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Li X, Shang H, Tang Q, Guo L, Li Z. Relationship between neutrophil lymphocyte ratio and red blood cell distribution width and respiratory failure in COPD patients. Medicine (Baltimore) 2024; 103:e38512. [PMID: 38875435 PMCID: PMC11175887 DOI: 10.1097/md.0000000000038512] [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: 11/28/2023] [Revised: 03/18/2024] [Accepted: 05/17/2024] [Indexed: 06/16/2024] Open
Abstract
The neutrophil lymphocyte ratio (NLR) and red blood cell distribution width (RDW) have been repeatedly demonstrated to be associated with risk of severity, progression, and prognosis of chronic obstructive pulmonary disease (COPD), but data on respiratory failure (RF) in patients with COPD are very limited. This study aimed to examine the relationship between NLR and RDW and the incident RF in patients with COPD. This is a retrospective study that reviewed data by examining the hospitalization medical records to identify those who were admitted with a diagnosis of COPD. Based on whether RF occurred during index hospitalization, patients were classified as COPD group and COPD combined with RF group. Also, healthy controls of the same age and sex were enrolled in a 1:1 ratio as the COPD group. Univariate comparisons were performed between three groups to examine differences. With the COPD group as reference, multivariable logistic regression was formed to identify the relationship between NLR and RDW and RF, with adjustment for multiple covariates. There were 136 healthy controls, 136 COPD patients and 62 patients with COPD combined with RF included for analysis. There was a significant difference for eight variables, including age, WBC, neutrophil, NLR, RDW, platelet, PLR, and CRP. The Spearman test showed the significant correlation between NLR and WBC (correlation coefficient, 0.38; P = .008), NLR and RDW (correlation coefficient, 0.32; P = .013), and NLR and CRP level (correlation coefficient, 0.54; P < .001). The multivariable logistic regression showed that age (every additional 10 years) (OR, 1.785), NLR (OR, 1.716), RDW (OR, 2.266), and CRP (OR, 1.163) were independently associated with an increased risk of RF. This study demonstrated the independent associative effect of NLR and RDW with RF in patients with COPD, exhibiting the potential clinical role in evaluating the progress of COPD to RF.
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Affiliation(s)
- Xinghong Li
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
| | - Huanxia Shang
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
| | - Qian Tang
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
| | - Lijuan Guo
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
| | - Zhensheng Li
- Department of Respiratory and Critical Care Medicine, Hebei Chest Hospital, Shijiazhuang, China
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Yildiz EO, Işcen K, Kaya F, Güney OA, Ulukent SC. Evaluation of the correlation of neutrophil/lymphocyte ratio with prognostic classification systems in papillary thyroid carcinoma patients. Medicine (Baltimore) 2024; 103:e37210. [PMID: 38306518 PMCID: PMC10843553 DOI: 10.1097/md.0000000000037210] [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: 12/06/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
We aimed to evaluate the use of cost-effective NLR (Neutrophil Lymphocyte Ratio) in determining the prognosis and recurrence risk of thyroid papillary carcinoma patients. This retrospective, cross-sectional and single-center study was carried out in the Department of General Surgery, Istanbul Gaziosmanpaşa Training and Research Hospital. Between 2018 and 2021, who were diagnosed with papillary thyroid cancer and underwent total thyroidectomy, and patients who underwent total thyroidectomy due to multinodular goiter were analyzed. For patients in the malignancy group, the NLR cutoff value was determined as 1.73, the sensitivity was calculated as 51.77% and the specificity as 86.15%. NLR in the malignant group was found to be 9.5 times higher than the NLR in the control group (Odds Ratio: 9.5). A statistically significant difference was found between NLR and papillary thyroid carcinoma prognostic classification systems (AJCC/TNM, AMES, and MACIS). NLR medians differ according to ATA recurrence risk classification (P = .020). According to the results we obtained in our study, we believe that cost-effective NLR can be a useful indicator in terms of predicting malignancy in a patient with thyroid nodule and in determining the prognosis and risk of recurrence in patients with thyroid papillary carcinoma.
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Affiliation(s)
- Eren Ozan Yildiz
- Department of General Surgery, Samandağ State Hospital, Hatay, Turkiye
| | - Kutay Işcen
- Department of General Surgery, Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkiye
| | - Feyza Kaya
- Department of General Surgery, Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkiye
| | - Onur Alptekin Güney
- Department of General Surgery, Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkiye
| | - Suat Can Ulukent
- Department of General Surgery, Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkiye
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Balbaloglu H, Tasdoven I, Buyukuysal MC, Karadeniz E, Comert M, Cakmak GK. Predicting coexisting thyroid cancer with primary hyperparathyroidism in an endemic region of multinodular goiter: evaluating the effectiveness of preoperative inflammatory markers. Ann Surg Treat Res 2023; 105:290-296. [PMID: 38023432 PMCID: PMC10648613 DOI: 10.4174/astr.2023.105.5.290] [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: 06/05/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The aim is to examine the efficacy of inflammatory indicators to predict thyroid cancer in patients with primary hyperparathyroidism (PHPT) in an endemic region of nodular goiter. Methods The prospective database was reviewed to identify patients operated on with the diagnosis of PHPT and thyroid disease between April 2015 and June 2021. Permanent pathologic reports were used as the gold standard for diagnosis. Detailed imaging data with peripheral blood inflammation indices were analyzed to assess their predictive values for concomitant PHPT with thyroid cancer. Postoperative complications and the duration of hospitalization were also reviewed. Results Thyroid malignancy accompanying PHPT was found in 13 patients (26.0%) out of 50 who had concurrent surgery. The analysis regarding inflammatory indexes revealed nothing significant between thyroid cancer and preoperative blood biochemistry (P > 0.05). In the concurrent surgery group, recurrent laryngeal nerve injury was observed in 1 patient (2.0%) and the mean hospital stay was longer. Conclusion In endemic regions of nodular thyroid disease, thyroid cancer might accompany PHPT. The value of inflammatory indexes to predict thyroid malignancy in PHPT is controversial and should not be employed in the surgical decision-making process.
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Affiliation(s)
- Hakan Balbaloglu
- Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Ilhan Tasdoven
- Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | | | - Emre Karadeniz
- Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Mustafa Comert
- Department of General Surgery, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
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Vural S, Muhtaroğlu A, Güngör M. Systemic immune-inflammation index: A new marker in differentiation of different thyroid diseases. Medicine (Baltimore) 2023; 102:e34596. [PMID: 37543770 PMCID: PMC10402992 DOI: 10.1097/md.0000000000034596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
Inflammation plays an important role in the pathogenesis of many cancer types and is associated with thyroid malignancy. The systemic immune-inflammation index (SII) is a new inflammation marker that can be calculated from routine complete blood count (CBC). This study investigated the association between SII, a marker derived from routine CBC, and different thyroid diseases. The objective was to determine if this simple inflammation marker can distinguish between benign and malignant thyroid diseases. The medical records of all patients who underwent surgical treatment for thyroid disease between January 2018 and January 2022 were systematically evaluated. The routine preoperative CBC parameters' demographic, clinical, and laboratory data were recorded. A total of 241 patients were included in the study, and the patients were grouped as having multinodular goiter (n = 125), lymphocytic thyroiditis (n = 44), and papillary thyroid carcinoma (PTC) (n = 73) according to pathological results. The SII was defined as the ratio of the total count of neutrophils × platelets divided by the lymphocyte count. Subgroup analysis of patients was performed according to the presence of follicular variant or thyroiditis, micro or macro carcinoma, or bilaterality of the tumor. The SII level was significantly higher in the PTC group than in the lymphocytic thyroiditis and multinodular goiter groups (P < .001). When we grouped the patients according to the presence of PTC as benign or malignant, the optimum cutoff point for SII level was found 654.13, with 73.8% sensitivity and 72.3% specificity from ROC analysis. In the subgroup analysis of patients with PTC, the SII level was similar according to the clinicopathological characteristics of the tumor. The differential diagnosis of thyroid diseases is important for patient management. We found that preoperative SII levels were significantly elevated in patients with PTC compared to those with benign thyroid disorders, and this simple marker can be used for the differentiation of benign and malignant thyroid disease.
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Affiliation(s)
- Selahattin Vural
- Department of General Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Ali Muhtaroğlu
- Department of General Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Mert Güngör
- Department of General Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey
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Modica R, Minotta R, Liccardi A, Cannavale G, Benevento E, Colao A. Evaluation of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR) and Systemic Immune-Inflammation Index (SII) as Potential Biomarkers in Patients with Sporadic Medullary Thyroid Cancer (MTC). J Pers Med 2023; 13:953. [PMID: 37373942 DOI: 10.3390/jpm13060953] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Medullary thyroid cancer (MTC) is a rare neuroendocrine neoplasm, and calcitonin is its main biomarker. An elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) have been considered as negative prognostic factors in several neoplasms. The aim of this study is to evaluate the potential role of NLR, PLR and SII as biomarkers in MTC. Clinical data and tumor histological characteristics of patients with sporadic MTC, referred to the NET Unit of Federico II University of Naples (ENETS CoE) from 2012 to 2022, were retrospectively evaluated by analyzing preoperative and postoperative calcitonin, NLR, PLR and SII. We included 35 MTC patients undergoing total thyroidectomy. The mean preoperative NLR was 2.70 (±1.41, 0.93-7.98), the PLR was 121.05 (±41.9, 40.98-227.23) and SII was 597.92 (±345.58, 186.59-1628). We identified a statistically significant difference between pre- and post-thyroidectomy NLR (p = 0.02), SII (p = 0.02) and calcitonin (p = 0.0) values. No association with prognosis or tumor characteristics emerged. Elevated preoperative NLR and SII suggest a possible disease-associated inflammatory response, and their reduction after surgery may be related to debulking effects. Further studies are needed to define the role of NLR, PLR and SII as prognostic markers in MTC.
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Affiliation(s)
- Roberta Modica
- Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Federico II University of Naples, 80131 Naples, Italy
| | - Roberto Minotta
- Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Federico II University of Naples, 80131 Naples, Italy
| | - Alessia Liccardi
- Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Federico II University of Naples, 80131 Naples, Italy
| | - Giuseppe Cannavale
- Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Federico II University of Naples, 80131 Naples, Italy
| | - Elio Benevento
- Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Federico II University of Naples, 80131 Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Endocrinology, Diabetology and Andrology Unit, Federico II University of Naples, 80131 Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, Federico II University of Naples, 80138 Naples, Italy
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Figueiredo AA, Esteves S, Moura MM, Marques P, Simões-Pereira J, Leite V. Preoperative serum inflammation-based scores in medullary thyroid cancer. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2023; 70:48-55. [PMID: 36764748 DOI: 10.1016/j.endien.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/15/2022] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) are prognostic factors in several tumours, though little is known in medullary thyroid cancer (MTC). OBJECTIVE To evaluate the association between preoperative NLR, PLR and SII with MTC clinicopathological and molecular features, and their predictive value for lymph node and distant metastasis. METHODS We retrospectively analysed 75 patients with MTC who underwent surgery at our institution. The familial form of MTC was found in 12% of patients. RESULTS In our cohort, 56% were females, the median age at diagnosis was 57 years (44-69), the median tumour diameter was 25mm (15-50); 21.3% were multifocal and 34.7% had extrathyroidal extension. Lymph node and distant metastasis were observed in 36 (48.0%) and 8 (10.7%) patients, respectively. Higher NLR was associated with preoperative calcitonin, angioinvasion, extrathyroidal extension, moderate/severe fibrosis; higher PLR was associated with extrathyroidal extension and advanced T stages; lower SII and NLR were associated with biochemical cure after surgery. Increased PLR, NLR and SII were associated with advanced MTC stages. In the univariate analysis, only NLR was associated with lymph node metastasis (odds ratio (OR)=2.69, 95% confidence interval (CI): 1.50-5.84; p=0.004); however, in the multivariate model, NLR was no longer a predictive factor for lymph node metastasis. None of these serum inflammatory markers predicted the occurrence of distant metastasis. CONCLUSION In conclusion, NLR, PLR and SII are associated with aggressive MTC, but do not predict lymph node or distant metastasis.
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Affiliation(s)
- Ana Abrantes Figueiredo
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal.
| | - Susana Esteves
- Unidade de Investigação Clínica, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
| | - Margarida Maria Moura
- Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal
| | - Pedro Marques
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Endocrinology Department, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisbon, Portugal
| | - Joana Simões-Pereira
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal; Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal; Nova Medical School
- Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Campo Mártires da Pátria, n° 130, 1169-056 Lisboa, Portugal
| | - Valeriano Leite
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal; Unidade de Investigação em Patobiologia Molecular, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, 1099-023 Lisboa, Portugal; Nova Medical School
- Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Campo Mártires da Pátria, n° 130, 1169-056 Lisboa, Portugal
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Figueiredo AA, Esteves S, Moura MM, Marques P, Simões-Pereira J, Leite V. Preoperative serum inflammation-based scores in medullary thyroid cancer. ENDOCRINOL DIAB NUTR 2023. [DOI: 10.1016/j.endinu.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Durgut O, Gökgün ÖF, Gencay S. Evaluation of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Mean Platelet Volume in Patients with Branchial Cleft Cyst. Indian J Otolaryngol Head Neck Surg 2022; 74:5465-5468. [PMID: 36742740 PMCID: PMC9895673 DOI: 10.1007/s12070-021-02789-1] [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: 05/12/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023] Open
Abstract
Branchial cleft cysts are benign masses of the head and neck. Etiopathogenesis is unclear and many factors such as inflammatory mechanisms can play a role. The aim of our study is to investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV), which are hematologic inflammatory markers, in branchial cleft cyst (BCC). The records of 27 patients who were operated with the diagnosis of BCC in the ENT clinic between January 2011 and March 2020 and 27 healty subjects were retrospectively reviewed. The control group consisted age and sex-matched subjects scheduled for rhinoplasty. Neutrophil, lymphocyte, platelet and MPV values were recorded from the complete blood count samples for all participants. The statistical relationship for NLR, PLR and MPV values between the patient and the control groups was investigated. The NLR values of the patients were significantly lower than the healthy controls (p:0.007). But no statistically significant correlation was found for PLR (p:0.586) and MPV(p:0.676) values between the groups. This is the first study to evaluate the significance of NLR, PLR and MPV in branchial cleft cyst. Decreased NLR may be used as a predictive marker for BCC. But PLR ande MPV should not be used to predict branchial cleft cyst. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02789-1.
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Affiliation(s)
- Osman Durgut
- Department of Otorhinolaryngology, Bursa Yuksek Ihtisas Training and Research Hospital, Health Science University, Mimarsinan Mahallesi, Emniyet Cd. No:35, 16310 Yıldırım, Bursa Turkey
| | - Ömer Faruk Gökgün
- Department of Otorhinolaryngology, Bursa Yuksek Ihtisas Training and Research Hospital, Health Science University, Mimarsinan Mahallesi, Emniyet Cd. No:35, 16310 Yıldırım, Bursa Turkey
| | - Sündüz Gencay
- Department of Otorhinolaryngology, Bursa Yuksek Ihtisas Training and Research Hospital, Health Science University, Mimarsinan Mahallesi, Emniyet Cd. No:35, 16310 Yıldırım, Bursa Turkey
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Liu Y, He M, Wang C, Zhang X, Cai S. Prognostic value of neutrophil-to-lymphocyte ratio for patients with triple-negative breast cancer: A meta-analysis. Medicine (Baltimore) 2022; 101:e29887. [PMID: 35839045 PMCID: PMC11132410 DOI: 10.1097/md.0000000000029887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/08/2022] [Indexed: 12/24/2022] Open
Abstract
We aimed to evaluate the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) in patients with triple-negative breast cancer (TNBC). We searched the PubMed Database, Cochrane Library, Web of science, and Embase. Overall survival (OS), disease-free survival (DFS), and hazard ratio (HR) were the endpoints of the study. Eleven studies involving 2355 patients with TNBC were included in this meta-analysis. Among them, 10 studies involving 2069 patients with TNBC investigated the role of NLR in predicting OS; elevated NLR was associated with poor prognosis (hazard ratio [HR]: 2.48, 95% confidence interval [CI]: 2.03-3.03, P < 0.001). Ten studies involving 2054 patients with TNBC explored the role of NLR in predicting DFS; elevated NLR was associated with a significantly worse prognosis with a pooled HR of 2.20 (95% CI: 1.88-2.58, P < 001). This meta-analysis suggests that patients with TNBC who have a higher NLR have poorer prognoses. As a clinical parameter that we can easily obtain, NLR might be a potential predictor of patients' survival, and may be useful for physicians' treatment decisions.
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Affiliation(s)
- Yi Liu
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Meilin He
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Shaoxin Cai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
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Deng Y, Zhang J, Zou G, Li S, Gong Z, Yue G, Fan P, Xu J. Peripheral Blood Inflammatory Markers Can Predict Benign and Malignant Thyroid Nodules. Int J Endocrinol 2022; 2022:2319660. [PMID: 35795844 PMCID: PMC9251144 DOI: 10.1155/2022/2319660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/27/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Inflammation is related to the occurrence and development of various cancers. This study was designed to explore the role of peripheral blood platelet count, neutrophil-lymphocyte ratio (NLR), platelet count-lymphocyte count ratio (PLR), systemic inflammation index (SII), and other inflammatory markers in predicting benign and malignant Thyroid Imaging Reporting and Data System (TI-RADS) grade 3 thyroid nodules. METHODS In this retrospective study, 514 patients with TI-RADS grade 3 thyroid nodules were enrolled. According to the pathological results, the patients were divided into the benign and malignant nodule groups. We compared the clinical characteristics between the two groups and analysed the influencing factors for malignant thyroid nodules by univariate and stepwise multivariate logistic regression analyses and then analysed the cutoff value of each influencing factor according to the receiver operating characteristic curve. RESULTS The leukocyte count, neutrophil count, platelet count, NLR, PLR, and SII of the malignant nodule group were significantly higher than those of the benign nodule group (P < 0.05), the age and the diameter of nodule of the malignant nodule group were significantly smaller than those of the benign nodule group (P < 0.05). After excluding the influence of confounding factors, SII (odds ratio (OR) = 1.006; 95% confidence interval (CI) = 1.003-1.008; P < 0.001), PLR (odds ratio (OR) = 0.981; 95% confidence interval (CI) = 0.981-0.992; P < 0.05), leukocyte count (odds ratio (OR) = 0.654; 95% confidence interval (CI) = 0.466-0.892; P < 0.05), and age (OR = 0.969; 95% CI = 0.954-0.985; P < 0.001) were independent risk factors for malignant thyroid nodules, and the cutoff value of SII and PLR in predicting benign and malignant thyroid nodules were 545.63 × 109/L and 138.63. CONCLUSION This study showed that peripheral blood SII, PLR, leukocyte count and age were independent risk factors for malignant thyroid nodules, and the combination of these can better predict benign and malignant thyroid nodules, which can further guide the diagnosis and treatment of TI-RADS grade 3 thyroid nodules.
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Affiliation(s)
- Yuanyuan Deng
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang 330006, China
| | - Jie Zhang
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang 330006, China
| | - Guilin Zou
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang 330006, China
| | - Shanshan Li
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang 330006, China
| | - Zhaoxia Gong
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang 330006, China
| | - Guanru Yue
- Department of Basic Medicine, Jiangxi Medical College, Nanchang University, Nanchang 330006, China
| | - Ping Fan
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang 330006, China
| | - Jixiong Xu
- Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang 330006, China
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Platelet Activation and Inflammation in Patients with Papillary Thyroid Cancer. Diagnostics (Basel) 2021; 11:diagnostics11111959. [PMID: 34829306 PMCID: PMC8624142 DOI: 10.3390/diagnostics11111959] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 01/04/2023] Open
Abstract
Background: The primary endpoint was to analyze the preoperatory inflammatory markers and platelet indices in papillary thyroid cancer (PTC) patients compared with patients with benign thyroid pathology. The secondary endpoints were to analyze the relationship between these markers and the pathological features of PTC and to compare their pre- and postoperative levels in PTC patients. Methods: In this retrospective case-control study, we analyzed the files of 1183 patients submitted to thyroidectomy between January 2012 and December 2018. A total of 234 patients with PTC (mean age 51.54 ± 13.10 years, 84.6% females) were compared with an age-, gender- and BMI-matched control group of 108 patients with histologic benign thyroid disorders. Results: PTC patients had higher platelet count (PLT) (p = 0.011), plateletcrit (PCT) (p = 0.006), neutrophil (p = 0.022) and fibrinogen (p = 0.005) levels. Subgroup analysis showed that PTC females had higher PLT (p = 0.006), PCT (p < 0.001) and erythrocyte sedimentation rate (ESR) (p = 0.005), while males had higher neutrophil (p = 0.040) levels. Papillary thyroid cancer patients under 55 years had higher PLT (p < 0.001) and PCT (p = 0.010), while patients over 55 years had higher mean platelet volume (p = 0.032), neutrophil-to-lymphocyte ratio (p = 0.013), ESR (p = 0.005) and fibrinogen (p = 0.019) levels. Preoperative values for platelet indices and inflammatory markers were similar to the postoperative determinations in PTC patients. Fibrinogen (AUROC = 0.602, p = 0.02; cut-off = 327.5 mg/dL, Se = 53.8%, Sp = 62.9%) and PLT (AUROC = 0.584, p = 0.012; cut-off = 223.5 × 103/mm3, Se = 73.1%, Sp = 42.6%) were independent predictors of the presence of PTC. Conclusions: Our data show that fibrinogen and platelet count could be promising, inexpensive, independent predictors for the presence of PTC when compared with benign thyroid disorders.
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Marques P, de Vries F, Dekkers OM, Korbonits M, Biermasz NR, Pereira AM. Serum Inflammation-based Scores in Endocrine Tumors. J Clin Endocrinol Metab 2021; 106:e3796-e3819. [PMID: 33837783 PMCID: PMC8475227 DOI: 10.1210/clinem/dgab238] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 12/13/2022]
Abstract
CONTEXT Serum inflammation-based scores reflect systemic inflammatory response and/or patients' nutritional status, and may predict clinical outcomes in cancer. While these are well-described and increasingly used in different cancers, their clinical usefulness in the management of patients with endocrine tumors is less known. EVIDENCE ACQUISITION A comprehensive PubMed search was performed using the terms "endocrine tumor," "inflammation," "serum inflammation-based score," "inflammatory-based score," "inflammatory response-related scoring," "systemic inflammatory response markers," "neutrophil-to-lymphocyte ratio," "neutrophil-to-platelet ratio," "lymphocyte-to-monocyte ratio," "Glasgow prognostic score," "neutrophil-platelet score," "Systemic Immune-Inflammation Index," and "Prognostic Nutrition Index" in clinical studies. EVIDENCE SYNTHESIS The neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio are the ones most extensively investigated in patients with endocrine tumors. Other scores have also been considered in some studies. Several studies focused in finding whether serum inflammatory biomarkers may stratify the endocrine tumor patients' risk and detect those at risk for developing more aggressive and/or refractory disease, particularly after endocrine surgery. CONCLUSIONS In this review, we summarize the current knowledge on the different serum inflammation-based scores and their usefulness in predicting the phenotype, clinical aggressiveness, and disease outcomes and prognosis in patients with endocrine tumors. The value of such serum inflammation-based scores in the management of patients with endocrine tumors has been emerging over the last decade. However, further research is necessary to establish useful markers and their cut-offs for routine clinical practice for individual diseases.
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Affiliation(s)
- Pedro Marques
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
- Correspondence: Pedro Marques, Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center. Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail:
| | - Friso de Vries
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
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Ito Y, Onoda N, Kihara M, Miya A, Miyauchi A. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Differentiated Thyroid Carcinoma Having Distant Metastasis: A Comparison With Thyroglobulin-doubling Rate and Tumor Volume-doubling Rate. In Vivo 2021; 35:1125-1132. [PMID: 33622910 DOI: 10.21873/invivo.12358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND/AIM To date, thyroglobulin-doubling rate (Tg-DR) and tumor volume-doubling rate (TV-DR) of metastatic lesions have been identified as dynamic prognostic factors for differentiated thyroid carcinoma (DTC). In this study, we investigated the prognostic impact for another dynamic factor, the neutrophil-to-lymphocyte ratio (NLR), for DTC with distant metastasis. PATIENTS AND METHODS We enrolled 321 patients in total, and NLR at the first detection of distant metastasis (initial NLR) was collected for 312. RESULTS Patients with initial NLR >3 had a significantly poorer cause-specific survival than those with initial NLR ≤3. On multivariate analysis, initial NLR >3 was recognized as an independent prognostic factor together with Tg-DR >1/year, TV-DR >1/year, radioactive iodine-refractory distant metastasis, and distant metastasis to organs other than the lung. CONCLUSION Careful observation and active therapies, including multitarget kinase inhibitors, are recommended for patients with NLR >3 at the first detection of distant metastasis or during follow-up.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | | | | | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Kobe, Japan
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ÖZDEMİR Ö, ÇINAR H, AKALIN Ç, AKÇAY ÇELİK M. Evaluation of Serum Neutrophil to Lymphocyte Ratio in The Results of Thyroid Fine Needle Aspiration: Can It Discriminate A Clinical Benefit for the Atypia of Undetermined Significance? TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.898205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ataş H, Korukluoğlu Bİ, Çomçali B, Yakşi N, Saylam B, Tez M. Can preoperative modified systemic inflammation score (mSIS) be used to predict malignancy in persistent nondiagnostic thyroid nodules? Turk J Med Sci 2021; 51:700-705. [PMID: 33550761 PMCID: PMC8203171 DOI: 10.3906/sag-2011-177] [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: 11/15/2020] [Accepted: 02/06/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Despite the use of ultrasound guidance, a significant part of thyroid biopsies are nondiagnostic (ND). We aimed to investigate the utility of the preoperative modified systemic inflammation score (mSIS) to predict malignancies in patients with persistent ND thyroid nodules (TNs). Materials and methods Records of 924 patients underwent thyroidectomy between September 2016 and May 2019 were retrospectively reviewed. The calculation of mSIS was as follows: mSIS 0 [patients with albumin (ALB) ≥ 4.0 g/dL and lymphocyte to monocyte ratio (LMR) ≥ 3.4], mSIS 1 [ALB < 4.0 g/dL or LMR < 3.4], and mSIS 2 [ALB < 4.0 g/dL and LMR < 3.4]. Results One hundred and thirty-six patients were included in the study. Of the patients with a median age of 49 (21–81) years, 26 (19.1%) were male, and 110 (80.9%) were female. Besides low lymphocyte count (P = 0.03), and ALB levels (P < 0.01), higher BMI (P = 0.02) were also associated with malignancy. In patients classified as mSIS 2, 1 and 0; malignancy rates were 100%, 25.8%, and 16.1%, respectively. The association between preoperative mSIS and thyroid malignancies was statistically significant (P < 0.01). Conclusion We recommend that when patients with persistent ND TNs are assigned to mSIS 2 or 1, surgery should not be delayed due to the risk of malignancy.
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Affiliation(s)
- Hakan Ataş
- Department of Endocrine Surgery, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Bİrol Korukluoğlu
- Department of Endocrine Surgery, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Bülent Çomçali
- Department of Endocrine Surgery, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Neşe Yakşi
- Niğde Community Health Center, Niğde, Turkey
| | - Barış Saylam
- Department of Endocrine Surgery, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Mesut Tez
- Department of General Surgery, Ministry of Health Ankara City Hospital, Ankara, Turkey
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BÖLÜKBAŞI H, YILMAZ S. Nötrofil lenfosit oranı: Papiller tiroit kanserini multinodüler guatrdan gerçekten ayırt eder mi? EGE TIP DERGISI 2021. [DOI: 10.19161/etd.888863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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He C, Lu Y, Wang B, He J, Liu H, Zhang X. Development and Validation of a Nomogram for Preoperative Prediction of Central Compartment Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma and Type 2 Diabetes Mellitus. Cancer Manag Res 2021; 13:2499-2513. [PMID: 33762845 PMCID: PMC7982555 DOI: 10.2147/cmar.s300264] [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: 01/13/2021] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To develop and validate a nomogram to predict central compartment lymph node metastasis in PTC patients with Type 2 Diabetes. Patients and Methods The total number of enrolled patients was 456. The optimal cut-off values of continuous variables were obtained by ROC curve analysis. Significant risk factors in univariate analysis were further identified to be independent variables in multivariable logistic regression analysis, which were then incorporated and presented in a nomogram. The ROC curve analysis was performed to evaluate the discrimination of the nomogram, calibration curves and Hosmer-Lemeshow test were used to visualize and quantify the consistency. Decision curve analysis (DCA) was performed to evaluate the net clinical benefit patients could get by applying this nomogram. Results ROC curve analysis showed the optimal cutoff values of NLR, PLR, and tumor size were 2.9204, 154.7003, and 0.95 (cm), respectively. Multivariate logistic regression analysis indicated that age, multifocality, largest tumor size, and neutrophil-to-lymphocyte ratio were independent prognostic factors of CLNM. The C-index of this nomogram in the training data set was 0.728, and 0.618 in the external validation data set. When we defined the predicted possibility (>0.5273) as high-risk of CLNM, we could get a sensitivity of 0.535, a specificity of 0.797, a PPV(%) of 67.7, and an NPV(%) of 68.7. Great consistencies were represented in the calibration curves. DCA showed that applying this nomogram will help patients get more clinical net benefit than having all of the patients or none of the patients treated with central compartment lymph node dissection (CLND). Conclusion A high level of preoperative NLR was an independent predictor for CLNM in PTC patients with T2DM. And the verified optimal cutoff value of NLR in this study was 2.9204. Applying this nomogram will help stratify high-risk CLNM patients, consequently enabling these patients to be treated with appropriate measures. What is more, we hope to find more sensitive indicators in the near future to further improve the sensitivity and specificity of our nomogram.
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Affiliation(s)
- Chao He
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yiqiao Lu
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Binqi Wang
- The Second Clinical Medicine Faculty, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China
| | - Jie He
- Operating Room, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Haiguang Liu
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiaohua Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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Inflammation-Related Markers and Thyroid Function Measures in Pediatric Patients: Is the Grade of Obesity Relevant? Diagnostics (Basel) 2021; 11:diagnostics11030485. [PMID: 33803348 PMCID: PMC7999014 DOI: 10.3390/diagnostics11030485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 01/28/2023] Open
Abstract
We aimed to investigate the effect of weight status on inflammation-related markers and thyroid function tests in overweight and obese pediatric patients. Children and adolescents diagnosed between January 2017 and January 2019 with overweight or obesity were included in the study. Neutrophil-to-lymphocyte ratio (NLR), platelet-to lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) were calculated for the groups defined according to Body Mass Index (BMI)-for-age z-score: overweight (≥1 BMI-for-age z-score), obese (≥2 BMI-for-age z-score) and severely obese (≥3 BMI-for-age z-score). Severely obese patients had significantly higher value of white blood cells (WBC) counts (median = 7.92) compared with overweight patients (7.37, p = 0.014). Absolute lymphocyte count was significantly associated with obesity degree in children (Spearman’s Rho coefficient ρ = 0.228. p = 0.035), whereas absolute polymorphonuclear neutrophils (PMNCs) count was significantly higher in severely obese adolescents than overweight adolescents (overweight: 4.04 vs. severely obese: 5.3 (p = 0.029)). In 8.19% of patients an elevated thyroid-stimulating hormone (TSH) level was found, and 3.36% of patients had a low level of free thyroxine with an elevated level of TSH. Total absolute WBC count may be a reliable inflammation-related marker in obese pediatric patients without metabolic syndrome, but needs to be validated in the context of all possible covariates. Subclinical and overt hypothyroidism may develop from an early age in overweight or obese patients.
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Bozan MB, Yazar FM, Kale İT, Yüzbaşıoğlu MF, Boran ÖF, Azak Bozan A. Delta Neutrophil Index and Neutrophil-to-Lymphocyte Ratio in the Differentiation of Thyroid Malignancy and Nodular Goiter. World J Surg 2020; 45:507-514. [PMID: 33067685 DOI: 10.1007/s00268-020-05822-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND It was aimed to evaluate the relationship between delta neutrophil index (DNI) and neutrophil-to-lymphocyte ratio (NLR) in the preoperative differentiation of nodular goiter and thyroid malignancy. METHODS Patients over the age of 18 who underwent thyroid surgery between November 2014 and November 2019 were evaluated in this retrospective cohort study. Patients were divided into two groups according to their pathology results: malignant (Group M) and benign (Group B) thyroid disorders. White blood cell (WBC) count, neutrophil count, lymphocyte count, IG count and DNI were measured using an automated hematological analyzer from blood samples obtained at the preoperative period and postoperative 6th month of the follow-up. Neutrophil-to-lymphocyte ratio (NLR) values were manually calculated. Numerical data are expressed as means ± standard deviations (minimum-maximum values) or medians (minimum-maximum values) according to the normal distribution. Categorical values are expressed as percentages (%). RESULTS A total of 243 patients (190 patients in Group B and 53 patients in Group M) who met the inclusion criteria were evaluated. The male/female ratio was 49/194. A statistically significant difference between Group M and Group B in terms of preoperative NLR, DNI and IG count was observed (p = 0.001, < 0.001 and < 0.001, respectively). No statistically significant difference was observed between the groups in terms of the control values performed in the postoperative period in terms of the NLR, DNI and IG count (p = 0.711, 0.333 and 0.714, respectively). A significant decrease was observed in the preoperative and postoperative DNIs, IG counts and NLRs in Group M (p = 0.009, < 0.001 and < 0.001, respectively). For the diagnosis of malignant thyroid diseases, the cut-off value of DNIs was ≥0.35%, and DNI sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 79.2%, 78.9%, 79.2% and 77.9%, respectively (area under the curve [AUC]: 0.847; confidence interval [CI]: 0.784-0.911). The cut-off value of the IG count was ≥25/mm3, and its sensitivity, specificity, PPV and NPV were 83%, 72.1%, 83%, and 72.1%, respectively (AUC: 0.847; CI: 0.784-0.911). CONCLUSION DNI and IG counts are cheap and easily accessible tests that can be automatically calculated from automated systems without additional cost in differentiation of thyroid malignancies from benign disorders in the preoperative period.
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Affiliation(s)
- Mehmet Buğra Bozan
- Faculty of Medicine, Department of Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
| | - Fatih Mehmet Yazar
- Faculty of Medicine, Department of Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - İlhami Taner Kale
- Faculty of Medicine, Department of Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Mehmet Fatih Yüzbaşıoğlu
- Faculty of Medicine, Department of Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Ömer Faruk Boran
- Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - Ayşe Azak Bozan
- Department of Anesthesiology and Reanimation, Necip Fazıl State Hospital, Kahramanmaraş, Turkey
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ÇADIRCI K, YILDIZ F, KESKIN H, BAYRAK M, KİZİLTUNC OZMEN H, ARIKAN DURMAZ Ş, ÇARLIOĞLU A. Investigation of the neutrophil/lymphocyte and monocyte to high-density lipoprotein cholesterol ratios in differentiated thyroid cancers. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.689142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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21
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Can neutrophil/lymphocyte ratio be used as an indicator of inflammation in patients with hyperthyroidism? J Med Biochem 2020; 39:7-12. [PMID: 32549771 DOI: 10.2478/jomb-2019-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/23/2019] [Indexed: 01/02/2023] Open
Abstract
Background In our study, we aimed to evaluate changes in the neutrophil and lymphocyte series and investigate whether the neutrophil/lymphocyte ratio (NLR) is indicative of inflammations in patients with hyperthyroidism. Methods A total of 161 patients were enrolled, 121 of which had hyperthyroidism (71 Graves' Disease (GD) and 50 non-Graves hyperthyroidism (NGH) patients) and 40 of which were control group members. Retrospectively, patients' neutrophil and lymphocyte counts were taken, and the NLR was calculated. Results While the number of neutrophils was significantly lower in the GD group (p = 0.003), there was no significant difference between the NGH and the control group. In the GD group, NLR values were significantly lower than the other two groups (median 1.39 for GD, median 1.84 for NGH and median 1.83 for the control group, p < 0.001). Only three patients in the GD group had neutropenia. There was also a significant negative correlation between free T3 and neutrophil count and NLR in hyperthyroid patients (r = -0.28, p = 0.001 and r = -0.34, p < 0.001, respectively). Conclusions In our study, we found that NLR did not in crease in hyperthyroid patients and that this ratio decreased due to the decrease in neutrophil levels in GD. We thus concluded that NLR is not a suitable indicator of hyperthyroidism.
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Cengiz H, Varim C, Demirci T, Cetin S. Hemogram parameters in the patients with subacute thyroiditis. Pak J Med Sci 2019; 36:240-245. [PMID: 32063967 PMCID: PMC6994909 DOI: 10.12669/pjms.36.2.1063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background &Objective Subacute Granulomatous Thyroiditis (De Quervain's Thyroiditis) is an acute painful inflammatory disease of the thyroid. We aimed to investigate easily accessible and cheap hemogram based parameters of Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Mean Platelet Volume (MPV) in the follow up of inflammatory thyroid disease. Methods Patients admitted to Sakarya University Education and Research Hospital Endocrinology and Metabolism Outpatient Clinic and diagnosed as Subacute Granulomatous Thyroiditis between May 2017 and November 2018 were included in the study. Hemogram, thyroid function tests and acute phase values of these patients were recorded and compared with the values after treatment and disease recovery. On the sixth month, thyroid function tests were repeated and the rate of permanent hypothyroidism was screened. The relationships between initial hemogram parameters and acute phase reactants were evaluated. Results Total 71 patients were included in our study. 60 (84.5%) were female and 11 (15.5%) were male. The F/M ratio was found to be 6/1. Mean age was 43 ± 9.95 years. Receiver Operating Characteristics (ROC) Curve Analysis was performed and values for Area Under the Curve (AUC) for NLR and PLR, respectively, were 0.739 (95% CI 0.657-0.820 p<0.0001) and 0.772 (95% CI 0.694-0.850 p<0.0001), which are significant and associated with disease activity. However, the AUC for MPV parameter was: 0.578 (95% CI 0.484-0.672 P: 0.10) and was not significant. The cut off values defined as 2.4 (80% sensitivity and 51% specificity) for NLR and 146.84 (83% sensitivity and 54% specificity) for PLR for the acute phase of the disease. In the Correlation Analysis, NLR and PLR values were significantly correlated with ESR and CRP parameters, which are the most commonly used acute phase reactants. Conclusion According to the present study, we believe that the NLR and PLR parameters will be of benefit in the follow-up the disease, accurately demonstrate the inflammatory load in the acute phase of the disease, and correlate with the common acute phase reactants.
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Affiliation(s)
- Hasret Cengiz
- Hasret Cengiz, Medical Doctor, Department of Endocrinology, Sakarya University Medicine Faculty, Sakarya, Turkey
| | - Ceyhun Varim
- Ceyhun Varim, Associate Professor, Department of Internal Medicine, Sakarya University Medicine Faculty, Sakarya, Turkey
| | - Taner Demirci
- Taner Demirci, Medical Doctor, Department of Endocrinology, Sakarya University Medicine Faculty, Sakarya, Turkey
| | - Sedat Cetin
- Sedat Cetin, Medical Doctor, Department of Endocrinology, Sakarya University Medicine Faculty, Sakarya, Turkey
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Eroglu HA, Karayol SS, Guvendi B, Adali Y. İnsidental tiroid papiller karsinomda enflamatuar hücre oranlarının prediktif değeri. FAMILY PRACTICE AND PALLIATIVE CARE 2019. [DOI: 10.22391/fppc.518251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Yokota M, Katoh H, Nishimiya H, Kikuchi M, Kosaka Y, Sengoku N, Watanabe M, Yamashita K. Lymphocyte-Monocyte Ratio Significantly Predicts Recurrence in Papillary Thyroid Cancer. J Surg Res 2019; 246:535-543. [PMID: 31711613 DOI: 10.1016/j.jss.2019.09.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/23/2019] [Accepted: 09/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND A growing body of evidences shows that systemic inflammatory responses are involved in patient prognosis in multiple cancers. Combinations of peripheral leukocyte fractions have been shown to be useful markers for the inflammatory responses. However, significance of such systemic inflammatory responses is still unknown in thyroid cancer. Accordingly, we aimed to clarify clinical impact of peripheral leukocyte fractions in papillary thyroid cancer (PTC). METHODS Clinicopathological analyses were performed including preoperative leukocyte fractions in 570 patients with curatively resected PTC. Receiver operating characteristic curves were used to determine cutoffs of leukocyte fraction or inflammation indexes such as lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio. A Kaplan-Meier analysis and a Cox's proportional hazard model were used to conduct prognostic analysis. A multivariable logistic regression analysis was performed for correlation assay. RESULTS Preoperative low LMR predicted recurrence with high sensitivity (63.3%) and specificity (68.7%) (P = 0.002). The multivariable prognostic analyses revealed that preoperative low LMR (P = 0.025), pathological N1b (P = 0.019), high metastatic lymph node ratio (node density) (P = 0.014), and high thyroglobulin level (P = 0.002) independently predicted worse prognosis. The combination of these independent parameters clearly enriched high-risk patients (P < 0.001). Of note, low LMR was dramatically associated with recurrence especially in patients with advanced PTC. CONCLUSIONS Preoperative low LMR dramatically predicts high-risk patients for recurrences. The results in this study give rational to focusing on immune cell profiles to tackle advanced PTC.
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Affiliation(s)
- Mitsuo Yokota
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan; Department of Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Hiroshi Katoh
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan.
| | - Hiroshi Nishimiya
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Mariko Kikuchi
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Yoshimasa Kosaka
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Norihiko Sengoku
- Department of Breast and Endocrine Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Keishi Yamashita
- Department of Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan; Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
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Evaluation of preoperative neutrophil-lymphocyte ratio in differentiated thyroid carcinoma with lymph node metastasis. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.516942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Erdogan Yucel E, Demiral Sezer S. Relationship Between the Neutrophil to Lymphocyte Ratio and the Presence and Size of Thyroid Nodules. Cureus 2019; 11:e3866. [PMID: 30899617 PMCID: PMC6414185 DOI: 10.7759/cureus.3866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim To investigate the possible relationship between the neutrophil to lymphocyte ratio (NLR) value and the presence and size of thyroid nodules. Patients and methods Data of 216 patients between 18 and 65 years of age, who had presented to the internal medicine department of our hospital between February 2018 and September 2018, were collected retrospectively. A total of 216 patients fulfilling the inclusion criteria were included in the study. Results An ultrasonographic examination revealed thyroid nodules in 105 patients and no thyroid nodules in 111 patients. Among those with a nodule, 52 had a nodule size of ≤10 mm and 53 had a nodule size of >10 mm. These groups were compared with regard to age, gender, body mass index, thyroid function tests, neutrophil, lymphocyte and platelet count, NLR, and mean platelet volume (MPV). Although the absolute counts of lymphocytes and neutrophils were lower in the group with nodules, no significant difference was observed between the groups. Among those with a nodule, no significant difference was determined between nodule size and thyroid function tests, NLR, or MPV. In the group of patients with a nodule, malignant pathology was reported in 2.7%. Conclusions Although there are studies suggesting a relationship between NLR, MPV, and the presence of malignancy and mortality, we determined no such relationship between nodule formation and their size in thyroid tissue.
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Affiliation(s)
- Elcin Erdogan Yucel
- Internal Medicine, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
| | - Sibel Demiral Sezer
- Internal Medicine, University of Health Sciences Tepecik Training and Research Hospital, Izmir, TUR
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Kutluturk F, Gul SS, Sahin S, Tasliyurt T. Comparison of Mean Platelet Volume, Platelet Count, Neutrophil/ Lymphocyte Ratio and Platelet/Lymphocyte Ratio in the Euthyroid, Overt Hypothyroid and Subclinical Hyperthyroid Phases of Papillary Thyroid Carcinoma. Endocr Metab Immune Disord Drug Targets 2019; 19:859-865. [PMID: 30727930 PMCID: PMC7040522 DOI: 10.2174/1871530319666190206125545] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Thyroid hormones are essential for the normal development, differentiation, metabolic balance and physiological function of all tissues. Mean platelet volume (MPV) indicates mean platelet size and reflects platelet production rate and stimulation. Increased platelet size has been observed in association with known cardiovascular risk factors. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are known markers of the systemic inflammatory response. This study aimed to investigate the effect of thyroid hormone changes by comparing platelet count, MPV values, NLR and PLR in thyroid papillary carcinoma. METHODS Forty-nine females and nine males comprising a total of 58 patients were included in the study. Clinical and laboratory parameters of patients were recorded in the following three phases of the disease: euthyroid phase (before thyroid surgery), overt hypothyroid (OH) phase (before radioactive iodine [RAI] treatment) and subclinical hyperthyroid (SCH) phase (six months after RAI treatment). RESULTS The mean thyroid-stimulating hormone (TSH) values of the patients in the euthyroid, OH and SCH phases were 1.62±1.17, 76.4±37.5 and 0.09±0.07 µIU/mL, respectively. The mean MPV values of the patients in the euthyroid, OH and SCH phases were 9.45±1.33, 9.81±1.35 and 9.96±1.21 fL, respectively. MPV was significantly higher in the SCH phase than in the euthyroid phase (p=0.013). Platelet count, NLR and PLR were not statistically different between the euthyroid, OH and SCH phases. CONCLUSION The results of this study demonstrated that the levels of MPV increased significantly in the SCH phase in patients with papillary thyroid carcinoma (PTC), and increased MPV values contributed to increased risk of cardiovascular complications. These findings suggest that MPV can be a valuable, practical parameter for monitoring the haemostatic condition in thyroid disorders. No significant difference was observed in platelet count, NLR and PLR in all stages of PTC.
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Affiliation(s)
- Faruk Kutluturk
- Address correspondence to this author at the Department of Endocrinology and Metabolism, Gaziosmanpasa University, School of Medicine, 60100 Tokat, Turkey; Tel: +90 (507) 247 73 98; Fax: +90 (356) 212 21 42; E-mail:
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Xu N, Jian Y, Wang Y, Tian W. Evaluation of neutrophil-to-lymphocyte ratio and calcitonin concentration for predicting lymph node metastasis and distant metastasis in patients with medullary thyroid cancer. Mol Clin Oncol 2018; 9:629-634. [PMID: 30546892 DOI: 10.3892/mco.2018.1727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/14/2018] [Indexed: 12/18/2022] Open
Abstract
The aim of the present study was to investigate potential predictive factors of lymph node metastasis (LNM) and distant metastasis (DM) of medullary thyroid cancer (MTC). A total of 61 patients newly diagnosed with MTC at the General Hospital of the Chinese People's Liberation Army between January 2001 and January 2016 were enrolled and divided into two groups according to the results of preoperative examinations and surgical histopathology as follows: Group NM (without metastases), and group M (with metastases). Univariate logistic regression analysis demonstrated that sex, tumor size, preoperative peripheral blood neutrophil-to-lymphocyte ratio (NLR), and concentration of carcinoembryonic antigen (CEA) and calcitonin (Ctn), were significantly associated with LNM and DM. The multivariate analysis revealed that a Ctn concentration of >500 pg/ml [odds ratio (OR)=21.422; 95% confidence interval (CI): 2.611-175.731] and the NLR (OR=5.918; 95% CI: 1.147-30.541) were positively correlated with LNM and DM. The optimal cut-off value of the NLR for predicting LNM and DM obtained from receiver operating characteristic curve analysis was 1.784 (sensitivity 68.3% and specificity 80%), and the area under the curve was 0.717. In conclusion, the findings of the present study strongly suggest that inflammation and immune activation of MTC cells promote LNM and DM, and that higher values of NLR and Ctn concentration confer a high risk of metastasis.
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Affiliation(s)
- Nizhen Xu
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yanbing Jian
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yaxi Wang
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China
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El Menshawy N, Eissa M, Abdeen HM, Elkhamisy EM, Joseph N. CD58; leucocyte function adhesion-3 (LFA-3) could be used as a differentiating marker between immune and non-immune thyroid disorders. ACTA ACUST UNITED AC 2018; 27:721-727. [PMID: 29706856 PMCID: PMC5910489 DOI: 10.1007/s00580-018-2657-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/05/2018] [Indexed: 12/02/2022]
Abstract
The link between Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) has been debated for decades due to the shared pathological and immunological components. Immune intolerance and inappropriate immune reaction against self-thyroid cells are distinctive features of both diseases, but definitive data for the clinical presentation of autoimmune thyroid disease remains unclear. To analyse the expression of T-regulatory cells, CD58, the CD4/CD8 ratio and the neutrophil/lymphocyte ratio and to determine if these parameters could be used as differentiating markers between auto- and non-immune thyroid diseases, 75 patients were enrolled in this study—40 with autoimmune thyroid disease (HT and GD ), 15 with non-immune thyroid disease, and 20 healthy controls. Multicolour flow cytometry was used to analyse CD58, T-regulatory cells (Treg) expressing CD4, CD25, HLA-DR and CD8 using different stained fluorescent labelled monoclonal antibodies. The neutrophils and lymphocyte ratio was also measured. Lower expression of Treg with higher expression of CD58 (LFA-3) was found in the autoimmune diseases when compared with the non-immune and control groups. ROC analysis showed that CD58 with sensitivity 88% and specificity 100% with cut-off value more than or equal to 29.9 indicates Hashimoto’s disease, while lower value indicates colloid goitre, and higher or equal to 29.84 indicates Graves’ disease and lower indicates colloid goitre with 100% sensitivity and specificity. CD58 could be used as differentiating marker between immune and non-immune thyroid disorders.
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Affiliation(s)
- Nadia El Menshawy
- 1Clinical Pathology Department, Hematology Unit, Mansoura Medical School, Mansoura University, Mansoura, Egypt
| | - Mohammed Eissa
- 2Clinical Pathology Department, Faculty of Medicine, Zagazig University and King Khalid University, Zagazig, Egypt
| | - Hanaa M Abdeen
- 3Biochemistry Department, Mansoura Medical School, Mansoura University, Mansoura, Egypt
| | - Enas M Elkhamisy
- 4Internal Medicine Department, Specialized Medicine Hospital, Mansoura Medical School, Mansoura University, Mansoura, Egypt
| | - Nabil Joseph
- 5Community Medicine Department, Mansoura Medical School, Mansoura University, Mansoura, Egypt
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Diagnostic Accuracy of Preoperative Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Detecting Occult Papillary Thyroid Microcarcinomas in Benign Multinodular Goitres. J Thyroid Res 2018; 2018:3470429. [PMID: 29850011 PMCID: PMC5937414 DOI: 10.1155/2018/3470429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/28/2018] [Indexed: 12/14/2022] Open
Abstract
Objective To investigate the diagnostic accuracy of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in detecting occult papillary thyroid microcarcinomas in benign, multinodular goitres. Methods 397 total thyroidectomy patients were identified from the institutional thyroid surgery database between 2007 and 2016 (94 males, 303 females, mean age 53 ± 14.5 years). NLR and PLR were calculated as the absolute neutrophil and absolute platelet counts divided by the absolute lymphocyte count, respectively, based on the preoperative complete blood cell count. Results NLR was significantly higher in carcinomas and microcarcinomas compared to benign pathology (p = 0.026), whereas a direct association could not be established for PLR. Both NLR and PLR scored low in all parameters of diagnostic accuracy, with overall accuracy ranging between 45 and 50%. Conclusions As surrogate indices of the systemic inflammatory response, NLR and PLR are inexpensive and universally available from routine blood tests. Although we found higher NLR values in cases of malignancy, NLR and PLR cannot effectively predict the presence of occult papillary microcarcinomas in otherwise benign, multinodular goitres.
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Evaluation of Neutrophil-to-Lymphocyte Ratio and Mean Platelet Volume in Patients with Active and Inactive Thyroid Orbitopathy. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:26-30. [PMID: 32595367 PMCID: PMC7315080 DOI: 10.14744/semb.2017.07269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022]
Abstract
Objectives: The aim of this study was to evaluate the neutrophil-to-lymphocyte ratio (NLR) and the mean platelet volume (MPV) in patients with active thyroid orbitopathy (TO) and to compare it with that of both healthy subjects and patients with inactive TO. Methods: Twenty patients with active TO (Group 1), 25 patients with inactive TO (Group 2), and 35 age- and sex-matched healthy subjects (Group 3) were included in this study. Patients with other systemic and ocular diseases, patients with a history of intraocular or orbital surgery, and patients using systemic drugs were excluded. The VISA (vision, inflammation, strabismus, appearance) classification scheme was used to discriminate between active and inactive TO. The neutrophil and lymphocyte counts and the MPV of all participants were recorded. The NLR was calculated by dividing the neutrophil count by the lymphocyte count, and the result was compared between groups. The optimal cut-off value was determined for NLR and MPV and the data were compared with a one-way analysis of variance test and the ’Bonferroni post-test. Results: The mean age was 45.4±13.4, 41.0±13.7, and 42.6±14.4 years in Group 1, 2, and 3, respectively (p=0.68). The NLR was 2.11 in Group 1, 1.56 in Group 2, and 1.47 in Group 3 (p=0.03). The ’Bonferroni post-test revealed a difference between Group 1 and Group 2 (p=0.01) and between Group 1 and Group 3 (p<0.001). The MPV was 10.76 fL in Group 1, 9.94 fL in Group 2, and 8.19 fL in Group 3 (p<0.001). The results of the ’Bonferroni post-test showed a difference between Group 1 and Group 2 (p=0.04), between Group 1 and Group 3 (p<0.001), and between Group 2 and Group 3 (p<0.001). The mean cut-off value obtained from receiver operating characteristic (ROC) analysis of NLR was 1.69 (sensitivity: 72%; specificity: 66%). The mean cut-off value obtained from ROC analysis of MPV was 9.95 (sensitivity: 63%; specificity: 66%). Conclusion: High NLR and MPV values may be indicative of active inflammation in patients with TO.”
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Machairas N, Kostakis ID, Prodromidou A, Stamopoulos P, Feretis T, Garoufalia Z, Damaskos C, Tsourouflis G, Kouraklis G. Trends in white blood cell and platelet indices in a comparison of patients with papillary thyroid carcinoma and multinodular goiter do not permit differentiation between the conditions. Endocr Res 2017; 42:311-317. [PMID: 28506088 DOI: 10.1080/07435800.2017.1319859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM Carcinogenesis has been related to systematic inflammatory response. Our aim was to study white blood cell and platelet indices as markers of this inflammatory response in thyroid cancer and to associate them with various clinicopathological parameters. METHODS We included 228 patients who underwent thyroidectomy within a period of 54 months, 89 with papillary thyroid carcinoma and 139 with multinodular hyperplasia. We examined potential links between white blood cell and platelet indices on the one hand and the type thyroid pathology and various clinicopathological parameters on the other. RESULTS No significant differences were detected between thyroid cancer and multinodular hyperplasia and no significant associations were detected with regard to lymphovascular invasion and tumor size. However, the mean platelet volume was higher in multifocal tumors, while the platelet count, plateletcrit, and platelet-to-lymphocyte ratio were increased in cases with extrathyroidal extension and in T3 tumors. Additionally, T3 tumors had lower platelet distribution width. These associations demonstrated low accuracy in predicting these pathological features, but they were found to provide a satisfying negative predictive value, with the exception of the mean platelet volume. CONCLUSIONS White blood cell and platelet indices cannot assist in distinguishing benign goiter from thyroid cancer. However, they can provide information about tumor multifocality, extrathyroidal extension, and presence of a T3 tumor, and they may be used as a means to exclude these pathological characteristics, especially the last two, in papillary thyroid carcinoma.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Biomarkers/blood
- Carcinoma, Papillary/blood
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/immunology
- Carcinoma, Papillary/pathology
- Diagnosis, Differential
- Goiter, Nodular/blood
- Goiter, Nodular/diagnosis
- Goiter, Nodular/immunology
- Goiter, Nodular/pathology
- Humans
- Leukocyte Count
- Mean Platelet Volume
- Middle Aged
- Platelet Count
- Predictive Value of Tests
- ROC Curve
- Retrospective Studies
- Thyroid Cancer, Papillary
- Thyroid Gland/immunology
- Thyroid Gland/pathology
- Thyroid Neoplasms/blood
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/immunology
- Thyroid Neoplasms/pathology
- Tumor Burden
- Young Adult
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Affiliation(s)
- Nikolaos Machairas
- a Second Department of Propedeutic Surgery , " Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Ioannis D Kostakis
- a Second Department of Propedeutic Surgery , " Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Anastasia Prodromidou
- a Second Department of Propedeutic Surgery , " Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Paraskevas Stamopoulos
- a Second Department of Propedeutic Surgery , " Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Themistoklis Feretis
- a Second Department of Propedeutic Surgery , " Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Zoe Garoufalia
- a Second Department of Propedeutic Surgery , " Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Christos Damaskos
- a Second Department of Propedeutic Surgery , " Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Gerasimos Tsourouflis
- a Second Department of Propedeutic Surgery , " Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Gregory Kouraklis
- a Second Department of Propedeutic Surgery , " Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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Yaylaci S, Tosun O, Sahin O, Genc AB, Aydin E, Demiral G, Karahalil F, Olt S, Ergenc H, Varim C. Lack of Variation in Inflammatory Hematological Parameters between Benign Nodular Goiter and Papillary Thyroid Cancer. Asian Pac J Cancer Prev 2017; 17:2321-3. [PMID: 27221938 DOI: 10.7314/apjcp.2016.17.4.2321] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inflammatory hematological parameters like the neutrophil/lymphocyte (N/L) ratio have been investigated in many cancer types and significant relationships found with prognosis, for example. The aim of this present study was to investigate the impact of hematological parameters notably on N/L ratio and mean platelet volume (MPV) in papillary thyroid cancer cases. MATERIALS AND METHODS A total of 79 patients who underwent a thyroidectomy operation in Findikli, Goiter Research and Treatment Center during 2011- 2015 period were enrolled in the study, 41 with papillary thyroid cancer and 38 with benign goiter confirmed by pathological examination. We collected clinical and laboratory data for the patients from hospital records retrospectively. Blood samples taken at admission were assessed for parameters compared between the groups. RESULTS No significant differences between papillary thyroid cancer and benign goiter groups were apparent in terms of age, the N/L ratio, MPV, white blood cell count (WBC), red blood cell count (RBC), hemoglobin, hematocrit, platelet, neutrophil, lymphocyte, red blood cell distribution width (RDW) and platelet crit (PCT) levels (>0.05). Only the level of platelet distribution width (PDW) significantly differed, being lower in the papillary cancer group (<0.05). CONCLUSIONS No significant relationship between papillary thyroid cancer and inflammatory hematological parameters including in particular the N/L ratio and MPV. The relevance of the PDW values remains unclear.
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Affiliation(s)
- Selcuk Yaylaci
- Department of Internal Medicine, Medical Faculty, Sakarya University, Sakarya E-mail :
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Manatakis DK, Tseleni-Balafouta S, Balalis D, Soulou VN, Korkolis DP, Sakorafas GH, Plataniotis G, Gontikakis E. Association of Baseline Neutrophil-to-Lymphocyte Ratio with Clinicopathological Characteristics of Papillary Thyroid Carcinoma. Int J Endocrinol 2017; 2017:8471235. [PMID: 28572821 PMCID: PMC5441114 DOI: 10.1155/2017/8471235] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the potential association of neutrophil-to-lymphocyte ratio (NLR), a surrogate systemic inflammatory biomarker, with clinical and pathological characteristics of papillary thyroid cancers. METHODS 205 patients with papillary carcinoma were identified from the institutional thyroid cancer database between 2006 and 2015 (55 males, 150 females, mean age 51.2 ± 14.7 years). NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count, based on the preoperative complete blood cell counts. RESULTS NLR was significantly higher in carcinomas with extrathyroidal invasion (2.74 ± 01.24 versus 2.39 ± 0.96, p = 0.04) and bilateral (2.67 ± 1.15 versus 2.35 ± 0.96, p = 0.03) and multifocal tumours (2.65 ± 1.08 versus 2.29 ± 0.96, p = 0.01), as well as lymph node-positive tumours (3.12 ± 1.07 versus 2.41 ± 1.02, p = 0.03). On the other hand, NLR values were not associated with gender, age, tumour size, histologic subtype, the presence of thyroiditis, and TNM staging. CONCLUSIONS As an index of inflammation, NLR is inexpensive, readily available, and easy to extract from routine blood tests. We found increased NLR values in papillary carcinomas with poorer histopathological profile and more aggressive clinical behaviour. Whether this systemic inflammatory response, as expressed by the NLR, represents the inflammatory microenvironment leading to tumourigenesis, or is a tumour-associated phenomenon, remains to be elucidated and warrants further study.
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Affiliation(s)
- Dimitrios K. Manatakis
- First Department of Surgical Oncology, St. Savvas Cancer Hospital, Athens, Greece
- *Dimitrios K. Manatakis:
| | - Sofia Tseleni-Balafouta
- Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Balalis
- First Department of Surgical Oncology, St. Savvas Cancer Hospital, Athens, Greece
| | - Vasiliki N. Soulou
- First Department of Surgical Oncology, St. Savvas Cancer Hospital, Athens, Greece
| | | | - George H. Sakorafas
- First Department of Surgical Oncology, St. Savvas Cancer Hospital, Athens, Greece
| | - Georgios Plataniotis
- First Department of Surgical Oncology, St. Savvas Cancer Hospital, Athens, Greece
| | - Emmanouil Gontikakis
- First Department of Surgical Oncology, St. Savvas Cancer Hospital, Athens, Greece
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Liu JF, Ba L, Lv H, Lv D, Du JT, Jing XM, Yang NJ, Wang SX, Li C, Li XX. Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: a meta-analysis. Sci Rep 2016; 6:38551. [PMID: 27941815 PMCID: PMC5150572 DOI: 10.1038/srep38551] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023] Open
Abstract
The association between neutrophil-to-lymphocyte ratio (NLR) and differentiated thyroid cancer (DTC) is undecided. To rectify this question, we conducted a systematic meta-analysis based on 7 prospective cohort studies published between 2013 and 2015, comprising 7349 patients. Six of these cohorts included pretreatment (baseline) NLR data for patients with thyroid nodules. The meta-analysis of these 6 cohorts showed that the NLR of patients with DTC (4617 cases) was statistically similar to patients with benign nodules only (1666 cases), with a mean difference (MD) of 0.19 (95% CI: −0.09 to 0.46; I2 = 93%; P < 0.001). No significant difference in NLR was found between patients with DTC and patients with benign nodules. Two studies addressed an association between NLR and papillary thyroid carcinoma in patients stratified by age <45 and ≥45 years (496 and 891 cases, respectively); the pooled MD was 0.09 (95% CI: −0.37 to 0.55; I2 = 92.2%, P < 0.001). An elevated NLR seems not a reliable indicator of progressing DTC in patients with goiters, and there was no difference in NLR between patients aged <45 years and those aged ≥45 years. Well-designed and large-scale investigations are warranted to understand the value of NLR in the prognosis of DTC.
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Affiliation(s)
- Ji-Feng Liu
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Luo Ba
- Department of Otorhinolaryngology of People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Hong Lv
- Department of Otorhinolaryngology - Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Dan Lv
- Department of Otorhinolaryngology - Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jin-Tao Du
- Department of Otorhinolaryngology - Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao-Mei Jing
- Department of oncology, Sichuan Cancer Hospital, Chengdu, China
| | - Ning-Jing Yang
- Department of Image, Sichuan Cancer Hospital, Chengdu, China
| | - Shao-Xin Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Xiao-Xia Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu, China
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Jiang K, Lei J, Chen W, Gong Y, Luo H, Li Z, Gong R, Zhu J. Association of the preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with lymph node metastasis and recurrence in patients with medullary thyroid carcinoma. Medicine (Baltimore) 2016; 95:e5079. [PMID: 27749581 PMCID: PMC5059084 DOI: 10.1097/md.0000000000005079] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are known to be prognostic factors in several cancers. However, no previous investigation has been performed to evaluate the significance of the NLR and PLR in medullary thyroid carcinoma (MTC).The aim of this study was to identify the ability of the preoperative NLR or PLR to predict lymph node metastasis and recurrence in patients with MTC. Data from all patients with MTC who had undergone surgery at our institution from May 2009 to May 2016 were retrospectively evaluated. Receiver operating characteristic (ROC) analysis was performed to identify optimal NLR and PLR cutoff points, and we assessed independent predictors of lymph node metastasis and recurrence using univariate and multivariate analyses.Based on the inclusion and exclusion criteria, a total of 70 patients were enrolled in this study. The ideal cutoff points for predicting lymph node involvement were 2.7 for the NLR and 105.3 for the PLR. The optimal cutoff points of the NLR and PLR for predicting recurrence were 2.8 and 129.8, respectively. Using the cutoff values, we found that PLR>105.3 (odds ratio [OR] 4.782, 95% confidence interval [CI] 1.4-16.7) was an independent predictor of lymph node metastasis and that PLR>129.8 (OR 3.838, 95% CI 1.1-13.5) was an independent predictor of recurrence.Our study suggests that the preoperative PLR, but not NLR, was significantly associated with lymph node metastasis and recurrence in patients with MTC.
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Affiliation(s)
- Ke Jiang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- State Key Laboratory of Biotherapy/Collaborative Innovation Centre of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Wenjie Chen
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yanping Gong
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Han Luo
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Rixiang Gong
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
- Correspondence: Jingqiang Zhu, Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China (e-mail: )
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Wang H, Gu L, Jia R, Zeng J, Liu X, Zhang D, Wu Y, Luo G, Zhang X. Retrospective evaluation of ultrasound-indeterminate renal multilocular cystic masses by using neutrophil-lymphocyte ratio and computed tomography. Urol Oncol 2016; 35:35.e7-35.e14. [PMID: 27671994 DOI: 10.1016/j.urolonc.2016.08.011] [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: 02/19/2016] [Revised: 07/27/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the clinical usefulness of neutrophil-lymphocyte ratio (NLR) in differentiating the ultrasound-indeterminate renal multilocular cystic masses (RMCM) in comparison with computed tomography (CT) and whether NLR has additional benefits to CT on sensitivity of detecting the malignant. MATERIALS AND METHODS Overall, 93 patients who underwent normal ultrasound with a conclusion of indeterminate RMCM were examined by NLR and CT within 30 days before surgery or follow-up from March to September 2014 at PLA General Hospital and enrolled in this retrospective study. Logistic regression model was performed to find independent predictors for differentiating true nature of RMCM; differences in the validity parameters and diagnostic power of CT, NLR, and their combination were compared using McNemar tests and AUC model, respectively. RESULTS The final diagnoses of the 93 patients consisted of 36 patients with benign complex cysts, 16 with multilocular cystic renal cell carcinoma, 9 with multilocular cystic nephroma, and 32 with clear cell renal cell carcinoma. Higher NLR were strongly associated with malignant masses. Multivariate logistic regression analysis revealed that NLR could be an independent predictor for differentiating true nature of these masses (OR = 3.617; 95% CI: 1.219-10.727; P = 0.020). For detecting the malignant masses, the sensitivity, specificity, and accuracy were 71.9%, 80.6%, and 75.3% for CT and 57.9%, 88.9%, and 69.9% for NLR under cutoff value of 2.31, respectively, whereas those of CT+NLR were 89.5%, 69.4%, and 81.7%. No significant difference was found between CT and NLR in sensitivity (P = 0.185), specificity (P = 0.549), and accuracy (P = 0.428). But the sensitivity of CT+NLR was significantly higher than those of CT (P = 0.002) and NLR (P<0.001), respectively; AUC model analysis indicated that CT+NLR got the largest area of 0.795 (P<0.001, 95% CI: 0.693-0.896) in comparison with those of CT (area = 0.795, P<0.001, 95% CI: 0.661-0.864) and NLR (area = 0.734, P<0.001, 95% CI: 0.631-0.836). CONCLUSIONS Given that NLR, under cutoff value of 2.31, had no diagnostic difference with CT in evaluating the ultrasound-indeterminate RMCM. However, combination of CT and NLR could increase the sensitivity of detecting malignant masses and acquire the best diagnostic power. Prospectively larger cohort and multicenter studies are still necessary.
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Affiliation(s)
- Hanfeng Wang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, PLA Medical School, Beijing, China
| | - Liangyou Gu
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, PLA Medical School, Beijing, China
| | - Rui Jia
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jing Zeng
- Institute of Geriatrics, Chinese PLA General Hospital, Beijing, China
| | - Xiaoxia Liu
- Department of Ultrasonics, Chinese PLA General Hospital, Beijing, China
| | - Dawei Zhang
- Department of Urology, Chinese PLA 309 Hospital, Beijing, China
| | - Yongjie Wu
- Department of General Surgery, Chinese PLA 264 Hospital, Taiyuan, China
| | - Guangda Luo
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, PLA Medical School, Beijing, China
| | - Xu Zhang
- Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, PLA Medical School, Beijing, China.
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Wei B, Yao M, Xing C, Wang W, Yao J, Hong Y, Liu Y, Fu P. The neutrophil lymphocyte ratio is associated with breast cancer prognosis: an updated systematic review and meta-analysis. Onco Targets Ther 2016; 9:5567-75. [PMID: 27660475 PMCID: PMC5021064 DOI: 10.2147/ott.s108419] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Breast cancer (BC) is the most common female malignancy within the spectrum of human cancer. One promising way to reduce the mortality and morbidity of BC is to explore novel diagnostic markers for early diagnosis and prognostication. The neutrophil lymphocyte ratio (NLR) is a good reflection of inflammation, which plays an important role in tumor progression and metastasis. However, the association between NLR and BC prognosis remains unclear. The aim of this meta-analysis is to explore the prognostic value of NLR in BC. Among the screened references in the database, 12 eligible studies were identified in this study. Patients with a higher NLR had a shorter disease-free survival (hazard ratio =1.46, 95% confidence interval: 1.12-1.90, P=0.044) and overall survival (hazard ratio =2.03, 95% confidence interval: 1.41-2.93, P<0.001). In the subgroup analysis of NLR and disease-free survival, the studies from Eastern countries had a positive result with perfect homogeneity (I (2)=0); however, this homogeneity has not been achieved in studies from Western countries. In the subgroup analysis of the NLR and overall survival, the results of the univariate and multivariate analyses were completely different, with different heterogeneity. In the luminal A and luminal B subtypes, we found that there was no association between the NLR and overall survival in the BC patients. Positive results were obtained in the analyses of the human epidermal growth factor receptor 2 (HER2)-positive and triple-negative BC subtypes. In conclusion, this meta-analysis suggests that NLR is a good prognostic marker for BC, and patients with a higher NLR have poorer prognoses. Future studies should perform more detailed investigations to decrease heterogeneity and determine the appropriate cut-off values for different races.
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Affiliation(s)
- Bajin Wei
- Diagnosis and Treatment of Breast Diseases Center; Key Laboratory of Organ Transplantation, Key Laboratory of Combined Multi-Organ Transplantation, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Minya Yao
- Diagnosis and Treatment of Breast Diseases Center
| | - Chunyang Xing
- Key Laboratory of Organ Transplantation, Key Laboratory of Combined Multi-Organ Transplantation, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Wei Wang
- Key Laboratory of Organ Transplantation, Key Laboratory of Combined Multi-Organ Transplantation, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Jia Yao
- Diagnosis and Treatment of Breast Diseases Center
| | - Yun Hong
- Diagnosis and Treatment of Breast Diseases Center
| | - Yu Liu
- Diagnosis and Treatment of Breast Diseases Center
| | - Peifen Fu
- Diagnosis and Treatment of Breast Diseases Center; Key Laboratory of Organ Transplantation, Key Laboratory of Combined Multi-Organ Transplantation, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Khan AA, Akritidis G, Pring T, Alagarathnam S, Roberts G, Raymond R, Varcada M, Novell R. The Neutrophil-to-Lymphocyte Ratio as a Marker of Lymph Node Status in Patients with Rectal Cancer. Oncology 2016; 91:69-77. [DOI: 10.1159/000443504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022]
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