significant association between tumor stage and NLR or LMR (p = 0.30, p = 0.06, respectively). The total mesorectal excision was especially obtained in cases with low NLR (p = 0.0005) and high LMR (p = 0.0009) values. A significant association was also seen between preoperative chemoradiotherapy and high NLR (p = 0.0001) and low LMR (p = 0.0001). In patients with rectal cancer, the preoperative values of NLR and LMR can be used as independent prognostic parameters. An NLR value of ≥3.11 can be used to indicate the response to preoperative chemoradiotherapy, but a low chance of sphincter preservation or obtaining a complete TME. Higher values of NLR and lower values of LMR require a more attentive preoperative evaluation of the mesorectum.
Collapse
Affiliation(s)
- Zsolt Zoltán Fülöp
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania; (Z.Z.F.); (R.L.F.); (T.B.J.)
| | - Réka Linda Fülöp
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania; (Z.Z.F.); (R.L.F.); (T.B.J.)
| | - Simona Gurzu
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania;
- Research Center (CCAMF), George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania
- Correspondence: ; Tel.: +40-745-673550; Fax: +40-265-210407
| | - Tivadar Bara
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540139 Targu Mures, Romania; (Z.Z.F.); (R.L.F.); (T.B.J.)
| | - József Tímár
- Second Department of Pathology, National Institute of Oncology, Faculty of Medicine, Semmelweis University, H-1085 Budapest, Hungary;
| | - Emőke Drágus
- Department of Urology, Clinical County Hospital, 540167 Targu Mures, Romania;
| | - Ioan Jung
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania;
| |
Collapse
|
7
|
Timudom K, Akaraviputh T, Chinswangwatanakul V, Pongpaibul A, Korpraphong P, Petsuksiri J, Ithimakin S, Trakarnsanga A. Predictive significance of cancer related-inflammatory markers in locally advanced rectal cancer. World J Gastrointest Surg 2020; 12:390-396. [PMID: 33024513 PMCID: PMC7520570 DOI: 10.4240/wjgs.v12.i9.390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/11/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Locally advanced rectal cancer is treated using neoadjuvant chemoradiation (nCRT), followed by total mesorectal excision (TME). Tumor regression and pathological post-treatment stage are prognostic for oncological outcomes. There is a significant correlation between markers representing cancer-related inflammation, including high neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) and unfavorable oncological outcomes. However, the predictive role of these markers on the effect of chemoradiation is unknown.
AIM To evaluate the predictive roles of NLR, MLR, and PLR in patients with locally advanced rectal cancer receiving neoadjuvant chemoradiation.
METHODS Patients (n = 111) with locally advanced rectal cancer who underwent nCRT followed by TME at the Minimally Invasive Surgery Unit, Siriraj Hospital between 2012 and 2018 were retrospectively analyzed. The associations between post-treatment pathological stages, neoadjuvant rectal (NAR) score and the pretreatment ratios of markers of inflammation (NLR, MLR, and PLR) were analyzed.
RESULTS Clinical stages determined using computed tomography, magnetic resonance imaging, or both were T4 (n = 16), T3 (n = 94), and T2 (n = 1). The NAR scores were categorized as high (score > 16) in 23.4%, intermediate (score 8-16) in 41.4%, and low (score < 8) in 35.2%. The mean values of the NLR, PLR, and MLR correlated with pathological tumor staging (ypT) and the NAR score. The values of NLR, PLR and MLR were higher in patients with advanced pathological stage and high NAR scores, but not statistically significant.
CONCLUSION In patients with locally advanced rectal cancer, pretreatment NLR, MLR and PLR are higher in those with advanced pathological stage but the differences are not significantly different.
Collapse
Affiliation(s)
- Kitinat Timudom
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thawatchai Akaraviputh
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Vitoon Chinswangwatanakul
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Ananya Pongpaibul
- Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pornpim Korpraphong
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Janjira Petsuksiri
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Suthinee Ithimakin
- Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Atthaphorn Trakarnsanga
- Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| |
Collapse
|
8
|
Xia LJ, Li W, Zhai JC, Yan CW, Chen JB, Yang H. Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and prognostic nutritional index for predicting clinical outcomes in T1-2 rectal cancer. BMC Cancer 2020; 20:208. [PMID: 32164623 PMCID: PMC7066735 DOI: 10.1186/s12885-020-6698-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background Inflammation-related parameters have been revealed to have prognostic value in multiple caners. However, the significance of some inflammation-related parameters, including the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and prognostic nutritional index (PNI), remains controversial in T1–2 rectal cancer (RC). Methods Clinical data of 154 T1–2 RC patients were retrospectively reviewed. The cut-off values for NLR, PLR, LMR, and PNI were determined by receiver operating characteristic curves. The relationships of these parameters with postoperative morbidities and prognosis were statistically analysed. Results The optimal cut-off values for preoperative NLR, PLR, LMR and PNI were 2.8, 140.0, 3.9, and 47.1, respectively. Significant but heterogeneous associations were found between NLR, PLR, LMR and PNI and clinicopathological factors. In addition, high NLR, high PLR, and low PNI were correlated with an increased postoperative morbidity rate. Patients with high NLR/PLR or low LMR/PNI had lower OS and DFS rates. On multivariate analysis, only high NLR was identified as an independent risk factor for poor DFS. Conclusions NLR, PLR, and PNI are valuable factors for predicting postoperative complications in T1–2 RC patients. A preoperative NLR of more than 2.8 is an independent prognostic factor for poor DFS in T1–2 RC patients.
Collapse
Affiliation(s)
- Li-Jian Xia
- Department of Colorectal and Anal Surgery, the First Affiliated Hospital of Shandong First Medical University, Jinan, 250012, Shandong Province, China
| | - Wen Li
- Department of Colorectal and Anal Surgery, the First Affiliated Hospital of Shandong First Medical University, Jinan, 250012, Shandong Province, China
| | - Jian-Cheng Zhai
- Department of Colorectal and Anal Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Jinan, 250012, Shandong Province, China
| | - Chuan-Wang Yan
- Department of Colorectal and Anal Surgery, Shandong Provincial Qianfoshan Hospital, Weifang Medical College, Jinan, 250012, Shandong Province, China
| | - Jing-Bo Chen
- Department of Colorectal and Anal Surgery, the First Affiliated Hospital of Shandong First Medical University, Jinan, 250012, Shandong Province, China
| | - Hui Yang
- Department of Colorectal and Anal Surgery, the First Affiliated Hospital of Shandong First Medical University, Jinan, 250012, Shandong Province, China.
| |
Collapse
|
9
|
Cha YJ, Park EJ, Baik SH, Lee KY, Kang J. Prognostic impact of persistent lower neutrophil-to-lymphocyte ratio during preoperative chemoradiotherapy in locally advanced rectal cancer patients: A propensity score matching analysis. PLoS One 2019; 14:e0214415. [PMID: 30901357 PMCID: PMC6430363 DOI: 10.1371/journal.pone.0214415] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/12/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose This study investigated the significance of change in neutrophil-to-lymphocyte ratio (NLR) during preoperative chemoradiotherapy (preop-CRT) in patients with non-metastatic rectal cancer using a propensity score matching method (PSM). Methods Patients who underwent surgery after completion of preop-CRT for non-metastatic rectal cancers from Jan 2004 to Dec 2013 were retrospectively enrolled. NLRs were obtained before commencement of CRT (pre-NLR) and between completion of CRT and surgery (post-NLR). Using Cox regression hazards models, the association of NLRs with survival after PSM was examined. Results A total of 131 patients were grouped as follows: group A, pre-NLR < 3 & post-NLR < 3 (n = 47); group B, pre-NLR < 3 & post-NLR ≥ 3 (n = 45); group C, pre-NLR ≥ 3 & post-NLR < 3 (n = 5); group D, pre-NLR ≥ 3 & post-NLR ≥ 3 (n = 34). There was no difference in disease-free survival (DFS) or overall survival (OS) rate according to group. When dichotomized into group A versus groups B-D, DFS was higher in group A (84.7%) than groups B-D (67.5%, p = 0.021). After PSM (n = 94), multivariable analysis identified persistent lower NLR as an independent favorable prognosticator of DFS (HR 0.37, 95% CI 0.15–0.92, p = 0.033). Conclusions Persistent non-inflammatory state measured by NLR may be an indicator of decreased risk of recurrence in patients with locally advanced rectal cancer treated with preop-CRT.
Collapse
Affiliation(s)
- Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Jung Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hyuk Baik
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kang Young Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeonghyun Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail:
| |
Collapse
|
10
|
Abstract
The management of locally-advanced rectal cancer involves a combination of chemotherapy, chemoradiation, and surgical resection to provide excellent local tumor control and overall survival. However, aspects of this multimodality approach are associated with significant morbidity and long-term sequelae. In addition, there is growing evidence that patients with a clinical complete response to chemotherapy and chemoradiation treatments may be safely offered initial non-operative management in a rigorous surveillance program. Weighed against the morbidity and significant sequelae of rectal resection, recognizing how to best optimize non-operative strategies without compromising oncologic outcomes is critical to our understanding and treatment of this disease.
Collapse
Affiliation(s)
- Iris H Wei
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering, New York, NY, USA -
| | - Julio Garcia-Aguilar
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering, New York, NY, USA
| |
Collapse
|
11
|
Portale G, Cavallin F, Valdegamberi A, Frigo F, Fiscon V. Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio Are Not Prognostic Biomarkers in Rectal Cancer Patients with Curative Resection. J Gastrointest Surg 2018; 22:1611-1618. [PMID: 29687424 DOI: 10.1007/s11605-018-3781-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Actual predictors of survival and recurrence for rectal cancer patients undergoing curative resection mostly come from pathological data of surgical specimen. Recently, novel blood biomarkers have been proposed as useful tools in cancer patient management, but few and conflicting data have been reported in rectal cancer. We evaluated the prognostic relevance of preoperative platelet-to-lymphocyte (P/L) ratio and neutrophil-to-lymphocyte (N/L) ratio on survival and recurrence in patients undergoing laparoscopic curative resection for rectal cancer. METHODS All consecutive patients who referred for primary rectal disease to the Department of General Surgery in Cittadella (Italy) from June 2005 to September 2015 were retrospectively evaluated. Patients with metastatic disease at surgery were excluded. P/L and N/L ratios were calculated. For patients undergoing neoadjuvant chemo-radiotherapy, pre-treatment data were considered. Follow-up data were updated at December 2016. RESULTS One hundred fifty-two patients were included in the study, 49 (32%) received neoadjuvant chemo-radiotherapy. Both P/L and N/L ratios showed poor discriminative performance on 5-year OS and DFS. Time-dependent ROC curves showed no improvements in discriminative performance of P/L and N/L ratios when considering different time endpoints. Multivariable analysis identified CEA-rather than P/L or N/L ratios-as independent predictor of OS and DFS, adjusting for age, tumor stage, and postoperative morbidity. CONCLUSION Neither P/L nor N/L ratios were associated with survival after rectal cancer surgery. Further studies on large series might provide insights on the role of these inexpensive blood biomarkers in rectal cancer.
Collapse
Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy.
| | | | - Alessandro Valdegamberi
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy
| | - Flavio Frigo
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy
| |
Collapse
|
12
|
Jones HG, Qasem E, Dilaver N, Egan R, Bodger O, Kokelaar R, Evans MD, Davies M, Beynon J, Harris D. Inflammatory cell ratios predict major septic complications following rectal cancer surgery. Int J Colorectal Dis 2018; 33:857-862. [PMID: 29705942 DOI: 10.1007/s00384-018-3061-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The inflammatory response is known to have an important role in tumourigenesis and the response to treatment. Previous studies have demonstrated that inflammatory cell ratios such as the neutrophil-to-lymphocyte ratio (NLR) can predict survival and recurrence following surgery for various cancers. The objective of this study was to demonstrate if pre-operative NLR has a role in predicting post-operative septic complications in patients undergoing rectal cancer surgery. METHODOLOGY Consecutive patients undergoing scheduled resection for rectal cancer in a tertiary centre from July 2007 to Dec 2015 were included. Data was gathered from a prospectively held database of rectal cancer. Normally distributed data were compared with paired t tests (mean ± standard error in the mean (SEM)), and proportions were compared with Fisher's exact test. A p value of < 0.05 was considered statistically significant. RESULTS Three hundred fourteen patients were identified in this study. Sixty nine (22.0%) patients had a major septic complication following surgery for rectal cancer, which was associated with a poor survival outcome (p < 0.01) Both pre and post-operative NLR and PLR (platelet lymphocyte ratio) were associated with post-operative septic complications (both p < 0.01). A pre-operative NLR threshold level of 4 was chosen from ROC analysis, and this provided a relatively specific test to predict post-operative septic complications in these patients (specificity = 83.7%, negative predictive value (NPV) = 74.8%). DISCUSSION In this study, the pre-operative NLR and PLR were both predictive of major post-operative septic complications. A pre-operative NLR of less than 4 was strongly negative predictor of post-operative complications in rectal cancer surgery. It can be regarded as a predictive and prognostic factor for these patients.
Collapse
Affiliation(s)
- H G Jones
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK.
| | - E Qasem
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - N Dilaver
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - R Egan
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - O Bodger
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - R Kokelaar
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - M D Evans
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - M Davies
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - J Beynon
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| | - D Harris
- Department of Colorectal Surgery, Morriston Hospital, Swansea, UK
| |
Collapse
|
13
|
Gonda K, Shibata M, Sato Y, Washio M, Takeshita H, Shigeta H, Ogura M, Oka S, Sakuramoto S. Elevated neutrophil-to-lymphocyte ratio is associated with nutritional impairment, immune suppression, resistance to S-1 plus cisplatin, and poor prognosis in patients with stage IV gastric cancer. Mol Clin Oncol 2017; 7:1073-1078. [PMID: 29285377 DOI: 10.3892/mco.2017.1438] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer continues to be a major cause of morbidity and mortality worldwide. Recently, there has been a growing interest in the host inflammatory response and there is increasing evidence that the neutrophil to lymphocyte ratio (NLR), which is a useful marker of systemic inflammation, can be an effective prognostic indicator in various types of malignant diseases. A total of 110 patients with stage IV gastric cancer who received chemotherapy of S-1 plus cisplatin were enrolled in this study. Eleven patients did not complete four cycles of the chemotherapy. The patients were divided into two groups with 3.0 of NLR. The percentage of patients with a partial response to chemotherapy was significantly higher in the group of patients with a lower NLR (<3) (19.1 vs. 38.5%, high vs. low NLR group, respectively; P<0.05). The percentage of patients with progressive disease was higher in the high vs. low NLR group (57.4 vs. 25.0%, respectively; P<0.05). NLR levels were significantly inversely correlated with serum levels of prealbumin (P<0.01) and retinol binding protein (P<0.05). NLR levels were also significantly correlated with c-reactive protein levels (P<0.05), white blood cell count (P<0.05) and inversely with the stimulation index (a marker of cell-mediated immune function; P<0.05). Overall survival was significantly longer in patients with a lower NLR (≤ 3.0) than in those with a higher NLR (>3.0). The present study demonstrated that the NLR is a useful marker for resistance to chemotherapy, malnutrition, systemic inflammation and immune suppression. Moreover, the NLR was demonstrated to be a strong prognostic indicator in these patients.
Collapse
Affiliation(s)
- Kenji Gonda
- Department of Surgery, Japan Community Healthcare Organization, Nihonmatsu Hopsital, Nihonmatsu, Fukushima 964-8501, Japan.,Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Masahiko Shibata
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Advanced Cancer Immunotherapy, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yu Sato
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba 285-8741, Japan
| | - Maria Washio
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Kitasato University, Sagamihara, Kanagawa 252-0375, Japan
| | - Hiroyuki Takeshita
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Matsushita Memorial Hospital, Moriguchi, Osaka 570-8540, Japan
| | - Hirofumi Shigeta
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Toshima Hospital, Sakae, Tokyo 173-0015, Japan
| | - Michikazu Ogura
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Kasukabe Medical Center, Kasukabe, Saitama 344-8588, Japan
| | - Shinichi Oka
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Juntendo University School of Medicine, Hongo, Tokyo 113-8431, Japan
| | - Shinich Sakuramoto
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| |
Collapse
|
14
|
Neutrophil-to-Lymphocyte Ratio Is a Potential Prognostic Biomarker in Patients with Ovarian Cancer: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7943467. [PMID: 28815182 PMCID: PMC5549495 DOI: 10.1155/2017/7943467] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023]
Abstract
Background and Aims Plenty of studies were conducted to explore the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in ovarian cancer with contradictory results. This study aims to summarize the prognostic significance of NLR in patients with ovarian cancer. Methods A literature search in PubMed, Cochrane Library, and Embase was conducted. The endpoints were progression-free survival (PFS) and overall survival (OS). Results Eleven studies involving a total of 2,892 patients were identified. The results indicated that patients with high NLR had shorter PFS compared to patients with low NLR in ovarian cancer (HR = 1.55, 95% CI = 1.15–2.08, p = 0.004, and I2 = 61%). Similarly, high NLR was related to shorter OS (HR = 1.51, 95% CI = 1.03–2.23, p = 0.04, and I2 = 85%). Moreover, high NLR was significantly associated with shorter PFS when the NLR cut-off was less than 3.3 (p = 0.03) or when treatment is operation (p = 0.002). In addition, high NLR was distinctly related to worse OS in Asian people (p = 0.04) or operation (p = 0.04). Conclusion High NLR was associated with shorter PFS and shorter OS in ovarian cancer. NLR is potentially a promising prognostic biomarker in patients with ovarian cancer.
Collapse
|
15
|
Takenaka Y, Kitamura T, Oya R, Ashida N, Shimizu K, Takemura K, Yamamoto Y, Uno A. Prognostic role of neutrophil-lymphocyte ratio in nasopharyngeal carcinoma: A meta-analysis. PLoS One 2017; 12:e0181478. [PMID: 28715474 PMCID: PMC5513538 DOI: 10.1371/journal.pone.0181478] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/30/2017] [Indexed: 12/15/2022] Open
Abstract
Background Inflammatory markers are used to predict prognosis of nasopharyngeal carcinoma (NPC). Previous reports of neutrophil-to-lymphocyte ratio (NLR) and NPC mortality are inconsistent. This study aimed to quantify the prognostic impact of NLR on NPC. Methods The primary outcome was overall survival (OS), and the secondary outcomes were disease-specific survival (DSS), progression-free survival (PFS) and distant metastasis-free survival (DMFS). We systematically searched electronic databases, identified articles reporting an association between NLR and NPC prognosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted, and pooled HRs for each outcome were estimated using random effect models. Results Nine studies enrolling 5397 patients were included in the analyses. NLR greater than the cutoff value was associated with poor overall survival (HR 1.51, 95% CI 1.27–1.78), disease-specific survival (HR 1.44, 95% CI 1.22–1.71), progression-free survival (HR 1.53, 95% CI 1.22–1.90), and distant metastasis-free survival (HR 1.83, 95% CI 1.14–2.95). Conclusions Elevated NLR predicts worse OS, DSS, PFS and DMFS in patients with NPC.
Collapse
Affiliation(s)
- Yukinori Takenaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
- * E-mail:
| | - Takahiro Kitamura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Ryohei Oya
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Naoki Ashida
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kotaro Shimizu
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kazuya Takemura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yoshifumi Yamamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| |
Collapse
|
16
|
Pan WY, Bian C, Zou GL, Zhang CY, Hai P, Zhao R, Wang YY. Combing NLR, V20 and mean lung dose to predict radiation induced lung injury in patients with lung cancer treated with intensity modulated radiation therapy and chemotherapy. Oncotarget 2017; 8:81387-81393. [PMID: 29113398 PMCID: PMC5655293 DOI: 10.18632/oncotarget.19032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/18/2017] [Indexed: 12/25/2022] Open
Abstract
The purpose was to evaluate the predictive value of baseline neutrophil to lymphocyte ratio (NLR) level in the incidence of grade 3 or higher radiation induced lung injury (RILI) for lung cancer patients. A retrospectively analysis with 166 lung cancer patients was performed. All of the enrolled patients received chemoradiotherapy at our hospital between April 2014 and May 2016. The Cox proportional hazard model was used to identify the potential risk factors for RILI. In this cohort, the incidence of grade 3 or higher RILI was 23.8%. Univariate analysis showed that radiation dose, volume at least received 20Gy (V20), mean lung dose and NLR were significantly associated with the incidence of grade 3 or higher RILI (P = 0.012, 0.008, 0.012, and 0.039, respectively). Multivariate analysis revealed that total dose ≥ 60 Gy, V20 ≥ 20%, mean lung dose ≥ 12 Gy, and NLR ≥ 2.2 were still independent predictive factors for RILI (P = 0.010, 0.043, 0.028, and 0.015, respectively). A predictive model of RILI based on the identified risk factors was established using receiver operator characteristic curves. The results demonstrated that the combination analysis of V20, mean lung dose and NLR was superior to either of the variables alone. Additionally, we found that the constraint of V20 and mean lung dose were meaningful for patients with higher baseline NLR level. If the value of V20 and mean lung dose lower than the threshold value, the incidence of grade 3 or higher RILI for the high NLR level patients could be decreased from 63.3% to 8.7%. Our study showed that radiation dose, V20, mean lung dose and NLR were independent predictors for RILI. Combination analysis of V20, mean lung dose and NLR may provide a more accurate model for RILI prediction.
Collapse
Affiliation(s)
- Wen-Yan Pan
- Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China.,Cancer Institute, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Chao Bian
- Graduate School, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Guan-Lian Zou
- Graduate School, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Cui-Ying Zhang
- Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China.,Cancer Institute, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Ping Hai
- Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China.,Cancer Institute, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Ren Zhao
- Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China.,Cancer Institute, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Yan-Yang Wang
- Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China.,Cancer Institute, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| |
Collapse
|
17
|
Sato Y, Gonda K, Harada M, Tanisaka Y, Arai S, Mashimo Y, Iwano H, Sato H, Ryozawa S, Takahashi T, Sakuramoto S, Shibata M. Increased neutrophil-to-lymphocyte ratio is a novel marker for nutrition, inflammation and chemotherapy outcome in patients with locally advanced and metastatic esophageal squamous cell carcinoma. Biomed Rep 2017; 7:79-84. [PMID: 28685065 DOI: 10.3892/br.2017.924] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is one of the most common types of cancer, and its progression is strongly influenced by the presence of inflammation. Recently, there has been growing interest in the host inflammatory response, and increasing evidence has indicated that the neutrophil-to-lymphocyte ratio (NLR), a useful marker of systemic inflammation, may be an effective prognostic indicator in various types of malignant diseases. In the present study, 260 patients with ESCC were enrolled, including 110 who received chemoradiation therapy (CRT) involving irradiation and chemotherapy of 5-fluorouracil and cisplatin, and 150 received chemotherapy using 5-fluorouracil and cisplatin (FP). The patients of each group were both divided into two groups according to their NLR: High NLR (NLR>3.0) and low NLR (NLR≤3.0). Serum levels of prealbumin and retinol binding protein, which are nutritional parameters, were both significantly inversely correlated with NLR in patients treated with CRT, and patients treated with FP. Levels of CRP, a marker of inflammation, were significantly correlated with NLR, and stimulation indices, markers of immune reactions, were inversely correlated with NLR in both of CRT patients and FP patients. In patients treated with CRT, a partial response was significantly higher in patients with a low NLR and with progressive disease compared to those with a high NLR. In patients treated with FP, a partial response was also significantly higher in patients with a low NLR and with progressive disease compared to those with a high NLR. The overall survival of patients with CRT and FP were both significantly worse in patients with a high NLR than in those with a low NLR. NLR may serve as a useful marker of the tumor response, immune suppression, malnutrition and prognosis upon CRT or FP in patients with locally advanced or metastatic ESCC.
Collapse
Affiliation(s)
- Yu Sato
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba 285-8741, Japan.,Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Kenji Gonda
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan.,Department of Surgery, Japan Community Healthcare Organization, Nihonmatsu Hospital, Nihonmatsu, Fukushima 964-8501, Japan
| | - Maiko Harada
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Yuki Tanisaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shin Arai
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Yumi Mashimo
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Hirotoshi Iwano
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Hiroshi Sato
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Takao Takahashi
- Department of Palliative Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shinichi Sakuramoto
- Department of Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Masahiko Shibata
- Department of Advanced Cancer Immunotherapy, Fukushima Medical University, Fukushima, Fukushima 960-1259, Japan
| |
Collapse
|
18
|
Prognostic significance of neutrophil-to-lymphocyte ratio in diffuse large B-cell lymphoma: A meta-analysis. PLoS One 2017; 12:e0176008. [PMID: 28441396 PMCID: PMC5404792 DOI: 10.1371/journal.pone.0176008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/12/2017] [Indexed: 12/11/2022] Open
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) has been investigated as a prognostic marker in patients with diffuse large B-cell lymphoma (DLBCL); however, the results remain controversial. This study aimed to explore the association between NLR and survival outcomes and clinicopathological factors in DLBCL. Methods Relevant studies were retrieved by searching PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) databases. The last search was updated on February 17, 2017. Hazard ratios (HRs) and odds ratios (ORs) and their 95% confidence intervals (CIs) were used as effective measures in the meta-analysis. Random-effects models and fixed-effects models were used for analyses. Meta-regression was performed. Publication bias was assessed using Begg’s test. Stata version 12.0 was used for all analyses. Results A total of 9 studies with 2297 patients were included in the meta-analysis. The pooled results showed that NLR was a significant indicator for poor overall survival (OS) (HR = 1.84, 95% CI = 1.52–2.22, p<0.001) and poor progression-free survival (PFS) (HR = 1.64, 95% CI = 1.36–1.98, p<0.001). NLR remained a significant biomarker for OS and PFS regardless of location, sample size or cut-off value. In addition, high NLR was also associated with Ann Arbor stage (OR = 2.09, 95% CI = 1.14–3.81, p = 0.017), lactate dehydrogenase level (OR = 2.74, 95% CI = 1.16–6.46, p = 0.021), extranodal disease (OR = 1.63, 95% CI = 1.06–2.52, p = 0.027), and International Prognostic Index score (OR = 2.44, 95% CI = 1.03–5.08, p = 0.043). However, NLR was found to have no significant association with sex (OR = 0.89, 95% CI = 0.71–1.11, p = 0.29), age (OR = 1.18, 95% CI = 0.94–1.48, p = 0.152), European Cooperative Oncology Group performance status score (OR = 1.78, 95% CI = 0.71–4.46, p = 0.217), or presence of B symptoms (OR = 1.56, 95% CI = 0.7–3.48, p = 0.278). Conclusion In conclusion, our meta-analysis demonstrated that NLR has a strong association with worse OS and PFS in patients with DLBCL. NLR could be recommended as an inexpensive prognostic biomarker in DLBCL.
Collapse
|
19
|
Dayde D, Tanaka I, Jain R, Tai MC, Taguchi A. Predictive and Prognostic Molecular Biomarkers for Response to Neoadjuvant Chemoradiation in Rectal Cancer. Int J Mol Sci 2017; 18:ijms18030573. [PMID: 28272347 PMCID: PMC5372589 DOI: 10.3390/ijms18030573] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 12/16/2022] Open
Abstract
The standard of care in locally advanced rectal cancer is neoadjuvant chemoradiation (nCRT) followed by radical surgery. Response to nCRT varies among patients and pathological complete response is associated with better outcome. However, there is a lack of effective methods to select rectal cancer patients who would or would not have a benefit from nCRT. The utility of clinicopathological and radiological features are limited due to lack of adequate sensitivity and specificity. Molecular biomarkers have the potential to predict response to nCRT at an early time point, but none have currently reached the clinic. Integration of diverse types of biomarkers including clinicopathological and imaging features, identification of mechanistic link to tumor biology, and rigorous validation using samples which represent disease heterogeneity, will allow to develop a sensitive and cost-effective molecular biomarker panel for precision medicine in rectal cancer. Here, we aim to review the recent advance in tissue- and blood-based molecular biomarker research and illustrate their potential in predicting nCRT response in rectal cancer.
Collapse
Affiliation(s)
- Delphine Dayde
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Ichidai Tanaka
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Rekha Jain
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Mei Chee Tai
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Ayumu Taguchi
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| |
Collapse
|
20
|
Shen J, Zhu Y, Wu W, Zhang L, Ju H, Fan Y, Zhu Y, Luo J, Liu P, Zhou N, Lu K, Zhang N, Li D, Liu L. Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Locally Advanced Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy. Med Sci Monit 2017; 23:315-324. [PMID: 28100902 PMCID: PMC5270760 DOI: 10.12659/msm.902752] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Increasing evidence suggests that cancer-associated inflammation is associated with poorer outcomes. The neutrophil-to-lymphocyte ratio (NLR), considered as a systemic inflammation marker, is thought to predict prognoses in colorectal cancer. In this study, we explored the association between the NLR and prognoses following neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC). Material/Methods From February 2002 to December 2012, a group of 202 patients diagnosed with LARC and receiving neoadjuvant CRT followed by radical surgery was included in our retrospective study. The associations between the pre-CRT NLR and clinicopathological characteristics, as well as the predictive value of pre-CRT NLR against survival outcomes, were analyzed. Results The average NLR was 2.7±1.5 (median 2.4, range 0.6–12.8). There were 63 (31.2%) patients with NLR ≥3.0, and 139 (68.8%) patients with NLR <3.0. Correlation analyses showed that no clinicopathological characteristics except age were associated with NLR. We did not find an association between NLR and survival outcomes. In multivariate Cox model analyses, the R1/R2 resection, lymph node ratio ≥0.1, and perineural/lymphovascular invasion were independently associated with worse disease-free survival and overall survival. Conclusions In our cohort, the NLR did not correlate with survival outcomes in LARC patients undergoing neoadjuvant CRT. The prognostic value of NLR should be validated in large-scale prospective studies.
Collapse
Affiliation(s)
- Jinwen Shen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Yuan Zhu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Wei Wu
- Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Lingnan Zhang
- Department of Diagnostic Radiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Haixing Ju
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Yongtian Fan
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Yuping Zhu
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Jialin Luo
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Peng Liu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Ning Zhou
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Ke Lu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Na Zhang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiang, China (mainland)
| | - Dechuan Li
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Luying Liu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China (mainland).,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, Zhejiangq, China (mainland)
| |
Collapse
|