Abstract
BackgroundDetermining prognosis in advanced cancer is of key importance. Various prognostic scores have been developed. However, they are often very complex. In this study, we evaluated the feasibility of neutrophil/lymphocyte ratio (NLR) as an index to estimate survival in terminal cancer patients.MethodsNLR was calculated retrospectively based on blood tests performed at 3 months, 2 months, 4 weeks, 3 weeks, 2 weeks, 1 week, and within 3 days before death in 160 cancer patients (82 men, 78 women; age range, 33–99 years; mean age, 69.8 years).ResultsNLR increased significantly with time (P < 0.0001). Mean NLR was significantly higher in patients who died within 4 weeks (29.82) than in those who lived more than 4 weeks (6.15). The NLR cutoff point was set at 9.21 according to receiver operating characteristic curve analysis (area under the curve, 0.82; 95 % confidence interval, 0.79–0.85). We inferred that life expectancy would be <4 weeks when NLR >9.21. The sensitivity, specificity, positive predictive value, and negative predictive value were 65.6, 84.1, 90.6, and 51.1 %, respectively. The positive and negative likelihood ratios were 4.125 and 0.409, respectively.ConclusionsNLR appears to be a useful and simple parameter to predict the clinical outcomes of patients with terminal cancer.
Highlights
Determining prognosis in advanced cancer is of key importance
Neutrophil/lymphocyte ratio (NLR) is an immunological index commonly used in cancer therapy and diagnosis [6,7,8,9,10,11,12]
We assessed the predictive value of life expectancy
Summary
The average age of the patients (82 men, 78 women) was 69.8 years (age range, 33–99 years). The feasibility of using NLR was evaluated from 735 data points. The median NLR values were 3.83 at 3 months before death, 5.38 at 2 months, 8.53 at 4 weeks, 10.22 at 3 weeks, 11.48 at 2 weeks, 21.16 at 1 week, and 37.40 within 3 days (Table 2). NLR values increased significantly with time (P < 0.0001) (Fig. 1). The mean NLR value of patients who lived more than 4 weeks was 6.15 ± 5.86, while that of those who died within 4 weeks was 29.82 ± 44.19; a significant difference was observed between the two groups (P < 0.00000001) (Table 3). Using a cutoff point of NLR of 9.21, life expectancy was assumed to be
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