Preoperative Blood Counts Predict Overall Survival in Patients Undergoing Surgical Removal of Brain Metastasis

OBJECTIVE

The prognosis for patients with cancer with brain metastasis (BM) requiring surgical removal is quite limited. Preoperative prognostic factors can provide meaningful information to surgeons, oncologists, and patients. This study evaluated the preoperative blood counts in patients with BM who were treated with surgical removal.

METHODS

Between January 2011 and November 2021, 221 consecutive surgeries were conducted on 198 patients with BM. Among the 198 patients, 188 patients with sufficient blood test data and follow-up were analyzed in this study. The tumors originated from the lungs (n = 102, 54.3%), colon (n = 26, 13.3%), breast (n = 13, 6.9%), kidney (n = 8, 4.3%), stomach (n = 6, 3.2%), and others (n = 33, 17.6%). The blood test data included neutrophils, lymphocytes, monocytes, eosinophils, basophils, red blood cell count, hemoglobin, and albumin.

RESULTS

The median follow-up and median survival times were both 11 months (range: 0-139 months). Higher neutrophil-lymphocyte ratio ≥ 3.17, platelet-lymphocyte ratio ≥112.7, systemic immune-inflammation index ≥594.4, systemic inflammation response index ≥1.25 were unfavorable predictors of prognosis for the patients treated with surgical removal for BM (P < 0.001). Furthermore, lower lymphocyte-monocyte ratio < 2.33 and prognostic nutritional index < 48.5 were unfavorable predictors.

CONCLUSIONS

Simple, less expensive, routinely ordered preoperative blood count assessments, such as the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and prognostic nutritional index, can predict the overall survival of patients treated with surgical removal for BM.

Clinical significance of systemic inflammation response index and platelet-lymphocyte ratio in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer

Background

Tumor immunity plays an important role in assessing the tumor progression. The purpose of this study was to investigate the prognostic value of combined systemic inflammation response index (SIRI) and platelet-lymphocyte ratio (PLR) of gastroesophageal junction cancer (AEG) and upper gastric cancer (UGC) patients.

Methods

In this retrospective study, patients from 2003 to 2014 were divided into training and validation sets. The prognostic accuracy of each variable was compared using time-independent ROC analysis. The scoring system was calculated by cut-off values of SIRI and PLR in 5-year. Kaplan-Meier and Log-rank tests were used to analyze overall survival (OS). Chi-square test was used to analyze the association between clinical characteristics and the scoring system. Univariate and multivariate analyses based on the competitive risk regression model were used to analyze independent predictors of death due to AGC and UGC. R software was used to construct the Nomogram model of risk assessment.

Results

Patients with SIRI-PLR = 2 had worse survival time than those with 0 and 1 (P < 0.001) and more suitable for postoperative adjuvant chemotherapy (P = 0.002). High PLR patients were more suitable for proximal gastrectomy (P = 0.049). SIRI-PLR were independent predictors in training set (P < 0.001), which could be combined with age, pTNM stage and postoperative chemotherapy to construct Nomogram for predicting OS.

Conclusions

Preoperative SIRI-PLR score was an independent predictor for patients with AEG and UGC. The Nomogram model constructed by age, SIRI-PLR, pTNM stage and postoperative chemotherapy can correctly predict the prognosis of patients.

Can the Inflammatory Cell Ratio NLR and PLR be Used as a Reliable Marker in Colon Cancer? A Prospective Study

Background

Simple approaches for detecting the tumor stage of colon cancer patients are required during the preoperative period. In recent years, the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been employed as predictive parameters for systemic inflammatory response and long-term prognosis in a variety of malignancies. The purpose of this study was to determine whether the NLR and PLR correspond with tumor characteristics in colon cancer patients.

Materials and methods

About 90 patients with colon cancer who reported to our institute during the time interval July 2021 to December 2022 were included in the study. The NLR and PLR were calculated using data obtained from a complete blood count evaluation. The relationship between inflammatory cell ratio and tumor-specific characteristics were analyzed.

Results

Neutrophil-lymphocyte ratio and PLR correlated with pTNM staging in 88 patients. Two patients exhibited diffuse peritoneal metastasis. A significant association was found between PLR and early (Tis + T1 + T2) and advanced (T3 + T4) groups. Although the difference was not statistically significant, patients with lymphovascular invasion (LVI) and perineural invasion (PNI) had greater mean NLR and PLR.

Conclusion

Platelet-lymphocyte ratio was found to be more accurate than NLR in predicting colon cancer tumor depth/invasion. A high PLR value aids in prognosticating advanced T-stage colon cancer patients and can be used as a valuable tool for preoperative counseling, but it must be validated with a survival analysis.

Clinical practice points

The tumor microenvironment contains a variety of inflammatory cells that contribute to the growth and spread of the neoplasm. The NLR and PLR have been shown to be clinically and prognostically important in a variety of gastrointestinal cancers. The results of this study demonstrate that PLR was more accurate than NLR in predicting colon cancer tumor depth/invasion. Also, a high PLR value aids in prognosticating advanced T-stage colon cancer patients and may be used as a valuable tool for preoperative counseling.

How to cite this article

Ramesh SK, Swain SK, Munikrishnan V, et al. Can the Inflammatory Cell Ratio NLR and PLR be Used as a Reliable Marker in Colon Cancer? A Prospective Study. Euroasian J Hepato-Gastroenterol 2023;13(2):61-65.

Pulmonary neuroendocrine tumors: study of 266 cases focusing on clinicopathological characteristics, immunophenotype, and prognosis

OBJECTIVE

Pulmonary neuroendocrine tumors (PNETs) consist of small-cell lung cancer (SCLC), large-cell neuroendocrine carcinoma (LCNEC), typical carcinoid (TC), and atypical carcinoid (AC). We aimed to analyze the immunophenotypic, metastatic, and prognostic risk factors for PNETs.

MATERIALS AND METHODS

A total of 266 patients with PNETs were enrolled, including 219 patients with SCLC, 18 patients with LCNEC, 11 patients with TC, and 18 patients with AC. Clinicopathological characteristics and immunophenotypes were compared among the subtypes of PNETs. Risk factors for metastasis, progression-free survival (PFS), and overall survival (OS) were analyzed.

RESULTS

Thyroid transcription factor-1 (TTF-1) and the Ki-67 index were significantly different among subtypes of PNETs (all P < 0.05). Smoking (OR, 2.633; P = 0.031), high pretreatment carcinoembryonic antigen (CEA > 5 ng/ml: OR, 3.084; P = 0.014), and poorly differentiated pathotypes (P = 0.001) were independent risk factors for lymph-node metastasis. Smoking (OR, 2.071; P = 0.027) and high pretreatment CEA (OR, 2.260; P = 0.007) were independent risk factors for distant metastasis. Results of the multivariate Cox regression model showed pretreatment CEA (HR, 1.674; P = 0.008) and lymphocyte-monocyte ratio (LMR) (HR = 0.478, P = 0.007) were significantly associated with PFS; BMI (P = 0.031), lymph-node metastasis (HR = 4.534, P = 0.001), poorly differentiated pathotypes (P = 0.015), platelet-lymphocyte ratio (PLR) (HR = 2.305, P = 0.004), and LMR (HR = 0.524, P = 0.045) were significantly associated with OS.

CONCLUSIONS

PNETs are a group of highly heterogeneous tumors with different clinical manifestations, pathological features, and prognoses. Knowing clinicopathological characteristics and immunophenotypes of PNETs is significant for diagnosis. Pretreatment PLR, LMR, and CEA have certain value in the prognosis of PNETs.

U-shaped relationship between platelet-lymphocyte ratio and postoperative in-hospital mortality in patients with type A acute aortic dissection

Background

The platelet-lymphocyte ratio (PLR), a novel inflammatory marker, is generally associated with increased in-hospital mortality risk. We aimed to investigate the association between PLR and postoperative in-hospital mortality risk in patients with type A acute aortic dissection (AAAD).

Methods

Patients (n = 270) who underwent emergency surgery for AAAD at Xiangya Hospital of Central South University between January 2014 and May 2019 were divided into three PLR-based tertiles. We used multiple regression analyses to evaluate the independent effect of PLR on in-hospital mortality, and smooth curve fitting and a segmented regression model with adjustment of confounding factors to analyze the threshold effect between PLR and in-hospital mortality risk.

Results

The overall postoperative in-hospital mortality was 13.33%. After adjusting for confounders, in-hospital mortality risk in the medium PLR tertile was the lowest (Odds ratio [OR] = 0.20, 95% confidence interval [CI] = 0.06–0.66). We observed a U-shaped relationship between PLR and in-hospital mortality risk after smoothing spline fitting was applied. When PLR < 108, the in-hospital mortality risk increased by 10% per unit decrease in PLR (OR = 0.90, P = 0.001). When the PLR was between 108 and 188, the mortality risk was the lowest (OR = 1.02, P = 0.288). When PLR > 188, the in-hospital mortality risk increased by 6% per unit increase in PLR (OR = 1.06, P = 0.045).

Conclusions

There was a U-shaped relationship between PLR and in-hospital mortality in patients with AAAD, with an optimal PLR range for the lowest in-hospital mortality risk of 108–188. PLR may be a useful preoperative prognostic tool for predicting in-hospital mortality risk in patients with AAAD and can ensure risk stratification and early treatment initiation.

Red blood cell distribution width values in erectile dysfunction

PURPOSE

Erectile dysfunction (ED) has increased prevalence by age and significantly affects the quality of life of men and their partners. To investigate the relationship between ED and red blood cell distribution width (RDW) values.

MATERIALS AND METHOD

Between September 2019 and December 2019, a total of 192 individuals comprising those that were admitted to the urology outpatient clinic with ED complaints and healthy volunteers from among hospital staff were prospectively included in the study. The participants were divided into two groups according to the international erectile function index (IIEF-5) as ED group (n=148) and control group (n=44).

RESULTS

There was no statistically significant difference between the two groups in terms of age, smoking status, presence of hypertension, triglyceride, low-density lipoprotein, high-density lipoprotein, total cholesterol, total prostate-specific antigen and haematocrit values. Body mass index, fasting blood sugar, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were significantly higher in the ED group (28.5±27.4kg/m² vs 26.8±26.5kg/m², p=.021, 109.05±49.7mg/dl vs 93.39±10.2mg/dl, p<.001, 2.18±1.3 vs 1.74±0.3, p=.031, and 113.7±47 vs 92.4±24.1, p=.004, respectively). The mean RDW values were 13.7±1.1 in the ED group and 13±0.5 in the control group (p<.001). The multivariate analysis revealed PLR [1.02 OR (1-1.04), p=.007] and RDW [2.75 OR (1.56-4.85), p<.001] as independent predictors for an ED diagnosis.

CONCLUSION

Based on the strong relationship between RDW and ED, we consider that RDW may be a new indicator in the diagnosis of ED.

The neutrophil-lymphocyte ratio and locoregional melanoma: a multicentre cohort study

OBJECTIVES

The neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker which is useful in cancer prognostication. We aimed to investigate the differences in baseline NLR between patients with localised and metastatic cutaneous melanoma and how this biomarker changed over time with the recurrence of disease.

METHODS

This multicentre cohort study describes patients treated for Stage I-III cutaneous melanoma over 10 years. The baseline NLR was measured immediately prior to surgery and again at the time of discharge or disease recurrence. The odds ratios (OR) for sentinel node involvement are estimated using mixed-effects logistic regression. The risk of recurrence is estimated using multivariable Cox regression.

RESULTS

Overall 1489 individuals were included. The mean baseline NLR was higher in patients with palpable nodal disease compared to those with microscopic nodal or localised disease (2.8 versus 2.4 and 2.3, respectively; p < 0.001). A baseline NLR ≥ 2.3 was associated with 30% higher odds of microscopic metastatic melanoma in the sentinel lymph node [adjusted OR 1.3 (95% CI 1.3, 1.3)]. Following surgery, 253 patients (18.7%) developed recurrent melanoma during surveillance although there was no statistically significant association between the baseline NLR and the risk of recurrence [adjusted HR 0.9 (0.7, 1.1)].

CONCLUSION

The NLR is associated with the volume of melanoma at presentation and may predict occult sentinel lymph metastases. Further prospective work is required to investigate how NLR may be modelled against other clinicopathological variables to predict outcomes and to understand the temporal changes in NLR following surgery for melanoma.

Platelet-lymphocyte ratio as a potential prognostic factor in gynecologic cancers: a meta-analysis

PURPOSE

Cancer-related inflammation plays an important role in tumor development and progression. Platelet-lymphocyte ratio (PLR) has been studied as a biomarker for prognosis in gynecologic cancers. But, the results of previous studies were controversial, so we performed this meta-analysis.

METHODS

We searched the scientific database of PubMed, Embase, Web of Science, Wanfang, and China National Knowledge Infrastructure (CNKI) using free text and MeSH keywords. Crude HR (hazard ratio) with 95% confidence interval was used to evaluate the risk association between PLR and overall survival (OS) or progression-free survival (PFS) in gynecologic neoplasms.

RESULTS

There totally 23 studies, including 6869 patients who were eligible, most of which are published after 2015 or later. PLR greater than the cut-off was associated with poorer survival prognosis in ovarian cancer [OS: HR 1.80 (95% CI 1.37-2.37), p = 0.000; PFS: HR 1.63 (95% CI 1.38-1.91), p = 0.000] and cervical cancer [OS: HR 1.36 (95% CI 1.10-1.68), p = 0.005; PFS: HR 1.40 (95% CI 1.16-1.70), p = 0.002], but not in endometrial cancer [OS: HR 1.95 (95% CI 0.65-5.84), p = 0.234].

CONCLUSIONS

The current meta-analysis revealed that pretreatment PLR was a simple, promising prognostic indicator for OS and PFS in ovarian and cervical cancers. But, its significance of prognosis did not agree with endometrial neoplasm. However, due to the limited number of original studies, future large-scale studies with more well-designed, high-quality studies are still needed.

Neutrophil-lymphocyte ratio is prognostic in early stage resected small-cell lung cancer

Background

For selected early stage small cell lung cancer (SCLC), curative intent surgery is often performed. Previous studies, predominantly from East Asia, reported that high neutrophil to lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR) correlate with poor prognosis in several types of tumors including SCLC. Our aim was to investigate the prognostic value of NLR and PLR in Caucasian patients with resected SCLC, as potential tool to select patients for multimodal treatment including surgery.

Methods

Consecutive patients evaluated at three centers between 2000 and 2013 with histologically confirmed and surgically resected SCLC were retrospectively analyzed. NLR and PLR at diagnosis was used to categorize patients into “high” and “low” groups based on receiver operating curve analysis. Univariate and multivariate analyses were used to evaluate the impact of clinical and pathological characteristics on outcome.

Results

There were a total of 189 patients with a median age of 58 years, and the majority had stage I or II disease. We found a significant correlation between NLR and tumor stage (p = 0.007) and age (p = 0.038). Low NLR (LNLR) was associated with significantly longer overall survival, while PLR had no prognostic impact. There were significant associations between NLR and PLR but not with gender, vascular involvement, tumor necrosis, peritumoral inflammation, or tumor grade.

Conclusion

Pre-operative LNLR may be a favorable prognostic factor in stage I–II SCLCs. PLR is not prognostic in this population. LNLR is easy to assess and can be integrated into routine clinical practice. Further prospective studies are needed to confirm these observations.

Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer

Background

The neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) are representative blood markers of systemic inflammatory responses. However, the clinical significance of the combination of these markers is unclear. This study aimed to investigate the NLR and PLR in patients with advanced gastric cancer treated with chemotherapy and assess the clinical utility of a new blood score combining the NLR and PLR (NLR-PLR score) as a predictor of tumor response and prognosis.

Methods

We retrospectively analyzed 175 patients with gastric cancer receiving chemotherapy or chemoradiotherapy. These patients were categorized into progressive disease (PD) and non-PD groups according to tumor response. The NLR and PLR before treatment were examined, and the cut-off values were determined. The NLR-PLR score ranged from 0 to 2 as follows: score of 2, high NLR (> 2.461) and high PLR (> 248.4); score of 1, either high NLR or high PLR; score of 0, neither high NLR nor high PLR.

Results

With regard to tumor response, 64 and 111 patients had PD and non-PD, respectively. The NLR-PLR score was significantly higher in patients with PD than in those with non-PD (p = 0.0009). The prognosis was significantly poorer in patients with a higher NLR-PLR score than in those with a lower NLR-PLR score (p <  0.0001). Multivariate analysis demonstrated that the NLR-PLR score was an independent prognostic factor for prediction of overall survival (p = 0.0392).

Conclusion

Low-cost stratification according to the NLR-PLR score might be a promising approach for predicting tumor response and prognosis in patients with advanced gastric cancer.

Platelet-lymphocyte and neutrophil-lymphocyte ratios are prognostic but not predictive of response to abiraterone acetate in metastatic castration-resistant prostate cancer

PURPOSE

Recently neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been reported to be inflammatory parameters that confer poorer outcome in metastatic castration-resistant prostate cancer (mCPRPC). However, these ratios have not been analyzed in patients treated with abiraterone acetate. We explored the relationship between different values of PLR and NLR and survival in mCPRCP treated with abiraterone and their possible relation with a prostate specific antigen (PSA) response.

METHODS

We retrospectively analyzed 101 patients with mCRPC treated with abiraterone from January of 2012 to November of 2015 in two different hospitals. A cut-off value of 5 for NLR and 150 for PLR were used to compare survival by Kaplan-Meier method. Moreover, an association between these cut-off values and the PSA response was analyzed by a χ ² test.

RESULTS

In the case of NLR, the median DFS were 12, 1 months for NLR <5 and 7 months for NLR ≥5, p = 0.061. The median OS were 23.9 months for NLR <5 and 16.3 months for NLR ≥5, p = 0.046. In the case of PLR, the median DFS were 11.8 months for PLR <150 and 10.6 months for PLR ≥150, p = 0.549. The median OS were 27.4 months for PLR <150 and 15.9 months for PLR ≥150, p = 0.005. It was not observed a correlation between the different cut-off values of PLR or NLR and a PSA response ≥25% (p = 0.31).

CONCLUSIONS

It is shown a better prognostic relationship between PLR and NLR low values and OS that is statistically significant in mCPRC patients treated with abiraterone. Furthermore, it was not shown a relation between PLR and NLR values and PSA response.

Preoperative platelet-lymphocyte ratio is an independent prognostic marker and superior to carcinoembryonic antigen in colorectal peritoneal carcinomatosis patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

OBJECTIVE

The aim of this study was to examine the prognostic significance of preoperative inflammatory-based indices, platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and carcinoembryonic antigen (CEA) in predicting overall survival (OS) in patients with colorectal peritoneal carcinomatosis (CPC) treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

METHODS

Sixty patients with pathologically confirmed CPC treated with CRS and HIPEC between 2003 and 2015 were included. Levels of preoperative PLR, NLR, and CEA were recorded. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS.

RESULTS

Median OS was 36 months (95% CI, 26.6-45.4) and 5-year OS was 40.5% (95% CI, 27.3-51.6%). Preoperative PLR (p = 0.034) and CEA (p = 0.036) were found to be significant prognostic markers of OS, whereas NLR did not affect OS. PLR remained significant on multivariate analysis (hazard ratio, 1.035; 95% CI, 1.027-1.043; p < 0.001).

CONCLUSION

Our study indicates that preoperative PLR may be used as a prognostic marker in CPC patients undergoing CRS and HIPEC and could be useful in the preoperative setting when selecting patients for surgery. The subset of patients with PLR > 300 have a median OS of 5 months (95% CI, 0-24.6 months), indicating that CRS and HIPEC may not be superior to systemic chemotherapy in this subset of patients.

Relationships of neutrophil-lymphocyte and platelet-lymphocyte ratios with the severity of major depression

We aimed to evaluate the neutrophil-lymphocyte (NLR) and platelet-lymphocyte (PLR) ratios of inpatients and outpatients suffering from different levels of major depression. In total, 100 inpatients and 60 patients treated at an outpatient clinic were included the study. The presence of mood and anxiety disorders was identified with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version, and the Hamilton Depression Rating Scale was used to assess the severity of major depression (MD). Inpatients and outpatients with MD did not differ in NLR or PLR. The PLRs of patients who had severe major depression with psychotic features were higher than those of patients with other types of depression, but no differences in NLRs were detected across types of depression. The PLRs were higher in patients with severe levels of major depression with psychotic features than in other patients. This parameter may be more predictive than is NLR for assessing the prognosis of major depression.

Associations between sleep quality and inflammatory markers in patients with schizophrenia

Sleep disorder is a risk factor for several systemic inflammation-related diseases and there are extensive data showing that schizophrenia is associated with chronic low-grade systemic inflammation. This study investigated the associations between sleep quality and inflammatory markers in patients with schizophrenia, which has not been examined before. Sleep quality (total sleep time, sleep efficiency, sleep onset latency, total activity counts, wake after sleep onset, number of awakening, and average length of awakening) was measured using actigraphy in 199 schizophrenia inpatients. The state of inflammation was measured using blood concentration of white blood cells (WBC) and neutrophils, together with neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). The results showed that total sleep time was negatively associated with NLR and PLR, and sleep efficiency was negatively associated with neutrophil counts and NLR. Sleep onset latency, total activity counts, wake after sleep onset, and number of awakening were positively associated with WBC and neutrophil counts. The average length of awakening was positively associated with NLR and PLR. This is the first report to suggest that improving sleep quality may modulate the state of inflammation in patients with schizophrenia.

Prognostic significance of platelet-lymphocyte ratio in patients receiving first-line tyrosine kinase inhibitors for metastatic renal cell cancer

BACKGROUND

The platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) have been reported as prognostic factors in various cancers, but their roles in metastatic renal cell cancer (mRCC) remain unclear. We investigated the significance of PLR and NLR, along with that of established prognostic factors, in mRCC patients receiving first-line tyrosine kinase inhibitors (TKI).

METHODS

Data obtained from 63 mRCC patients who received first-line TKI between 2007 and 2013 were evaluated retrospectively. The association of PLR, NLR, and established prognostic factors with progression-free survival (PFS) and overall survival (OS) was analyzed using the Kaplan-Meier method. The influence of independent prognostic factors on survival was determined using multivariable Cox regression analysis.

RESULTS

High NLR (>3.6) and PLR (>150) were related to shorter PFS (p = 0.001) and OS (p = 0.001). The presence of brain metastases [hazard ratio (HR) 4.94, 95% CI 1.75-13.9; p = 0.002] and high PLR (>150, HR 13.1, 95% CI 5.14-33.2; p = 0.001) were independently associated with PFS, and Eastern Cooperative Oncology Group Performance status ≥2 (HR 3.60, 95% CI 1.39-9.31; p = 0.008), lymph node metastasis (HR 2.76, 95% CI 1.11-6.86; p = 0.029), brain metastasis (HR 9.39, 95% CI 2.74-32.1; p = 0.001), and high PLR (>150, HR 16.1, 95% CI 4.41-58.4; p = 0.001) with OS.

CONCLUSIONS

High PLR was associated with shorter survival of mRCC patients receiving first-line TKI. The PLR may be an effective independent prognostic factor in this setting.

A Systematic Review of the Prognostic Role of Hematologic Scoring Systems in Patients With Renal Cell Carcinoma Undergoing Nephrectomy With Curative Intent

The objective is to evaluate the prognostic benefit of the Glasgow Prognostic Score (GPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and Prognostic Nutrition Index (PNI) in patients with localized renal cell carcinoma undergoing nephrectomy with curative intent. Embase and MEDLINE databases were searched for all publications before April 2015. Duplicates were excluded, and inclusion/exclusion criteria were applied to all abstracts; of those remaining, full articles were obtained and inclusion/exclusion criteria were again applied, and the remaining articles were included and critically appraised. Eight articles were included in this review. Three articles were included for GPS. Outcomes included recurrence-free survival, cancer-specific survival (CSS), and overall survival (OS). All articles demonstrated better prognosis associated with a lower GPS on multivariate analysis: 1-year recurrence-free survival hazard ratio (HR), 7.0 (P = .001); CSS HR, 6.7 to 8.6 (P < .001); and OS HR 4.2 (P < .001). Four articles were included for NLR. All articles demonstrated elevated NLR to be associated with a poorer prognosis. Two articles demonstrated elevated NLR to be associated with a lower progression-free survival. One article demonstrated elevated NLR to be associated with a lower CSS (HR, 1.02, P = .009), and 2 articles demonstrated elevated NLR to be associated with a lower OS (HR, 1.02-1.6). No articles were included for PLR, and only 1 article was identified for PNI. There may be a role for modified GPS and NLR in patients with renal cell carcinoma undergoing nephrectomy with curative intent. Evidence for PLR and PNI is minimal.

Clinical significance of preoperative neutrophil-lymphocyte vs platelet-lymphocyte ratio in primary operable patients with non-small cell lung cancer

BACKGROUND

Our aim was to determinate the prognostic value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in primary operable patients with non-small cell lung cancer (NSCLC).

METHODS

Six hundred seventy-eight NSCLC patients were enrolled in this study. The prognostic significance of both markers was determined by both univariate and multivariate Cox survival analysis. The cut-off value for NLR and PLR was selected by using receiver operating characteristic curve analysis.

RESULTS

Multivariate analysis showed that NLR was an independent prognostic factor for disease-free survival (hazard ratio = 1.593, 95% confidence interval [CI] 1.277 to 1.988, P < .001) and overall survival (hazard ratio = 1.624, 95% CI 1.304 to 2.022, P < .001). The area under the curve was .640 (95% CI .599 to .682, P < .001) for NLR and .547 (95% CI .503 to .590, P = .036) for PLR, indicating that NLR was superior to PLR as a predictive factor in primary operable NSCLC patients.

CONCLUSIONS

Preoperative NLR represents a significant independent prognostic indicator in primary operable NSCLC patients. Our results also demonstrate that high-risk patients based on the NLR do not benefit from adjuvant chemotherapy.