Abstract
BackgroundSystemic inflammation has long been related with adverse survival outcomes in cancer patients, and its biomarkers, such as the Neutrophil-to-Lymphocyte Ratio (NLR), are recognized as poor prognostic indicators. However, the role of eosinophils in this field has been largely overlooked. Here, we describe two new pre-treatment biomarkers, expressed as Eosinophil-to-Lymphocytes Ratio (ELR) and Eosinophil*Neutrophil-to-Lymphocytes ratio (ENLR), and we analyse their impact on prognosis of endometrial cancer (EC) patients.MethodsA total of 163 consecutive patients diagnosed with EC and treated with postoperative radiotherapy +/− chemotherapy in our institution from January 2011 to December 2015 were evaluated. The cohort was divided in two groups applying the cut-off value of 0.1 and 0.5 according to ROC curve for pre-treatment ELR and ENLR, respectively. After patients’ stratification according to the ESMO-ESGO-ESTRO modified risk assessment, subgroup analyses were conducted.ResultsHigher values of ELR and ENLR were associated with worse OS (p = 0.004 and p = 0.010, respectively). On univariate analysis, the factors associated with shorter OS were ELR ≥ 0.1 (HR = 2.9, p = 0.017), ENLR ≥ 0.5 (HR = 3.0, p = 0.015), advanced FIGO stage (HR = 3.4, p = 0.007), endometrioid histology (HR = 0.26, p = 0.003) and ESMO-ESGO-ESTRO high-risk (HR = 10.2, p = 0.023). On multivariate Cox regression, higher ELR and ENLR were independently associated with a worse outcome adjusted for the standardly applied prognostic factors.ConclusionsIncreased values of ELR and ENLR portend worse OS in EC, especially in patients classified by the ESMO-ESGO-ESTRO guidelines as a high-risk group. To our best knowledge, this is the first report describing eosinophils-related ratios as prognostic biomarkers in malignant tumours.
Highlights
Systemic inflammation has long been related with adverse survival outcomes in cancer patients, and its biomarkers, such as the Neutrophil-to-Lymphocyte Ratio (NLR), are recognized as poor prognostic indicators
The impact of other factors, such as systemic inflammation, is gaining importance as an indicator of poor prognostic in cancer patients [6, 7]. The interest of this host-dependent response, expressed through prognostic ratios composed of circulating white blood cells, lies mainly on circulating neutrophils, which have been studied as neutrophil-to-lymphocytes ratio (NLR) [8, 9]
Some reports dating from the 1950s already suggested the role of circulating eosinophils as a biomarker of tumour persistence or recurrence after radiotherapy, recent studies confirm that eosinophils act as an important modulator and effector of both innate and adaptive immune response [11,12,13,14,15]
Summary
Systemic inflammation has long been related with adverse survival outcomes in cancer patients, and its biomarkers, such as the Neutrophil-to-Lymphocyte Ratio (NLR), are recognized as poor prognostic indicators. The impact of other factors, such as systemic inflammation, is gaining importance as an indicator of poor prognostic in cancer patients [6, 7]. The interest of this host-dependent response, expressed through prognostic ratios composed of circulating white blood cells, lies mainly on circulating neutrophils, which have been studied as neutrophil-to-lymphocytes ratio (NLR) [8, 9]. A high level of blood eosinophils was associated with better survival in metastatic melanoma [20]
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