Prognostic significance of pre-treatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in non-surgically treated uterine cervical carcinoma

Nomograms for predicting prognostic value of combined neutrophil-to-lymphocyte ratio and SCC-Ag in locally advanced cervical cancer

Background

Accumulating evidence supports the important role of inflammation in tumorigenesis and progression. Squamous cell carcinoma-associated antigen (SCC-Ag) is a tumor marker widely used to predict the prognosis of patients with cervical squamous cell carcinoma. This paper explored the predictive value of combined detection of neutrophil-to-lymphocyte ratio (NLR) to SCC-Ag for prognosis in patients with locally advanced cervical cancer (LACC).

Methods

A retrospective analysis was conducted on 190 LACC patients who underwent concurrent chemoradiotherapy (CCRT) from January 2012 to December 2016. NLR and SCC-Ag were analyzed before treatment. Receiver operating characteristic (ROC) curve analysis was employed to determine the optimal cutoff point for NLR and SCC-Ag. Kaplan-Meier analysis and Cox regression analysis were performed to assess their prognostic values. Nomograms were established to predict progression-free survival (PFS) and overall survival (OS), and the Harrell's concordance index (C-index) was introduced to evaluate the accuracy of predictions.

Results

The optimal cutoff values for SCC-Ag and NLR were 3.25 ng/mL and 2.52, respectively. Patients with SCC-Ag >3.25 ng/mL and NLR >2.52 were significantly associated with decreased PFS and OS. Multivariate analysis indicated that SCC-Ag and NLR were independent prognostic factors for PFS (P=0.022 and P=0.004, respectively) and OS (P=0.031 and P=0.001, respectively). The area under the curve of SCC-Ag, NLR and their combination to predict PFS and OS of LACC were 0.688, 0.623, 0.708 and 0.684, 0.658, 0.723, respectively. C-index of nomograms based on PFS and OS were 0.725 [95% confidence interval (CI): 0.653-0.797] and 0.731 (95% CI: 0.658-0.804), respectively.

Conclusions

The combination of SCC-Ag and NLR could provide a better predictive prognosis than SCC-Ag or NLR alone, and nomograms based on PFS and OS can be recommended as practical models for evaluating the prognosis of LACC patients.

The Usefulness of Extended Inflammation Parameters and Systemic Inflammatory Response Markers in the Diagnostics of Autoimmune Hepatitis

(1) Introduction: Autoimmune hepatitis (AIH) is a chronic disease. A persistent autoimmune reaction in the liver is significantly related to the systemic inflammatory response. Extended Inflammation Parameters (EIP) can be used to assess the activation of immune cells such as activated neutrophils (NEUT-RI and NEUT-GI) and activated lymphocytes (RE-LYMP and AS-LYMP) in the phase of active inflammation. The role of the systemic inflammatory response markers should also be emphasised, especially: NLR, PLR, and RLR, which have recently been widely studied as markers in autoimmune skin diseases or liver diseases. (2) Materials and Methods: The study included 30 patients with AIH and 30 healthy volunteers. The parameters of the EIP group (RE-LYMP, AS-LYMP, NEUT-RI, NEUT-GI), calculated haematological indices Red Blood Cell Distribution Width-to-Platelet Ratio (RPR), Mean Platelet Volume-to-Platelet Ratio (MPR), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Red Blood Cell Distribution Width-to-Lymphocyte Ratio (RLR), and selected blood morphological and biochemical indices were analysed. The aim of the study was to assess the usefulness of the EIP and systemic inflammatory response markers in the diagnostics of AIH. (3) Results: Compared to the controls, the patients with AIH showed significantly higher EIP values: NEUT-RI (48.05 vs. 43.30), NEUT-GI (152.65 vs. 147.40), RE-LYMP (0.07 vs. 0.03), and the inflammatory response markers: MPR (0.05 vs. 0.04), RPR (0.07 vs. 0.05), and NLR (2.81 vs. 1.42. Among the examined markers, EIP has significant diagnostic potential: NEUT-RI (AUC = 0.86), NEUT-GI (AUC = 0.80), and RE-LYMP (AUC = 0.78), and so do calculated haematological indices, i.e., MPR (AUC = 0.75), PLR (AUC = 1.00), and RLR (AUC = 1.00) Moreover, the importance of NEUT-GI (AUC = 0.89), MPR (AUC = 0.93), PLR (AUC = 0.86), RPR (AUC = 0.91), and FIB-4 (AUC = 0.83) in the detection of liver fibrosis in the course of AIH has also been proven. (4) Conclusions: EIP and systemic inflammatory response markers may turn out to be useful in detecting AIH and in looking for features of already developed liver cirrhosis in its course.

Inflammatory Biomarkers as Promising Predictors of Prognosis in Cervical Cancer Patients

INTRODUCTION

Increasing evidence demonstrates a crucial role of inflammation in inducing and promoting several cancers. Pro-inflammatory upregulation of cytokines such as IL-6 has been implicated in cervical cancer development and progression through several mechanisms, for example, by inducing platelet production, activation, and aggregation. The aim of the study was to evaluate the effective prognostic impact of inflammatory biomarkers such as platelet count, platelet to lymphocyte ratio (PLR), and IL-6 in cervical cancer patients.

MATERIALS AND METHODS

Between 2016 and 2019, 108 out of 159 patients with cervical cancer have been enrolled. Cutoff level of pretreatment platelet count and PLR was identified by using the ROC curve. IL-6 tumoral and peritumoral expression was analyzed and stratified as low and high (low expression: 0 and +1; marked expression: +2 and +3).

RESULTS

Median follow-up duration was 30 months (range 16-44). Patients with higher platelet counts showed worse DFS and OS (DFS p < 0.001; OS p < 0.001). Cumulative rates of DFS and OS in patients with lower PLR were higher than in patients with higher values of PLR (DFS p = 0.032; OS p < 0.001). Survival analysis showed a better prognosis in patients with lower IL-6 expression (DFS p < 0.001; OS p < 0.001).

CONCLUSION

Nowadays, causal relationship between inflammation, innate immunity, and cancer is more widely accepted. However, many of the molecular and cellular mechanisms mediating this relationship remain unresolved. Ongoing inflammatory response was associated with poor outcomes in cervical cancer patients. A higher pretreatment platelet count and PLR value associated with higher IL-6 tumoral expression could be used to predict poor prognosis in cervical cancer patients.

Descriptive statistics of dataset from the meta-analysis and meta-regression analysis on prognostic significance of pre-treatment systemic hemato-immunological indices of cervical cancer patients

In this study, we perform a meta-analysis and meta-regression analysis for the article entitled “Prognostic value of systemic hemato-immunological indices in uterine cervical cancer: A systemic review, meta-analysis, and meta-regression of observational studies.” [1] We implemented quantitative meta-analyses and time series meta-regression analysis to determine whether systemic hemato-immunological indices, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), thrombocyte-to-lymphocyte ratio (TLR), and C-reactive protein/albumin ratio (CAR) are associated with an increased risk of cervical collision cancer. In all, 9558 patients from 22 studies were included after a systematic data search, performed comprehensively using the following databases: MEDLINE, Web of Science, Embase, and Cochrane. The meta-analysis was conducted with a random-effects model using the Review Manager software (Revman version 5.3). The overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) data were compared among each observational study. All data are expressed as hazard ratios (HRs) and 95% confidence intervals (CIs), and were calculated using the generic inverse of variance method. Statistical heterogeneity was quantified using Cochrane's Q statistic and Higgins I² statistic. Subgroup analysis was performed to investigate the sources of heterogeneity. Furthermore, quality assessment of the included datasets was presented according to the Newcastle-Ottawa Scale method. Additionally, sensitivity analysis was conducted to explore the sources of heterogeneity and analyze whether the results were stable and reliable. Meta-analysis random-effect approach was used for the regression to evaluate the effect of age, presence of squamous cell carcinoma patients, and number of evaluated NLR and PLR parameters on patient survival.

Prognostic role of pretreatment thrombocytosis on survival in patients with cervical cancer: a systematic review and meta-analysis

BACKGROUND

This meta-analysis summarized the prognostic role of an elevated platelet count before treatment on survival outcomes in patients with cervical cancer.

METHODS

The PubMed, Embase, and Cochrane library electronic databases were systematically searched for studies reporting the effect estimates with 95% confidence intervals (CIs) of pretreatment thrombocytosis on survival from the database inceptions to December 2018. The pooled hazard ratios (HRs) with 95% CIs for overall survival (OS), progression-free survival (PFS), and recurrence-free survival (RFS) were calculated using random-effects models.

RESULTS

Nineteen retrospective studies that recruited 6521 patients with cervical cancer were eligible for this study. The summary results indicated that an elevated platelet count was significantly associated with a poor OS (HR 1.50; 95% CI 1.19-1.88; P = 0.001), PFS (HR 1.33; 95% CI 1.07-1.64; P = 0.010), and RFS (HR 1.66; 95% CI 1.20-2.28; P = 0.002). Sensitivity analysis indicated that the pooled PFS was variable after sequential exclusion of individual studies. The predictive value of pretreatment thrombocytosis on OS differed according to the publication year (P = 0.039), country (P = 0.013), and sample size (P = 0.029), and the role of pretreatment thrombocytosis on PFS could be affected by the study quality (P = 0.046).

CONCLUSION

The findings of this study indicated that an elevated platelet count before treatment was associated with poor OS, PFS, and RFS. These results require further verification in large-scale prospective studies.

Preoperative systemic inflammation score (SIS) is superior to neutrophil to lymphocyte ratio (NLR) as a predicting indicator in patients with esophageal squamous cell carcinoma

BACKGROUND

The aim of this study was to assess the prognostic significance of preoperative systemic inflammation score (SIS) on patients with esophageal squamous cell carcinoma (ESCC).

METHODS

A total of 357 ESCC patients who accepted radical esophagectomy between January 2008 and December 2009 at our institution were recruited in the analysis. The cut-off finder application was used to calculate the optimal cutoff values. The Chi-squared test or Fisher's exact test were used to analyze categorical variables. Overall survival (OS) was calculated using the Kaplan-Meier method and the log-rank test. Multivariate analysis was calculated using Cox regression analysis model. A model combining SIS was created and its performance was evaluated using the Akaike information criterion (AIC) and concordance index (C-index).

RESULTS

The median follow-up time was 58 months (range, 1-84 months). The 5-year OS rate was 50% (95% CI, 49.94-50.06%). The optimal cut-off values for preoperative neutrophil to lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and serum albumin (Alb) were 2.27, 3.79 and 36.55, respectively. Univariate analyses revealed that gender (P = 0.047), T stage (P < 0.001), N stage (P < 0.001), vascular invasion (P < 0.001), tumor location (P = 0.018), tumor length(P < 0.001), NLR (P = 0.006), LMR (P = 0.007), serum Alb (P = 0.001), and SIS (P < 0.001) were significantly associated with OS. Independent prognostic factors for OS were T stage, N stage, tumor location, tumor length, and SIS. However, NLR was not an independent prognostic factor in multivariate analysis. The model combining SIS had smaller AIC and higher C-index compared to the model without SIS, which suggesting that the adding the SIS to the multivariate model increasing the predictive accuracy of the OS in the ESCC patients treated with radical esophagectomy and 3-field lymphadenectomy (3-FL).

CONCLUSIONS

SIS may treat as a novel prognostic factor than NLR for ESCC patients who underwent radical esophagectomy and 3-FL. However, Larger-scale studies are needed to validate these findings.

Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer

Background: Inflammation represents a pivotal role in the progression of cervical cancer. The hematological markers of inflammation in complete blood count (CBC) panel are potentially useful in determining the prognosis of the disease. Objective: The aim of the study was to investigate whether the pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) could be used as in predicting the stage of cervical cancer. Methods: A retrospective cross-sectional study involving 282 patients with cervical cancer was enrolled at Sanglah General Hospital for five years (2013-2017). The histopathological records and complete blood counts (CBC) of the patients were collected and analyzed using SPSS ver. 16 software. FIGO stage I–II and III-IV were classified as early and advance stage respectively. Results: The median NLR and PLR were significantly higher in the advance stage compared with early stage (7.58 (1.36-33.20) and 247.89 (97.10-707.11); p-value = 0.001). A strong positive correlation was found between the staging of cervical cancer and NLR (r=0.638) and PLR (r=0.668). The AUC, sensitivity, and specificity value of NLR and PLR were 0.803 (82%; 71%) and 0.716 (72%; 70%). Advanced stage of cervical cancer was found in high NLR (adjusted OR: 9.02; 95%CI=2.42-33.64; p=0.001) and PLR (adjusted OR = 2.47; 95% CI = 1.45-4.85; p = 0.032). Conclusion: Increased pretreatment NLR and PLR values may provide a useful information in predicting the staging of cervical cancer.