Neutrophil-lymphocyte-ratios and lymphocyte-monocyte-ratios as prognostic biomarkers for vulvar cancer (160)

Abstract

Objectives: Neutrophil to lymphocyte ratios (NLR) and lymphocyte to monocyte ratios (LMR) have been identified as potential biomarkers for prognosis in multiple solid tumors and may be indicative of systemic inflammation and tumor-promoting immune responses, with high NLR and low LMR indicating poorer prognostic outlook. We sought to examine whether the relationships between NLR and LMR near diagnosis and overall survival identified in other solid tumors extend to those diagnosed with vulvar cancer. Methods: This retrospective study included 109 patients treated for vulvar cancer at the University of Minnesota Gynecologic Oncology clinics between 2009 and 2020 with available laboratory measurements within 60 days of diagnosis. Clinical data were abstracted from electronic health records. Laboratory measurements of interest included absolute neutrophils, lymphocytes, and monocytes. NLR and LMR were defined as absolute neutrophils or absolute lymphocytes divided by absolute lymphocytes and monocytes, respectively. Multivariable Cox proportional hazard models were used to examine the associations between NLR and LMR with overall risk of death, computing hazard ratios (HR) with 95% confidence intervals (CI), adjusting for age, histology, and FIGO stage. Results: Patients included in this analysis were 66.5 (±12.7) years old on average and primarily non-Hispanic Whites (95.1%). The majority of patients were diagnosed with squamous cell carcinoma (89.9%), with 35.6% being diagnosed at an advanced stage (III/IV). Most patients underwent surgical resection (76.2%), and less than half received chemotherapy (33.0%) and/or radiation (43.1%). The median NLR and LMR values observed in our cohort were 2.78 (0.21-41.0) and 2.86 (0.78-66.4), respectively. In multivariable analysis, each unit increase in NLR was associated with a 16% increased risk of dying (HR: 1.16; 95% CI: 1.08-1.26, p=0.0001). Additionally, each unit increase in LMR was associated with a 21% decreased risk of dying, though this association was not statistically significant (HR: 0.79; 95% CI: 0.60-1.04, p=0.09). Conclusions: Our study demonstrates the potential prognostic association between NLR and overall survival among patients diagnosed with cancer of the vulva. Future research is necessary to reproduce these findings. Identification of subgroups at high risk for poor outcomes at diagnosis could inform treatment decisions and surveillance. Objectives: Neutrophil to lymphocyte ratios (NLR) and lymphocyte to monocyte ratios (LMR) have been identified as potential biomarkers for prognosis in multiple solid tumors and may be indicative of systemic inflammation and tumor-promoting immune responses, with high NLR and low LMR indicating poorer prognostic outlook. We sought to examine whether the relationships between NLR and LMR near diagnosis and overall survival identified in other solid tumors extend to those diagnosed with vulvar cancer. Methods: This retrospective study included 109 patients treated for vulvar cancer at the University of Minnesota Gynecologic Oncology clinics between 2009 and 2020 with available laboratory measurements within 60 days of diagnosis. Clinical data were abstracted from electronic health records. Laboratory measurements of interest included absolute neutrophils, lymphocytes, and monocytes. NLR and LMR were defined as absolute neutrophils or absolute lymphocytes divided by absolute lymphocytes and monocytes, respectively. Multivariable Cox proportional hazard models were used to examine the associations between NLR and LMR with overall risk of death, computing hazard ratios (HR) with 95% confidence intervals (CI), adjusting for age, histology, and FIGO stage. Results: Patients included in this analysis were 66.5 (±12.7) years old on average and primarily non-Hispanic Whites (95.1%). The majority of patients were diagnosed with squamous cell carcinoma (89.9%), with 35.6% being diagnosed at an advanced stage (III/IV). Most patients underwent surgical resection (76.2%), and less than half received chemotherapy (33.0%) and/or radiation (43.1%). The median NLR and LMR values observed in our cohort were 2.78 (0.21-41.0) and 2.86 (0.78-66.4), respectively. In multivariable analysis, each unit increase in NLR was associated with a 16% increased risk of dying (HR: 1.16; 95% CI: 1.08-1.26, p=0.0001). Additionally, each unit increase in LMR was associated with a 21% decreased risk of dying, though this association was not statistically significant (HR: 0.79; 95% CI: 0.60-1.04, p=0.09). Conclusions: Our study demonstrates the potential prognostic association between NLR and overall survival among patients diagnosed with cancer of the vulva. Future research is necessary to reproduce these findings. Identification of subgroups at high risk for poor outcomes at diagnosis could inform treatment decisions and surveillance.