Abstract
BackgroundPeripheral blood-derived inflammation-based markers, such as Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Fibrinogen have been identified as prognostic markers in various solid malignancies. Here we aimed to investigate the prognostic and diagnostic impact of NLR, PLR, and Fibrinogen in patients with thymic epithelial tumors (TETs).ResultsPretreatment Fibrinogen serum concentrations, NLRs and PLRs were highest in patients with TCs and advanced tumor stages. High pretreatment Fibrinogen serum concentration (≥452.5 mg/dL) was significantly associated with worse cause specific survival (CSS; p = 0.001) and freedom from recurrence (FFR; p = 0.043), high NLR (≥4.0) with worse FFR (p = 0.008), and high PLR (≥136.5) with worse CSS (p = 0.032). Longitudinal analysis revealed that compared to patients without tumor recurrence, patients with tumor recurrence had significantly higher NLR (11.8 ± 4.0 vs. 4.70 ± 0.5; p = 0.001) and PLR (410.8 ± 149.1 vs. 228.3 ± 23.7; p = 0.031).ConclusionOverall, Fibrinogen serum concentrations, NLRs, and PLRs were associated with higher tumor stage, more aggressive tumor behavior, recurrence, and worse outcome. Prospective multicenter studies of the diagnostic and prognostic potential of Fibrinogen, NLR, and PLR are warranted.MethodsThis retrospective analysis included 122 patients with TETs who underwent surgical resection between 1999-2015. Fibrinogen serum concentrations, NLRs, and PLRs were measured in patients preoperatively, postoperatively, and later during follow-up. These markers were analyzed for association with several clinical variables, including tumor stage, tumor subtype, FFR, and CSS and to evaluate their prognostic and diagnostic impact for detecting tumor recurrence.
Highlights
Thymic epithelial tumors (TETs) are intrathoracic malignancies that, rare, represent the most common anterior mediastinal tumors in adults
Overall, Fibrinogen serum concentrations, Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) were associated with higher tumor stage, more aggressive tumor behavior, recurrence, and worse outcome
We recently demonstrated that increased serum concentrations of C-reactive protein (CRP), heat shock proteins (HSPs), and high-mobility group box-1 (HMGB1) were associated with advanced tumor stage and worse outcome [7, 12, 13]
Summary
Thymic epithelial tumors (TETs) are intrathoracic malignancies that, rare, represent the most common anterior mediastinal tumors in adults. The Masaoka-Koga staging system has been used to pathologically grade TETs as stage I to IV depending on their level of invasiveness [2]. The International Thymic Malignancy Interest Group (ITMIG) recently proposed the use of the eighth edition of the TNM staging classification system for TETs by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC), which might replace the currently accepted Masaoka-Koga staging system [3,4,5,6]. We aimed to investigate the prognostic and diagnostic impact of NLR, PLR, and Fibrinogen in patients with thymic epithelial tumors (TETs)
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