Abstract
In cancer patients, a high pre-treatment neutrophil-to-lymphocyte ratio (NLR) is associated with poorer survival outcomes. Significant variation in the magnitude of this association has been observed between studies, but sources of this variation are poorly understood. Here, we explore differences in the prognostic potential of NLR between patient subgroups stratified by demographic and clinical characteristics using a retrospective cohort of 5,363 patients treated at Moffitt Cancer Center (Tampa, FL). We identify patients for whom NLR has maximum prognostic potential via adjusted hazard ratios (HRs) calculated using multivariable Cox proportional hazards models and area under the curve analysis. NLR demonstrates stronger associations (HRs > 2) with survival among African-American patients, patients receiving radiation therapy, stage IV patients, and melanoma patients when compared with the overall study population (HR = 1.58). Sensitivity and specificity of NLR as a prognostic marker are also higher in these patient subgroups, and increase further with combinations of multiple “high-risk” demographic or clinical characteristics. In summary, NLR may have greater prognostic value in patients with certain demographic and clinical features. Future prospective studies could validate this hypothesis, after further characterization of populations in which NLR has maximum prognostic potential and the identification of meaningful thresholds for risk stratification.
Highlights
In cancer patients, a high pre-treatment neutrophil-to-lymphocyte ratio (NLR) is associated with poorer survival outcomes
Neutrophilia is a common feature of cancer-associated chronic inflammation; neutrophils are an integral part of the innate immune response, both tumor-promoting and immune-suppressive roles of neutrophil subpopulations have been documented[9,10,11,12,13]
Many previous studies have examined the prognostic value of pre-treatment NLR5,6, and strong associations have consistently been demonstrated between high NLR and poor patient outcomes across many cancer types
Summary
A high pre-treatment neutrophil-to-lymphocyte ratio (NLR) is associated with poorer survival outcomes. Descriptive statistics including median, quartiles and range characterize baseline NLR in subgroups of patients stratified by clinical and demographic characteristics of the patient (cancer type, disease stage, age, sex, race).
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