Elevated Platelet-lymphocyte Ratio Research Articles

Platelet to lymphocyte ratio in differentiation of benign and malignant thyroid nodules

Aim: Differentiation of thyroid nodules, either as benign or malignant, is a real diagnostic challenge. Inflammation has an important role in development of the malignancy. Therefore, inflammatory markers are associated with malignant thyroid nodules. Platelet /lymphocyte ratio (PLR) is also one of the novel inflammatory indices derived from hemogram tests. We hypothesized whether PLR was associated with malignant thyroid nodules. For this purpose, we compared PLR levels of the patients with benign thyroid nodules to the PLR of the subjects with malignant nodules. Methods: The subjects who visited outpatient internal medicine clinics of our institution with a diagnosis of thyroid nodule were enrolled to the present retrospective study. According to the examination of the fine needle aspiration cytology (FNAC) specimen of the nodules, patients grouped into benign or malignant nodule groups. PLR of groups were compared. Results: Median PLR values of the benign and malignant thyroid nodule groups were 106 (48-432) % and 119 (48-365) %, respectively (p=0.001). PLR value higher than 106% has 69% sensitivity and 51% specificity in detecting malignant nodules (AUC: 0.59, p=0.001, 95% CI: 0.54-0.65). PLR was positively correlated with TSH level (r=0.10, p=0.34). Conclusion: We suggest that elevated PLR could be an additional tool to differentiate malignant thyroid nodules from benign ones in supportive of sonography, scintigraphy and cytology.

Does inflammation play a role in the pathophysiology of tinnitus?

The present study aimed to investigate the potential of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) as prognostic markers in tinnitus patients at inflammatory process. This study consisted of 216 subjects (124 males and 92 females), Routine laboratory CBC test results were calculated in this study. All the patients were divided into three groups according to their hearing thresholds: a high frequency hearing loss-tinnitus group (HFHL-TN) consisted of 55 subjects, an hearing loss in all frequencies tinnitus group (AFHL-TN) consisted of 53 subjects and a normal hearing-tinnitus group (NH-TN) consisted of 51 subjects. The control group (CNT) included 57 age-and sex-matched healthy subjects. NLR, PLR and MPV were observed in the HFHL-TN group when compared to AFHL-TN, NH-TN and CNT group (P < 0.001). An increase in NLR was observed in the AFHL-TN group compared with the CNT group (P = 0.004). The PLR value of the HFHL-TN group was significantly higher than that of the AFHL-TN (P = 0.028) and NH-TN,CNTgroup (P < 0001). The PLR value of the HFHL-TN group was significantly higher than that of the AFHL-TN (p=0.028) and NH-TN, CNT group (P < 0001). MPV values in HFHL-TN group was slightly higher AFHL-TN group and significantly higher than NH-TN (P = 0.025) and CNT (P < 0.001) group. Our results confirm that elevated NLR, PLR and MPV values has been suggested to be a useful inflammatuar prognostic biomarker of tinnitus patients.

Prognostic Role of Peripheral Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) in Patients with Rectal Cancer Undergoing Neoadjuvant Chemoradiotherapy.

To investigate the predictive and prognostic role of pretreatment hematological parameters for tumor response and outcomes in locally advanced rectal cancer (LARC) patients undergoing surgery after neoadjuvant chemoradiotherapy (nCRT). From 2010 to 2016, 53 patients with LARC who underwent surgery following nCRT were analyzed. All hematological parameters were obtained from the initial blood tests performed before nCRT. The optimal cutoff values of significant hematological parameters for pathological tumor response (pTR), disease-free survival (DFS), and overall survival (OS) were determined using receiver operating characteristic (ROC) analysis. Patients have categorized into "good" and "poor" response groups according to their pathological results, and clinical-pathologic variables compared between the two groups. All survival analysis was calculated by the Kaplan-Meier method. Uni-multivariate analyses were performed using the Cox proportional hazard model. In the ROC analysis, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) for OS and absolute platelet count and PLR for DFS were found as significant prognostic factors. In multivariate analysis, surgical margin, ypN stage, and elevated PLR were significantly associated with OS, and likewise, high PLR was found as an independent poor prognostic factor for DFS. The 5-year OS and DFS rates were worse in patients with high PLR group (82.3 vs. 47.3% for OS, p = 0.018 and 88.2 vs. 51.3% for DFS, p = 0.002). Pretreatment high PLR is associated with worse OS and DFS in patients with rectal cancer. To use in daily practice, further studies are needed on its validation.

Impact of Colon Cancer Location on the Prognostic Significance of Nutritional Indexes and Inflammatory Markers.

The prognosis of colorectal cancer is reported to differ depending on the tumor site, and clinical differences depending on the site of occurrence have gained attention. The aim was to compare nutrition index and inflammatory markers according to the site of colon cancer. We retrospectively analyzed 272 cases of stage I-III colon cancer (55% males, 45% females). The clinical characteristics, nutrition index and inflammatory markers were compared between patients with right colon cancer (RCC, n=119) and those with left colon cancer (LCC, n=153), and the relapse-free survival was then compared. RCC was associated with older age (p=0.03), female gender (p=0.003), higher T stage (p=0.01), elevated platelet/lymphocyte ratio (PLR) (p=0.009), and elevated CONUT score (p=0.028). The prognostic values differed between RCC and LCC (RCC: CONUT score, p=0.04, LCC: PLR, p=0.02). RCC was associated with an elevated CONUT score and PLR. In RCC, the CONUT score was an independent recurrence factor, and in LCC, the PLR was an independent recurrence factor.

The importance of laboratory tests and Body Mass Index in the diagnosis of acute appendicitis.

&lt;b&gt;Background:&lt;/b&gt; Acute appendicitis is the most common cause of acute abdomen. Delay in diagnosis increases the mortality and morbidity. &lt;br&gt;&lt;b&gt;Aim: &lt;/b&gt;In this study, we aimed to investigate whether the body mass index is useful in diagnosis and whether the neutrophil /lymphocyte and platelet/lymphocyte ratios can help in determining the inflammation level of acute appendicitis. &lt;br&gt;&lt;b&gt;Meterial and Methods:&lt;/b&gt; Cases of appendectomy performed between June 2012 and December 2018 in our clinic were analyzed retrospectively. Based on the pathology results of the cases included in the study, 4 groups were formed, i.e.: Group 1 (initial stage), Group 2 (catarrhal stage), Group 3 (phlegmonous-gangrenous stage) and Group 4 (perforation). The study compared age, body mass index, leukocyte values, red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), platelet /lymphocyte ratio (PLR), and mean platelet volume (MPV) between groups. &lt;br&gt;&lt;b&gt; Results:&lt;/b&gt; 828 cases were included in the study. When compared between groups, the values of Group 3 and Group 4 were higher than those of Group 1 and Group 2 for PLR and NLR. There was no difference in RDW and MPV values in the blood. When Body Mass Index (BMI) was compared between groups, it was found to be significantly higher with increasing histopathological stage. &lt;br&gt;&lt;b&gt;Conclusion:&lt;/b&gt; In acute appendicitis, the blood leukocyte value, elevated PLR and NLR are helpful in diagnosis. We aimed to emphasize that the diagnosis of acute appendicitis is delayed in patients with a BMI above 30 and/or at age of over 40 years, with the perforation rate being determined more frequently.

Relationship between platelet/lymphocyte ratio and prognosis of patients with septic acute kidney injury: A pilot study.

Background:To explore the potential role of the platelet/lymphocyte ratio (PLR) as a prognostic marker in septic patients with acute kidney injury (AKI) and to provide theoretical evidence for the epidemiological study of the prognosis of patients with septic AKI in its early stage.Methods:A pilot study was conducted. A logistic regression analysis was conducted to screen the risk factors, and the selected factors were performed using multiple logistic regression analysis; a Receiver Operating Characteristic curve was used to determine the optimal cutoff value of the PLR and then to calculate the sensitivity and specificity of the PLR ratio.Results:Mechanical ventilation, platelet count, PLR, and arterial blood lactate concentration have a correlation with sepsis (p < 0.05). An elevated PLR is significantly associated with a worse prognosis of sepsis-induced AKI (higher mortality).Conclusion:The PLR might be an effective factor in predicting a worse prognosis of septic AKI patients.

Clinicopathological and prognostic significance of platelet-lymphocyte ratio (PLR) in gastric cancer: an updated meta-analysis

BackgroundPre-treatment PLR (platelet-lymphocyte ratio) was reported to be associated with the prognosis in gastric cancer (GC), but the results remain inconclusive. This meta-analysis aimed to investigate the prognostic potential of the pre-treatment PLR in gastric cancer.MethodsWe performed a systematic literature search in PubMed, Embase, and the Cochrane Library to identify eligible publications. The hazard ratio (HR)/odds ratio (OR) and its 95% confidence (CI) of survival outcomes and clinicopathological parameters were calculated.ResultsA total of 49 studies (51 cohorts), collecting data from 28,929 GC patients, were included in the final analysis. The pooled results demonstrated that the elevated pre-treatment PLR was significantly associated with poor overall survival (OS) (HR 1.37, 95% CI 1.26–1.49, p < 0.001; I2 = 79.90%, Ph < 0.001) and disease-free survival (DFS) (HR 1.52, 95% CI 1.22–1.90, p < 0.001, I2 = 88.6%, Ph < 0.001). Furthermore, the patients with the elevated PLR had a higher risk of lymph node metastasis (OR = 1.17, 95% CI 1.02–1.33, p = 0.023), serosal invasion (T3+T4) (OR = 1.34, 95% CI 1.10–1.64, p = 0.003), and increased advanced stage (III+IV) (OR = 1.20, 95% CI 1.06–1.37, p = 0.004).ConclusionsAn elevated pre-treatment PLR was a prognostic factor for poor OS and DFS and associated with poor clinicopathological parameters in GC patients.

Elevated platelet lymphocyte ratio is a poor prognostic factor in advanced epithelial ovarian cancer

The platelet lymphocyte ratio (PLR) is an important prognostic biomarker in various cancers. The current retrospective study was undertaken to determine the association between PLR and prognosis of advanced epithelial ovarian cancer. We determined the optimal cutoff values of PLR for predicting survival outcomes using the receiver operating characteristic curve analysis. Based on the PLR cutoff values, patients were divided into two groups: <226 and ≥226. Univariate analysis revealed a greater risk of death in the PLR ≥ 226 group than the PLR < 226 group (HR (hazard ratio), 2.7; 95 % CI (confidence interval), 1.3–5.4; P = 0.006). In multivariate analysis, PLR (HR, 1.9; 95 % CI, 1.1–3.6; P = 0.047) significantly affected the overall survival. Our data indicates that PLR can be used as an independent significant prognostic factor in advanced epithelial ovarian cancer.

Predictive value of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in non-small cell lung cancer patients treated with immune checkpoint inhibitors: A meta-analysis

BackgroundHigh neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are associated with poor prognosis in cancer patients treated with Immune checkpoint inhibitors (ICIs). However, whether this relationship exists in non-small cell lung cancer (NSCLC) patients remains unclear. Thus, this meta-analysis was conducted to investigate the prognostic role of NLR and PLR in NSCLC treated with ICIs. MethodsEligible studies that evaluated the value of pre-treatment or post-treatment NLR/PLR in NSCLC patients received ICIs were obtained by searching PubMed, Web of Science, Cochrane Library, and EMBASE. The pooled hazard ratio (HR) and 95% confidence interval (CI) were used to assess the relationship between NLR/PLR and overall survival (OS) and progression-free survival (PFS). Subgroup analysis and publication bias were conducted to investigate heterogeneity. Results1845 NSCLC patients from 21 studies were included and three ICIs(nivolumab, pembrolizumab, and atezolizumab) were used. Overall, high NLR was associated with poor OS (HR: 2.50, 95% CI:1.79–3.51, P < 0.001) and PFS (HR: 1.77, 95% CI:1.51–2.01, P < 0.001). Subgroup analyses were consistent with the pooled results. Similarly, the pooled results for PLR showed that elevated PLR was related to inferior OS (HR: 1.93, 95% CI: 1.51–2.01, P < 0.001) and PFS (HR: 1.57, 95%CI: 1.30–1.90, P < 0.001). However, the subgroup analysis based on test time indicated that there was no significant correlation between post-treatment PLR and survival outcomes. ConclusionNLR and pre-treatment PLR could serve as prognostic biomarkers in NSCLC patients treated with ICIs. However, the value of post-treatment PLR needs further to be evaluated.

Prognostic Value of the Neutrophil-Lymphocyte, Platelet-Lymphocyte, and Monocyte-Lymphocyte Ratios in Male Breast Cancer Patients

Background: The aim of the present study was to assess the blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) as prognostic factors in male breast cancer (BC) patients. Methods: A retrospective analysis of 38 male BC patients who were treated at the Institute of Oncology (Gliwice, Poland) between January 2005 and December 2018 was performed. The prognostic value (in terms of overall survival [OS]) of the pretreatment PLR, NLR, and MLR was assessed by univariate analysis. Results: We observed a tendency towards worse OS among male BC patients with lymph node metastases (N+) (5-year OS: 43.5 vs. 73.9%; p = 0.087), a greater tumor size (T4 vs. T1 + T2) (42.0 vs. 70.5%; p = 0.061), and a negative steroid receptor status (PR–) (28.6 vs. 65.6%; p = 0.109). Patients with a family history of cancer had significantly better 5-year OS than patients without a family history of cancer (86.3 vs. 35.0%; p = 0.001). Younger male BC patients (age ≤56 years) had better 5-year OS than patients >56 years of age (82.5 vs. 42.3%; p = 0.028). The 5-year OS was lower among patients with a lower lymphocyte value (≤1.82 × 10³) (29.0 vs. 75.6%; p = 0.010). There was a tendency towards worse OS among patients with a higher platelet count (>281 × 10³) (4.5-year OS: 16.7 vs. 65.8%; p = 0.056). The 5-year OS was insignificantly lower in the group with NLRs >2.74 than in the group with NLRs ≤2.74 (37.5 vs. 62.8%; p = 0.078). A worse OS rate was associated with an elevated PLR (>169.1) (22.2 vs. 70.1%; p = 0.008). Similarly, there was worse OS in the group with higher MLR (>0.30) (41.8 vs. 78.3%; p = 0.025). Conclusions: The present results reveal that elevated MLRs (>0.30) and PLRs (>169.1) are associated with poor OS among male BC patients. Similarly, but insignificantly, an elevated NLR (>2.74) affected OS.

Prognostic value of laboratory values in older patients with cervical spine fractures

ObjectivesTo understand the prognostic value of laboratory markers at presentation on post-treatment survival of patients 50 and older following cervical spine fracture. Patients and MethodsWe obtained clinical data on patients 50 and older treated for cervical spine fracture in a single healthcare system (2006–2016). Our primary outcome consisted of 1-year mortality, with mortality within 3-months of presentation considered secondarily. Our primary predictors included serum glucose, serum creatinine, platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) at presentation. We used multivariable logistic regression to adjust for confounding from sociodemographic and clinical characteristics. Point estimates and 95 % confidence intervals (CI) from the final model were refined using Bayesian regression techniques. ResultsWe included 1781 patients in this analysis, with an average age of 75.3 (SD 12.0). The mortality rate at 3-months was 12 % and 17 % at 1-year. In multivariable testing, neither elevated PLR or NLR were significant predictors of 1-year mortality. Elevated serum creatinine was associated with increased mortality at 1-year (OR 1.89; 95 % CI 1.30, 2.74), as was hyperglycemia (OR 1.50; 95 % CI 1.06, 2.13). Elevated serum creatinine remained influential (OR 1.64; 95 % CI 1.06, 2.54) on mortality at 3-months. ConclusionsThis is the first study to evaluate laboratory values at presentation in conjunction with survival following cervical fractures. The results can be used to help forecast natural history and in expectation management. They may also help formulate treatment plans, especially when the need for surgical intervention is not clearly defined.

Abstract P3-08-67: Prognostic value of the neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratio breast cancer patients according to HER2 overexpression

Abstract Introduction: HER2 gene amplificationis associated with shorter disease-free and overall survival in breast cancer.The prognostic value of the NLR, PLR, LMR or MLR has been also reported for many types of cancer. The aim of the present study was to assess the blood the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) as a prognostic factors in breast cancer patients (BC) according to HER2 overexpression. Material and Methods: A the retrospective analysis of 529 BC patients who were treated at COI (Gliwice, Poland) between January 2005 and June 2018 was performed. The prognostic value (OS) of the pre-treatment PLR, NLR and MLR was assessed by univariate and multivariate analysis. The cut-off values were determined using receiver operating characteristic curves. Based on the cut-off values determined, the NLR was considered as ‘elevated’ at &amp;gt;1.68, the MLR value was ‘elevated’ at &amp;gt;0.23 and the PLR was considered ‘elevated’ at&amp;gt;119.0. Result: The 5-year OS rates in HER2 positive and HER2 negative BC were 86.5 and 90.4%, respectively.The 5-year OS in the NLR &amp;gt;1.68 subgroup with HER2 (83.0 vs. 93.0%; P=0.579) and without HER2 overexpression (88.7 vs. 92.9%; P=0.159) were lower compared with a patients with NLR &amp;lt;1.68. Similarly, 5-year OS was lower in patients with a PLR of &amp;gt;119.0 with HER2 (85.9vs. 87.8%; P=0.782) and without HER2 overexpression (88.1 vs. 94.0%; P=0.060) compared with that in patients with a PLR of ≤119.0. The 5-year OS was similar in patients with a MLR of &amp;gt;0.23 with HER2 overexpression compared with that in patients with a MLR of ≤119.0 (86.1 vs. 86.7%; P=0.745). In group with a MLR of &amp;gt;0.23 without HER2 overexpression OS was lower compared with that in patients with a MLR of ≤0.23 (89.5 vs. 91.7%; P=0.185). Univariate Cox regression analyses of OS showed that in subgroup with HER2 overexpression factors such as tumor size (T3-4 vs. T1-2, HR=2.47; P=0.008), the presence of lymph node metastases (N+ vs.N0, HR=3.15; P=0.006) and estrogen receptor status (ER(+) vs. ER(-), HR=0.50; P=0.039) were statistically significant. Factors such as NLR, PLR and MLR were not statistically significant.Multivariate analysis revealed that in group breast cancer patients with HER2 overexpression negative prognostic factors were: tumor size and lymph node metastases. In contrary, positive prognostic factor was positive steroid receptor status (ER+).Univariate Cox regression analyses of OS showed that in subgroup without HER2 overexpression factors such as tumor size (T3-4 vs. T1-2, HR=3.89; P=0.0001), the presence of lymph node metastases (N+ vs.N0, HR=3.16; P=0.001), tumor grade (G3 vs. G1-2, HR=2.59; P=0.005), estrogen receptor status (ER(+) vs. ER(-), HR=0.43; P=0.012), progesterone receptor status (PR(+) vs. PR(-), HR=0.31; P=0.001), leukocytes &amp;gt;6.22 (HR=2.11; P=0.041), monocytes &amp;gt;0.52 (HR=2.24; P=0.018) and PLT&amp;gt;291 (HR=2.24; P=0.024) were statistically significant. Factors such as NLR (HR=1.66; P=0.166), PLR (HR=2.03; P=0.067) and MLR (HR=1.61; P=0.192) were not statistically significant. Multivariate analysis revealed that significant negative prognostic factors in without HER2 overexpression breast cancer patients were: tumor size, lymph node metastases and leukocyte number. In contrary, positive prognostic factor were positive steroid receptor status (PR+) and lymphocytes number. Conclusion: Elevated PLR, NLR and MLR worsens insignificantly prognosis in group of patients with tumors without HER2 overexpression. The presence of elevated MLR, PLR, NLR did not influence overall survival (prognosis) in group with HER2 overexpression. In both subgroups (HER2 positive and HER2 negative) common negative prognostic factors were tumor size and lymph node metastases. Citation Format: Joanna Huszno, Zofia Kolosza, Jolanta Mrochem Kwarciak, Aleksander Zajusz. Prognostic value of the neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratio breast cancer patients according to HER2 overexpression [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-67.

Recipient Pre-Operative Neutrophil Lymphocyte Ratio Better Predicts Delayed Graft Function than Platelet Lymphocyte Ratio in Donation after Brain Death Kidney Transplantation

Background: Neutrophil lymphocyte Ratio (NLR) and Platelet lymphocyte Ratio (PLR) are an indicator of the status of inflammation. The objective of this study was to evaluate the relationship between recipient pre-operative Neutrophil lymphocyte Ratio (NLR) and Platelet lymphocyte Ratio (PLR) with delayed graft function in the kidney transplant patient.&#x0D; Methods: The preoperative full blood count, data regarding patient demographics and postoperative graft function was retrospectively evaluated from the database of our institution. All statistical calculations were carried out using SPSS 20.0 version (SPSS Inc., Chicago, IL, USA). A p-value&lt;0.05 was considered statistically significant.&#x0D; Results: 289 patients were included in this study. DGF occurred in 33 cases. Elevated preoperative NLR had a sensitivity of 75.75% and specificity of 76.56% whereas elevated preoperative PLR had a sensitivity of 72.72% and specificity of 58.20% for predicting DGF. The area under the ROC curve was found to be 0.762 and 0.655 for NLR and PLR, respectively. Multivariate analysis showed NLR&gt;3.5 and PLR&gt;120 independently responsible for DGF.&#x0D; Conclusion: Recipient preoperative NLR and PLR can predict the occurrence of DGF following DBD renal transplantation. In addition, NLR is better than PLR in predicting DGF. DGF prolongs the total ICU and in-hospital stay.

Predictive Value of Cellular Blood Indices for All-Cause Mortality in Acute Pulmonary Embolism

Introduction: Pulmonary embolism (PE) contributes to more than 100,000 annual deaths in the United States and is the third most common cause of cardiovascular death. Short-term all-cause mortality rates differ widely, from 2% among low risk normotensive patients to 95% among those experiencing cardiac arrest. Prognostic models for PE help clinicians facilitate decision making but have suboptimal predictive values. The most widely used tool is the simplified Pulmonary Embolism Severity Index (sPESI) - a scoring system which utilizes 6 clinical variables to predict death. Cellular indices, like platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), have been shown to be markers of systemic inflammation and are associated with worsened prognosis in acute PE. Other ratios, such as lymphocyte-monocyte ratio (LMR) and platelet-neutrophil ratio (PNR), have not been fully explored. Given the need to further improve sPESI to better manage PE patients, we sought to determine the association of PLR, NLR, LMR, and PNR with all-cause mortality in patients presenting with acute PE. We also evaluated the additive effect of these cellular indices on the predictive value of sPESI. Methods: We retrospectively investigated patients who were consecutively diagnosed and treated between March 2016 and June 2019 at Loyola Medical Center in Maywood, Illinois and Gottlieb Memorial Hospital in Melrose Park, Illinois. Diagnosis of PE was made using CT pulmonary angiography or ventilation perfusion (VQ) scan. Patients were excluded if there was presence of infection, sepsis, ongoing cancer treatment, or a chronic inflammatory condition at the time of PE diagnosis. Clinical characteristics were collected using the electronic medical record system. Differential complete blood count data was collected within 24 hours prior to PE diagnosis. Mann Whitney U and Chi-Square tests were used to determine associations between all-cause mortality and clinical data. ROC curves were constructed to illustrate the sensitivity and specificity of cellular indices to predict all-cause mortality. Optimal ratio cutoffs were determined using Youden J Index. A composite sPESI score was created using cellular blood indices cutoff values. One point was added to the sPESI score for every additional condition met. Results: Among the 228 PE patients, 48 (21%) were non-survivors with median follow up period of 56 days (IQR: 17-182). Elevated PLR and NLR, as well as decreased LMR, were associated with all-cause mortality (all p &lt; 0.01). PNR was not associated with all-cause mortality (p &gt; 0.62). PLR &gt; 256.7 was predictive of mortality (p &lt; 0.01) with sensitivity 54.2% and specificity 85.6%. NLR &gt; 5.5 was predictive of mortality (p &lt; 0.01) with sensitivity 66.7% and specificity 68.3%. LMR &lt; 1.6 was predictive of mortality (p &lt; 0.01) with sensitivity 66.7% and specificity 70.8%. sPESI was predictive of mortality (p &lt; 0.01) with sensitivity 72.9% and specificity 64.0%. A composite model including sPESI, PLR, NLR, and LMR had further improved predictive abilities for all-cause mortality with sensitivity 85.4% and specificity 66.3% as compared to sPESI alone (AUC: 0.82, 95% CI: 0.76-0.89 vs AUC 0.75, 95% CI: 0.68-0.83). Conclusion: This study demonstrated an association between PLR, NLR, and LMR and all-cause mortality in PE patients. Our findings were consistent with past literature and contribute to the argument that these routine laboratory tests can supplement existing risk prediction models. Lymphopenia as well as elevated neutrophil count are associated with pro-inflammatory states during cardiopulmonary events, which may increase risk for thrombotic events. Platelets, a key component of thrombosis, are significantly decreased immediately after a thrombotic event. The composite sPESI model, including PLR, NLR, and LMR exhibited higher sensitivity which allows for improved detection of patients who are at high risk for death. Future studies are required to assess the predictive value of other routine blood tests on all-cause mortality in this patient population to further optimize sPESI and other predictive tools. Disclosures No relevant conflicts of interest to declare.

Evaluation of the prognostic role of platelet-lymphocyte ratio in cancer patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis

ObjectiveWhether platelet-lymphocyte ratio (PLR) is a prognostic factor for cancer patients treated with immunotherapy is under debate. In this study, we aimed to evaluate the relationship between PLR and survival of cancer patients treated with immune checkpoint inhibitors (ICIs). MethodsA systematical search was performed in databases including PubMed, Embase, and the Cochrane library to retrieve potential eligible clinical studies assessing the prognosis of cancer patients with high versus low PLR after immunotherapy, from the establishment of the database to June 2019. Quality evaluation of included studies was performed, and meta-analyses with regards to overall survival (OS) and progression-free survival (PFS) were conducted using RevMan 5.3 and STATA 11. ResultsA total of 12 eligible studies with 1340 cancer patients were included. Combined results showed that elevated PLR was a negative factor affecting the efficacy of ICIs in cancer patients. Patients with high PLR had a significantly shorter OS compared to those with low PLR (hazard ratio (HR) = 2.02, 95% confidence interval (CI): 1.46 to 2.80, P < 0.0001), as well as PFS (HR = 1.74, 95%CI: 1.27 to 2.38, P = 0.0006). Similar results were observed in sensitivity analyses. Subgroup analyses revealed that the prognostic role of PLR on OS and PFS was dependent on cancer type, region, and cutoff value. For NSCLC patients, the disease stage, ICIs agent, and line of treatment may not influence the prognostic role of PLR. ConclusionPLR could be a routinely potential prognostic factor for ICIs. Low PLR may be associated with better survival for cancer patients when treated with immunotherapy.

Prognostic value of the neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratio in breast cancer patients.

The aim of the present study was to assess the blood the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) as prognostic factors in breast cancer (BC) patients. A retrospective analysis of 436 BC patients who were treated at COI (Gliwice, Poland) between January 2005 and June 2018 was performed. The prognostic value [overall survival (OS)] of the pre-treatment PLR, NLR and MLR was assessed by univariate and multivariate analysis. The 5-year OS was lower in the NLR >2.65 compared with that in the NLR≤2.65 group (82.5 vs. 89.6%; P=0.053), and significantly lower in the subgroup of triple-negative breast cancer (TNBC; 70.3 vs. 89.3%; P=0.034) and in patients whose tumors had an estrogen receptor-negative [ER(-)] status (66.6 vs. 83.6%; P=0.018). The 5-year OS was lower in patients with PLR >190.9 compared with that in the PLR≤190.9 group (78.7 vs. 89.4%; P=0.020). A poor OS rate associated with an elevated PLR was also observed in the subgroups with TNBC (68.2 vs. 88.5%; P=0.032) and with ER(-) status tumors (57.7 vs. 83.6%, P=0.002). An elevated MLR (>0.28) was not associated with OS time (P=0.830). Multivariate analysis revealed that the NLR and PLR were insignificant negative prognostic factors, except for the subgroup of patients with ER(-) tumors, where an elevated NLR [hazard ratio (HR)=2.40; 95% confidence interval (CI): 1.20-4.80; P=0.013] and a higher PLR (HR=2.51; 95%CI: 1.23-5.14; P=0.012) were independent prognostic factors for poor OS together with lymph node metastasis ((HR=5.47; 95%CI: 2.46-12.15; P=0.0001 and HR=4.82; 95% CI: 2.15-10.78; P=0.0001), respectively. The present results revealed that an elevated NLR (>2.65) and PLR (>190.9) are associated with poor OS in BC patients. In the ER(-) subgroup of patients, an elevated NLR and PLR were significant independent prognostic factors. However, the MLR did not affect OS.

1915P - Prognostic value of the neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratio in male breast cancer patients

BackgroundInflammation impacts each step of tumorigenesis, including tumor initiation, promotion and metastatic progression. Biomarkers including the neutrophil, lymphocyte and platelet count, as well as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) are indices of inflammation. The aim of the present study was to assess the blood the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) as a prognostic factors in male breast cancer patients (BC). MethodsA the retrospective analysis of 38 male BC patients who were treated at COI (Gliwice, Poland) between January 2005 and December 2018 was performed. Based on the cut-off values determined, the NLR was considered as ‘elevated’ at>2.65, the MLR value was ‘elevated’ at>0.28 and the PLR was considered ‘elevated’ at>190.9. The prognostic value (OS) of the pre-treatment PLR, NLR and MLR was assessed by univariate analysis. ResultsThere was observed tendency to worse 5-year OS in male BC patients with lymph node metastases (N+) (43.5% vs. 73.9%, p=0.171); higher tumor size (T4 vs. T1) (42% vs.85.79%, p=0.128); negative steroid receptor status (PR-) (28.6% vs. 65.6%, p=0.109). Patients with cancer family history had significantly better 5-year OS than patients without cancer family history (86.3% vs.35.0%, p=0.004).Younger male BC patients (age ≤53 years) had better 5 year OS in comparison to patients over 53 years (88.9% vs. 43.1%, p=0.014).The 5-year OS was lower in patients with lower lymphocyte value ≤1.52 (24.0% vs. 67.4%, p=0.010). There was reported tendency to the worse 5-year OS in patients with higher PLT value (PLT>193 x 10^3) (47.3% vs. 78.8%, p=0.157). The 5-year OS was lower in the NLR >2.75 compared with that in the NLR≤2.75 group (29.6% vs. 64.4%, p=0.031). Similarly, a worse OS rate was associated with an elevated PLR (>114.5) (34.4% vs.77.5%, p=0.021). There was detected tendency to worse OS in group with lower MLR level (≤3.23) (39.5% vs. 71.9%, p=0.155). ConclusionsThe present results revealed that an elevated NLR (>2.75) and PLR (>114.5) are associated with poor OS in male breast cancer patients. In contrary, the elevated MLR affected better OS. Legal entity responsible for the studyMSC Memorial Cancer Center and Institute of Oncology, Gliwice Branch. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Laboratory markers as useful prognostic measures for survival in patients with spinal metastases

BACKGROUND CONTEXT Laboratory values have been found to be useful predictive measures of survival following surgery. The utility of laboratory values for prognosticating outcomes among patients with spinal metastases has not been studied. PURPOSE To determine the prognostic capacity of laboratory values at presentation including white blood cell (WBC) count, serum albumin and platelet-lymphocyte ratio (PLR) in patients with spinal metastases. STUDY DESIGN Retrospective review of records from two tertiary care centers (2005-2017). PATIENT SAMPLE Patients, aged 40-80, who received operative or nonoperative management for spinal metastases. OUTCOME MEASURES Survival, complications or hospital readmissions within 90 days of treatment and a composite measure for treatment failure accounting for changes in ambulatory function and mortality at 6 months following presentation. METHODS Multivariable Cox proportional hazard regression analysis was used to analyze the relationship between laboratory values and length of survival, adjusting for confounders. Multivariable logistic regression was used in analyses related to 6-month and 1-year mortality, complications, readmissions and treatment failure. A scoring rubric was developed based on the performance of laboratory values in the multivariable tests. Internal validation was performed using a bootstrap simulation that consisted of sampling with replacement and 1,000 replications. RESULTS We included 1,216 patients. Thirty-seven percent of patients received a surgical intervention and 63% were treated nonoperatively. Median survival for the cohort as a whole was 255 days (inter-quartile range 93-642 days). PLR (HR 1.53; 95% CI 1.29, 1.80; p<0.001) and albumin (HR 0.54; 95% CI 0.45, 0.64; p<0.001) were significantly associated with survival, while WBC count (HR 1.08; 95% CI 0.86, 1.36; p=0.50) was not associated with this outcome. Similar findings were encountered for 6-month and 1-year mortality as well as the composite measure for treatment failure. PLR and albumin performed well in our scoring rubric and findings were preserved in the bootstrapping validation. CONCLUSIONS Individuals with low serum albumin and elevated PLR should be advised regarding the impact of these laboratory markers on outcomes including survival, irrespective of treatments received. An effort should also be made to optimize nutrition and PLR, if practicable, prior to treatment to minimize the potential for development of adverse events. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Laboratory values have been found to be useful predictive measures of survival following surgery. The utility of laboratory values for prognosticating outcomes among patients with spinal metastases has not been studied. To determine the prognostic capacity of laboratory values at presentation including white blood cell (WBC) count, serum albumin and platelet-lymphocyte ratio (PLR) in patients with spinal metastases. Retrospective review of records from two tertiary care centers (2005-2017). Patients, aged 40-80, who received operative or nonoperative management for spinal metastases. Survival, complications or hospital readmissions within 90 days of treatment and a composite measure for treatment failure accounting for changes in ambulatory function and mortality at 6 months following presentation. Multivariable Cox proportional hazard regression analysis was used to analyze the relationship between laboratory values and length of survival, adjusting for confounders. Multivariable logistic regression was used in analyses related to 6-month and 1-year mortality, complications, readmissions and treatment failure. A scoring rubric was developed based on the performance of laboratory values in the multivariable tests. Internal validation was performed using a bootstrap simulation that consisted of sampling with replacement and 1,000 replications. We included 1,216 patients. Thirty-seven percent of patients received a surgical intervention and 63% were treated nonoperatively. Median survival for the cohort as a whole was 255 days (inter-quartile range 93-642 days). PLR (HR 1.53; 95% CI 1.29, 1.80; p<0.001) and albumin (HR 0.54; 95% CI 0.45, 0.64; p<0.001) were significantly associated with survival, while WBC count (HR 1.08; 95% CI 0.86, 1.36; p=0.50) was not associated with this outcome. Similar findings were encountered for 6-month and 1-year mortality as well as the composite measure for treatment failure. PLR and albumin performed well in our scoring rubric and findings were preserved in the bootstrapping validation. Individuals with low serum albumin and elevated PLR should be advised regarding the impact of these laboratory markers on outcomes including survival, irrespective of treatments received. An effort should also be made to optimize nutrition and PLR, if practicable, prior to treatment to minimize the potential for development of adverse events.

Laboratory markers as useful prognostic measures for survival in patients with spinal metastases

BACKGROUND CONTEXTLaboratory values have been found to be useful predictive measures of survival following surgery. The utility of laboratory values for prognosticating outcomes among patients with spinal metastases has not been studied. PURPOSETo determine the prognostic capacity of laboratory values at presentation including white blood cell count, serum albumin and platelet-lymphocyte ratio (PLR) in patients with spinal metastases. STUDY DESIGNRetrospective review of records from two tertiary care centers (2005–2017). PATIENT SAMPLEPatients, aged 40 to 80, who received operative or nonoperative management for spinal metastases. OUTCOME MEASURESSurvival, complications, or hospital readmissions within 90 days of treatment and a composite measure for treatment failure accounting for changes in ambulatory function and mortality at 6 months following presentation. METHODSMultivariable Cox proportional hazard regression analysis was used to analyze the relationship between laboratory values and length of survival, adjusting for confounders. Multivariable logistic regression was used in analyses related to 6-month and 1-year mortality, complications, readmissions, and treatment failure. A scoring rubric was developed based on the performance of laboratory values in the multivariable tests. Internal validation was performed using a bootstrap simulation that consisted of sampling with replacement and 1,000 replications. RESULTSWe included 1,216 patients. Thirty-seven percent of patients received a surgical intervention and 63% were treated nonoperatively. Median survival for the cohort as a whole was 255 days (interquartile range 93–642 days). The PLR (hazard ratio [HR] 1.53; 95% confidence interval [CI] 1.29, 1.80; p<.001) and albumin (HR 0.54; 95% CI 0.45, 0.64; p<.001) were significantly associated with survival, whereas WBC count (HR 1.08; 95% CI 0.86, 1.36; p=.50) was not associated with this outcome. Similar findings were encountered for 6-month and 1-year mortality as well as the composite measure for treatment failure. The PLR and albumin performed well in our scoring rubric and findings were preserved in the bootstrapping validation. CONCLUSIONSIndividuals with low serum albumin and elevated PLR should be advised regarding the impact of these laboratory markers on outcomes including survival, irrespective of treatments received. An effort should also be made to optimize nutrition and PLR, if practicable, before treatment to minimize the potential for development of adverse events.

The Role of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Platelets in the Prognosis of Metastatic Renal Cell Carcinoma

Objective(s): The aim of this analysis was to evaluate the platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), platelets (PLT), and neutrophil level for their prognostic value in patients with metastatic renal cell carcinoma (mRCC). Materials: We retrospectively reviewed medical records of 141 patients with mRCC (2006–2016). Univariate and multivariate analyses were performed with the Cox proportional hazards regression model. The cutoff value of NLR was “elevated” as >3.68 and the PLR cutoff value was “elevated” as >144.4. Results: The median PFS and OS were shorter in elevated NLR and PLR. A higher value of PLT was associated with worse median OS and higher neutrophil level with worse OS and PFS. In multivariate analysis, higher NLR (p = 0.007) and PLR (p = 0.006) were independent prognostic factors for shorter OS together with BMI ≤30 (p = 0.004), higher Fuhrman grade (p = 0.0002), lower level of hemoglobin (p= 0.010), and ZUBROD 2 (p = 0.0002). Higher PLR (p = 0.0002) was an independent negative prognostic factor for PFS together with higher Fuhrman grade (p = 0.001), higher neutrophil level (p = 0.001), and lower lymphocyte level (p = 0.013). Conclusion: Elevated pretreatment NLR, PLR, PLT, and neutrophil count are associated with shorter OS and PFS in patients with mRCC. NLR and PLR are independent prognostic factors for OS. However, PLR and neutrophil count are independent prognostic factors for PFS.