The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Metastatic Testicular Cancer.

Eitan Amir,Michael Jewett,Lynn Anson-Cartwright,Igor Stukalin,Daniel Y C Heng,Aaron R Hansen,Robert J Hamilton,Jeremy Lewin,Padraig Warde,Peter Chung,Philippe L Bedard,Arnoud J Templeton,Domen Ribnikar

doi:10.3390/curroncol28010014

Abstract

We investigated the prognostic utility of pre-chemotherapy neutrophil-to-lymphocyte ratio (NLR) in patients with metastatic germ cell tumors (GCTs) undergoing first-line chemotherapy. We utilized two institutional databases to analyze the pretreatment-derived NLR (dNLR). Predictive accuracy was evaluated using the Cox proportional hazard model adjusted for the international germ cell cancer collaborative group (IGCCCG) risk classification. Discriminatory accuracy was evaluated by determining the area under the receiver operating characteristic curve (AUROC). In total, 569 of 690 patients had available dNLR (IGCCCG: good, 64%; intermediate, 21%; poor, 16%). The 5-year and 10-year overall survivals (OSs) for good, intermediate, and poor risk groups were 96.2%, 92.8%, and 62.7% and 93.9%, 90.3%, and 62.7%, respectively. A dNLR of 2 provided the best discriminatory accuracy with an AUROC of 0.58 (95% CI: 0.52–0.65, p = 0.01) for progression-free survival (PFS), whereas for OS, a dNLR of 3 provided the best discriminatory accuracy with an AUROC of 0.62 (95% CI: 0.53–0.70, p < 0.01). A dNLR > 2 was associated with a hazard ratio (HR) of 1.99 (95% CI: 1.27–3.12, p < 0.01) for PFS, which lost its effect after adjustment for IGCCCG (HR: 1.44, 95% CI: 0.90–2.30, p = 0.13). For OS, a dNLR >3 was associated with an HR of 3.00 (95% CI: 1.79–5.01, p < 0.01), but lost its effect after adjustment for IGCCCG. Systemic inflammation plays a role in metastatic GCT, but its prognostic utility beyond established algorithms is limited. The general prognostic value of NLR can be seen across a number of tumors, although the consistency and magnitude of the effect differ according to cancer type, disease stage, and treatment received. We identified that an elevated NLR was associated with an adverse PFS and OS, but not independent of the IGCCCG risk classification. dNLRs >2 and >3 were associated with an adverse PFS and OS, respectively, in patients with metastatic GCT receiving first-line chemotherapy, but not independent of the IGCCCG risk classification.

Highlights

Since the development of the international germ cell cancer collaborative group (IGCCCG) classification, patients with metastatic germ cell tumors (GCTs) are traditionally treated with three or four cycles of bleomycin, etoposide, and cisplatin (BEP) in good or intermediate/poor risk disease, respectively [1]
Absolute white blood count (WBC; 109/l) and neutrophil count (109/l) before chemotherapy were used to calculate the derived neutrophil-to-lymphocyte ratio (NLR) [15]
A total of 690 patients with metastatic GCT treated with first-line chemotherapy were identified (475 at PM and 215 at Tom Baker Cancer Centre (TBCC))

Summary

Introduction

Since the development of the international germ cell cancer collaborative group (IGCCCG) classification, patients with metastatic germ cell tumors (GCTs) are traditionally treated with three or four cycles of bleomycin, etoposide, and cisplatin (BEP) in good or intermediate/poor risk disease, respectively [1]. This risk-stratified approach utilizing clinical parameters (site of primary tumor, location of metastatic lesions, histological subgroup, and degree of tumor marker elevation) was initially reported to have 5-year survival rates of 91%, 79%, and 48% for good, intermediate, and poor risk groupings, respectively, and is the classification scheme commonly used in patient selection for GCT clinical trials. The real prognostic significance of the IGCCCG classification is being challenged, and attempts to create improved risk stratification are underway [2,3,9,10]

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