Abstract
BackgroundInflammation can promote tumor growth, invasion, angiogenesis and even metastasis. Inflammatory markers have been identified as prognostic indicators in various malignances. This study compared the usefulness of platelet-lymphocyte ratio (PLR) with that of neutrophil-lymphocyte ratio (NLR) for predicting outcomes of patients who underwent radical resection for soft tissue sarcoma (STS).MethodsWe included 222 STS patients in this retrospective study. Kaplan-Meier curves and multivariate Cox proportional models were used to calculate overall survival (OS) and disease free survival (DFS).ResultsIn univariate analysis, elevated PLR and NLR were both significantly associated with decreased OS. In multivariate analysis, PLR (HR: 2.60; 95 % CI: 1.17–5.74, P = 0.019) but not NLR was still identified as independent predictors of outcome. Median OS was 62 and 76 months for the high PLR and low PLR groups, respectively. High PLR and NLR were both significantly associated with shorter DFS in univariate analysis, with median DFS of 18 and 57 months in the high PLR and low PLR groups. In multivariate analysis, elevated PLR (HR: 1.77; 95 % CI: 1.05–2.97, P = 0.032) was also related to decreased DFS.DiscussionOur findings provide a new and valuable clue for diagnosing and monitoring STS. Prediction of disease progression is not only determined by the use of clinical or histopathological factors including tumor grade, tumor size, and tumor site but also by host-response factors such as performance status, weight loss, and systemic inflammatory response. They also significantly affect clinical outcomes. Thus, PLR can be used to enhance clinical prognostication. Furthermore, the PLR can be assessed from peripheral blood tests that are routinely available without any other complicated expenditure, thus providing lower cost and greater convenience for the prognostication.ConclusionElevated preoperative PLR as an independent prognostic factor is superior to NLR in predicting clinical outcome in patients with STS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1654-6) contains supplementary material, which is available to authorized users.
Highlights
Inflammation can promote tumor growth, invasion, angiogenesis and even metastasis
Elevated preoperative platelet-lymphocyte ratio (PLR) as an independent prognostic factor is superior to neutrophil-lymphocyte ratio (NLR) in predicting clinical outcome in patients with soft tissue sarcoma (STS)
Relationships between PLR or NLR and other clinical characteristics Elevated PLR was significantly associated with female sex, poor performance status, diabetes mellitus, smoking history, deep tumor depth, high tumor grade and large tumor size; Elevated NLR was significantly associated with poor performance status, deep tumor depth, high tumor grade, large tumor size, deep tumor site and high American Joint Committee on Cancer (AJCC) stage (Table 2)
Summary
Inflammation can promote tumor growth, invasion, angiogenesis and even metastasis. Inflammatory markers have been identified as prognostic indicators in various malignances. This study compared the usefulness of platelet-lymphocyte ratio (PLR) with that of neutrophil-lymphocyte ratio (NLR) for predicting outcomes of patients who underwent radical resection for soft tissue sarcoma (STS). Primary treatments for STS include surgical resection with or without adjuvant radiation; the 5-year probability of local recurrence and metastasis remains high [2,3,4]. Methylated RASSF1A was significantly related with the risk of death for STS patients [6]; high serum osteopontin is correlated with poor prognosis in STS [7]; Brownhill et al have advocated use of the proliferation index (by detecting Ki-67) in a risk model of outcome for Ewing’s sarcoma [8].
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