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Battista RA, Pini GM, Finco A, Corso F, Galli A, Arrigoni G, Doglioni C, Callea M, Paccagnella M, Porcu L, Filipello F, Mazzola M, Foggetti G, Gregorc V, Giordano L, Bussi M, Mirabile A, Veronesi G. From Tumor Macroenvironment to Tumor Microenvironment: The Prognostic Role of the Immune System in Oral and Lung Squamous Cell Carcinoma. Cancers (Basel) 2024; 16:2759. [PMID: 39123486 PMCID: PMC11312115 DOI: 10.3390/cancers16152759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/11/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND The interplay between cancer cells and the immune system is crucial in cancer progression and treatment. In this regard, the tumor immune microenvironment and macroenvironment, marked by systemic inflammation markers and TILs, could be considered key prognostic factors in tumors, including oral and lung squamous cell carcinoma. METHODS We conducted a retrospective clinical study on patients with Oral Squamous Cell Carcinoma (OSCC) and Lung Squamous Cell Carcinoma (LUSCC), examining stages, comorbidities, treatments, and outcomes. We evaluated the prognostic significance of pre-surgical systemic inflammation markers and tumor microenvironment composition. RESULTS Associations were found between systemic inflammation markers-NLR, MLR, and PLR-and tumor microenvironment factors, such as TILs and CD8+ cell prevalence-elevated inflammation markers correlated with advanced stages. Specifically, NLR was prognostic in OSCC, whereas PLR was prognostic in LUSCC. Using a cutoff value, we divided our tumor samples into two prognostic groups. Moreover, TILs levels >15% of tumor stroma correlated with prolonged overall survival in both OSCC and LUSCC, while increased CD8+ expression was linked to extended disease-free survival in LUSCC. DISCUSSION Systemic inflammation markers and TILs can be valuable prognostic factors of survival, highlighting the immune response's role in OSCC and LUSCC. Despite limited clinical integration of the presented cohorts due to a lack of standardization, we concluded that analyzing tumor immune profiles may offer novel prognostic insights. CONCLUSIONS Future integration into cancer classification could improve risk stratification and treatment guidance.
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Affiliation(s)
- Rosa Alessia Battista
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (R.A.B.); (A.F.); (F.C.); (A.G.); (C.D.); (G.F.); (L.G.); (M.B.); (G.V.)
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giacomo Maria Pini
- Department of Pathology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.M.P.); (G.A.); (M.C.); (F.F.)
| | - Alex Finco
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (R.A.B.); (A.F.); (F.C.); (A.G.); (C.D.); (G.F.); (L.G.); (M.B.); (G.V.)
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Filippo Corso
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (R.A.B.); (A.F.); (F.C.); (A.G.); (C.D.); (G.F.); (L.G.); (M.B.); (G.V.)
| | - Andrea Galli
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (R.A.B.); (A.F.); (F.C.); (A.G.); (C.D.); (G.F.); (L.G.); (M.B.); (G.V.)
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gianluigi Arrigoni
- Department of Pathology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.M.P.); (G.A.); (M.C.); (F.F.)
| | - Claudio Doglioni
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (R.A.B.); (A.F.); (F.C.); (A.G.); (C.D.); (G.F.); (L.G.); (M.B.); (G.V.)
- Department of Pathology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.M.P.); (G.A.); (M.C.); (F.F.)
| | - Marcella Callea
- Department of Pathology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.M.P.); (G.A.); (M.C.); (F.F.)
| | | | - Luca Porcu
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Robinson Way, Cambridge CB2 0RE, UK;
| | - Federica Filipello
- Department of Pathology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.M.P.); (G.A.); (M.C.); (F.F.)
- Division of Pathology, Ospedale Michele e Pietro Ferrero, Verduno, 12060 Cuneo, Italy
| | - Marco Mazzola
- Department of Otolaryngology-Head and Neck Surgery, University of Verona, 37129 Verona, Italy;
| | - Giorgia Foggetti
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (R.A.B.); (A.F.); (F.C.); (A.G.); (C.D.); (G.F.); (L.G.); (M.B.); (G.V.)
- Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Vanesa Gregorc
- Clinical Research and Innovation, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy;
| | - Leone Giordano
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (R.A.B.); (A.F.); (F.C.); (A.G.); (C.D.); (G.F.); (L.G.); (M.B.); (G.V.)
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Mario Bussi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (R.A.B.); (A.F.); (F.C.); (A.G.); (C.D.); (G.F.); (L.G.); (M.B.); (G.V.)
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Aurora Mirabile
- Department of Otolaryngology-Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giulia Veronesi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy; (R.A.B.); (A.F.); (F.C.); (A.G.); (C.D.); (G.F.); (L.G.); (M.B.); (G.V.)
- Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
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Bastard P, Cozic N, Brion R, Gaspar N, Piperno-Neumann S, Cordero C, Leculée-Thébaud E, Gomez-Mascard A, Rédini F, Marchais A, Ikonomova R, Cleirec M, Laurence V, Rigaud C, Abbas R, Verrecchia F, Brugières L, Minard-Colin V. Prognostic value of hemogram parameters in osteosarcoma: The French OS2006 experience. Pediatr Blood Cancer 2024; 71:e31029. [PMID: 38679845 DOI: 10.1002/pbc.31029] [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: 04/24/2022] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Previous studies have shown that neutrophil-to-lymphocyte (NLR) ratio at diagnosis and early lymphocytes recovery on doxorubicin-based chemotherapy, may impact the outcome in patients with osteosarcoma (OST). This study aimed to evaluate the prognostic value of hemogram parameters in patients with OST treated with high-dose methotrexate and etoposide/ifosfamide (M-EI) chemotherapy. MATERIALS AND METHODS We retrospectively analyzed the prognostic value of various hemogram parameters at diagnosis and during therapy in a large consecutive cohort of patients with OST included in the French OS2006 trial and treated with M-EI chemotherapy. RESULTS A total of 164 patients were analyzed. The median age was 14.7 years (interquartile range [IQR]: 11.7-17). Median follow-up was 5.6 years (IQR: 3.3-7.7 years). Three-year event-free survival (EFS) and overall survival (OS) were 71.5% (95% confidence interval [CI]: 64%-78%) and 86.4% (95% CI: 80%-91%), respectively. In univariate analysis, blood count parameters at diagnosis and early lymphocyte recovery at Day 14 were not found prognostic of survival outcomes. By contrast, an increase of NLR ratio at Day 1 of the first EI chemotherapy (NLR-W4) was associated with reduced OS in univariate (p = .0044) and multivariate analysis (hazards ratio [HR] = 1.3, 95% CI: 1.1-1.5; p = .002), although not with EFS. After adjustment on histological response and metastatic status, an increase of the ratio NLR-W4 of 1 was associated with an increased risk of death of 30%. CONCLUSIONS We identified NLR-W4 as a potential early biomarker for survival in patients with OST treated with M-EI chemotherapy. Further studies are required to confirm the prognostic value of NLR and better identify immune mechanisms involved in disease surveillance.
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Affiliation(s)
- Paul Bastard
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | | | - Régis Brion
- Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers (CRCI2NA), INSERM UMR 1307, CNRS UMR 6075, Université de NantesCHU de Nantes, Nantes, France
| | - Nathalie Gaspar
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
- INSERM U1015, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | | | - Camille Cordero
- Pediatric Oncology Department, CHU-Hôpital de la Mère et de l'Enfant, Nantes, France
| | | | - Anne Gomez-Mascard
- Department of Pathology, CHU, IUCT-Oncopole, University of Toulouse, Eq19. ONCOSARC CRCT, UMR 1037 Inserm/UT3, ERL 5294 CNRS, Toulouse, France
| | - Françoise Rédini
- Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers (CRCI2NA), INSERM UMR 1307, CNRS UMR 6075, Université de NantesCHU de Nantes, Nantes, France
| | - Antonin Marchais
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
- INSERM U1015, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | | | - Morgane Cleirec
- Pediatric Oncology Department, CHU-Hôpital de la Mère et de l'Enfant, Nantes, France
| | | | - Charlotte Rigaud
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Rachid Abbas
- Biostatistics Unit, Gustave Roussy, Villejuif, France
| | - Franck Verrecchia
- Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers (CRCI2NA), INSERM UMR 1307, CNRS UMR 6075, Université de NantesCHU de Nantes, Nantes, France
| | - Laurence Brugières
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Véronique Minard-Colin
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
- INSERM U1015, University Paris-Saclay, Gustave Roussy, Villejuif, France
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Feier CVI, Muntean C, Faur AM, Gaborean V, Petrache IA, Cozma GV. Exploring Inflammatory Parameters in Lung Cancer Patients: A Retrospective Analysis. J Pers Med 2024; 14:552. [PMID: 38929773 PMCID: PMC11204880 DOI: 10.3390/jpm14060552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
Inflammation-related parameters serve as pivotal indicators in the prognosis and management of lung cancer. This retrospective investigation aimed to explore the relationship between inflammatory markers and diverse clinical variables in non-small-cell lung cancer patients. A cohort of 187 individuals undergoing elective lobectomy for lung cancer was retrospectively analyzed, spanning an 11-year data collection period. Six inflammation ratios derived from complete peripheral blood counts were assessed. Significantly elevated levels of neutrophil-to-lymphocyte ratio (NLR) (p = 0.005), platelet-to-lymphocyte ratio (PLR) (p = 0.001), Aggregate Index of Systemic Inflammation (AISI) (p = 0.015), Systemic Inflammation Response Index (SIRI) (p = 0.004), and Systemic Immune Inflammation Index (SII) (p = 0.004) were observed in patients with advanced T stages. Significantly, elevated values (p < 0.05) of these parameters were observed in the study's smoker patients compared to non-smokers. A statistically significant correlation was identified between the NLR parameter and tumor size (p = 0.07, r = 0.204), alongside a significant elevation in SIRI (p = 0.041) among patients experiencing postoperative complications. Inflammatory biomarkers emerge as invaluable prognostic indicators for patients with non-small-cell lung cancer, offering potential utility in forecasting their prognosis.
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Affiliation(s)
- Catalin Vladut Ionut Feier
- First Discipline of Surgery, Department X-Surgery, “Victor Babes” University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania;
- First Surgery Clinic, “Pius Brinzeu” Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Calin Muntean
- Medical Informatics and Biostatistics, Department III-Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 2 E. Murgu Sq., 300041 Timisoara, Romania
| | - Alaviana Monique Faur
- Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Vasile Gaborean
- Thoracic Surgery Research Center, “Victor Babeş” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (V.G.); (I.A.P.); (G.V.C.)
- Department of Surgical Semiology, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Ioan Adrian Petrache
- Thoracic Surgery Research Center, “Victor Babeş” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (V.G.); (I.A.P.); (G.V.C.)
- Department of Surgical Semiology, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Gabriel Veniamin Cozma
- Thoracic Surgery Research Center, “Victor Babeş” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (V.G.); (I.A.P.); (G.V.C.)
- Department of Surgical Semiology, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
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Li K, Qiu L, Zhao Y, Sun X, Shao J, He C, Qin B, Jiao S. Nomograms Predict PFS and OS for SCLC Patients After Standardized Treatment: A Real-World Study. Int J Gen Med 2024; 17:1949-1965. [PMID: 38736664 PMCID: PMC11088392 DOI: 10.2147/ijgm.s457329] [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: 01/02/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose This study aims to investigate the process of small cell lung cancer (SCLC) patients from achieving optimal efficacy to experiencing disease progression until death. It examines the predictive value of the treatment response on progression free survival (PFS) and overall survival (OS) of SCLC patients. Patients and Methods We conducted a retrospective analysis on 136 SCLC patients diagnosed from 1992 to 2018. Important prognostic factors were identified to construct nomogram models. The predictive performance of the models was evaluated using the receiver operating characteristic curves and calibration curves. Survival differences between groups were compared using Kaplan-Meier survival curves. Subsequently, an independent cohort consisting of 106 SCLC patients diagnosed from 2014 to 2021 was used for validation. Results We constructed two nomograms to predict first-line PFS (PFS1) and OS of SCLC. The area under the receiver operating characteristic curves for the PFS1 nomogram predicting PFS at 3-, 6-, and 12-months were 0.919 (95% CI: 0.867-0.970), 0.908 (95% CI: 0.860-0.956) and 0.878 (95% CI: 0.798-0.958), and for the OS nomogram predicting OS at 6-, 12-, and 24-months were 0.814 (95% CI: 0.736-0.892), 0.819 (95% CI: 0.749-0.889) and 0.809 (95% CI: 0.678-0.941), indicating those two models with a high discriminative ability. The calibration curves demonstrated the models had a high degree of consistency between predicted and observed values. According to the risk scores, patients were divided into high-risk and low-risk groups, showing a significant difference in survival rate. And these findings were validated in another independent validation cohort. Conclusion Based on the patients' treatment response after standardized treatment, we developed and validated two nomogram models to predict PFS1 and OS of SCLC. The models demonstrated good accuracy, reliability and clinical applicability by validating in an independent cohort.
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Affiliation(s)
- Ke Li
- Medical School of Chinese PLA, Beijing, 100853, People’s Republic of China
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Lupeng Qiu
- Medical School of Chinese PLA, Beijing, 100853, People’s Republic of China
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Yang Zhao
- Department of Vascular Intervention, Special Medical Center for Strategic Support Forces, Beijing, 100101, People’s Republic of China
| | - Xiaohui Sun
- Medical School of Chinese PLA, Beijing, 100853, People’s Republic of China
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Jiakang Shao
- Medical School of Chinese PLA, Beijing, 100853, People’s Republic of China
| | - Chang He
- Medical School of Chinese PLA, Beijing, 100853, People’s Republic of China
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Boyu Qin
- Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People’s Republic of China
| | - Shunchang Jiao
- Department of Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People’s Republic of China
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Bi H, Ren D, Xiao Y, Zhou Y, Yi B, Han W, Shao Y, Wang J, Zhang C, Wang H. Prognostic implications of neutrophil-to-lymphocyte ratio in patients with extensive-stage small cell lung cancer receiving chemoimmunotherapy: A multicenter, real-world study. Thorac Cancer 2024; 15:559-569. [PMID: 38294282 PMCID: PMC10912525 DOI: 10.1111/1759-7714.15225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are closely related to the prognosis of patients with non-small cell lung cancer, but their effect on extensive-stage small cell lung cancer (ES-SCLC) remains uncertain. METHODS This retrospective study was conducted in ES-SCLC patients treated with first-line atezolizumab or durvalumab and platinum-etoposide. Clinical data from three hospitals were analyzed. Significant risk factors for survival were identified using descriptive statistics and Cox regression. Homogeneity was assessed using t-tests or nonparametric tests. Kaplan-Meier analysis revealed an association between high NLR level and median PFS and OS. RESULTS A total of 300 ES-SCLC patients were included in the study. Cox regression analysis revealed that an elevated NLR level after the second treatment cycle (defined as NLRT2) was an independent prognostic factor for survival. Stratifying patients based on median NLRT2 showed significant differences in both PFS (HR: 1.863, 95% CI: 1.62-2.12, p < 0.001) and OS (HR: 2.581, 95% CI: 2.19-3.04, p < 0.001) between NLR ≥ 1.75 and NLR < 1.75 groups. mPFS and mOS were 8.2 versus 6.1 months and 13.7 versus 9.5 months, respectively. NLR was also associated with treatment efficacy and occurrence of irAEs. Further stratification based on NLR and irAEs showed that in the NLR < 1.75 group, patients with irAEs had prolonged mPFS and mOS. In the NLR ≥ 1.75 group, only mPFS showed a significant difference between patients with and without irAEs. CONCLUSION NLRT2 and irAEs can predict the prognosis of ES-SCLC patients with first-line ES-SCLC receiving PD-L1 inhibitors combined with chemotherapy.
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Affiliation(s)
- Huanhuan Bi
- Department of Respiratory and Critical Care Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
- Department of Respiratory and Critical Care MedicineThe Affiliated Qingdao Central Hospital of Medical College of Qingdao UniversityQingdaoChina
| | - Dunqiang Ren
- Department of Respiratory and Critical Care Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yuting Xiao
- Department of Respiratory and Critical Care Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yinxue Zhou
- Department of Respiratory and Critical Care Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Bingqian Yi
- Department of Respiratory and Critical Care Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Weizhong Han
- Department of Respiratory and Critical Care Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yanmei Shao
- Department of Respiratory and Critical Care Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Jingluan Wang
- Department of Respiratory and Critical Care Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Chunling Zhang
- Department of Respiratory and Critical Care MedicineThe Affiliated Qingdao Central Hospital of Medical College of Qingdao UniversityQingdaoChina
| | - Hongmei Wang
- Department of Respiratory and Critical Care Medicinethe Affiliated Hospital of Qingdao UniversityQingdaoChina
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Khanzadeh M, Foroughi Nematollahi S, Shavakhi M, Ghaedi A, Mallahi A, Bazrgar A, Khanzadeh S. Prognostic Role of Neutrophil to Lymphocyte Ratio in Allergic Rhinitis: A Systematic Review and Meta-analysis. Indian J Otolaryngol Head Neck Surg 2024; 76:1389-1397. [PMID: 38440632 PMCID: PMC10909046 DOI: 10.1007/s12070-023-04148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/17/2023] [Indexed: 03/06/2024] Open
Abstract
One of the crucial triggers of allergic diseases is an inflammatory reaction and neutrophil to lymphocyte ratio (NLR) is one of the systemic inflammation biomarkers. Our review aimed to evaluate role of NLR in predicting severity and comorbidities of allergic rhinitis (AR). We systematically searched Scopus, Web of Science, and PubMed to find relevant studies. Standardized mean difference (SMD) with a 95% confidence interval (CI) was reported. Due to the high levels of heterogeneity, the random-effects model was used to generate pooled effects. Eleven articles were included in the systematic review, among which ten were included in meta-analysis including 1122 healthy controls and 1423 patients with AR. We found that patients with AR had a significantly higher level of NLR than healthy controls (SMD = 0.19, 95%CI = 0.03-0.36, P = 0.03). In addition, patients with moderate to severe AR had significantly higher levels of NLR compared to those with mild AR (SMD = 0.41, 95%CI = 0.20-0.63, P < 0.001). Interestingly, it was found that NLR could associate with some comorbidities of AR, like asthma. Our results confirmed that NLR could assist clinicians in predicting the severity and comorbidities of AR. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-04148-8.
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Affiliation(s)
- Monireh Khanzadeh
- Geriatric and Gerontology Department, Medical School, Tehran University of Medical and Health Sciences, Tehran, Iran
| | | | - Mitra Shavakhi
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Mallahi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Bazrgar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Wang X, Zheng K, Hao Z. In-depth analysis of immune cell landscapes reveals differences between lung adenocarcinoma and lung squamous cell carcinoma. Front Oncol 2024; 14:1338634. [PMID: 38333684 PMCID: PMC10850392 DOI: 10.3389/fonc.2024.1338634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
Background Lung cancer is the leading cause of cancer deaths globally, with lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC) being major subtypes. Immunotherapy has emerged as a promising approach for the treatment of lung cancer, but understanding the underlying mechanisms of immune dysregulation is crucial for the development of effective therapies. This study aimed to investigate the distinctive cellular features of LUAD and LUSC and identify potential biomarkers associated with the pathogenesis and clinical outcomes of each subtype. Methods We used digital cytometry techniques to analyze the RNA-Seq data of 1128 lung cancer patients from The Cancer Genome Atlas (TCGA) database. The abundance of cell subtypes and ecotypes in LUAD and LUSC patients was quantified. Univariate survival analysis was used to investigate their associations with patient overall survival (OS). Differential gene expression analysis and gene co-expression network construction were carried out to explore the gene expression patterns of LUSC patients with distinct survival outcomes. Scratch wound-healing assay, colony formation assay, and transwell assay were used to validate the candidate drugs for LUSC treatment. Results We found differential expression of cell subtypes between LUAD and LUSC, with certain cell subtypes being prognostic for survival in both subtypes. We also identified differential gene expression and gene co-expression modules associated with macrophages.3/PCs.2 ratio in LUSC patients with distinct survival outcomes. Furthermore, ecotype ratios were found to be prognostic in both subtypes and machine learning models showed that certain cell subtypes, such as epithelial.cells.1, epithelial.cells.5, and endothelial.cells.2 are important for predicting LUSC. Ginkgolide B and triamterene can inhibit the proliferation, invasion, and migration of LUSC cell lines. Conclusion We provide insight into the distinctive cellular features of LUAD and LUSC, and identify potential biomarkers associated with the pathogenesis and clinical outcomes of each subtype. Ginkgolide B and triamterene could be promising drugs for LUSC treatment.
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Affiliation(s)
| | | | - Zhiying Hao
- Department of Pharmacy, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
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Urbarova I, Skogholt AH, Sun YQ, Mai XM, Grønberg BH, Sandanger TM, Sætrom P, Nøst TH. Increased expression of individual genes in whole blood is associated with late-stage lung cancer at and close to diagnosis. Sci Rep 2023; 13:20760. [PMID: 38007577 PMCID: PMC10676373 DOI: 10.1038/s41598-023-48216-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: 08/31/2023] [Accepted: 11/23/2023] [Indexed: 11/27/2023] Open
Abstract
Lung cancer (LC) mortality rates are still increasing globally. As survival is linked to stage, there is a need to identify markers for earlier LC diagnosis and individualized treatment. The whole blood transcriptome of LC patients represents a source of potential LC biomarkers. We compared expression of > 60,000 genes in whole blood specimens taken from LC cases at diagnosis (n = 128) and controls (n = 62) using genome-wide RNA sequencing, and identified 14 candidate genes associated with LC. High expression of ANXA3, ARG1 and HP was strongly associated with lower survival in late-stage LC cases (hazard ratios (HRs) = 2.81, 2.16 and 2.54, respectively). We validated these markers in two independent population-based studies with pre-diagnostic whole blood specimens taken up to eight years prior to LC diagnosis (n = 163 cases, 184 matched controls). ANXA3 and ARG1 expression was strongly associated with LC in these specimens, especially with late-stage LC within two years of diagnosis (odds ratios (ORs) = 3.47 and 5.00, respectively). Additionally, blood CD4 T cells, NK cells and neutrophils were associated with LC at diagnosis and improved LC discriminative ability beyond candidate genes. Our results indicate that in whole blood, increased expression levels of ANXA3, ARG1 and HP are diagnostic and prognostic markers of late-stage LC.
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Affiliation(s)
- Ilona Urbarova
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Anne Heidi Skogholt
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yi-Qian Sun
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pathology, Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Center for Oral Health Services and Research Mid-Norway (TkMidt), Trondheim, Norway
| | - Xiao-Mei Mai
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Henning Grønberg
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torkjel Manning Sandanger
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Pål Sætrom
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Bioinformatics Core Facility, Norwegian University of Science and Technology, Trondheim, Norway
| | - Therese Haugdahl Nøst
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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9
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Heshmat-Ghahdarijani K, Sarmadi V, Heidari A, Falahati Marvasti A, Neshat S, Raeisi S. The neutrophil-to-lymphocyte ratio as a new prognostic factor in cancers: a narrative review. Front Oncol 2023; 13:1228076. [PMID: 37860198 PMCID: PMC10583548 DOI: 10.3389/fonc.2023.1228076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
The increasing incidence of cancer globally has highlighted the significance of early diagnosis and improvement of treatment strategies. In the 19th century, a connection was made between inflammation and cancer, with inflammation recognized as a malignancy hallmark. The neutrophil-to-lymphocyte ratio (NLR), calculated from a complete blood count, is a simple and accessible biomarker of inflammation status. NLR has also been proven to be a prognostic factor for various medical conditions, including mortality classification in cardiac patients, infectious diseases, postoperative complications, and inflammatory states. In this narrative review, we aim to assess the prognostic potential of NLR in cancer. We will review recent studies that have evaluated the association between NLR and various malignancies. The results of this review will help to further understand the role of NLR in cancer prognosis and inform future research directions. With the increasing incidence of cancer, it is important to identify reliable and accessible prognostic markers to improve patient outcomes. The study of NLR in cancer may provide valuable insights into the development and progression of cancer and inform clinical decision-making.
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Affiliation(s)
- Kian Heshmat-Ghahdarijani
- Cardiac Rehabilitation, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vida Sarmadi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Heidari
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Sina Neshat
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Biostatistics and Epidemiology, University of California, San Francisco, San Francisco, CA, United States
| | - Sina Raeisi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Wang Y, Mathai J, Alamgeer M, Parakh S, Paul E, Mitchell P, Arulananda S. Real-World Analysis of Clinical Characteristics and Survival Outcomes in Patients With Extensive-Stage SCLC Treated With First-Line Chemoimmunotherapy. JTO Clin Res Rep 2023; 4:100544. [PMID: 37529402 PMCID: PMC10388193 DOI: 10.1016/j.jtocrr.2023.100544] [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: 03/06/2023] [Revised: 05/17/2023] [Accepted: 06/16/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction There are no clinically validated prognostic biomarkers in the management of extensive-stage SCLC (ES-SCLC). We explored the association between clinical characteristics and survival outcomes in patients with ES-SCLC treated with chemoimmunotherapy. Methods In this retrospective cohort study, patients with ES-SCLC treated with first-line platinum-etoposide chemotherapy and atezolizumab were identified from medical records. Pretreatment clinical characteristics, biochemical parameters, and tumor and treatment characteristics were collected. Univariate and multivariate Cox regression were used to evaluate treatment effect on progression-free survival (PFS) and overall survival (OS). Results We evaluated 75 patients in total. The median PFS and OS were 6.1 months and 9.2 months, respectively. Statistically significant associations were found with lower lactate dehydrogenase and improved OS (hazard ratio [HR] = 1.0, 95% confidence interval [CI]: 1.0-1.01, p = 0.006), whereas higher age (HR = 0.94, 95% CI: 0.90-0.98, p = 0.006) and lower neutrophil-to-lymphocyte ratio (HR = 1.08, 95% CI: 1.02-1.14, p = 0.005) were associated with improved PFS. The number of chemotherapy cycles received were associated with both an improved PFS (HR = 0.57, 95% CI: 0.37-0.89, p = 0.011) and OS (HR = 0.5, 95% CI: 0.30-0.84, p = 0.008). Conclusions This study highlights the important effect of chemotherapy on survival. Furthermore, the association between lactate dehydrogenase and neutrophil-to-lymphocyte ratio on survival further suggests that baseline tumor burden and optimizing sarcopenia are important factors for clinicians to consider as we seek to develop personalized treatment for this disease.
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Affiliation(s)
- Yang Wang
- Department of Medical Oncology, Monash Health, Clayton, Australia
| | - Jared Mathai
- Department of Medical Oncology, Austin Health, Heidelberg, Australia
| | | | - Sagun Parakh
- Department of Medical Oncology, Austin Health, Heidelberg, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- School of Cancer Medicine, La Trobe University, Bundoora, Australia
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Paul Mitchell
- Department of Medical Oncology, Austin Health, Heidelberg, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | - Surein Arulananda
- Department of Medical Oncology, Monash Health, Clayton, Australia
- School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, Australia
- Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, Australia
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11
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Pabst L, Lopes S, Bertrand B, Creusot Q, Kotovskaya M, Pencreach E, Beau-Faller M, Mascaux C. Prognostic and Predictive Biomarkers in the Era of Immunotherapy for Lung Cancer. Int J Mol Sci 2023; 24:ijms24087577. [PMID: 37108738 PMCID: PMC10145126 DOI: 10.3390/ijms24087577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
The therapeutic algorithm of lung cancer has recently been revolutionized by the emergence of immune checkpoint inhibitors. However, an objective and durable response rate remains low with those recent therapies and some patients even experience severe adverse events. Prognostic and predictive biomarkers are therefore needed in order to select patients who will respond. Nowadays, the only validated biomarker is the PD-L1 expression, but its predictive value remains imperfect, and it does not offer any certainty of a sustained response to treatment. With recent progresses in molecular biology, genome sequencing techniques, and the understanding of the immune microenvironment of the tumor and its host, new molecular features have been highlighted. There are evidence in favor of the positive predictive value of the tumor mutational burden, as an example. From the expression of molecular interactions within tumor cells to biomarkers circulating in peripheral blood, many markers have been identified as associated with the response to immunotherapy. In this review, we would like to summarize the latest knowledge about predictive and prognostic biomarkers of immune checkpoint inhibitors efficacy in order to go further in the field of precision immuno-oncology.
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Affiliation(s)
- Lucile Pabst
- Pulmonology Department, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Sébastien Lopes
- Pharmacy Department, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Basil Bertrand
- Pulmonology Department, University Hospital of Strasbourg, 67000 Strasbourg, France
- Laboratory Streinth (STress REsponse and INnovative THerapy against Cancer), Inserm UMR_S 1113, IRFAC, Université de Strasbourg, ITI InnoVec, 67000 Strasbourg, France
| | - Quentin Creusot
- Pulmonology Department, University Hospital of Strasbourg, 67000 Strasbourg, France
- Laboratory Streinth (STress REsponse and INnovative THerapy against Cancer), Inserm UMR_S 1113, IRFAC, Université de Strasbourg, ITI InnoVec, 67000 Strasbourg, France
| | - Maria Kotovskaya
- Pulmonology Department, University Hospital of Strasbourg, 67000 Strasbourg, France
- Laboratory Streinth (STress REsponse and INnovative THerapy against Cancer), Inserm UMR_S 1113, IRFAC, Université de Strasbourg, ITI InnoVec, 67000 Strasbourg, France
| | - Erwan Pencreach
- Laboratory Streinth (STress REsponse and INnovative THerapy against Cancer), Inserm UMR_S 1113, IRFAC, Université de Strasbourg, ITI InnoVec, 67000 Strasbourg, France
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Michèle Beau-Faller
- Laboratory Streinth (STress REsponse and INnovative THerapy against Cancer), Inserm UMR_S 1113, IRFAC, Université de Strasbourg, ITI InnoVec, 67000 Strasbourg, France
- Laboratory of Biochemistry and Molecular Biology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Céline Mascaux
- Pulmonology Department, University Hospital of Strasbourg, 67000 Strasbourg, France
- Laboratory Streinth (STress REsponse and INnovative THerapy against Cancer), Inserm UMR_S 1113, IRFAC, Université de Strasbourg, ITI InnoVec, 67000 Strasbourg, France
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12
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Nakamura M, Ishikawa H, Ohnishi K, Mori Y, Baba K, Nakazawa K, Shiozawa T, Sekine I, Maruo K, Okumura T, Sakurai H. Effects of lymphopenia on survival in proton therapy with chemotherapy for non-small cell lung cancer. JOURNAL OF RADIATION RESEARCH 2023; 64:438-447. [PMID: 36592478 PMCID: PMC10036091 DOI: 10.1093/jrr/rrac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/12/2022] [Indexed: 06/17/2023]
Abstract
Lymphocytes play an important role in the cancer immune system. In the present study, we aimed to evaluate the associations of lymphopenia during proton beam therapy (PBT) and concurrent chemotherapy with clinical outcomes and to determine whether lung or bone is more influential on lymphopenia during PBT. Data from 41 patients with stage III non-small cell lung cancer (NSCLC) who received PBT of 74 GyE with concurrent chemotherapy between 2007 and 2017 were reviewed retrospectively. The correlation between dosimetry parameters obtained from dose-volume histograms of the bone and lung and lymphopenia during PBT were analyzed. Minimum absolute lymphocyte count (ALCmin) and maximum neutrophil/lymphocyte ratio (NLRmax) were used as indicators of lymphopenia. Bone V5-20 and lung V5-50 were significantly correlated with the ALCmin and NLRmax during PBT. Multivariable analysis showed that the NLRmax, but not the ALCmin, was associated with overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS). The 3-year rates of OS, PFS and DMFS of patients with a low (≤ 6.3) versus high (> 6.3) NLRmax were 73.9% vs 44.4% (P = 0.042), 26.1% vs 5.6% (P = 0.022) and 39.1% vs 5.6% (P < 0.001), respectively. Lung V20 was significantly associated with DMFS on multivariable analyses (hazard ratio: 1.094, P = 0.008), whereas bone V5 had no impact on survival outcomes. We concluded that the NLRmax was a better prognostic indicator than the ALCmin, and the lung dose had more influence than the bone dose on the main survival outcomes in stage III NSCLC patients treated with PBT combined with concurrent chemotherapy.
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Affiliation(s)
- Masatoshi Nakamura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Chiba 263-8555, Japan
| | - Kayoko Ohnishi
- Corresponding author: Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. E-mail: ; Tel: +81-29-853-7100; Fax: +81-29-853-7102
| | - Yutarou Mori
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Keiichiro Baba
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Kensuke Nakazawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Toshihiro Shiozawa
- Department of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Ikuo Sekine
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
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Zakosek M, Bulatovic D, Pavlovic V, Filipovic A, Igic A, Galun D, Jovanovic D, Sisevic J, Masulovic D. Prognostic Nutritional Index (PNI) and Neutrophil to Lymphocyte Ratio (NLR) as Predictors of Short-Term Survival in Patients with Advanced Malignant Biliary Obstruction Treated with Percutaneous Transhepatic Biliary Drainage. J Clin Med 2022; 11:jcm11237055. [PMID: 36498630 PMCID: PMC9741251 DOI: 10.3390/jcm11237055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Effective biliary tree decompression plays a central role in the palliation of malignant biliary obstruction (MBO). When endoscopic drainage is unfeasible or unsuccessful, percutaneous transhepatic biliary drainage (PTBD) is the method of choice and preferred treatment approach in advanced hilar MBO. The prognostic nutritional index (PNI) reflects the patient's immunonutritional status, while the neutrophil to lymphocyte ratio (NLR) reflects the patient's inflammation status. The aim of the present study was to evaluate the prognostic value of preprocedural PNI and NLR on short-term survival in the advanced stage MBO population threatened with PTBD and to characterize the differences in immunonutritional and inflammatory status between 60-day survivors and non-survivors, as well as analyze other variables influencing short-term survival. METHODS This single-center retrospective study was conducted on patients undergoing palliative PTBD caused by MBO as a definitive therapeutic treatment between March 2020 and February 2022. After the procedure, patients were followed until the end of August 2022. RESULTS A total of 136 patients with malignant biliary obstruction were included in the study. Based on receiver operating characteristic (ROC) curve analysis, optimal cut off-values for NLR (3) and PNI (36.7) were determined. In univariate regression analysis, age, absolute neutrophil count, albumin level, NLR ≤ 3, and PNI ≥ 36.7 were significant predictors of 60-day survival. Level of obstruction and PNI ≥ 36.7 were statistically significant independent predictors of 60-day survival in a multivariate regression model. Using PNI ≥ 36.7 as a significant coefficient from the multivariate regression model with the addition of NLR ≤ 3 from univariate analysis, a 60-day survival score was developed. CONCLUSIONS PNI and NLR are easy to calculate from routine blood analysis, which is regularly conducted for cancer patients. As such, they represent easily available, highly reproducible, and inexpensive tests capable of expressing the severity of systemic inflammatory responses in patients with cancer. Our study highlights that preprocedural PNI and NLR values provide predictors of short-term survival in patients with MBO treated with palliative PTBD. In addition, the proposed 60-day survival score can contribute to better selection of future candidates for PTBD and recognition of high-risk patients with expected poor outcomes.
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Affiliation(s)
- Milos Zakosek
- Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dusan Bulatovic
- Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Correspondence:
| | - Vedrana Pavlovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandar Filipovic
- Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksa Igic
- Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Danijel Galun
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- HPB Unit, Clinic for Digestive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Darko Jovanovic
- Clinic of Urology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Sisevic
- Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dragan Masulovic
- Center for Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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14
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Wang Y, Xu J, Fang Y, Gu J, Zhao F, Tang Y, Xu R, Zhang B, Wu J, Fang Z, Li Y. Comprehensive analysis of a novel signature incorporating lipid metabolism and immune-related genes for assessing prognosis and immune landscape in lung adenocarcinoma. Front Immunol 2022; 13:950001. [PMID: 36091041 PMCID: PMC9455632 DOI: 10.3389/fimmu.2022.950001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background As the crosstalk between metabolism and antitumor immunity continues to be unraveled, we aim to develop a prognostic gene signature that integrates lipid metabolism and immune features for patients with lung adenocarcinoma (LUAD). Methods First, differentially expressed genes (DEGs) related to lipid metabolism in LUAD were detected, and subgroups of LUAD patients were identified via the unsupervised clustering method. Based on lipid metabolism and immune-related DEGs, variables were determined by the univariate Cox and LASSO regression, and a prognostic signature was established. The prognostic value of the signature was evaluated by the Kaplan–Meier method, time-dependent ROC, and univariate and multivariate analyses. Five independent GEO datasets were employed for external validation. Gene set enrichment analysis (GSEA), gene set variation analysis (GSVA), and immune infiltration analysis were performed to investigate the underlying mechanisms. The sensitivity to common chemotherapeutic drugs was estimated based on the GDSC database. Finally, we selected PSMC1 involved in the signature, which has not been reported in LUAD, for further experimental validation. Results LUAD patients with different lipid metabolism patterns exhibited significant differences in overall survival and immune infiltration levels. The prognostic signature incorporated 10 genes and stratified patients into high- and low-risk groups by median value splitting. The areas under the ROC curves were 0.69 (1-year), 0.72 (3-year), 0.74 (5-year), and 0.74 (10-year). The Kaplan–Meier survival analysis revealed a significantly poorer overall survival in the high-risk group in the TCGA cohort (p < 0.001). In addition, both univariate and multivariate Cox regression analyses indicated that the prognostic model was the individual factor affecting the overall survival of LUAD patients. Through GSEA and GSVA, we found that tumor progression and inflammatory and immune-related pathways were enriched in the high-risk group. Additionally, patients with high-risk scores showed higher sensitivity to chemotherapeutic drugs. The in vitro experiments further confirmed that PSMC1 could promote the proliferation and migration of LUAD cells. Conclusions We developed and validated a novel signature incorporating both lipid metabolism and immune-related genes for all-stage LUAD patients. This signature can be applied not only for survival prediction but also for guiding personalized chemotherapy and immunotherapy regimens.
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Affiliation(s)
- Yuli Wang
- Clinical Medical Center of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Xu
- Clinical Medical Center of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuan Fang
- Clinical Medical Center of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiefei Gu
- Information Center, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fanchen Zhao
- Clinical Medical Center of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Tang
- School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Rongzhong Xu
- Clinical Medical Center of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bo Zhang
- Clinical Medical Center of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianchun Wu
- Clinical Medical Center of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Jianchun Wu, ; Zhihong Fang, ; Yan Li,
| | - Zhihong Fang
- Clinical Medical Center of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Jianchun Wu, ; Zhihong Fang, ; Yan Li,
| | - Yan Li
- Clinical Medical Center of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Jianchun Wu, ; Zhihong Fang, ; Yan Li,
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15
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Neutrophil-to-Lymphocyte Ratio and Early Neurological Deterioration in Stroke Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8656864. [PMID: 36033552 PMCID: PMC9402292 DOI: 10.1155/2022/8656864] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 12/26/2022]
Abstract
In light of the growing emphasis on classifying stroke patients for different levels of monitoring intensity and emergency treatments, we conducted a systematic review of a wide range of clinical studies, according to the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, with no restrictions on the language or publication date, to analyze the potential of the neutrophil-to-lymphocyte ratio (NLR) as an early neurological deterioration (END) risk predictor. A comprehensive search was carried out in PubMed, Scopus, and Web of Science databases from the inception to March 13, 2022. Nine articles were included in our study. Stroke patients with END had significantly higher NLR levels than the those without END (SMD = 0.73; CI 95% = 0.42-1.05, P value < 0.001). In the subgroup analysis, according to ethnicity, East Asian patients with END had elevated levels of NLR compared to those without END (SMD = 0.79; CI 95% = 0.52-1.06, P value < 0.001). However, the difference in the Caucasian group was not significant (SMD = 0.60; CI 95% = -0.50-1.70, P value = 0.28). In the subgroup analysis according to the type of stroke, the NLR levels in patients with hemorrhagic stroke who developed END were similar to those without END (SMD = 0.84, CI 95% = -0.10-1.77, P value = 0.07). Vice versa, in the ischemic stroke group, patients with END had elevated levels of NLR compared to those without END (SMD = 0.67, CI 95% = 0.38-0.96, P value < 0.001). NLR is a unique inflammatory biomarker whose increase in END suggests an immune system dysfunction in the pathogenesis of the disease.
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16
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Liu D, Heij LR, Czigany Z, Dahl E, Dulk MD, Lang SA, Ulmer TF, Neumann UP, Bednarsch J. The prognostic value of neutrophil-to-lymphocyte ratio in cholangiocarcinoma: a systematic review and meta-analysis. Sci Rep 2022; 12:12691. [PMID: 35879385 PMCID: PMC9314341 DOI: 10.1038/s41598-022-16727-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is used as biomarker in malignant diseases showing significant association with poor oncological outcomes. The main research question of the present study was whether NLR has also prognostic value in cholangiocarcinoma patients (CCA). A systematic review was carried out to identify studies related to NLR and clinical outcomes in CCA evaluating the literature from 01/2000 to 09/2021. A random-effects model, pooled hazard ratios (HR) and 95% confidence interval (CI) were used to investigate the statistical association between NLR and overall survival (OS) as well as disease-free survival (DFS). Subgroup analyses, evaluation of sensitivity and risk of bias were further carried out. 32 studies comprising 8572 patients were eligible for this systematic review and meta-analysis. The pooled outcomes revealed that high NLR prior to treatment is prognostic for poor OS (HR 1.28, 95% CI 1.18–1.38, p < 0.01) and DFS (HR 1.39, 95% CI 1.17–1.66, p < 0.01) with meaningful HR values. Subgroup analysis revealed that this association is not significantly affected by the treatment modality (surgical vs. non-surgical), NLR cut-off values, age and sample size of the included studies. Given the likelihood of NLR to be prognostic for reduced OS and DFS, pre-treatment NLR might serve as a useful biomarker for poor prognosis in patients with CCA and therefore facilitate clinical management.
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Affiliation(s)
- Dong Liu
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Lara R Heij
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.,Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Edgar Dahl
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel den Dulk
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.,Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Sven A Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Tom F Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Ulf P Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.,Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
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17
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Relationship between survival and erythrocyte sedimentation rate in patients operated for lung cancer. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:381-388. [PMID: 36303686 PMCID: PMC9580278 DOI: 10.5606/tgkdc.dergisi.2022.21217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/24/2021] [Indexed: 11/21/2022]
Abstract
Background
This study aims to investigate the relationship between preoperative erythrocyte sedimentation rate and survival in patients undergoing pulmonary resection due to lung cancer.
Methods
Between January 2011 and July 2017, a total of 575 patients (433 males, 142 females; mean age: 61.2±9.9 years; range, 29 to 82 years) who were operated due to primary lung cancer in our clinic were retrospectively analyzed. The patients were grouped according to erythrocyte sedimentation rate to analyze the relationship between erythrocyte sedimentation rate and survival.
Results
The mean overall survival time was 61.8±1.7 months in 393 patients with an erythrocyte sedimentation rate of ≤24 mm/h and 48.9±2.9 months in 182 patients with an erythrocyte sedimentation rate of ≥25 mm/h (p<0.001). Among the patients with Stage 1-2 disease, the mean survival time was 66.2±1.9 in patients with an erythrocyte sedimentation rate of ≤24 mm/h and 53.8±3.2 in patients with an erythrocyte sedimentation rate of ≥25 mm/h (p=0.008). The mean survival time in patients with adenocarcinoma was 62.4±2.4 months in patients with ≤24 mm/h erythrocyte sedimentation rate and 46.1±4.6 months in patients with ≥25 mm/h erythrocyte sedimentation rate (p=0.003).
Conclusion
The relationship between elevated erythrocyte sedimentation rate and poor prognosis in patients with the same stage of the disease is promising for the use of erythrocyte sedimentation rate as a prognostic marker.
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Lococo F, Chiappetta M, Evangelista J, Sperduti I, Nachira D, Porziella V, Congedo MT, Bria E, Vita E, Cesario A, Sassorossi C, Charles-Davies D, Boldrini L, Massaccesi M, Valentini V, Margaritora S. Role of Peripheral Blood Markers for Detecting Response and Predicting Prognosis in Patients with Non-small-cell Lung Cancer Undergoing Neoadjuvant Therapy and Surgery. Lung 2022; 200:393-400. [PMID: 35652971 DOI: 10.1007/s00408-022-00541-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To date, no validated predictors of response before neoadjuvant therapy (NAD) are currently available in locally advanced non-small-cell lung cancer (NSCLC). In this study, different peripheral blood markers were investigated before NAD (pre-NAD) and after NAD/before surgery (post-NAD) to evaluate their influence on the treatment outcomes. METHODS Patients affected by locally advanced NSCLC (cT1-T4/N0-2/M0) who underwent NAD followed by surgery from January 1996 to December 2019 were considered for this retrospective analysis. The impact of peripheral blood markers on downstaging post-NAD and on overall survival (OS) was evaluated using multivariate logistic and Cox regression models. Time to event analysis was performed by means of Kaplan-Meier survival curves and Log Rank tests at 5 years from surgery. RESULTS Two hundred and seventy-two consecutive patients were included. Most of the patients had Stage III NSCLC (83.5%). N2 disease was reported in 188 (69.1%) patients. Surgical resection was performed in patients with stable disease or downstaging post-NAD. Nodal downstaging was observed in 80% of clinical N2 (cN2) patients. The median follow-up of the total series was 74 months (range 6-302). Five-year OS in the overall population and in N2 population was 74.6% and 73.5%, respectively. The pre-surgery platelets level (PLT) (p = 0.019) and the variation (pre-NAD/post-NAD) of the neutrophil/lymphocyte ratio (p = 0.024) were identified as independent prognostic factors of OS. The preoperative PLT value (p value = 0.031) was confirmed as the only predictor of NAD response. CONCLUSIONS The clinical role of peripheral blood markers in locally advanced NSCLC needs to be further investigated. Based on these preliminary results, these factors may be used as auxiliary markers for the prediction of response to neoadjuvant treatment and as prognostic factors for stratification in multimodal approaches.
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Affiliation(s)
- Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00100, Rome, Italy
| | - Marco Chiappetta
- Università Cattolica del Sacro Cuore, Rome, Italy. .,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00100, Rome, Italy.
| | - Jessica Evangelista
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00100, Rome, Italy
| | - Isabella Sperduti
- Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Dania Nachira
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00100, Rome, Italy
| | - Venanzio Porziella
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00100, Rome, Italy
| | - Maria Teresa Congedo
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00100, Rome, Italy
| | - Emilio Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Medical Oncology, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Vita
- Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Medical Oncology, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Cesario
- Open Innovation Manager, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carolina Sassorossi
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00100, Rome, Italy
| | - Diepriye Charles-Davies
- Università Cattolica del Sacro Cuore, Rome, Italy.,Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Università Cattolica del Sacro Cuore, Rome, Italy.,Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mariangela Massaccesi
- Università Cattolica del Sacro Cuore, Rome, Italy.,Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo Valentini
- Università Cattolica del Sacro Cuore, Rome, Italy.,Radiotherapy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Margaritora
- Università Cattolica del Sacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, LARGO A. Gemelli 8, 00100, Rome, Italy
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Mangalesh S, Dudani S. Neutrophil-to-Lymphocyte Ratio for the Prediction of the Presence and Severity of Coronary Artery Disease. Angiology 2022; 73:985-986. [PMID: 35363558 DOI: 10.1177/00033197221087783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sridhar Mangalesh
- Department of Medicine, 214250Army College of Medical Sciences, New Delhi, India
| | - Sharmila Dudani
- Department of Pathology, 214250Army College of Medical Sciences, New Delhi, India
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20
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Wurth R, Rescigno M, Flippo C, Stratakis CA, Tatsi C. Inflammatory biomarkers in the evaluation of pediatric endogenous Cushing syndrome. Eur J Endocrinol 2022; 186:503-510. [PMID: 35171827 PMCID: PMC9059943 DOI: 10.1530/eje-21-1199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/15/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Inflammatory biomarkers, such as absolute neutrophil and lymphocyte counts, neutrophil-to-lymphocyte ratio (NLR), platelet (PLT)-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR), are associated with the progression and development of several disorders. Although patients with Cushing syndrome (CS) have immunosuppression with altered leucocyte counts, the profile of the inflammatory biomarkers in these patients has not been extensively studied. DESIGN We compared a panel of inflammatory biomarkers in patients with active endogenous CS (n of complete blood count (CBC) reports = 319) and eucortisolemic subjects of similar age, gender and BMI (n of CBC reports = 93). Patients were divided into two age groups (6-12 years at the time of CBC and >12 years at the time of CBC) based on age differences in normal reference ranges. RESULTS Patients with CS had higher NLR vs controls (6-12 years: 2.47 (1.86, 3.32) vs 1.35 (1.11, 2.27), P < 0.0001; >12 years: 3.00 (2.23-4.17) vs 1.80 (1.23-2.31), P < 0.0001). Similarly, absolute neutrophil and lymphocyte counts, MLR and PLR differed between patients with CS and controls. The inflammatory biomarkers correlated with indices of cortisol secretion, such as midnight serum cortisol, 24-h urinary free cortisol and morning cortisol. On receiver operating characteristic analysis, NLR showed high area under the curve (AUC) (6-12 years: cutoff of 1.72 had AUC: 0.77, >12 years: cutoff of 2.35 had AUC: 0.81). CONCLUSIONS We conclude that multiple inflammatory biomarkers differed between patients with CS and controls suggesting substantial effects of hypercortisolemia on the immune system.
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Affiliation(s)
- Rachel Wurth
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Megan Rescigno
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Chelsi Flippo
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Constantine A Stratakis
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
- Human Genetics & Precision Medicine, IMBB, FORTH, Heraklion, Crete, Greece
- Human Genetics & Precision Medicine, IMBB, FORTH, Heraklion, Crete, Greece
| | - Christina Tatsi
- Section on Endocrinology & Genetics (SEGEN), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
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21
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Abravan A, Salem A, Price G, Faivre-Finn C, van Herk M. Effect of systemic inflammation biomarkers on overall survival after lung cancer radiotherapy: a single-center large-cohort study. Acta Oncol 2022; 61:163-171. [PMID: 34979860 DOI: 10.1080/0284186x.2021.2022201] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Recent studies suggest that immune-related cells can be recruited for anti-tumor functions as well as tumor progression and the interplay between systemic inflammation and local immune response may play a major role in the development and progression of various cancers including lung cancer. Inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) can be used as surrogate biomarkers of host immune status. In this work, associations between neutrophils, lymphocytes, platelets, NLR, PLR, SII and overall survival (OS) are investigated in two cohorts of non-small cell lung cancer (NSCLC) patients treated with fractionated radiotherapy (RT) and stereotactic body radiation therapy (SBRT) and a cohort of small cell lung cancer (SCLC) patients treated with fractionated RT. MATERIAL AND METHODS Data from 2513 lung cancer patients were retrospectively analyzed. Baseline NLR, PLR, and SII (NLR × platelet count) were calculated from full blood test prior to RT initiation. Cox proportional hazards regression analyses were used to evaluate the association between systemic inflammation markers and known clinical factors with OS. RESULTS The two-year OS was 42%, 63%, and 62% in the NSCLC fractionated RT, SBRT, and SCLC cohort. NLR (per 1 unit: hazard ratio [HR]: 1.04, p < 0.05) and SII (per 100 × 109/L: HR: 1.01, p < 0.05) remained the strongest independent factors of OS in multivariable Cox analyses, correcting for clinical factors in early-stage and locally advanced NSCLC and SCLC patients treated with RT. DISCUSSION This single-center large-cohort study suggests that baseline NLR and SII are independent prognostic biomarkers associated with OS in locally advanced and early-stage NSCLC patients treated with either curative-intent fractionated RT or SBRT and SCLC patients treated with curative-intent fractionated RT. External validation is warranted to evaluate the utility of these biomarkers for patients' stratification and adapting new treatment approaches.
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Affiliation(s)
- A Abravan
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - A Salem
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - G Price
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - M van Herk
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
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22
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Reddy AV, Hill CS, Sehgal S, He J, Zheng L, Herman JM, Meyer J, Narang AK. High neutrophil-to-lymphocyte ratio following stereotactic body radiation therapy is associated with poor clinical outcomes in patients with borderline resectable and locally advanced pancreatic cancer. J Gastrointest Oncol 2022; 13:368-379. [PMID: 35284125 PMCID: PMC8899739 DOI: 10.21037/jgo-21-513] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/24/2021] [Indexed: 10/21/2023] Open
Abstract
Background The purpose of this study is to report on the prognostic role of pre- and post-stereotactic body radiation therapy (SBRT) neutrophil-to-lymphocyte ratio (NLR) in a cohort of patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) who was treated with multi-agent induction chemotherapy followed by five-fraction SBRT. Methods Patients treated with multi-agent induction chemotherapy followed by SBRT from August 2016 to January 2019 and who had laboratory values available for review were included in the study. Univariate (UVA) and multivariate analyses (MVA) were performed to determine associations between pre-/post-SBRT NLR and overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS). Results A total of 156 patients were treated with multi-agent induction chemotherapy followed by SBRT and had laboratory values available for review. On UVA, chemotherapy duration ≥4 months, poorly differentiated disease, inability to undergo resection, pre-SBRT ANC ≥3.7 No./µL, pre-SBRT NLR ≥2.3, and post-SBRT NLR ≥2.6 were associated with worse OS. Patients with post-SBRT NLR ≥2.6 had a median OS of 16.7 months versus median OS not yet reached in patients with post-SBRT <2.6 (P=0.009). On MVA, poorly differentiated disease [hazard ratio (HR) =1.82, 95% CI: 1.04-3.18, P=0.035], inability to undergo resection (HR =2.17, 95% CI: 1.25-3.70, P=0.006), and post-SBRT NLR ≥2.6 (HR =2.55, 95% CI: 1.20-5.45, P=0.015) were associated with inferior OS. On UVA, baseline CA 19-9 ≥219 U/mL, pre-SBRT platelet count ≥157×1,000/µL, and post-SBRT NLR ≥2.6 were associated with inferior LPFS. Patients with post-SBRT NLR ≥2.6 had a median LPFS of 18.3 months versus median LPFS not yet reached in patients with post-SBRT <2.6 (P=0.028). On MVA, only post-SBRT NLR ≥2.6 was associated with worse LPFS (HR =3.22, 95% CI: 1.04-9.98, P=0.043). Conclusions Post-SBRT NLR ≥2.6 predicted for inferior OS and LPFS in BRPC/LAPC patients treated with multi-agent chemotherapy and SBRT. These findings highlight the importance of further elucidating the immunologic effects of radiation therapy in this setting, which may have significant implications on both radiation design as well as combination strategies.
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Affiliation(s)
- Abhinav V. Reddy
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Colin S. Hill
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Shuchi Sehgal
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Lei Zheng
- Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Joseph M. Herman
- Department of Radiation Oncology, Northwell Health, New Hyde Park, NY, USA
| | - Jeffrey Meyer
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
| | - Amol K. Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA
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Xiaowei M, Wei Z, Qiang W, Yiqian N, Yanjie N, Liyan J. Assessment of systemic immune-inflammation index in predicting postoperative pulmonary complications in patients undergoing lung cancer resection. Surgery 2022; 172:365-370. [DOI: 10.1016/j.surg.2021.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 12/14/2022]
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24
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Tenuta M, Gelibter A, Pandozzi C, Sirgiovanni G, Campolo F, Venneri MA, Caponnetto S, Cortesi E, Marchetti P, Isidori AM, Sbardella E. Impact of Sarcopenia and Inflammation on Patients with Advanced Non-Small Cell Lung Cancer (NCSCL) Treated with Immune Checkpoint Inhibitors (ICIs): A Prospective Study. Cancers (Basel) 2021; 13:cancers13246355. [PMID: 34944975 PMCID: PMC8699333 DOI: 10.3390/cancers13246355] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sarcopenia is a condition characterized by loss of skeletal muscle mass associated with worse clinical outcomes in cancer patients. Data on sarcopenia in patients undergoing immune checkpoint inhibitors (ICI) therapy are still limited. The aim of this prospective observational study was to investigate the relationship between sarcopenia, ICI treatment response and immunological profile, in patients with advanced non-small cell lung cancer (NSCLC). METHODS Forty-seven stage IV NSCLC patient candidates for starting ICI, were enrolled from the Policlinico Umberto I outpatient Oncology. Patients underwent baseline blood test, inflammatory markers, cytokine assessment and body composition with dual-energy X-ray absorptiometry (DXA). Sarcopenia was defined with appendicular skeletal muscle mass over height2 (ASM/heigh2). RESULTS Overall, 19/47 patients (40.4%) results were sarcopenic. Sarcopenic patients showed significantly shorter PFS than non-sarcopenic ones (20.3 weeks, 95% CI 7.5-33.1 vs. 61 weeks, 95% CI 22.5-99.4, p = 0.047). Specifically, they had an 8.1 times higher risk of progression disease (PD) than non-sarcopenic patients (OR 8.1, 95%, p = 0.011). CONCLUSIONS Sarcopenic patients showed worse PFS and had a higher risk of PD compared to non-sarcopenic ones. Therefore, sarcopenia may reflect the increased metabolic activity of more aggressive tumors, which involves systemic inflammation and muscle wasting and could be considered a negative predictive factor for ICI response.
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Affiliation(s)
- Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (M.T.); (C.P.); (F.C.); (M.A.V.); (A.M.I.)
| | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (A.G.); (G.S.); (S.C.); (E.C.); (P.M.)
| | - Carla Pandozzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (M.T.); (C.P.); (F.C.); (M.A.V.); (A.M.I.)
| | - Grazia Sirgiovanni
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (A.G.); (G.S.); (S.C.); (E.C.); (P.M.)
| | - Federica Campolo
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (M.T.); (C.P.); (F.C.); (M.A.V.); (A.M.I.)
| | - Mary Anna Venneri
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (M.T.); (C.P.); (F.C.); (M.A.V.); (A.M.I.)
| | - Salvatore Caponnetto
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (A.G.); (G.S.); (S.C.); (E.C.); (P.M.)
| | - Enrico Cortesi
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (A.G.); (G.S.); (S.C.); (E.C.); (P.M.)
| | - Paolo Marchetti
- Medical Oncology Unit B, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (A.G.); (G.S.); (S.C.); (E.C.); (P.M.)
| | - Andrea M. Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (M.T.); (C.P.); (F.C.); (M.A.V.); (A.M.I.)
| | - Emilia Sbardella
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (M.T.); (C.P.); (F.C.); (M.A.V.); (A.M.I.)
- Correspondence: ; Tel.: +39-0649970512; Fax: +39-0649970598
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25
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de Rezende Ferreira Mendes AL, Sampaio HADC, Ferreira Carioca AA, Pinheiro LGP, Vasques PHD, Rocha DC, Cacau LT, Bezerra IN. Women with Abnormal Mammographic Findings and High Neutrophil-to-Lymphocyte Ratio have the Worst Dietary Carbohydrate Quality Index. Nutr Cancer 2021; 74:2436-2443. [PMID: 34854778 DOI: 10.1080/01635581.2021.2009885] [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: 10/06/2019] [Revised: 06/03/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There are gaps in knowledge in breast cancer prevention studies focusing on interactions among mammographic findings, inflammation, and diet, especially those related to carbohydrates. OBJECTIVE We aimed to verify the association among mammographic findings, inflammatory markers, and carbohydrate quality index (CQI) in women. METHODOLOGY This was a cross-sectional study of 532 women assisted in a healthcare service. The enrolled women were divided into two groups according to their mammographic findings: those without and those with abnormal mammographic findings. Two 24-hour dietary reminders were applied, and CQI was determined based on four components: fibers, glycemic index, ratio between whole and total grains, and ratio between solid and total carbohydrates. The neutrophil-to-lymphocyte ratio (NLR) was calculated as an inflammatory marker. RESULTS There were 178 (33.5%) women with abnormal mammographic findings, and 20 (3.8%) had NLR. There was no association between CQI and mammographic findings and NLR. Women with abnormal mammographic findings and high NLR had lower CQI (p = 0.039) and lower whole total ratio (p = 0.024). CONCLUSION Women with abnormal findings and high NLR had worse CQI and worse overall total grain ratio.
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Affiliation(s)
| | | | | | - Luiz Gonzaga Porto Pinheiro
- Education and Oncology Studies Group (Grupo de Educação e Estudos em Oncologia - GEEON), Federal University of Ceará, Fortaleza, Brazil
| | - Paulo Henrique Diógenes Vasques
- Education and Oncology Studies Group (Grupo de Educação e Estudos em Oncologia - GEEON), Federal University of Ceará, Fortaleza, Brazil
| | | | - Leandro Teixeira Cacau
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
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Biswas T, Gawdi R, Jindal C, Iyer S, Kang KH, Bajor D, Machtay M, Choi YM, Efird JT. Pretreatment neutrophil-to-lymphocyte ratio as an important prognostic marker in stage III locally advanced non-small cell lung cancer: confirmatory results from the PROCLAIM phase III clinical trial. J Thorac Dis 2021; 13:5617-5626. [PMID: 34795912 PMCID: PMC8575807 DOI: 10.21037/jtd-21-1018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022]
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) is an important pretreatment marker of systemic inflammation and tumor aggressiveness. Increased levels of this ratio have been associated with reduced survival in several observational studies of lung cancer. However, supporting analyses from large clinical trial data are lacking. Methods To validate the prognostic role of NLR, the current study evaluated data from a randomized phase III study (PROCLAIM; clinicaltrial.gov ID: NCT00686959) of patients with stage IIIA/B, unresectable, non-squamous, non-small cell lung cancer (NSCLC), originally comparing combination pemetrexed-cisplatin chemoradiotherapy with etoposide-cisplatin chemoradiotherapy. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for survival were estimated using a Cox proportional hazards model. Models were adjusted for age, race, sex, stage, treatment, and body mass index (BMI). Patients were followed for a median of 24 months. Results Increased NLR levels at baseline were associated with reduced overall (PTrend <0.0001) and progression-free survival (PTrend <0.005). A similar but decreasing linear trend was not observed for lymphocytes count alone. Conclusions These findings provide substantiating evidence that NLR, which is routinely available from standard blood testing of patients diagnosed with NSCLC, is an important inflammation-based prognostic marker for survival among patients with locally advanced disease undergoing chemoradiation. Future research will benefit by assessing the prognostic potential of NLR in the context of genetic mutations and molecular markers.
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Affiliation(s)
- Tithi Biswas
- Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Rohin Gawdi
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Sharanya Iyer
- Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Kylie H Kang
- Department of Radiation Oncology, Washington University School of Medicine and Alvin J. Siteman Comprehensive Cancer Center, St. Louis, MO, USA
| | - David Bajor
- Medical Oncology, Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mitchell Machtay
- Department of Radiation Oncology, Penn State University, Hershey, PA, USA
| | | | - Jimmy T Efird
- Cooperative Studies Program Epidemiology Center, Health Services Research and Development, DVAHCS, Durham, NC, USA
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Delikgoz Soykut E, Kemal Y, Karacin C, Karaoglanoglu O, Kurt M, Aytac Arslan S. Prognostic impact of immune inflammation biomarkers in predicting survival and radiosensitivity in patients with non-small-cell lung cancer treated with chemoradiotherapy. J Med Imaging Radiat Oncol 2021; 66:146-157. [PMID: 34632714 DOI: 10.1111/1754-9485.13341] [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: 05/13/2021] [Accepted: 09/25/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The purpose of this retrospective study was to investigate the prognostic impact of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), derived NLR (dNLR) and systemic immune-inflammation index (SII) in predicting outcomes for patients with locally advanced non-small-cell lung cancer (NSCLC). The secondary endpoint was to evaluate the radiosensitivity in terms of response rate. METHODS Newly diagnosed locally advanced NSCLC patients were enrolled. Immune inflammation biomarkers were calculated from baseline blood samples. Patients were stratified in two groups based on optimal cut-off values for each biomarker. The associations between biomarkers and overall survival (OS), progression-free survival (PFS), local regional recurrence-free survival (LRRFS), and also response to radiotherapy were analysed. RESULTS A total of 392 patients were included. Five-year OS, PFS and LRRFS rates were 14.6%, 12.1%, and 13.4% respectively. Optimal cut-off values for NLR, PLR, dNLR and SII were 3.07, 166, 2.02 and 817 respectively. Low NLR (HR 1.73, 95% CI 1.34-2.24, P < 0.001), low PLR (HR 1.37, 95% CI 1.06-1.76, P = 0.013), low dNLR (HR 1.66, 95% CI 1.29-2.13, P < 0.001) and low SII (HR 1.63, 95% CI 1.18-2.04, P < 0.001) were independent prognostic factors for OS. Low NLR, PLR, dNLR and SII were also significant prognostic factors for PFS and LRRFS. Low NLR, low dNLR and low SII groups had better radiosensitivity than compared with high NLR, high dNLR and high SII groups (P = 0.001, P = 0.001 and P = 0.012). CONCLUSION NLR, PLR, dNLR and SII were independently associated with improved OS, PFS and LRRFS. Low NLR, dNLR and SII groups had better radiosensitivity. Immune inflammation biomarkers are promising prognostic predictors which can be obtained easily and inexpensively.
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Affiliation(s)
- Ela Delikgoz Soykut
- Department of Radiation Oncology, Samsun Training and Research Hospital, Health Sciences University, Samsun, Turkey
| | - Yasemin Kemal
- Department of Medical Oncology, İstinye University, İstanbul, Turkey
| | - Cengiz Karacin
- Department of Medical Oncology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ozden Karaoglanoglu
- Department of Radiation Oncology, VM Medical Park Samsun Hospital, Samsun, Turkey
| | - Mumin Kurt
- Department of Radiation Oncology, Samsun Training and Research Hospital, Health Sciences University, Samsun, Turkey
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Li J, Mei X, Sun D, Guo M, Xie M, Chen X. A Nutrition and Inflammation-Related Nomogram to Predict Overall Survival in Surgically Resected Esophageal Squamous Cell Carcinoma (ESCC) Patients. Nutr Cancer 2021; 74:1625-1635. [PMID: 34369223 DOI: 10.1080/01635581.2021.1957131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pretreatment inflammation-based biomarkers and the prognostic nutrition index (PNI) have been used to evaluate prognosis in cancer patients. However, few studies have focused on the prognostic value of post-treatment inflammation-based biomarkers and PNI in ESCC patients. We aimed to investigate the values of pre/post-treatment inflammatory parameters and PNI for establishing a nomogram to predict overall survival (OS) in ESCC patients. A retrospective review was performed on 268 ESCC patients with esophagectomy. The prognostic values of inflammatory and nutrition indexes were evaluated. Based on the results of multivariable Cox analysis, a nomogram was developed. The predictive accuracy and discriminative ability of the nomogram were determined using the concordance-index (C-index) and a calibration curve and subsequently compared to tumor-node-metastasis (TNM) staging by C-index, receiver operating characteristic (ROC) and decision curve analysis (DCA). PreSII, PostSII, PrePNI, N stage, and TNM classification were assembled into a nomogram. The C-index of the nomogram was 0.774, and the area under curve (AUC) of the nomogram was 0.862. DCA demonstrated that the established nomogram was a better predictive model compared to the TNM system. The developed nomogram with superior predictive ability provides more valuable prognostic information for patients and clinicians than TNM classification.
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Affiliation(s)
- Juan Li
- Department of Thoracic Surgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Xinyu Mei
- Department of Thoracic Surgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Di Sun
- Department of Thoracic Surgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | - Mingfa Guo
- Department of Thoracic Surgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
| | | | - Xia Chen
- Department of Southern District Nursing, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China
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Punjabi A, Barrett E, Cheng A, Mulla A, Walls G, Johnston D, McAleese J, Moore K, Hicks J, Blyth K, Denholm M, Magee L, Gilligan D, Silverman S, Qureshi M, Clinch H, Hatton M, Philipps L, Brown S, O'Brien M, McDonald F, Faivre-Finn C, Hiley C, Evison M. Neutrophil-Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e331-e338. [PMID: 33863615 DOI: 10.1016/j.clon.2021.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/27/2021] [Accepted: 03/24/2021] [Indexed: 12/21/2022]
Abstract
AIMS The neutrophil-lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival. MATERIALS AND METHODS A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment. RESULTS In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06-2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49-3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5-3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76-4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001). CONCLUSION NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.
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Affiliation(s)
- A Punjabi
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - E Barrett
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Cheng
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Mulla
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - G Walls
- Queen's University Belfast, Belfast, UK
| | - D Johnston
- Northern Ireland Cancer Centre, Belfast, UK
| | - J McAleese
- Northern Ireland Cancer Centre, Belfast, UK
| | - K Moore
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - J Hicks
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - K Blyth
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - M Denholm
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - L Magee
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - D Gilligan
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - S Silverman
- University College London Hospital, London, UK
| | - M Qureshi
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - H Clinch
- The University of Sheffield Medical School, Sheffield, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | | | - S Brown
- The University of Manchester, Manchester, UK
| | | | | | - C Faivre-Finn
- The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - C Hiley
- CRUK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK
| | - M Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
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Goksel S, Ozcelik N, Telatar G, Ardic C. The Role of Hematological Inflammatory Biomarkers in the Diagnosis of Lung Cancer and in Predicting TNM Stage. Cancer Invest 2021; 39:514-520. [PMID: 34075845 DOI: 10.1080/07357907.2021.1938110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of study is to investigate whether hematological inflammatory biomarkers could be useful to detect patients with lung cancer. METHODS The contribution of hematological biomarkers to the diagnosis of lung cancer and prediction of TNM was examined. RESULTS NLR, PLR, MPV values were found to be higher in patients with lung cancer (all p < .001). NLR and PLR were found to be high, MPV was found to be lower in disease of advanced stage (p < .001). CONCLUSIONS This study found that NLR, PLR and MPV values were significantly higher in patients with lung cancer.
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Affiliation(s)
- Sibel Goksel
- Department of Nuclear Medicine, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - Neslihan Ozcelik
- Department of Chest Disease, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - Gokhan Telatar
- Department of Public Health, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - Cuneyt Ardic
- Department of Family Medicine, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
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31
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Brito GMC, Fontenele AMM, Carneiro ECRL, Nogueira IAL, Cavalcante TB, Vale AAM, Monteiro SCM, Salgado Filho N. Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Nondialysis Chronic Kidney Patients. Int J Inflam 2021; 2021:6678960. [PMID: 34257898 PMCID: PMC8245254 DOI: 10.1155/2021/6678960] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The Neutrophil-to-Lymphocyte Ratio (NLR) and the Platelet-to-Lymphocyte Ratio (PLR) are inflammatory biomarkers for several diseases, such as cancer and cardiovascular morbidities; however, there are currently few studies on kidney diseases. We aimed to evaluate nondialysis patients and determine the association of NLR and PLR with inflammation in these patients. METHODS A prospective cross-sectional study was conducted with 85 patients at different stages of chronic kidney disease (CKD), treated at the Kidney Disease Prevention Center of the University Hospital of the Federal University of Maranhão. This study included adult nondialysis patients diagnosed with CKD. The participants' blood samples were collected for a high-sensitivity C-reactive protein (hs-CRP) test and blood count. They were divided into two groups according to the presence or absence of inflammation based on the hs-CRP value (<0.5 mg/dL). NLR and PLR were calculated based on the absolute number of neutrophils, lymphocytes, and platelets and were compared between them and with hs-CRP. Statistical analysis was performed using the Stata software, with the Shapiro-Wilk, Mann-Whitney, Spearman's Correlation, and receiver operating characteristic curve tests. This study was approved by the local ethics committee. RESULTS The participants were categorized into two groups: with inflammation (n = 64) and without inflammation (n = 21). The mean age was 61.43 ± 14.63 y. The NLR and PLR values were significantly different between the groups with and without inflammation (p=0.045and p=0.004, respectively). However, only PLR showed a significant positive correlation with hs-CRP (p=0.015). The best cutoff point for NLR to detect inflammation was 1.98, with 76.19% sensitivity and 48.44% specificity. For PLR, it was 116.07, with 85.71% sensitivity and 51.56% specificity. There was no significant difference between the area under the NLR and PLR curve (0.71 vs. 0.64; p=0.186) for this population. CONCLUSIONS This study showed that PLR was positively correlated with hs-CRP in nondialysis CKD patients and can be used to identify inflammation in this population.
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Affiliation(s)
- Gysllene M. C. Brito
- University Hospital of the Federal University of Maranhão, São Luís 65020-070, Brazil
| | - Andrea M. M. Fontenele
- University Hospital of the Federal University of Maranhão, São Luís 65020-070, Brazil
- Federal University of Maranhão, CEP: 65080-805, São Luís, Brazil
| | | | | | | | - André A. M. Vale
- Federal University of Maranhão, CEP: 65080-805, São Luís, Brazil
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Lauko A, Thapa B, Sharma M, Muhsen B, Barnett A, Rauf Y, Borghei-Razavi H, Tatineni V, Patil P, Mohammadi A, Chao S, Murphy ES, Angelov L, Suh J, Barnett GH, Nowacki AS, Pennell N, Ahluwalia MS. Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases. Sci Rep 2021; 11:7490. [PMID: 33820922 PMCID: PMC8021556 DOI: 10.1038/s41598-021-85328-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/06/2021] [Indexed: 11/12/2022] Open
Abstract
Steroids are often utilized to manage patients with non-small cell lung cancer brain metastases (NSCLCBM). Steroids and elevated neutrophil-to-lymphocyte ratio (NLR) have been associated with decreased overall survival (OS) in patients treated with immune checkpoint inhibitors (ICI). We retrospectively investigated patients treated with ICI after the diagnosis of NSCLCBM at a single tertiary care institution examing the impact of steroids and NLR. Overall survival (OS) and intracranial progression-free survival (PFS) were analyzed. 171 patients treated with ICI for NSCLCBM were included. Thirty-six received steroids within 30 days of the start of ICI, and 53 patients had an NLR ≥ 5 before the start of ICI. Upfront steroids was associated with decreased OS on multivariable analysis (median OS 10.5 vs. 17.9 months, p = .03) and intracranial PFS (5.0 vs. 8.7 months, p = .045). NLR ≥ 5 was indicative of worse OS (10.5 vs. 18.4 months, p = .04) but not intracranial PFS (7.2 vs. 7.7 months, p = .61). When NLR and upfront steroids are modeled together, there is a strong interaction (p = .0008) indicating that the impact of steroids depended on the patient’s NLR. In a subgroup analysis, only in patients with NLR < 4 was there a significant difference in OS with upfront steroids (26.1 vs. 15.6 months, p = .032). The impact of steroids on the efficacy of ICI in patients with NSCLCBM is dependent on the patient's NLR underscoring its importance in these patients. Patients with a low NLR, steroid use decreases the efficacy of ICI. These results can inform clinicians about the impact of steroids in patients treated with ICI.
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Affiliation(s)
- Adam Lauko
- Cleveland Clinic Lerner College of Medicine At Case Western Reserve University, 9500 Euclid Ave, CA-51, Cleveland, OH, 44195, USA
| | - Bicky Thapa
- Foedtert and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mayur Sharma
- Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - Baha'eddin Muhsen
- Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Addison Barnett
- Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yasmeen Rauf
- Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Pradnya Patil
- Department of Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza Mohammadi
- Cleveland Clinic Lerner College of Medicine At Case Western Reserve University, 9500 Euclid Ave, CA-51, Cleveland, OH, 44195, USA.,Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samuel Chao
- Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erin S Murphy
- Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lilyana Angelov
- Cleveland Clinic Lerner College of Medicine At Case Western Reserve University, 9500 Euclid Ave, CA-51, Cleveland, OH, 44195, USA.,Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Suh
- Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gene H Barnett
- Cleveland Clinic Lerner College of Medicine At Case Western Reserve University, 9500 Euclid Ave, CA-51, Cleveland, OH, 44195, USA.,Rosa Ella Burkhart Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy S Nowacki
- Cleveland Clinic Lerner College of Medicine At Case Western Reserve University, 9500 Euclid Ave, CA-51, Cleveland, OH, 44195, USA.,Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nathan Pennell
- Department of Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Manmeet S Ahluwalia
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
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Zanghì A, Gallo A, Avolio C, Capuano R, Lucchini M, Petracca M, Bonavita S, Lanzillo R, Ferraro D, Curti E, Buccafusca M, Callari G, Barone S, Pontillo G, Abbadessa G, Di Francescantonio V, Signoriello E, Lus G, Sola P, Granella F, Valentino P, Mirabella M, Patti F, D'Amico E. Exit Strategies in Natalizumab-Treated RRMS at High Risk of Progressive Multifocal Leukoencephalopathy: a Multicentre Comparison Study. Neurotherapeutics 2021; 18:1166-1174. [PMID: 33844155 PMCID: PMC8423885 DOI: 10.1007/s13311-021-01037-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/27/2022] Open
Abstract
The main aim of the study is to evaluate the efficacy and safety profile of ocrelizumab (OCR), rituximab (RTX), and cladribine (CLA), employed as natalizumab (NTZ) exit strategies in relapsing-remitting multiple sclerosis (RRMS) patients at high-risk for progressive multifocal leukoencephalopathy (PML). This is a multicentre, retrospective, real-world study on consecutive RRMS patients from eleven tertiary Italian MS centres, who switched from NTZ to OCR, RTX, and CLA from January 1st, 2019, to December 31st, 2019. The primary study outcomes were the annualized relapse rate (ARR) and magnetic resonance imaging (MRI) outcome. Treatment effects were estimated by the inverse probability treatment weighting (IPTW), based on propensity-score (PS) approach. Additional endpoint included confirmed disability progression (CDP) as measured by Expanded Disability Status Scale and adverse events (AEs). Patients satisfying predefined inclusion and exclusion criteria were 120; 64 switched to OCR, 36 to RTX, and 20 to CLA. Patients from the 3 groups did not show differences for baseline characteristics, also after post hoc analysis. The IPTW PS-adjusted models revealed that patients on OCR had a lower risk for ARR than patients on CLA (ExpBOCR 0.485, CI 95% 0.264-0.893, p = 0.020). This result was confirmed also for 12-month MRI activity (ExpBOCR 0.248 CI 95% 0.065-0.948, p = 0.042). No differences were found in other pairwise comparisons (OCR vs RTX and RTX vs CLA) for the investigated outcomes. AEs were similar among the 3 groups. Anti-CD20 drugs were revealed to be effective and safe options as NTZ exit strategies. All investigated DMTs showed a good safety profile.
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Affiliation(s)
- Aurora Zanghì
- Department "G.F. Ingrassia", MS Center, Organization University of Catania, Catania, Italy
| | - Antonio Gallo
- MS Center I Division of Neurology, University Della Campania "L. Vanvitelli", Naples, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences Head of Multiple Sclerosis Center Dept. of Neurosciences, University of Foggia, Foggia, Italy
| | - Rocco Capuano
- MS Center I Division of Neurology, University Della Campania "L. Vanvitelli", Naples, Italy
| | - Matteo Lucchini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Petracca
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Simona Bonavita
- Dipartimento Di Scienze Mediche E Chirurgiche Avanzate, Università Della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Roberta Lanzillo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Diana Ferraro
- University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Curti
- Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
| | | | | | - Stefania Barone
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
- Department of Electrical Engineering and Information Technology, , University "Federico II", Naples, Italy
| | - Gianmarco Abbadessa
- Dipartimento Di Scienze Mediche E Chirurgiche Avanzate, Università Della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Napoli, Italy
| | - Valeria Di Francescantonio
- Department of Medical and Surgical Sciences Head of Multiple Sclerosis Center Dept. of Neurosciences, University of Foggia, Foggia, Italy
| | - Elisabetta Signoriello
- Department of Clinical and Experimental Medicine, Multiple Sclerosis Center, II Division of Neurology, Second University of Naples, Naples, Italy
| | - Giacomo Lus
- Department of Clinical and Experimental Medicine, Multiple Sclerosis Center, II Division of Neurology, Second University of Naples, Naples, Italy
| | - Patrizia Sola
- University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Granella
- Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Valentino
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - Massimiliano Mirabella
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", MS Center, Organization University of Catania, Catania, Italy
| | - Emanuele D'Amico
- Department "G.F. Ingrassia", MS Center, Organization University of Catania, Catania, Italy.
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Kao C, Powers E, Wu Y, Datto MB, Green MF, Strickler JH, Ready NE, Zhang T, Clarke JM. Predictive Value of Combining Biomarkers for Clinical Outcomes in Advanced Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors. Clin Lung Cancer 2021; 22:500-509. [PMID: 33972172 DOI: 10.1016/j.cllc.2021.03.017] [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: 01/25/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION A high tumor mutational burden (TMB) (≥10 mut/Mb) has been associated with improved clinical benefit in non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICI) and is a tumor agnostic indication for pembrolizumab across tumor types. We explored whether combining TMB with programmed cell death ligand 1 (PD-L1) and pretreatment neutrophil-lymphocyte ratio (NLR) was associated with improved outcomes in ICI-treated NSCLC. METHODS We retrospectively analyzed patients treated with ICI with Foundation One genomic testing, including TMB. Optimal cutoff for prediction of response by TMB was determined by receiver operating characteristic analysis, and area under the curve (AUC) was calculated for all 3 biomarkers and combinations. Cox model was used to assess prognostic factors of overall survival (OS) and time to progression (TTP). Survival cutoffs calculated with Kaplan-Meier survival curves were TMB ≥10 mut/Mb, PD-L1 ≥50%, NLR <5, and combined biomarkers. RESULTS Data from 88 patients treated were analyzed. The optimal TMB cutoff was 9.24 mut/Mb (AUC, 0.62), improving to 0.74 combining all 3 biomarkers. Adjusted Cox model showed that TMB ≥10 mut/Mb was an independent factor of OS (hazard ratio [HR], 0.31; 95% confidence interval; 0.14-0.69; P = .004) and TTP (HR, 0.46; 95% CI, 0.27-0.77; P = .003). The combination of high TMB with positive PD-L1 and low NLR was significantly associated with OS (P = .038) but not TTP. CONCLUSIONS TMB has modest predictive and prognostic power for clinical outcomes after ICI treatment. The combination of TMB, PD-L1, and NLR status improves this power.
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Affiliation(s)
- Chester Kao
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Eric Powers
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Yuan Wu
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Michael B Datto
- Department of Pathology, Duke University School of Medicine, Durham, NC
| | - Michelle F Green
- Department of Pathology, Duke University School of Medicine, Durham, NC
| | - John H Strickler
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Duke University, Durham, NC
| | - Neal E Ready
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Duke University, Durham, NC
| | - Tian Zhang
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Duke University, Durham, NC; Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, NC
| | - Jeffrey M Clarke
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Duke University, Durham, NC.
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Baldessari C, Guaitoli G, Valoriani F, Bonacini R, Marcheselli R, Reverberi L, Pecchi A, Menozzi R, Torricelli P, Bertolini F, Barbieri F, Dominici M. Impact of body composition, nutritional and inflammatory status on outcome of non-small cell lung cancer patients treated with immunotherapy. Clin Nutr ESPEN 2021; 43:64-75. [PMID: 34024567 DOI: 10.1016/j.clnesp.2021.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Body composition and balance of nutritional and inflammatory status are important for the immune system. Alterations of these aspects may impact on response, outcome and toxicities of immunotherapy. In this review we try to clarify some definitions and tools used for the assessment of the different aspects of nutritional disorders, body composition and inflammatory status with a focus on lung cancer. METHODS We primary investigate the definitions of malnutrition, cachexia, sarcopenia and overweight. Secondary, tools used to measure body composition, nutritional and inflammatory status, mainly in lung cancer are reviewed. RESULTS All these features, in the time of precision medicine may improve assessment and selection of patients, incorporating also early palliative care in standard therapy. CONCLUSIONS A multimodal approach based on nutrition assessment and physical exercise should be evaluated to improve aspects of the immune response against cancer and to propose the best treatment to every patient.
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Affiliation(s)
- Cinzia Baldessari
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy.
| | - Giorgia Guaitoli
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Filippo Valoriani
- Unit of Metabolic Disorder and Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Riccardo Bonacini
- Department of Radiology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Raffaella Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Linda Reverberi
- Unit of Metabolic Disorder and Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Annarita Pecchi
- Department of Radiology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Renata Menozzi
- Unit of Metabolic Disorder and Clinical Nutrition, Department of Specialist Medicines, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Pietro Torricelli
- Department of Radiology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Fausto Barbieri
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
| | - Massimo Dominici
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria of Modena, Italy
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NLR and CRP to albumin ratio as a predictor of in-hospital mortality in the geriatric ED patients. Am J Emerg Med 2021; 44:50-55. [PMID: 33578332 DOI: 10.1016/j.ajem.2021.01.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION We aimed to investigate the role of neutrophil to lymphocyte ratio (NLR) and the C-Reactive Protein/Albumin Ratio (CAR), which are obtained from the first laboratory values of the elderly patients at admission to the emergency department (ED), in predicting in-hospital mortality. METHODS This retrospective observational study includes the patients aged 65 and above who applied to the emergency department for two months. The patients' neutrophil, lymphocyte, C-reactive protein (CRP), albumin, NLR and CAR values were recorded. Statistical analysis of NLR and CAR values was performed according to in-hospital mortality and ED outcome. RESULTS 784 patients were included in the statistical analysis of the study. Increased NLR (8.82 (4.16-16.63), 4.76 (2.62-8.56), p˂0.001) and increased CAR (21.39 (6.02-55.07), 4.82 (1.17-17.03), p < 0.001) values were found to be statistically significant in the group with mortality compared to the group without mortality. Increased NLR (AUC: 0.642) and increased CAR (AUC: 0.723) were a predictor of in-hospital mortality. It was found that in-hospital mortality risk in patients with concurrent high NLR and CAR values (CAR˃12.3, NLR˃7.1) was 9.87 times more than the patients with concurrent low NLR and CAR values (CAR<12.3, NLR < 7.1). NLR and CAR values of the patients hospitalized in intensive care and service (NLR 7.21 (4.07-13.36), 5.77 (3.45-11.22); CAR 12.65 (2.79-36.8), 9.56 (1.74-33.97)) were found to be statistically significantly higher than those who were discharged (NLR 3.64 (2.26-7.02); CAR 2.88 (0.9-10.59)). CONCLUSION According to our results, the concurrent high levels of NLR and CAR values were found to be more effective in predicting in-hospital mortality compared to a separate evaluation.
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Prognostic Value of Red Blood Cell Distribution Width in Resected pN1 Lung Adenocarcinoma. Cancers (Basel) 2020; 12:cancers12123677. [PMID: 33302343 PMCID: PMC7762373 DOI: 10.3390/cancers12123677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Red blood cell distribution width is a measure of the variation of erythrocyte volume. Impaired erythropoiesis can lead to a wide variation in erythrocyte dimension—defined as anisocytosis—indicating that pathological modifications are taking place. Recently, red blood cell distribution width has been advocated as an effective prognostic factor in cardiovascular diseases, acute kidney injury, autoimmune disease, and oncologic settings. In many advanced and several early-stage oncologic conditions, it has shown excellent prognostic efficacy; we therefore investigated what prognostic role red blood cell distribution width may have in resected lung cancer, focusing on pN1 adenocarcinoma patients in whom adjuvant treatments—although well-established—are still proposed case by case. Our findings suggest that red blood cell distribution width is strictly related to disease-free survival; it could therefore be considered as a further tool for planning postoperative adjuvant treatments and setting up an adequate follow-up program. Abstract Background: Red blood cell distribution width is a measure of the variation of erythrocyte volume and has recently been advocated as a prognostic tool in neoplastic and non-neoplastic diseases. We studied the prognostic role of preoperative red blood cell distribution width (RDW) in resected pN1 lung adenocarcinoma patients. Methods: Sixty-seven consecutive pN1 lung adenocarcinoma patients operated in the last two years were retrospectively evaluated in the present study. Age, sex, smoking status, type of surgical resection, neoadjuvant and adjuvant treatments, pathological stage, T and N status, tumor size, preoperative hemoglobin (Hb) and RDW, preoperative neutrophils, lymphocytes, and their ratio were collected for each patient. Outpatient follow-up was performed and date of relapse was recorded. Results: There were 24 females (35.8%). Twenty-eight patients (41.8%) belonged to stage 3A and thirty-nine patients (58.2%) to stage 2B. Mean preoperative RDW % was 14.1 (IQR: 12.9–14.8). Univariate analysis disclosed preoperative RDW as strictly related to disease-free survival (p = 0.02), which was confirmed in the exploratory multivariable analysis (p = 0.003). Conclusions: Pre-operative RDW is an effective prognostic factor of disease-free survival in resected pN1 lung adenocarcinoma; it could therefore be considered as a further tool for planning postoperative adjuvant treatments and setting up an adequate follow-up program.
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Newman J, Preeshagul I, Kohn N, Devoe C, Seetharamu N. Simple parameters to solve a complex issue: predicting response to checkpoint inhibitor therapy in lung cancer. Lung Cancer Manag 2020; 10:LMT44. [PMID: 34084210 PMCID: PMC8162145 DOI: 10.2217/lmt-2020-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Noninvasive biomarkers predicting immune checkpoint inhibitor (ICI) response are urgently needed. We evaluated the predictive value of pretreatment neutrophil-to-lymphocyte ratio (NLR), smoking history, smoking intensity, BMI and programmed death ligand 1 (PD-L1) expression in non-small-cell lung cancer (NSCLC) patients treated with ICIs. Materials & methods: Single-center retrospective study included 137 patients from July 2015 to February 2018. Outcomes included 3-month disease control rate, progression-free survival, and overall survival. Predictive value of biomarkers was assessed independently and in a multivariable model. Results: NLR was associated with all outcomes. Smoking history was predictive of progression-free survival and smoking intensity was predictive of disease control rate. BMI and PD-L1 were not associated with any outcome. High BMI was associated with low NLR. Conclusion: Simple clinical biomarkers can predict response to ICIs. A score incorporating both clinical factors and established tissue/serum biomarkers may be useful in identifying NSCLC patients who would benefit from ICIs.
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Affiliation(s)
- James Newman
- Northwell Health Cancer Institute, Medical Oncology, New Hyde Park, NY 11042, USA
| | - Isabel Preeshagul
- Memorial Sloan Kettering Cancer Center, Medical Oncology, New York, NY 10065, USA
| | - Nina Kohn
- Feinstein Institute for Medical Research, Biostatistics Unit, Manhasset, NY 11030, USA
| | - Craig Devoe
- Northwell Health Cancer Institute, Medical Oncology, New Hyde Park, NY 11042, USA
| | - Nagashree Seetharamu
- Northwell Health Cancer Institute, Medical Oncology, New Hyde Park, NY 11042, USA
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Naito E, Yuki M, Hirano T, Kainuma D, Aoyama R. Prognostic utility of preoperative neutrophil-lymphocyte ratio in cats with malignant mammary tumors. Res Vet Sci 2020; 135:349-354. [PMID: 33129575 DOI: 10.1016/j.rvsc.2020.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 01/04/2023]
Abstract
Although studies have determined the neutrophil-lymphocyte ratio (NLR) to be a useful prognostic predictor in various human cancers, little is known regarding its preoperative prognostic significance in feline mammary tumors (FMTs). Thus, the present study aimed to determine the prognostic utility of preoperative peripheral blood NLR in malignant FMTs. Accordingly, medical records of 34 cats that had undergone mastectomy were searched, after which those histopathologically confirmed to have malignant FMTs were included. Univariate analysis was used to determine the effect of each variable on one-year survival time. Factors determined to be significant during univariate analysis were subsequently included for multivariate analysis. Receiver operating characteristic analysis was used to assess the accuracy of the tests for predicting one-year survival. Univariate analysis showed that a high NLR and large tumor size were significantly associated with shorter survival times (P < 0.01, for both). No significant differences in other factors were observed. Multivariate analysis showed that a high NLR (hazard ratio, 25.03; 95% confidence interval, 2.98-210.40; P < 0.01), but not tumor size and age, was an independent prognostic factor for poor outcomes. The sensitivity and specificity of the NLR (cut-off, 5.67) for predicting one-year survival were 93.8% and 88.9%, respectively. This study suggests that the NLR could potentially be used as a preoperative prognostic factor in FMTs. Preoperative NLR may help to establish therapeutic modalities by allowing prognostic evaluation among cats with mammary tumors.
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Affiliation(s)
- Eiji Naito
- Yuki Animal Hospital, 2-99, Kiba-cho, Minato-ku, Nagoya, Aichi, Japan
| | - Masashi Yuki
- Yuki Animal Hospital, 2-99, Kiba-cho, Minato-ku, Nagoya, Aichi, Japan.
| | - Takashi Hirano
- Yuki Animal Hospital, 2-99, Kiba-cho, Minato-ku, Nagoya, Aichi, Japan
| | - Daiki Kainuma
- Yuki Animal Hospital, 2-99, Kiba-cho, Minato-ku, Nagoya, Aichi, Japan
| | - Reina Aoyama
- Yuki Animal Hospital, 2-99, Kiba-cho, Minato-ku, Nagoya, Aichi, Japan
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Postoperative Adverse Events are Associated with Oncologic Recurrence Following Curative-intent Resection for Lung Cancer. Lung 2020; 198:973-981. [PMID: 33034720 DOI: 10.1007/s00408-020-00395-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Up to 50% of patients suffer short-term postoperative adverse events (AEs) and metastatic recurrence in the long-term following curative-intent lung cancer resection. The association between AEs, particularly infectious in nature, and disease recurrence is controversial. We sought to evaluate the association of postoperative AEs on risk of developing recurrence and recurrence-free survival (RFS) following curative-intent lung resection surgery. METHODS All lung cancer resections at a single institution (January 2008-July 2015) were included, with prospective collection of AEs using the Thoracic Morbidity & Mortality System. Cox proportional hazards models were used to estimate the effect of AEs on recurrence, with results presented as hazard ratio (HR) with 95% confidence interval (CI). An a priori, clinically driven approach to predictor variable selection was used. Kaplan-Meier curves were used examine the relationship between AE and RFS. p < 0.05 was considered statistically significant. RESULTS 892 patients underwent curative-intent resection. 342 (38.3%) patients experienced an AE; 69 (7.7%) patients developed infectious AEs. 17.6% (n = 157) of patients had disease recurrence after mean follow-up of 26.5 months. Severe (Grade IV) AEs were associated with increased risk of recurrence (3.40; 95% CI 1.56-7.41) and a trend to decreased RFS. Major infectious AEs were associated with increased risk of recurrence (HR 1.71; CI 1.05-2.8) and earlier time to recurrence (no infectious AE 66 months, minor infectious 41 months, major infectious 54 months; p = 0.02). CONCLUSION For patients undergoing curative-intent lung cancer resection, postoperative AEs associated with critical illness or major infection were associated with increased risk of oncologic recurrence.
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Park W, Bang JH, Nam AR, Jin MH, Seo H, Kim JM, Oh KS, Kim TY, Oh DY. Prognostic Value of Serum Soluble Programmed Death-Ligand 1 and Dynamics During Chemotherapy in Advanced Gastric Cancer Patients. Cancer Res Treat 2020; 53:199-206. [PMID: 33070562 PMCID: PMC7812012 DOI: 10.4143/crt.2020.497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/05/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose The soluble form programmed death-ligand 1 (sPDL1) has immunosuppressive properties and is being studied as a candidate biomarker for immuno-oncology drug development. We measured the serum sPDL1 at pre-and post-chemotherapy and evaluated its prognostic implication and dynamics during chemotherapy in advanced gastric cancer (GC). Materials and Methods We prospectively enrolled 68 GC patients who were candidates for palliative standard first-line chemotherapy, and serially collected blood at baseline and after one cycle of chemotherapy, at the best response and after disease progression. sPDL1 was measured using an enzyme-linked immunosorbent assay. Response to chemotherapy, overall survival (OS), progression-free survival (PFS) and other prognostic factors including neutrophil-lymphocyte ratio (NLR) were obtained. The cut-off value of sPDL1 levels for survival analysis was found using C-statistics. Results The median baseline sPDL1 was 0.8 ng/mL (range, 0.06 to 6.06 ng/mL). The median OS and PFS were 14.9 months and 8.0 months, respectively. sPDL1 and NLR showed a weak positive correlation (Spearman’s rho=0.301, p=0.013). Patients with low levels of sPDL1 at diagnosis (< 1.92 ng/mL) showed a better OS and PFS than patients with a high sPDL1. The baseline sPDL1 before treatment was higher in the progressive disease group than in the stable disease and partial response groups. Patients whose sPDL1 increased after the first cycle of chemotherapy showed worse PFS and OS. Following disease progression, sPDL1 increased compared with the baseline. Conclusion sPDL1 at prechemotherapy confers a prognostic value for PFS and OS in GC patients under palliative first-line chemotherapy. Dynamics of sPDL1 during chemotherapy correlates with disease progression.
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Affiliation(s)
- Woochan Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ju-Hee Bang
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ah-Rong Nam
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Mei Hua Jin
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyerim Seo
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Min Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Seok Oh
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Inflammatory Markers in Patients With Welders' Lung Disease. J Occup Environ Med 2020; 62:e523-e526. [PMID: 32890223 DOI: 10.1097/jom.0000000000001963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with welders' lung disease (PWLD) and its relation with pulmonary function parameters. METHODS One hundred sixteen male PWLD and 118 healthy non-exposed individuals were recruited. Pulmonary function tests (PFTs), complete blood count, erythrocyte sedimentation rate (SED), c-reactive protein (CRP), NLR and PLR of both groups were retrospectively analyzed. RESULTS NLR, PLR, WBC, ESR, and CRP were significantly higher in PWLD compared to controls (all P < 0.001). All PFTs, except for FEV1/FVC, significantly decreased in PWLD compared to controls as. NLR correlated positively with ESR (r = 0.241 and P < 0.001). CONCLUSION Our results show that NLR and PLR can be considered as new inflammatory markers in PWLD with their cheap, fast and easily measurable feature with routine blood count analysis.
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Radiotherapy-Induced High Neutrophil-to-Lymphocyte Ratio is a Negative Prognostic Factor in Patients with Breast Cancer. Cancers (Basel) 2020; 12:cancers12071896. [PMID: 32674376 PMCID: PMC7409084 DOI: 10.3390/cancers12071896] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 12/12/2022] Open
Abstract
Radiotherapy (RT) is the standard of care following breast-conserving operation in breast cancer patients. The neutrophil-to-lymphocyte ratio (NLR) reflects the systemic change caused as a result of the radiotherapy. We aimed to evaluate the association between RT and the change in NLR following the receipt of RT, and to investigate the prognostic impact. We retrospectively reviewed NLR values of breast cancer patients taken before the administration of the first and the last session of RT. The cut-off point for the NLR was determined using the Youden index and receiver operating characteristic (ROC) curve within the training set. Recurrence-free survival (RFS), distant metastasis free survival, and overall survival were the main outcomes. Patients with an NLR higher than 3.49 after RT were classified to an RT-induced high NLR group and showed a significantly higher recurrence rate compared to those with low NLR (p < 0.001). In a multivariate Cox proportional hazards model, RT-induced high NLR remained a significant prognostic factor (HR 2.194, 95% CI 1.230–3.912, p = 0.008 for tumor recurrence. We demonstrated that an increase in NLR over the course of RT has a negative impact on survival, putting these patients with RT-susceptible host immunity at a higher risk of tumor recurrence.
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Li H, Wang W, Yang X, Lian J, Zhang S, Cao J, Zhang X, Song X, Jia S, Xue R. The Clinical Prognostic Value of the Neutrophil-to-Lymphocyte Ratio in Brain Metastases from Non-Small Cell Lung Cancer-Harboring EGFR Mutations. Cancer Manag Res 2020; 12:5659-5665. [PMID: 32765069 PMCID: PMC7367746 DOI: 10.2147/cmar.s250688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/26/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Several studies have explored the correlation between the neutrophil-to-lymphocyte ratio (NLR) and the prognosis of patients with lung cancer. However, little is known about the correlation between the pretreatment NLR and the prognosis of patients with brain metastases from non-small cell lung cancer (NSCLC)-harboring mutations in the epidermal growth factor receptor (EGFR) gene. We sought to evaluate the predictive values in brain metastasis from lung adenocarcinoma with EGFR mutations. Methods We retrospectively examined 133 patients with brain metastases (BMs) from lung adenocarcinoma with EGFR mutations. NLR was calculated using N/L, where N and L, respectively, refer to peripheral blood neutrophil (N) and lymphocyte (L) counts. The cut-off value of NLR was assessed by the area under the curve (AUC). The Log rank test and Cox proportional hazard model were used to confirm the impact of NLR and other variables on survival. Results An NLR value equal to or less than 2.99 was associated with prolonged survival in this cohort of patients in both variable and multivariable analysis. Conclusion We concluded that NLR is an independent prognostic factor in BMs from lung adenocarcinoma with EGFR mutations. This could serve as a useful prognostic biomarker and could be incorporated in the clinical prognostic index specific to patients with BMs.
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Affiliation(s)
- Hongwei Li
- Department of Radiotherapy, Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Weili Wang
- Department of Radiotherapy, Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Xiaotang Yang
- Department of Radiotherapy, Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Jianhong Lian
- Department of Chemotherapy, Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Shuangping Zhang
- Department of Surgery, Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Jianzhong Cao
- Department of Radiotherapy, Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Xiaqin Zhang
- Department of Radiotherapy, Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Xin Song
- Department of Radiotherapy, Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Sufang Jia
- Department of Radiotherapy, Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
| | - Ruiqi Xue
- Shanxi Medical University, Shanxi Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China
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Li Y, Zhang Z, Hu Y, Yan X, Song Q, Wang G, Chen R, Jiao S, Wang J. Pretreatment Neutrophil-to-Lymphocyte Ratio (NLR) May Predict the Outcomes of Advanced Non-small-cell Lung Cancer (NSCLC) Patients Treated With Immune Checkpoint Inhibitors (ICIs). Front Oncol 2020; 10:654. [PMID: 32656072 PMCID: PMC7324627 DOI: 10.3389/fonc.2020.00654] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/08/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Recent studies have demonstrated the predictive value of pretreatment neutrophil-to-lymphocyte ratio (NLR) in advanced cancers; however, the role of NLR in patients with advanced non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) remained to be explored. Thus, we aimed to investigate whether pretreatment NLR was associated with the outcomes of advanced NSCLC patients treated with ICIs. Methods: A comprehensive literature research was first conducted in PubMed, the Cochrane Central Library, and Embase for studies that evaluated the association between pretreatment NLR and survival of advanced NSCLC patients with ICIs treatment. We then conducted a retrospective study in Chinese People's Liberation Army (PLA) General Hospital (Beijing, China) to validate these findings. Results: A total of 17 eligible studies with 2,106 patients were included in our meta-analysis, of which, 12 studies reported progression-free survival (PFS), and 13 studies reported overall survival (OS). The pooled results showed that high pretreatment NLR was significantly associated with poorer PFS (HR = 1.44, 95% CI 1.26–1.65; P < 0.001) and OS (HR = 2.86, 95% CI 2.11–3.87; P < 0.001) compared with those with low pretreatment NLR. Subgroup analysis demonstrated that the association between baseline NLR and PFS remained significant except that the cut-off value of NLR was 3 (HR = 1.48, 95% CI 0.93–2.37; P = 0.098) and region of Asia (HR = 1.55, 95% CI 1.00–2.39; P = 0.051). These results were further validated in our retrospective study that patients with pretreatment NLR ≥ 6.0 had shorter PFS (median: 5.0 vs. 9.1 months, HR = 1.39; 95% CI 1.01–1.91; P = 0.02) and OS (median: 10.0 vs. 17.3 months, HR = 1.71; 95% CI 1.18–2.46; P < 0.001) compared with those with NLR < 6.0. The associations between NLR and survival were consistent in subgroup analysis stratified by age, gender, ECOG PS, histology, stage, smoking history, treatment, and prior lines of therapy. Dynamics of NLR (dNLR) that increased ≥3.0 from baseline was also significantly associated with worse PFS (median: 3.1 vs. 9.1 months; P = 0.01) and OS (median: 6.8 vs. 17.0 months; P < 0.0001). Conclusions: Our study demonstrates that pretreatment NLR and dNLR from baseline are associated with the outcomes of advanced NSCLC patients treated with ICIs; however, it warrants further prospective studies.
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Affiliation(s)
- Ye Li
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Oncology Laboratory, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Zhibo Zhang
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China.,The 78th Group Army Hospital of Chinese PLA, Mudanjiang, China
| | - Yi Hu
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiang Yan
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qi Song
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guoqiang Wang
- The Medical Department, 3D Medicines Inc, Shanghai, China
| | - Runzhe Chen
- Departments of Thoracic/Head and Neck Medical Oncology and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Shunchang Jiao
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jinliang Wang
- Department of Oncology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, Deng Y, Wang H, Chen R, Yu Z, Li Y, Shang J, Zeng L, Zhao J, Guan C, Liu Q, Chen H, Gong W, Huang X, Zhang YJ, Liu J, Dong X, Zheng W, Nie S, Li D. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross-sectional study. J Med Virol 2020; 92:2573-2581. [PMID: 32458459 PMCID: PMC7283791 DOI: 10.1002/jmv.26061] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022]
Abstract
This retrospective study was designed to explore whether neutrophil to lymphocyte ratio (NLR) is a prognostic factor in patients with coronavirus disease 2019 (COVID‐19). A cohort of patients with COVID‐19 admitted to the Tongren Hospital of Wuhan University from 11 January 2020 to 3 March 2020 was retrospectively analyzed. Patients with hematologic malignancy were excluded. The NLR was calculated by dividing the neutrophil count by the lymphocyte count. NLR values were measured at the time of admission. The primary outcome was all‐cause in‐hospital mortality. A multivariate logistic analysis was performed. A total of 1004 patients with COVID‐19 were included in this study. The mortality rate was 4.0% (40 cases). The median age of nonsurvivors (68 years) was significantly older than survivors (62 years). Male sex was more predominant in nonsurvival group (27; 67.5%) than in the survival group (466; 48.3%). NLR value of nonsurvival group (median: 49.06; interquartile range [IQR]: 25.71‐69.70) was higher than that of survival group (median: 4.11; IQR: 2.44‐8.12; P < .001). In multivariate logistic regression analysis, after adjusting for confounding factors, NLR more than 11.75 was significantly correlated with all‐cause in‐hospital mortality (odds ratio = 44.351; 95% confidence interval = 4.627‐425.088). These results suggest that the NLR at hospital admission is associated with in‐hospital mortality among patients with COVID‐19. Therefore, the NLR appears to be a significant prognostic biomarker of outcomes in critically ill patients with COVID‐19. However, further investigation is needed to validate this relationship with data collected prospectively. NLR is a significant prognostic biomarker of outcomes in critically ill patients with COVID‐19. COVID‐19 is more likely to infected those elder men with chronic comorbidities. NLR may also help in the early identification of older patients at higher risk of COVID‐19. Close monitoring and timely intervention are needed for elderly patients with COVID‐19.
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Affiliation(s)
- Xisheng Yan
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fen Li
- Department of Neurology, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiao Wang
- Department of Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Yan
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, Hunan, China
| | - Fen Zhu
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shifan Tang
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yingzhong Deng
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hua Wang
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Rui Chen
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhili Yu
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yaping Li
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jingzhou Shang
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lingjun Zeng
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jie Zhao
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chaokun Guan
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qiaomei Liu
- Department of Medical Records Statistics, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Haifeng Chen
- Department of Clinical Medicine, Jianghan University, Wuhan, China
| | - Wei Gong
- Department of Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Huang
- Department of Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Jiao Zhang
- Department of Infectious Disease, National Clinical Research Center for Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
| | - Jianguang Liu
- Department of Neurology, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoyan Dong
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wen Zheng
- Department of Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shaoping Nie
- Department of Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongsheng Li
- Department of Cardiovascular Medicine, Wuhan Third Hospital & Tongren Hospital of Wuhan University, Wuhan, Hubei, China
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Dynamic evaluation of neutrophil-to-lymphocyte ratio as prognostic factor in stage III non-small cell lung cancer treated with chemoradiotherapy. Clin Transl Oncol 2020; 22:2333-2340. [PMID: 32449125 DOI: 10.1007/s12094-020-02396-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Locally advanced non-small cell lung cancer (LA-NSCLC) is frequently treated with chemoradiotherapy (CRT). Despite the efforts, long-term outcomes are poor, and novel therapies have been introduced to improve results. Biomarkers are needed to detect early treatment failure and plan future follow-up and therapies. Our aim is to evaluate the role of dynamics of neutrophil-to-lymphocyte ratio (NLR) in patients with locally advanced NSCLC treated with CRT. METHODS We retrospectively reviewed patients diagnosed with LA-NSCLC receiving definitive CRT at our center from 2010 to 2015. Baseline and post-treatment NLR were collected from our center database. NLR was dichotomized (threshold = 4) and patients were divided into two groups based on the variation from baseline to post-treatment NLR. The prognostic role and association with response were examined with logistic regression and multivariate Cox regression model, respectively. RESULTS Ninety-two patients were included. Our analysis shows that NLR after treatment is associated with response to treatment [OR in the multivariate analysis 4.94 (1.01-24.48); p value = 0.048]. Furthermore, NLR and ECOG are independent prognostic factors for progression-free survival (PFS) and overall survival (OS). Specifically, PFS was 25.79 months for the good prognosis group and 12.09 for the poor prognosis group [HR 2.98 (CI 95% = 1.74-5.10), p < 0.001]; and OS was 42.94 months and 18.86 months, respectively [HR 2.81 (CI 95% = 1.62-4.90), p < 0.001]. CONCLUSION Dynamics of NLR have a prognostic value in stage III NSCLC treated with definitive CRT. Pre- and post-CRT NLR should be evaluated in prospective clinical trials involving consolidation treatment with immunotherapy.
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48
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Zhu X, Li G, Li S, Gong Z, Liu J, Song S. Neutrophil-to-lymphocyte ratio and red blood cell distribution width-to-platelet ratio predict cardiovascular events in hemodialysis patients. Exp Ther Med 2020; 20:1105-1114. [PMID: 32742350 DOI: 10.3892/etm.2020.8756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular diseases are among the primary causes of decreased quality of life as well as mortality of hemodialysis patients with end-stage renal disease. The aim of the present study was to evaluate the predictive value of the red blood cell distribution width (RDW)-to-platelet ratio (RPR) and neutrophil-to-lymphocyte ratio (NLR) regarding the occurrence or development of cardiovascular events in hemodialysis patients, as well as the prognostic value of this metric. A total of 219 hemodialysis patients with cardiovascular events (HCE group) and 276 hemodialysis patients with no cardiovascular events (HNCE group) were enrolled in the present study. The clinical characteristics and laboratory parameters on admission, including RDW, as well as neutrophil, lymphocyte and platelet counts, were recorded. The NLR and RPR were increased in the HCE group compared with those in the HNCE group and there was a positive association between the NLR or RPR and the incidence of cardiovascular events in hemodialysis patients. In the receiver operating characteristics curve analysis, the area under the curve of the RPR for predicting cardiovascular events in hemodialysis patients was 0.88, while that for the NLR was 0.84. The sensitivity and specificity of the RPR for predicting cardiovascular events in hemodialysis patients were 0.87 and 0.82 respectively, and for the NLR, they were 0.75 and 0.79, respectively. The RPR was an independent risk factor for the prognosis regarding cardiovascular events in hemodialysis patients. In addition, the NLR and RPR were correlated with brain natriuretic peptide (BNP), cardiac troponin I (cTnI), creatine kinase isoenzyme-MB (CK-MB), and associated with ST segment changes in HCE patients. In conclusion, it was possible to predict the incidence of cardiovascular events in hemodialysis patients using the NLR and RPR, while the RPR had a better sensitivity and specificity than the NLR. The RPR was an independent risk factor for the prognosis regarding cardiovascular events in hemodialysis patients. These routinely available parameters should be considered as novel diagnostic markers for the occurrence and development of cardiovascular events in hemodialysis patients and their prognosis.
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Affiliation(s)
- Xiangjun Zhu
- Department of Nephrology, The First People's Hospital of Yancheng, Yancheng, Jiangsu 224005, P.R. China
| | - Gongqi Li
- Department of Clinical Laboratory, Linyi Traditional Hospital, Linyi, Shandong 276003, P.R. China
| | - Shujuan Li
- Department of Nephrology, The First People's Hospital of Yancheng, Yancheng, Jiangsu 224005, P.R. China
| | - Zhuang Gong
- Department of Nephrology, The First People's Hospital of Yancheng, Yancheng, Jiangsu 224005, P.R. China
| | - Jun Liu
- Department of Laboratory Medicine, The Fifth People's Hospital of Wuxi Affiliated to Jiangnan University, Wuxi, Jiangsu 214005, P.R. China
| | - Shu Song
- Department of Pathology, The First People's Hospital of Yancheng, Yancheng, Jiangsu 224005, P.R. China
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Wang Y, Hu X, Su MC, Wang YW, Che GW. Postoperative Elevations of Neutrophil-to-lymphocyte and Platelet-to-lymphocyte Ratios Predict Postoperative Pulmonary Complications in Non-small Cell Lung Cancer Patients: A Retrospective Cohort Study. Curr Med Sci 2020; 40:339-347. [PMID: 32337695 DOI: 10.1007/s11596-020-2189-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/06/2019] [Indexed: 02/05/2023]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are found to increase in patients who develop postoperative complications (PCs). The aim of the present study was to explore the association of the perioperative changes of NLR (ΔNLR) and PLR (ΔPLR) with PCs in non-small cell lung cancer (NSCLC). Clinical data of 509 patients, who were diagnosed with NSCLC and underwent thoracoscopic radical resection between January 1, 2014 and July 31, 2016 at the Department of Thoracic Surgery, West China Hospital, were reviewed. Patients were divided into PC and non-PC groups, and clinical characteristics including ΔNLR and ΔPLR were compared between them. The optimal cut-off values of ΔNLR and ΔPLR were determined by receiver operating characteristics (ROC) curves and patients were assigned to high ΔNLR/ΔPLR and low ΔNLR/ΔPLR groups in terms of the cut-off values. Clinicopathologic characteristics and the incidence of different PCs were compared between the dichotomized groups. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for PCs. The results showed that the ΔNLR and ΔPLR in the PC group were signifcantly higher than those in the non-PC group (P<0.001 for both). The optimal cutoff values of ΔNLR and ΔPLR were 6.6 and 49, respectively. Patients with ΔNLR>6.6 or ΔPLR>49 were more likely to experience postoperative pulmonary complications (PPCs) (P<0.001 for both). Multivariate logistic regression analysis demonstrated that smoking [odds ratio (OR): 2.450, 95% confdence interval (95% CI): 1.084-5.535, P=0.031)], tumor size (OR: 1.225, 95% CI: 1.047-1.433, P=0.011), ΔNLR>6.6 (OR: 2.453, 95% CI: 1.224-4.914, P=0.011) and ΔPLR>49 (OR: 2.231, 95% CI: 1.182-4.212, P=0.013) were predictive of PPCs. In conclusion, the ΔNLR and ΔPLR may act as novel predictors for PPCs in NSCLC patients undergoing thoracoscopic radical lung resection, and patients with ΔNLR>6.6 or ΔPLR>49 should be treated more actively to prevent or reduce PPCs.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xu Hu
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Meng-Chan Su
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Yan-Wen Wang
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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50
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Lu Y, Jiang J, Ren C. The clinicopathological and prognostic value of the pretreatment neutrophil-to-lymphocyte ratio in small cell lung cancer: A meta-analysis. PLoS One 2020; 15:e0230979. [PMID: 32241019 PMCID: PMC7117946 DOI: 10.1371/journal.pone.0230979] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/12/2020] [Indexed: 01/09/2023] Open
Abstract
Although many scholars have recently studied the relationships between the pretreatment neutrophil-to-lymphocyte ratio (NLR) and prognosis in patients with small cell lung cancer (SCLC), the conclusions have been inconsistent. Accordingly, in this meta-analysis, we attempted to assess the clinicopathological and prognostic value of the pretreatment NLR in SCLC. Related literature was searched using PubMed, Embase, Cochrane Library, Web of Science, Chinese Biomedical Literature, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Each eligible study was extracted, and a meta-analysis was performed using hazard ratios (HRs) and 95% confidence intervals (95% CIs) to assess the prognostic value of NLR. Evaluation of the clinicopathological significance of NLR in SCLC used odds ratios (ORs) and 95% confidence intervals (95% CIs). We included a total of 20 studies with 21 outcomes (5141 patients) in this meta-analysis. The results showed that high pretreatment NLR was closely related to poorer progression free survival (PFS) and overall survival (OS) (PFS, HR = 1.55, 95% CI = 1.27-1.88, P < 0.0001; I2 = 0%; OS, HR = 1.40, 95% CI = 1.26-1.55, P < 0.00001; I2 = 64%). In addition, pretreatment NLR was significantly associated with clinical stage of SCLC (OR = 2.14, 95% CI = 1.35-3.39, P = 0.001). Our meta-analysis showed that high levels of pretreatment NLR were significantly associated with a more serious clinical stage and poorer PFS and OS in SCLC.
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Affiliation(s)
- Yan Lu
- Clinical Laboratory, DongYang People’s Hospital, Dongyang, Zhejiang, China
- * E-mail:
| | - JinWen Jiang
- Clinical Laboratory, DongYang People’s Hospital, Dongyang, Zhejiang, China
| | - ChaoXiang Ren
- Clinical Laboratory, DongYang People’s Hospital, Dongyang, Zhejiang, China
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