High Platelet-lymphocyte Ratio Research Articles

Prognostic role of inflammatory markers in hepatocellular cancer patients receiving sorafenib therapy

Objective: Systemic inflammatory markers have been shown to have prognostic value in many types of cancers. Although the prognostic role of the systemic immune-inflammation index (SII), derived neutrophil-lymphocyte ratio (dNLR) and platelet lymphocyte ratio (PLR) has been shown in hepatocellular cancer (HCC) patients who underwent transplantation, its prognostic value has not been investigated in HCC patients under sorafenib treatment. We investigated the prognostic value of inflammatory indices in patients with HCC under sorafenib treatment.
 Materials and Methods: The data of 46 patients with stage III unresectable and stage IV HCC were evaluated retrospectively. SII and dNLR were dichotomized based on receiver operating characteristic (ROC) curve analysis (cut-off values: 355 and 1.8). No cut-off value could be determined for PLR; therefore, the median value was defined as the cut-off for PLR. At the time of diagnosis, values of these three inflammatory markers were analyzed to determine their association with clinicopathologic characteristics and to assess their prognostic values via the Kaplan-Meier method and multivariate Cox regression analysis.
 Results: Overall survival (OS) was significantly shorter in patients with a high SII, dNLR, or PLR. In univariate analyses, tumor stage, tumor focus count, and presence of extrahepatic lesions seemed to affect survival. Multivariate analysis revealed SII and the presence of extrahepatic lesions as independent risk factors for survival.
 Conclusion: The findings of the present study suggest that a high SII is an independent risk factor for survival in patients with HCC under sorafenib treatment.

A study of platelet to lymphocyte ratio in patients with metabolic syndrome

Background: The prevalence of the metabolic syndrome varies around the world, in part reflecting the age and ethnicity of the populations studied and the diagnostic criteria applied. Numerous studies have shown an association of Metabolic Syndrome (MS) and insulin resistance (IR) with inflammation. Platelet-lymphocyte ratio (PLR) has recently emerged as a novel inflammatory index that may serve as an important predictor of inflammatory state and overall mortality. Aim of this study is to evaluate the PLR in patients with MS and to correlate the same with the severity of MS based on its categories.Methods: A cross sectional study was conducted on 210 subjects (105 subjects with Metabolic Syndrome and 105 age and gender matched control participants without Metabolic Syndrome) seen on outpatient basis at hospitals attached to Basaveshwara medical college and research institute, Chitradurga. Detailed history including history of risk factors if any, physical examinations and baseline investigations like complete blood counts, HbA1c levels, serum glucose levels, fasting lipid profile, electrocardiography and the data was analyzed using appropriate statistical methods.Results: PLR was 6% higher in males (PLR-144.77±34.6) when compared to females (PLR-136.57±30.4) in subjects with metabolic syndrome. There was 95.9% higher PLR in subjects with metabolic syndrome when compared to subjects without metabolic syndrome (p<0.05). Furthermore, PLR increased more as severity of metabolic syndrome increased (5/5 PLR-180.55±25.3,4/5 PLR-132.33±23.6, 3/5 PLR- 109.63±22.6 and non-metabolic syndrome (PLR- 77.45±19.5).Conclusions: In this study, PLR above 90 predicted significant inflammation. PLR is calculated from complete blood count with differential, is an inexpensive, easy to obtain, widely available marker of inflammation, which can aid in the risk stratification of patients with various cardiovascular diseases in addition to the traditionally used markers.

The prognostic value of routine preoperative blood parameters in muscle-invasive bladder cancer

BackgroundA routine blood examination is one of the most rapid, convenient and inexpensive clinical examinations that can reflect a patient’s inflammatory status and other blood conditions, and the prognostic value of routine preoperative blood parameters in MIBC patients is still unclear, so we evaluated the prognostic value of routine preoperative blood parameters in muscle-invasive bladder cancer (MIBC) following radical cystectomy (RC).MethodsData on 202 patients with MIBC who underwent RC at our institution were retrospectively collected between October 2007 and August 2018. The median preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and hemoglobin (HGB) values were used as cutoffs to form the low and high NLR, low and high PLR, and low and high HGB groups, respectively. The clinicopathologic characteristics of each group were compared by chi-square and t tests. Kaplan-Meier survival and multivariate Cox regression analyses were used to analyze prognosis.ResultsThe median NLR, PLR and HGB values were 2.42, 112 and 125 g/L, respectively. Kaplan-Meier results showed that the low HGB group had poor progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). A high NLR and high PLR groups correlated only with poor OS. Multivariate Cox analyses showed that pathological T3/4 stage, positive lymph node status and low HGB were independent risk factors for PFS, CSS and OS, and age was the only independent risk factor for OS.ConclusionPreoperative peripheral blood HGB is an independent risk factor for the prognosis of MIBC patients. These data suggest that HGB may be a useful prognostic marker for MIBC patients undergoing RC.

Neutrophil to lymphocyte ratio as a potential predictive marker for treatment with pembrolizumab as a second line treatment in patients with non-small cell lung cancer.

The aim of this multicentric retrospective study is to evaluate the predictive and prognostic performance of neutrophil to lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and their dynamics in patients with non-small cell lung cancer (NSCLC) treated with pembrolizumab as a second line. Patients with metastatic NSCLC (n = 119), whose tumors expressed programmed death-ligand 1 (PD-L1) ≥ 1%, were retrospectively analyzed between Apr 2017 and Apr 2019. All patients received platinum-containing chemotherapy as a first line treatment. Pre-treatment NLR was calculated by dividing the number of neutrophils by the number of lymphocytes in peripheral blood before the first pembrolizumab infusion. Progression free survival (PFS) and overall survival (OS) was compared by Kaplan-Meier method and Cox Proportional Hazard model. Patients with NLR > 5 before immunotherapy showed significantly shorter mean PFS of 6.86 months (95% CI: 5.81-7.90) as compared to those with NLR ≤ 5 of 18.82 months (95% CI: 15.87-21.78) (long rank test p < 0.001). Furthermore in the multivariate analysis, only NLR > 5 was an independent predictive factor for shorter PFS (HR: 4.47, 95% CI: 2.20-9.07, p < 0.001). In multivariate analysis, presence of bone metastases (HR: 2.08, 95% CI: 1.10-4.94, p = 0.030), NLR > 5 before chemotherapy (HR: 8.09, 95% CI: 2.35-27.81, p = 0.001) and high PLR before chemotherapy (HR: 2.81, 95% CI: 1.13-6.97, p = 0.025) were found to be independent negative prognostic factors for poor OS. Our data suggests that NLR ≤ 5 is a potential predictive marker, which may identify patients appropriate for immunotherapy as a second line treatment.

Platelet/Lymphocyte Ratio Is Superior to Neutrophil/Lymphocyte Ratio as a Predictor of Chemotherapy Response and Disease-free Survival in Luminal B-like (HER2−) Breast Cancer

BackgroundThe neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been associated with the prognosis in breast cancer (BC). The relationship of the NLR and PLR with chemotherapy sensitivity and prognosis in luminal B-like (human epidermal growth factor receptor 2-negative [HER2−]) BC are not well studied. Patients and MethodsThe clinical data from 980 patients with luminal B-like (HER2−) BC from June 2012 to June 2016 were collected. The differences among the variables were calculated using the χ2 test. The associations among the clinicopathologic factors, pretreatment NLR, pretreatment PLR, and disease-free survival (DFS) were analyzed using Kaplan-Meier curves and Cox analyses. ResultsThe median follow-up was 37 months (range, 5-77 months). For the 480 patients who had received neoadjuvant chemotherapy, low pretreatment PLR values were associated with higher pathologic complete response (pCR) rates compared with the high PLR group (15.8% for low vs. 9.2% for high PLR group; P = .027). Multivariate analyses showed that larger tumors, a greater number of lymph nodes involved, a high Ki-67 score, and a high PLR were independent prognostic factors of worse outcomes for the patients with luminal B-like (HER2−) BC. The risk of metastasis and/or recurrence was greater for the high PLR group than for the low PLR group (hazard ratio, 1.576; 95% confidence interval, 1.039-2.390; P = .032). The pretreatment NLR showed no such associations among this cohort of patients. ConclusionsThe results of the present study have shown that the pretreatment PLR is superior to the NLR as a predictor of pCR and DFS outcomes in patients with luminal B-like (HER2−) BC. A low pretreatment PLR was associated with higher pCR rates after neoadjuvant chemotherapy and was an independent predictive factor for better DFS outcomes among patients with luminal B-like (HER2−) BC.

Assessment of Pretreatment Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Prognosis of Oral Squamous Cell Carcinoma

Recent data have provided evidence of systemic inflammatory markers playing an important role in determining the disease-free survival (DFS) and overall survival (OS) of patients with oral squamous cell carcinoma (OSCC). The aim of the present study was to determine the prognosis of OSCC using the preoperative neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). We enrolled 130 patients with OSCC who received treatment in the present retrospective study. Both PLR and NLR correlated with the demographic data, tumor characteristics, and prognosis. The optimal cutoff for PLR and NLR was determined by receiver operating characteristic curve analysis and was 142 and 3.1 for PLR and NLR, respectively. The prognostic significance of both markers was determined by univariate and multivariate analysis. Survival curves were plotted using the Kaplan-Meier method. The clinicopathologic variables correlated with cumulative survival on univariate analysis. Advanced clinical lymph node stage (P=.001), pathologic lymph node stage (P=.001), pathologic tumor stage (P=.049), pathologic TNM stage (P=.006), receipt of multimodality treatment (P=.013), and high PLRs (P=.001) and NLRs (P=.002) showed a statistically significant association with shorter DFS. A multivariate Cox proportional hazard regression model demonstrated that a high PLR (hazard ratio [HR], 2.998; 95% confidence interval [CI], 1.128 to 7.968; P=.028) and patient age (HR, 1.100; 95% CI, 0.750 to 1.613; P=.025) were independent factors for determining DFS and OS. We observed that high PLRs and NLRs were significant in determining the prognosis. The PLR was superior to the NLR in determining DFS and OS and can be used as an independent prognostic indicator in patients with OSCC.

Relationship Between FDG Uptake and the Platelet/lymphocyte Ratio in Patients With Breast Invasive Ductal Cancer

We investigated the relationship between F18-fluorodeoxyglucose (FDG) uptake and the platelet/lymphocyte ratio (PLR), as both represent inflammation. We retrospectively analyzed the cases of 143 consecutive invasive ductal carcinoma patients who had undergone preoperative FDG-PET and surgery. We divided the patients into groups based on their maximum standardized uptake value (SUVmax) values: low (<2.5) and high (≥2.5) and based on their PLRs: low (<130) and high (≥130). We determined the relationships between the SUVmax or PLR and clinicopathological features. Seventy-three patients (51.0%) had a high SUVmax in their primary tumor. There were significant associations between SUVmax and the PLR. A multivariate analysis revealed that high PLR, but not NLR, was independent factor associated with a high SUVmax. Seventy-four patients (51.7%) had a high PLR; The factors significantly associated with high PLR were large tumor size, presence of node metastasis, presence of vascular invasion, high NLR, and high SUVmax. In breast cancer patients, the PLR is independently associated with the SUVmax, but not with recurrent disease. In breast cancer patients with a high SUVmax and/or PLR, these values may reflect the tumor microenvironment.

Role of Pre-Operative of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in Prognosis of Hepatocellular Carcinoma

Introduction: Hepatocellular carcinoma (HCC) has a poor prognosis and is ranked in the top 2 leading causes of death in Taiwan. The clinical features which affect survival rate should be noticed for alarming. We tried to study the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) for the predictor of prognosis of HCC. Patients and Methods: A total of 525 patients with HCC were undergone surgical or non-surgical treatment registered in Cancer Registry Center of our hospital. The clinical features included patient’s basic profiles, and neutrophil, lymphocyte and platelet count in the peripheral blood at the time of diagnosis. The ratio of neutrophil/lymphocyte and platelate/lymphocyte was measured and their survival rates were analyzed based on their ratio scales. Results: Three scales of NLR and PLR were ≤1.62, 1.63 - 2.57, ≥2.58 and ≤224, 225 - 253, ≥254 respectively. Either higher NLR ≥ 2.58 or higher PLR ≥ 254 was found mostly in the male and TMN stage III and IV with a significant difference (P < 0.01). The 5-year survival rates of NLR ≤ 1.62, 1.63 - 2.57, ≥2.58 were 33.9%, 33.7%, and 16.7% respectively (P < 0.001). The mean survival times were 34.1 ± 1.4, 29.3 ± 8.1, and 14.2 ± 2.1 months for the scales of PLR ≤ 224, 225 - 253, and ≥ 254 respectively. The 5-year survival rates were 25.5%, 36.4%, and 7.7% for the groups of the PLR ≤ 224, 225 - 253, and ≥254 respectively (p < 0.001). Conclusion: Neutrophil, lymphocyte and platelet are players in cancer growth and have a potential role as predictors of survival in our HCC patients. Therefore, we should pay more attention to the higher NLR or PLR which will result in a poorer prognosis in our patients.

Significances of Peripheral Inflammatory Cells and Neutrophil/Platelet-Lymphocyte Ratio in Breast Cancer after Resection

Introduction: Breast cancer had become top leading cause of death in Taiwan and endangered women’s health worldwide. Therefore, we try to invest the peripheral inflammatory cell counts and neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) from our routine practice for the predictor of prognosis of breast cancer after resection. Patients and Methods: There were 574 breast cancer patients accepted surgical resection and registered in Cancer Registry Center of our hospital. Patient’s basic profiles, peripheral neutophil, lymphocyte and platelet count were measured for study. The scales of NLR and PLR were derived from the lower and higher normal range in cell count from neutrophil, lymphocyte and platelet respectively. Therefore, the scales for NLR and PLR were ≤1.62, 1.63 - 2.57, ≥2.58 and ≤224, 225 - 253, ≥254 respectively for analysis. Results: Poor 5-yr survival rate was found if higher cell counts of neutrophil and platelet (p ≤ 0.05). Three scales of NLR were ≤1.62, 1.63 - 2.57, ≥2.58, and their 5-year survival rates were 94%, 91% and 84% respectively (p = 0.019). In the subgroup of HER-2 (negative), and 3-Negative breast patients had a higher NLR of poor prognosis. But higher PLR was found less in 3-Negative and non in 3-Positive patients (p = 0.039). The PLR was ≤224, 225 - 253, ≥254 and their 5-year survival rates were 92%, 87%, and 64% respectively (p = 0.001); Multivariate Cox regression model for predictor of breast cancer patients who have 3.39 (PLR ≥ 254) and 2.45 (NLR ≥ 2.58 ) times risk (p = 0.02 and p = 0.002) of poor prognosis respectively. Conclusion: Peripheral inflammatory cell counts are easily to take in our clinical practice and have a potential role as predictors of prognosis. We have to pay attention to the trends of peripheral inflammatory cell count and their ratio in our clinical practice where possible.

Platelet/lymphocyte ratio for prediction of no-reflow phenomenon in ST-elevation myocardial infarction managed with primary percutaneous coronary intervention.

Background:Coronary no-reflow phenomenon in ST-segment elevation myocardial infarction (STEMI) is associated with a poor clinical outcome. Although its pathophysiology is not fully understood, a deregulated systemic inflammatory response plays an important role. We aimed to explore the relationship between platelet\\lymphocyte ratio (PLR) and no-reflow in patients with acute STEMI who were treated with a primary percutaneous coronary intervention (PPCI).Methods:A total of 200 patients with STEMI undergoing PPCI were included in the study. Transthoracic echocardiographic examination was performed to assess left ventricular (LV) ejection fraction (EF) and wall motion score index. Blood samples were assayed for platelet and lymphocyte count before PPCI. No-reflow was defined as coronary blood flow thrombolysis in myocardial infarction grade ≤II.Results:No-reflow was observed in 58 (29%) of STEMI patients following PPCI. PLR was significantly higher in hypertensive patients compared to normotensive patients (144.7±91.6 vs. 109.1±47.1, respectively, P<0.001) and in the no-reflow group compared to the normal reflow group (214±93 vs. 101.6±51.3, respectively, P<0.0001). Logistic regression analysis revealed that PLR (β: 0.485, 95% CI: −0.006-0.001, P<0.002) and LV EF (β: 0.272, 95% CI: 0.009-0.034, P<0.001) were independent predictors of no-reflow after PPCI.Conclusion:Pre-procedural increase in PLR is predictive of the no-reflow phenomenon following PPCI in STEMI patients.Relevance for Patients:No reflow phenomenon is an unfavorable complication following PPCI in patients with acute STEMI. High pre-procedural PLR is an independent predictor of reperfusion failure and helps to identify patients who require prophylactic treatment.

Prognostic Value of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Systemic Immune-Inflammatory Index in Resected Gastric Cancer

Objective: The prognostic value of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index has been studied in many cancer types. Our aim is to show the prognostic value of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index in resected gastric cancer patients. In addition, to determine which parameter is a better predictor of survival. Material and methods: The study included 95 patients resected gastric cancer between 2014-2018. Receiver operating curve analysis was used to determine neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index cut-off values. Systemic immune-inflammatory index was evaluated as neutrophil × platelet/lymphocyte. Long rank and cox regression analysis were used. Results: The median age was 62 (22-84) years. The median overall survival was 33 months. 49 (51.6%) patients were in stage 3 and 46 (48.4 %) patients were in stage 1-2. High neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index values, tumor depth, stage of metastatic lymph node and tumor-node-metastasis stage were poor prognostic factors for overall survival and disease-free survival. When multivariant cox regression analysis was performed, only platelet-lymphocyte ratio was found to be independent prognostic factor (p = 0.037 for overall survival, p = 0.024 for overall survival). Conclusion: High neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammatory index were found to be poor prognostic factors in predicting both overall survival and disease-free survival before treatment in patients who undergo curative resection for gastric cancer. As a result of multivariant analysis, only high platelet-lymphocyte ratio was determined as an independent poor prognostic factor for both overall survival and disease-free survival.

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.

Pre-treatment inflammatory biomarkers predict early treatment response and favorable survival in patients with metastatic colorectal cancer who underwent first line cetuximab plus chemotherapy.

ObjectiveThis study was to determine whether peripheral blood biomarkers including neutrophil‑lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) could predict early response to cetuximab; moreover, the prognostic ability of those biomarkers on progression free survival (PFS) and overall survival (OS) of metastatic colorectal cancer (mCRC) patients with wild-type (WT) RAS was also investigated.MethodsmCRC patients with WT RAS treated with cetuximab plus chemotherapy were retrospectively analyzed, and early response was evaluated according to RECIST 1.1 after three or four treatment cycles. In prior to chemotherapy, hematologic data and clinic-pathological parameters were collected. The associations between pre-treatment inflammatory biomarkers and early response, and the prognostic value of those biomarkers were analyzed. A total of 102 patients were enrolled and divided into low or high NLR, PLR, and SII groups, respectively.ResultsThe early response rate was significantly higher in the low NLR (p<0.001), low PLR (p=0.045), and low SII (p=0.011), respectively. In multivariate analyses, primary tumor resection (hazard ratio (HR) 0.411, p<0.001), carcino-embryonic antigen ≤5 ng/mL (HR 0.406, p<0.001), early treatment response (HR 0.322, p<0.001), and low NLR (HR 0.665, p=0.031) were independent factors of longer PFS. Primary tumor resection (HR 0.488, p=0.003) and early response (HR 0.392, p<0.001) were independent factors of longer OS. Further analysis showed that patients with early response, even in the high groups, can achieve better PFS and OS than non-responders.ConclusionPre-treatment inflammatory biomarkers, especially NLR were predictors of benefit from cetuximab-combined therapy in mCRC patients. They were also predictors of significantly longer PFS and OS of early responders compared to non-responders.

Post-Radiotherapy Inflammation Predicts Recurrence and Mortality in Stage I-III Triple-Negative Breast Cancer

Recent studies suggest that a pro-inflammatory lymphopenic microenvironment associated with radiotherapy (RT) may contribute to recurrence of triple-negative breast cancer (TNBC). Furthermore, adiposity may exacerbate this pro-tumor inflammation. To study how RT affects the immune system in this high-risk cancer, we investigated the systemic inflammatory response to RT in patients with TNBC. We hypothesized that inflammation in a lymphopenic setting within one year after RT correlates with recurrence and mortality in stage I-III TNBC. We also hypothesized that obesity would intensify the relapse risk associated with inflammation. We performed a single-institutional retrospective cohort study of adult women treated with definitive RT for stage I-III TNBC between 1999 and 2012. Patients had a minimum follow-up of 5 years. Clinicopathologic characteristics and complete blood counts were recorded. Neutrophil:lymphocyte ratio (NLR), platelet:lymphocyte ratio (PLR), and monocyte:lymphocyte ratio (MLR) were calculated. Time-to-event analyses for recurrence and mortality were analyzed by Cox proportional-hazards regression. Confounders were adjusted using forward stepwise selection to avoid multicollinearity. Optimal inflammatory marker cutoffs from receiver operating characteristic curves were analyzed by log-rank after stratification on Kaplan-Meier plots. After a median follow-up of 6.9 years after RT, 110 patients with stage I (n=32, 29%), stage II (n=53, 48%) and stage III (n=25, 23%) TNBC were studied. We evaluated early (2 mo) and long term (8-12 mo) effects of RT on peripheral immune markers in relation to TNBC outcomes. Within 2 months of RT, elevated neutrophil count was associated with metastasis (Hazard ratio 1.25, p=0.04). Patients with absolute lymphocyte count (ALC) less than 0.55 K/μL (HR 3.12, p=0.04) or monocyte count above 0.5 K/μL (HR 2.67, p=0.03) had greater TNBC-specific mortality. PLR > 345 predicted reduced overall survival (HR 2.50, p=0.04), and patients with MLR > 0.9 had a greater risk of TNBC-specific mortality (HR 5.72, p=0.001). After adjustment, elevated NLR was associated with TNBC-specific mortality (HR 1.2, p=0.04), and high PLR predicted local recurrence (HR 1.01, p<0.05). Sustained lymphopenia 8-12 mo following RT (ALC < 1.16 K/μL) predicted mortality (HR 3.77, p=0.02). Finally, body mass index was an independent poor prognostic factor in each inflammatory model. Systemic inflammation and lymphopenia after RT may represent novel prognostic biomarkers associated with recurrence, metastasis, and mortality in stage I-III TNBC. Further studies evaluating RT immune effects are needed to validate this finding and develop treatment strategies.

Significance of Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Patients with Multiple Myeloma

To investigate the significance of neutrophil/lymphocyte ratio(NLR) and platelet/lymphocyte ratio(PLR) in patients with multiple myeloma (MM). Eighty patients with multiple myeloma admitted in our hospital from August 2007 to August 2010 were selected. The clinical data of the patients, including hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), white blood cell(WBC) count, absolute neutrophil count (ANC), platelet count (PC), glomerular filtration rate (GFR), calcium, albumin, β2 microglobulin and so on were collected and analyzed. The optimal threshold of NLR was 2.78 (sensitivity: 83.3%, specificity: 43.1%). The optimal threshold of PLR was 155.58 (sensitivity: 67.7%, specificity: 36.9%). All patients were grouped according to NLR and PLR values, patients with high NLR and PLR had lower albumin levels and higher clinical stages. High NLR patients were mainly men, hemoglobin, GFR values, albumin levels were lower, and the white blood cells count and β2 microglobulin level were higher. High PLR patients showed low albumin level and higher clinical stage. Multivariate analysis showed that β2 microglobulin and NLR were prognostic factors in patients with multiple myeloma (P<0.05). Kaplan-Meier survival analysis showed that the median survival time was 37 months (95% CI: 21.80-52.19) for patients with high NLR and 66 months (95% CI: 53.19-78.80) for patients with low NLR. The median survival time was 45 months (95% CI: 0.00 to 91.18) in patients with high PLR and 62 months (95% CI: 45.67-78.33) in patients with low PLR. High NLR (>2.78) associates with poor prognosis in patients with MM, and it may be considered as an independent prognostic factor for MM patients.

Preoperative neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predict clinical outcome in patients with muscle-invasive bladder cancer

Objective To investigate whether the ratio of neutrophil-lymphocyte ratio (NLR) to platelet-lymphocyte ratio (PLR) can be used as a prognostic indicator for radical cystectomy (RC) for patients with muscle-invasive bladder cancer (MIBC). Methods The 132 patients with MIBC who underwent radical bladder cancer resection were divided into high NLR group (NLR 2.03, 65 cases), low NLR group (NLR<2.03, 59 cases), high PLR group (PLR 125.30, 37 cases) and low PLR group (PLR<125.30, 87 cases) according to the preoperative peripheral blood NLR and PLR. Kaplan-meier method was used to analyze the influence of each clinicopathological feature on the survival and death of patients. Log-rank test was used to compare the survival curves of NLR and PLR groups respectively. Cox regression model was used to analyze the factors affecting the prognosis of MIBC patients. Results High levels of NLR and PLR are closely related to the clinical staging of bladder cancer (χ2=4.422, P<0.05; χ2=3.115, P<0.05). In addition, univariate regression model analysis showed that both high level NLR [hazard ratio (HR)=3.503, P<0.01] and high level PLR (HR=2.688, P<0.01) could affect the 3-year survival time of bladder cancer patients, and the difference was statistically significant. Multivariate regression model analysis showed that only a high level of NLR (HR=3.678, P<0.05) was an independent risk factor for 3-year survival. Conclusion NLR is an independent risk factor for MIBC, and its predictive value is significantly better than PLR. Key words: Neutrophil lymphocyte ratio; Platelet lymphocyte ratio; Invasive bladder cancer; Progression

Hematologic markers of distant metastases in gastric cancer.

High neutrophil-lymphocyte ratio (NLR) is associated with poor overall survival (OS) in gastric cancer. This study evaluates whether NLR, in addition to other parameters including absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute eosinophil count (AEC), absolute monocyte count (AMC), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) are associated with distant metastases, a common and poor prognostic feature of gastric cancer. Clinical data from 502 gastric cancer patients treated at King Hussein Cancer Center (Amman, Jordan) have been retrospectively reviewed. We examined the association between ANC, ALC, AEC, AMC, NLR, MLR and PLR with the baseline distant metastases and OS. Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal NLR cutoff value for association with distant metastases. Univariate and multivariate analyses showed that patients with high baseline NLR (≥3.9) had more distant metastases on presentation than patients with low NLR (<3.9), (P value: 0.0001 and 0.0005, respectively). Furthermore, patients with high baseline ANC (≥6,015/µL), AEC (≥215/µL), PLR (≥0.15) had more distant metastases in comparison to patients with low baseline ANC (<6,015/µL), AEC (<215/µL), PLR (<0.15) (P value: 0.024, 0.001, and 0.001, respectively). High ANC, NLR, MLR and PLR are associated with poor OS (P value: 0.046, 0.0003, 0.027, and <0.0001, respectively). High ANC, AEC, NLR, and PLR are associated with distant metastases on presentation in gastric cancer. In the era of cancer immunotherapy, whether these immune phenomena predict the response of gastric cancer to immunotherapy is unknown.

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.

Prognostic significance of elevated pretreatment systemic inflammatory markers for patients with prostate cancer: a meta-analysis

BackgroundPretreatment inflammatory factors, including neutrophil, lymphocyte, platelet and monocyte counts as well as the ratios between them such as neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and lymphocyte–monocyte ratio (LMR) have been suggested as potential prognostic predictors for patients with prostate cancer (PCa). However, the prognostic effects remain controversial. Therefore, the goal of this study was evaluate the prognostic values of these markers for PCa patients using a meta-analysis.MethodsPotentially relevant publications in PubMed and Cochrane Library were searched. Pooled hazard ratio (HR) with 95% confidence interval (CI) for overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), recurrence free survival (RFS) and distant metastases-free survival (DMFS) were determined using a fixed or random effects model by STATA 13.0 software.ResultsThirty-two studies involving 21,949 participants were included. Our pooled results demonstrated that a high pretreatment NLR (HR = 1.55, 95% CI 1.37–1.76), PLR (HR = 1.72; 95% CI 1.36–2.18), neutrophil (HR = 1.10; 95% CI 1.03–1.18 and monocyte counts (HR = 2.25; 95% CI 1.67–3.05) predicted inferior OS, while elevated pretreatment LMR (HR = 2.27; 95% CI 1.76–2.94) was correlated with favorable OS. Furthermore, the higher NLR (HR = 1.62; 95% CI 1.29–2.04) and monocyte counts (HR = 1.75; 95% CI 1.36–2.25), but lower LMR predicted worse PFS (HR = 2.18; 95% CI 1.58–3.02); poor RFS was only associated with NLR (HR = 1.12; 95% CI 1.04–1.20). The subgroup analysis showed that the higher NLR may be a predictive factor for OS only in patients with mCRPC and undergoing chemotherapy; while the higher PLR was only significantly associated with OS in localized PCa regardless of treatment.ConclusionThis meta-analysis reveals that pretreatment NLR, PLR, LMR, neutrophil, and monocyte counts may be effective predictive biomarkers for prognosis in patients with PCa.