An elevated neutrophil-to-lymphocyte ratio associates with weight loss and cachexia in cancer

Tyler Barker,Terence Rhodes,Gail Fulde,Bryce Moulton,Lincoln D Nadauld

doi:10.1038/s41598-020-64282-z

Tyler Barker, Terence Rhodes + Show 3 more

Open Access

https://doi.org/10.1038/s41598-020-64282-z

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Abstract

Systemic inflammation is present during and serves as a diagnostic tool for cancer-associated cachexia and is detrimental to serum 25-hydroxyvitamin D (25(OH)D) concentrations in non-cancer conditions. The neutrophil-to-lymphocyte ratio (NLR) is a desirable measure of systemic inflammation because it is easily calculated from a routine complete blood cell count with differentials. We sought to determine if an elevation in the NLR associates with greater weight loss, cachexia, and lower serum 25-hydroxyvitamin D (25(OH)D) concentrations in patients with advanced cancer. Advanced colon, lung, and prostate cancer patients (stages III/IV; n = 50) were retrospectively studied and separated into one of two groups: 1) Above (n = 25) or 2) Below (n = 25) the median NLR of 3.15 determined at diagnosis. Around the time of diagnosis, serum 25(OH)D and body weight were assessed, while body weight was assessed again at a later date. Weight loss and cachexia were significantly (both p < 0.05) greater and there was a trend (p < 0.10) for lower serum 25(OH)D concentrations in the Above group. We conclude that an elevation in the NLR associates with greater weight loss and cachexia, and potentially, a lower serum 25(OH)D concentration in patients with advanced colon, lung, or prostate cancer.

Highlights

Systemic inflammation is present during and serves as a diagnostic tool for cancer-associated cachexia and is detrimental to serum 25-hydroxyvitamin D (25(OH)D) concentrations in non-cancer conditions
The neutrophil-to-lymphocyte ratio (NLR) is an attractive biomarker of systemic inflammation because it is calculated from the absolute neutrophil and lymphocyte counts obtained from a routine complete blood cell count with differentials
Serum 25(OH)D concentrations tended (p < 0.10) to be lower in the Above compared to the Below group (Fig. 1B), while vitamin D status classifications were not significantly different between NLR groups (Table 1)

Summary

Introduction

Systemic inflammation is present during and serves as a diagnostic tool for cancer-associated cachexia and is detrimental to serum 25-hydroxyvitamin D (25(OH)D) concentrations in non-cancer conditions. The neutrophil-to-lymphocyte ratio (NLR) is an attractive biomarker of systemic inflammation because it is calculated from the absolute neutrophil and lymphocyte counts obtained from a routine complete blood cell count with differentials This readily available biomarker of systemic inflammation predicts survival independent of tumor or disease stage in various cancers[8] and associates with cancer-related cachexia[9]. Low serum 25(OH)D increased systemic inflammation in patients with prostate cancer[24], it is unknown if systemic inflammation associates with low serum 25(OH)D concentrations in patients www.nature.com/scientificreports n (m/f) Disease site, n colon lung prostate Neutrophils, K/μL Lymphocytes, K/μL NLR age, y height, cm Body weight, kg first second Cachexic, n (%)* no yes days between body weight measures BMI, kg/m2 first second Deceased, n (%)b Overall survival, db Vitamin D status, n (%) Deficient Insufficient Sufficient. Identifying the detrimental influence of systemic inflammation on serum 25(OH)D concentrations could reveal a new therapeutic target intended to protect against low vitamin D and possibly poor outcomes (i.e., disease progression and mortality) associated with low vitamin D in cancer

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