Abstract
The objective of this study was to investigate the prognostic value of pretreatment NLR and its dynamic changes responsive to palliative care in advanced cancer patients. The study was retrospectively assessed in 378 consecutive advanced cancer patients receiving palliative care, and in an extended follow-up study of 106 of those patients. The cutoff value of pretreatment NLR was determined to be 3.0. In the 378 advanced cancer patients, 89 had pretreatment NLR ≤ 3, and 289 had an NLR > 3. Univariate and multivariate analyses showed that tumor stage, palliative care, albumin level, and pretreatment NLR (HR: 1.514, 95% CI: 1.125~2.038, P = 0.006) were independent prognostic indicators of OS. Moreover, in the follow-up cohort of 106 readmitted patients, 43 patients achieved a decreased NLR after palliative care, while the remaining 63 patients showed an increased NLR. Univariate and multivariate analyses showed that an increase in NLR was significantly associated with a poor survival (HR: 2.506, 95% CI: 1.474~4.261, P = 0.001). In conclusion, pretreatment NLR and changes in NLR independently predicted OS in advanced cancer patients undergoing palliative care. Incorporating NLR into clinical practice may better inform the prognosis and therapy decisions of advanced cancer patients in palliative settings.
Highlights
Cancer-related inflammation has been recognized as one of the hallmarks of cancer, with a vital role in the modulation of the tumor microenvironment[9]
After controlling for tumor stage, primary tumor site, palliative care, nutritional status, and albumin level, neutrophil/lymphocyte ratio (NLR) (HNLR vs. low NLR (LNLR)) remained significantly (HR: 1.514, 95% confidence intervals (95% CIs): 1.125~2.038, P = 0.006) associated with Overall survival (OS) (Table 3)
This study demonstrated that the pretreatment NLR was significantly and negatively associated with overall survival in advanced cancer patients
Summary
Cancer-related inflammation has been recognized as one of the hallmarks of cancer, with a vital role in the modulation of the tumor microenvironment[9]. Multiple lines of evidence indicate that inflammation plays an important role in carcinogenesis and tumor progression by fostering cancer cell proliferation, promoting tumor angiogenesis, invasiveness and metastasis, and affecting tumor response to systemic therapies[10]. The neutrophil/lymphocyte ratio (NLR), a marker of host inflammation, has been found to be an independent prognostic factor of adverse outcomes in various cancers, such as gastrointestinal cancer, liver cancer, renal cancer, lung cancer, and ovarian cancer[13]. Studies on the association between NLR and survival in advanced cancer patients in palliative settings are limited. This study was designed to investigate the clinical influence of elevated NLR levels on survival in advanced cancer patients in palliative settings, and to investigate the value of changes in NLR (increased or decreased) after palliative care as a prognostic indicator of OS
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