Low Platelet-lymphocyte Ratio Research Articles

The Role of Neutrophil-lymphocyte Ratio and Platelet-lymphocyte Ratio in Predicting Neoadjuvant Chemotherapy Response in Breast Cancer.

PurposeThe role of the host immunologic environment is crucial in cancer progression. Recent studies revealed that neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), are possible surrogate markers of outcome in various cancers. In breast cancer, the therapeutic effect of neoadjuvant chemotherapy (NAC) differs in patients, and higher response rate reflects better outcomes. This study aimed to determine the predictive value of peripheral blood NLR and PLR for NAC response along with their prognostic role in breast cancer.MethodA total of 105 patients with breast cancer treated with NAC between 2009 and 2017 were analyzed retrospectively. NAC response and prognosis (disease-free-survival [DFS], progression-free-survival [PFS] and overall survival [OS]) according to NLR and PLR were evaluated. According to the optimal cut-off values for NAC response obtained from receiver operating characteristic (ROC) curves, patients satisfying both low NLR and PLR levels (low-ratio group) were compared to those who did not (high-ratio group).ResultsThe NLR cut-off value was ≤ 2.21 (area under the ROC curve [AUC], 0.617; 95% confidence interval [CI], 0.517–0.710; p=0.030) with 94.1% sensitivity and 38.0% specificity. The PLR cut-off value was ≤ 143.36 (AUC, 0.618; 95% CI, 0.518–0.711; p = 0.040) with 85.3% sensitivity and 39.4% specificity. The low-ratio group demonstrated a better NAC response (p = 0.006) in multivariate analysis than the high-ratio group. The low-ratio group showed better DFS and PFS (p = 0.046 and p = 0.040, respectively) and longer OS (p = 0.078) in univariate survival analysis than the high-ratio group. In multivariate analysis, the low-ratio group had significantly better PFS (p = 0.049) and higher DFS (p = 0.054) than the high-ratio group.ConclusionsThe combination of NLR and PLR showed improved prediction of NAC response, revealing their potential as screening tools, significant prognostic role in breast cancer patients who receive NAC. Further studies with subgroup analysis, larger population and longer follow up duration are required.

İleri evre küçük hücreli akciğer kanseri olan hastalarda bazal nötrofil lenfosit oranının prognostik değeri

Purpose: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocytopenia are markers of poor prognosis in lung cancer patients. The aim of this trial is evaluate the prognostic significance of basal NLR, PLR and lymphocytopenia in patients with extensive stage (ES) small cell lung cancer(SCLC).Materials and Methods: This study was designed as a hospital-based retrospective observational case-series study. A total of 117 patients with extensive stage small cell lung cancer have been treated at four different oncology centers in Turkey between 2011 and 2017. Laboratory results and demographic data were collected.Results: The median follow-up time was 12 months and 95 (81%) patients died. Progression-free survival (PFS) and overall survival (OS) were estimated, respectively, as 8 and 13 months. 65 (55.6 %) patients had complete response at the end of first line platin-etoposide combination treatment. The cut-off value for NLR and PLR were determined for whole group and patients were dichotomized into high (≥3.28) and low (<3.28) NLR groups and high (≥139.8) and low (<139.8) PLR groups.. Median OS was lower in patients who had high neutrophil lymphocyte ratio (NLR) (14 versus 12 months respectively). Conclusion: This study showed that basal NLR may have prognostic biological value in patients with ES SCLC treated with cisplatin + etoposide.

Preoperative Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Are Not Clinically Useful in Predicting Prognosis in Early Stage Cervical Cancer.

Background An objective of this study was to determine the prognostic role of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in patients with cervical cancer (CC) stages IA2-IB1. Methods The study included 484 patients who underwent radical hysterectomy with pelvic node dissection. The associations of preoperative NLR and PLR with clinicopathologic characteristics and oncological outcomes were analyzed. The cut-off values of NLR (=1.8) and PLR (=119) were set as medians. Results The clinicopathologic analysis showed that NLR was associated with age (p=0.010), tumor size (p=0.045), and adjuvant treatment (p=0.005), and PLR was associated with only adjuvant treatment (p=0.033). DFS and OS were not significantly different between patients with high and low NLR (p=0.670 and p=0.934) or high and low PLR (p=0.780 and p=0.306). The independent prognostic factors associated with OS were lymph node status and anemia, and with DFS were histology, deep stromal invasion, and lymph node status. Conclusions NLR and PLR have no use as prognostic biomarker for DFS and OS in early-stage CC. However, NLR and PLR might be of use in determining the risk for adjuvant treatment.

Pretreatment neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, and neutrophil/monocyte ratios and outcome in elderly breast cancer patients.

Several studies have found an association between peripheral inflammatory cells and outcome. However, no study has explored their impact specifically in elderly patients. We have retrospectively examined pretreatment peripheral neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and neutrophil/monocyte ratio (NMR) in 113 elderly breast cancer patients and correlated our findings with disease-free survival (DFS) and overall survival (OS). All patients ≥ 65years diagnosed from 2004 to 2018 with locally advanced breast cancer were included and classified as high vs low NLR, PLR, LMR, and NMR based on previously identified cutoffs. Estimated 1-, 3-, and 5-year DFS and OS were compared by Chi square analysis. Among 104 evaluable patients, only PLR was significantly associated with estimated 3-year DFS (85.1% vs 63.6%; P = 0.04) and OS (89.3% vs 68.1%; P = 0.03). Among 69 patients with three or more years of follow-up, PLR (P = 0.05), absolute lymphocyte count (ALC) (P = 0.01), polychemotherapy (P = 0.04), number of comorbidities (P = 0.02), polypharmacy (P = 0.005), and clinical stage (P = 0.03) were associated with 3-year DFS. Polypharmacy (OR 4.9; P = 0.02) and ALC (OR 4.6; P = 0.04) retained their significance in the multivariate analysis. We have found an association between low PLR and longer DFS in elderly breast cancer patients that is in line with findings in patients with a wider range of ages. Our findings on NLR contrast with those of other studies, indicating a potential differential effect in elderly patients. In addition, the effect of polypharmacy on outcome in elderly patients warrants further investigation.

Prognostic role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with bone metastases

BackgroundSkeletal metastases are a common problem in patients with cancer, and surgical decision making depends on multiple factors including life expectancy. Identification of new prognostic factors can improve survival estimation and guide healthcare providers in surgical decision making. In this study, we aim to determine the prognostic value of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in patients with bone metastasis.MethodsOne thousand and twelve patients from two tertiary referral centers between 2002 and 2014 met the inclusion criteria. Bivariate and multivariate Cox regression analyses were performed to determine the association of NLR and PLR with survival.ResultsAt 3 months, 84.0% of the patients with low NLR were alive versus 61.3% of the patients with a high NLR (p < 0.001), and 75.8% of the patients with a low PLR were alive versus 55.6% of the patients with a high PLR (p < 0.001). Both elevated NLR and elevated PLR were independently associated with worse survival (hazard ratio (HR): 1.311; 95% confidence interval (CI): 1.117–1.538; p = 0.001) and (HR: 1.358; 95% CI: 1.152–1.601; p < 0.001), respectively.ConclusionThis study showed both NLR and PLR to be independently associated with survival in patients who were treated for skeletal metastasis.

Clinical implication of platelet-lymphocyte ratio and PD-L1 in breast cancer patients

Background: The anti-tumor action of the host immune systems and cancer-immune interaction are associated with tumor prognosis. Combination of neutrophil-lymphocyte ratio (NLR)/platelet-lymphocyte ratio (PLR) and programmed death ligand-1 (PD-L1) in predicting prognosis in breast cancer has not been reported. The aim of this study is to evaluate the prognostic role of NLR/PLR and PD-L1 in breast cancer. Methods: A total of 870 patients with breast cancer treated in Sun Yat-sen University Cancer Center from 2000 to 2012 with known PD-L1 status were included. Clinicopathological data and pretreatment complete blood count (CBC) were retrospectively collected. Chi-square test and Mann-Whitney U test were used to compare baseline characteristics, Kaplan-Meier and univariate Cox proportional hazards model analyses were used to compare the survival of patients between different groups. Results: High PLR group achieved worse result than low PLR group in overall survival (OS) and disease-free survival (DFS) (5-year OS rate: 82.6% vs. 88.8%, P=0.010; 5-year DFS rate: 78.7% vs. 85.6%, P=0.003). High PLR was associated with shorter DFS [adjusted HR =1.525, 95% confidence interval (CI): 1.111–2.094, P=0.009] and OS (adjusted HR =1.527, 95% CI: 1.073–2.174, P=0.019). NLR was not associated with patients’ survival outcome. Patients with PD-L1 expression and high PLR had the worst prognosis. The 5-year DFS rates were 68.4%, and 85.8% in high PLR + PD-L1(+) group and low PLR + PD-L1(−) group respectively (P=0.002). The 5-year OS rates were 73.4% and 90.1%, respectively (P<0.001). Conclusions: High PLR is associated with poor DFS and OS in breast cancer patients. PD-L1 expression combined with high PLR was associated with an aggressive clinical outcome. Further studies are needed to evaluate the predictive value of the combination of PD-L1 and peripheral blood immune markers.

Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio Cannot Predict Lymph Node Metastasis and Prognosis in Patients with Early Gastric Cancer: a Single Institution Investigation in China.

In the present study, we aimed at exploring the applied value of preoperative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in the prediction of lymph node metastasis (LNM) and prognosis in patients with early gastric cancer (EGC). We retrospectively analyzed a total of248 consecutive patients who underwent curative gastrectomy to be identified T1 stage gastric adenocarcinoma between January 1, 2010 and May 1, 2016 in a single institution. According to median preoperative NLR and PLR value, we divided the patients into four groups: high NLR >1.73 and low NLR <1.73, high PLR >117.78 and low PLR <117.78. Furthermore, to evaluate the relationship between preoperative NLR and PLR values, we categorized patients according to cutoff preoperative NLR-PLR score of 2 [high NLR (>1.73) and high PLR (>117.78)], 1 [either high NLR or high PLR], and 0 [neither high NLR nor high PLR], Statistical analyses were conducted using SPSS 20.0 software. The results showed that the preoperative NLR or PLR values, lower or higher, could not predict the LNM in patients with EGC (both P=0.544>0.05). The invasive depth of tumor was significantly correlated with LNM of EGC (P0.001). Kaplan-Meier plots illustrated that preoperative NLR and PLR values were not associated with overall survival (OS) in patients with EGC. It was concluded that the preoperative NLR and PLR may be the predictors for LNM and prognosis in patients with advanced gastric cancer; nevertheless, they cannot predict LNM and prognosis in patients with EGC.

Assessment of risk factors on morbidity and mortality in patients undergoing percutaneous endoscopic gastrostomy

Aim: Percutaneous endoscopic gastrostomy (PEG) is a minimal invasive procedure that is performed in patients who are unable to take oral feeding. Herein, we aimed to assess the risk factors for morbidity and mortality in patients who undergo PEG. Material and Methods: This study was conducted, in a total of 143 patients who underwent PEG for enteral feeding, who were retrospectively analyzed in terms of clinical features, biochemical, hematological and microbiological parameters, and also morbidity and mortality. Results: The study enrolled 140 of 143 consecutive patients who underwent PEG, and a total of 206 interventions were performed. The rate of successful insertion was 98.5% (140/142). Complications were peristomal leakage (%29.3), infection due to PEG (9.3%), and tube blockage (6.4%), respectively. In multivariate logistic regression analysis; a ≤ 3.5cm length of the PEG tube between the gastric mucosa and the skin (95% CI: 1.290-33.442 and P= 0.023) and a low platelet lymphocyte ratio (OR = 0.994, 95% CI: 0.989-0.999 and p = 0.022) were risk factors of peristomal leakage. The 30-day mortality rate was 16%. Discussion: In patient with PEG, the complication rate varies between 5% and 66% according to follow-ups in the literature. The mortality usually depends on the primary disease, and it has been reported between 5% and 20%. Conclusion: PEG is a safe, effective, and minimal invasive procedure. A ≤3.5 cm length of a PEG tube between the gastric mucosa and skin and a low platelet lymphocyte ratio are risk factors for the development of peristomal leakage.

Systemic Inflammation Biomarkers Predict Survival in Patients of Early Stage Non-Small Cell Lung Cancer Treated With Stereotactic Ablative Radiotherapy - A Single Center Experience

Background: Increasing evidence indicates a relationship between systemic inflammation and survival following treatment in various tumors. However, the correlation of systematic inflammation with survival after stereotactic ablative radiotherapy (SABR) in early stage non-small cell lung cancer (NSCLC) has not been well established.Patients and methods: We retrospectively analyzed patients with newly diagnosed early stage NSCLC treated with SABR in a single institution from 2011 to 2015. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte- monocyte ratio (LMR) were calculated as systemic inflammation biomarkers. Overall survival (OS) was the first end-point. Receiver operating characteristic (ROC) was used to determine cut-off points for OS. Univariate and multivariate Cox proportional hazards regression were used to investigate the potential factors associated with OS.Results: In the 63 patients who were eligible for analysis. The median follow up after SBRT was 29.5 months (range 8-67 months) while the 3-year OS was 74.2%. Based on ROC analysis, optimal cut-off values of NLR, PLR, and LMR were 2.06, 199.55 and 4.0, respectively. Significant survival benefit was found in the NLR ≤2.06 group (p=0.028), PLR≤199.55 group (p=0.001), and LMR˃4.0 group (p=0.046). Univariate analysis indicated that low NLR (p=0.011), low PLR (p=0.003), and high LMR (p=0.014) were correlated with improved survival. Multivariate analysis indicated that high PLR (p=0.033) and low LMR (p=0.046) were independent prognostic factors for poor survival.Conclusions: In patients of early stage NSCLC who received SABR, pretreatment NLR, PLR, and LMR could be considered useful prognostic indicators of OS. These metrics may provide reliable and convenient predictors to identify patients who would benefit from SABR.

Clinical baseline and prognostic difference of platelet lymphocyte ratio (PLR) in right-sided and let-sided colon cancers

BackgroundRight-sided colon cancer (RCC) and left-sided colon cancer (LCC) differ with respect to their biology and genomic patterns, but inflammatory index variation did not fully investigate. This study aimed to examine the difference of inflammatory indexes and its value between RCC and LCC.MethodsThe differences of common clinicopathologic factors, inflammatory indexes including PLR (Platelet lymphocyte ratio) between LCC and RCC were analyzed in the training cohort with logistic regression model, subsequently, confirmed in validation cohort. Kaplan-Meier analysis was applied for the analysis of the survival difference distinguished by the PLR and the Nonparametric Test was adopted to demonstrate the difference of PLR variation with the standard TNM classification between RCC and LCC.ResultsA total of 1846 CRC patients entered the study, 744 (40.3%) patients were RCC, 1102 (59.7%) were LCC. The patients’ number in both cohorts was 923. It was found that LCC patients in the training cohort significantly to be with higher CEA, adenocarcinoma, early UICC/AJCC stage, p-MMR (mismatch-repair proficient), and lower PLR, and the later four features were confirm in validation cohort. Higher PLR, the unique inflammatory index, was significantly associated with poorer OS in LCC cohort (P = 0.002) and was elevated with the TNM stage in the LCC patients (P < 0.001), however, the two relationships did not sustain in RCC patients.ConclusionExpect the classical characteristics, PLR, an inexpensive and easily assessable inflammatory index was found first time to be significant differ between LCC and RCC. Further, elevated PLR associated with poor OS (overall survival) in the LCC and more common in advanced TNM stage.

Effect of nutritional status and inflammatory markers on acute adverse reactions during concurrent chemoradiotherapy for esophageal carcinoma

Objective To examine the effects of different pre-treatment nutritional status and inflammatory markers on acute adverse reactions in esophageal cancer patients during concurrent intensity-modulated radiation therapy (IMRT) and chemotherapy. Methods The acute adverse reactions of 338 eligible esophageal cancer patients who received concurrent IMRT and chemotherapy in our hospital from 2006 to 2014 were reviewed. The effects of different pre-treatment nutritional status, such as body mass index level (BMI), albumin level (ALB), total lymphocyte count (TLC), the presence or absence of anemia, and inflammatory indicators including neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), on acute adverse reactions in the patients were examined. Data were analyzed using the chi-square test with continuity correction and logistic regression analysis. Results The incidence rate of malnutrition in the patients based on their nutritional status was 5.62%-54.14%. The incidence rate of grade≥2 acute radiation esophagitis (RE) was significantly higher in the low ALB group than in the normal ALB group (P=0.000). The incidence rate of adverse reactions in the hematologic system increased as TLC decreased (P=0.006), but the incidence rate of acute radiation pneumonitis (RP) was reduced as TLC decreased (P=0.001). In addition, the incidence rate of grade ≥2 acute RE was significantly higher in the anemia group than in the non-anemia group. Inflammatory marker analysis demonstrated that the incidence rate of acute RE was significantly higher in the high NLR group and high PLR group than in the low NLR group and low PLR group (P=0.000 and P=0.024, respectively). Logistic regression analysis of nutritional status and inflammatory markers showed that TLC was an independent risk factor for acute adverse reactions in the hematologic system (P=0.001), and ALB and PLR were independent risk factors for acute RE (P=0.017 and P=0.011, respectively). Conclusions Nutritional status and inflammatory markers are associated with concurrent chemoradiotherapy-induced acute adverse reactions in esophageal carcinoma patients, and hence may be valuable indicators of acute adverse reactions during treatment. In addition, nutritional treatment and support care should be actively provided to the patients to prevent the development of acute adverse reactions during treatment. Key words: Esophageal neoplasms/radiotherapy; Nutritional status; Inflammation

1651P - Pre-treatment neutrophil lymphocyte ratio/platelet lymphocyte ratio as surrogate markers of survival in non-metastatic head and neck cancer patients: An observational study

Background: Neutrophil lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are known to be surrogate markers of inflammation and have been shown to predict mortality in patients with heart disease and cancer. In this study, we evaluate the influence of pre-treatment NLR and PLR on overall survival in head and neck cancer patients. Methods: In this observational correlational study, subjects with a diagnosis of non-metastatic head and neck cancer were analyzed for neutrophil-lymphocyte ratio and the platelet-lymphocyte ratio at baseline before the start of their cancer-directed therapy. Results: In this study, 189 subjects were analyzed for neutrophil-lymphocyte ratio and platelet-lymphocyte ratio before their treatment. The mean age of the study sample was 54.5±11.8. Forty-two percent underwent surgery followed by adjuvant chemoradiation while remaining underwent concurrent chemoradiation. Neoadjuvant chemotherapy was done in 29.4% of the study population. Mean NLR was 3.4±3.13 and PLR was 12.7±8.8. ROC analysis revealed 2.23 as the cutoff for NLR and 9.49 as the cutoff for PLR. Based on these cutoffs a Kaplan-Meir analysis on overall survival showed significantly improved survival (67.5% vs 58% at their mean estimates of 52 and 36 months) in those with <2.23 NLR ratio compared to > 2.23 (Log Rank χ2=5.3, p = 0.02). Similarly, those with <9.49 PLR had better overall survival (69% vs 56% at their mean estimates of 46 and 39 months) compared to > 9.49 (Log Rank χ2=8.1, p = 0.005). Lower NLR also showed better disease-free survival (44 vs 33 months, Log Rank χ2=4.8, p = 0.03) and lower PLR also showed better disease-free survival (44 vs 33 months, Log Rank χ2=8.2, p = 0.004). Conclusions: Both NLR and PLR are inflammatory biomarkers in cancer. The results from this study suggest pretreatment NLR and PLR as predictive markers of survival in non-metastatic head and neck cancer patients. Legal entity responsible for the study: Vijay Agarwal Funding: HCG Foundation Disclosure: All authors have declared no conflicts of interest.

Neutrophil/lymphocyte & platelet/lymphocyte ratios are not predictors of the metastatic behavior of hepatocellular carcinoma

Objective: Several inflammatory markers such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), have been linked to prognosis of several malignancies including hepatocellular carcinoma (HCC). We aim to assess NLR and PLR as potential predictors of extra-hepatic spread of HCC. Methods: Retrospective analysis of prospectively collected data on newly diagnosed patients with HCC between 2011 and 2015 was done. Results: A total of 180 patients were included. The mean age at the time of diagnosis was 58.8 (range: 31–82) years. HCV was found to be the most common cause of liver cirrhosis 108 (60%). 22 (12.2%) patients were classified as class C according to Child-Pugh criteria. The follow up of patients ranged from 0.1 to 4.4 years (mean=1.0±1.1 years). During follow-up 80 patients died (overall survival of 51.1%). Forty seven patients (26%) had at least one extra-hepatic metastasis at the time of diagnosis (Single site-10 vs Multiple sites-37). Comparative analysis between those who developed metastasis and those who didn't included several variable including inflammatory markers. Potential risk factors, at significance level of P<0.05, included higher serum platelets, lower PLR, bigger tumor diameter, bigger total tumor volume, multiple/bilobar HCC and macroscopic vascular invasion. However, multi-variate regression analysis revealed that tumor diameter larger than 5 cm (OR=6.10, 95% CI=1.85–20.12) (P=0.003), and bilobar liver involvement (OR=5.49, 95% CI=1.10–27.30) (P=0.037) were the only predictors of metastatic behavior of HCC. Conclusion: Tumors size (>5 cm) and bilobar involvement are determinants of the extra-hepatic metastasis in HCC patients while NLR and PLR ratios are not.

Systemic Inflammatory Response After Preoperative Chemoradiotherapy Can Affect Oncologic Outcomes in Locally Advanced Rectal Cancer.

Systemic inflammatory response (SIR) has been reported to be an important determinant of disease progression and survival in patients with colorectal cancer. This study investigated the prognostic relevance of changes in the platelet count on survival and the predictive value of changes in platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) on the pathological tumor response to preoperative chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). From 2006 to 2015, 291 consecutive patients with LARC who were treated with preoperative CRT followed by curative surgery at the Kyungpook National University Medical Center (Daegu, Korea) were retrospectively analyzed. A cut-off value of 370×103/μl for the platelet count was used and a PLR ≥235 was defined as high. Any change in the PLR or NLR was calculated based on subtracting the pre-CRT PLR or NLR from the post-CRT values. A total of 17.5% patients had stage II and 82.5% had stage III LARC. Initially high NLR and PLR were significantly associated with poor clinical outcomes. Patients who maintained a high platelet count after CRT also had an advanced pathological stage (p=0.028), low pathological complete response rate (p=0.048), and high relapse rate (p=0.021). For patients with an initially low PLR, the multiple logistic regression analysis revealed that a high PLR change (odds ratio (OR)=2.301, 95% confidence interval (CI)=1.269-4.174; p=0.006) and clinical stage II compared to stage III (OR=1.878, 95% CI=1.231-2.865; p=0.003) were significant independent markers predictive of a good response to CRT. The present results suggest that platelet and PLR change after preoperative CRT, along with the initial platelet count, can be used as prognostic and predictive markers for the oncological outcomes in patients with LARC.

Association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with ER and PR in breast cancer patients and their changes after neoadjuvant chemotherapy.

Proinflammatory markers, including neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), are associated with many aspects of different malignancies. The aim of this study was to assess the associations of NLR and PLR with estrogen receptor (ER) and progesterone receptor (PR) expression in locally advanced breast cancer patients and their changes after neoadjuvant chemotherapy (NAC). Whether these parameters were predictive for the response to NAC in breast cancer patients was also evaluated. 132 Female primary locally advanced breast cancer patients treated with either ET (epirubicin-docetaxel), TEC (docetaxel-epirubicin-cyclophosphamide), or CEF (cyclophosphamide-epirubicin-fluorouracil) as NAC were retrospectively studied. NLR and PLR were calculated from peripheral blood cell count and their optimal cutoff levels were determined by receiver operating characteristic curves. The proportion of ER-positive breast cancers before NAC was higher both in NLRlow (<2.05) group and PLRlow group (<159.01). Changes in ER or PR expression level or status were observed in some patients. The alterations of NLR and PLR after NAC correlated with chemotherapy regimens, and elevated PLR was found. The patients with low pretreatment NLR (<1.67) or PLR (<151.27) had better responses to NAC than those with high NLR (≥1.67, 67.3 vs. 47.1%, P<0.05) or PLR (≥151.27, 64.0 vs. 45.1%, P<0.05). The patients with low pretreatment NLR (<2.05) or PLR (<159.01) had higher ER expression. Changes in ER and PR expression status or level occured following NAC. Elevated PLR was found aft-NAC. Pretreatment NLR and PLR may be important predictive indicators for NAC response in breast cancer patients.

P1.05-075 The Correlation between the Prognoses of Patients with Non-Small Cell Lung Cancer and Preoperative Platelet- Lymphocyte Ratio

The platelet- lymphocyte ratio (PLR) is a prognostic factor that correlates immunity or inflammation with tumor invasion. We retrospectively investigated the correlation between prognosis and preoperative PLR in patients with non-small cell lung cancer who underwent anatomical lung resection in our hospital. We conducted a retrospective study of 116 patients with primary lung cancer who underwent anatomical lung resection in our hospital from January 2009 to May 2014. We excluded patients who underwent previous lung resection or had intraoperative malignant pleural effusion or positive surgical margins. We analyzed 105 patients (65 with adenocarcinoma, 25 with squamous cell carcinoma, 9 with large cell carcinoma, and 2 with adenosquamous carcinoma). We constructed a ROC curve with PLR values calculated preoperative blood analyses and determined that the threshold was 160. We divided the patients into high and low PLR groups. We analyzed these two groups with respect to background, pathological findings, and cancer-specific survival. Additionally, we investigated factors that correlated with cancer-specific survival with. The median patient age was 71 years (range, 50-88 years). There were 75 male patients and 25 female patients. The median follow-up duration was 43 months (range, 0-85 months). Regarding surgical techniques, 101 patients underwent lobectomy, 3 underwent segmentectomy, and 1 patient underwent sleeve lobectomy. A total of 47, 34, 8, 9, 6, and 1 patients were diagnosed with pathological stage IA, IB, IIA, IIB, IIIA, and IIIB cancer. The overall survival rate was 71.3%. When examining background characteristics, tumor size was larger and T factor was more elevated in the high PLR groups, and pathological stage was more advanced in the high PLR group. N factor was not significantly different between the two groups. Cancer-specific survival was significantly poorer in the high PLR group than in the low group (p=0.0007). Considering tumor types, patients with adenocarcinoma in the high PLR group had poorer prognosis compared to the patients with adenocarcinoma in the low PLR group (p=0.0002), but for squamous cell carcinoma and in the other tumor types, there was no significant difference (p=0.20 and p=0.86, respectively). Multivariate analysis revealed that PLR was an independent prognosis factor for the cancer-specific survival. In the patients who underwent anatomical resection with lung cancer, PLR was correlated with prognosis.

The correlation between platelet-lymphocyte ratio and the prognosis of patients with peripheral T-cell lymphoma, unspecified

Objective: To identify the correlation between pre-treatment peripheral blood platelet-lymphocyte ratio (PLR) and the clinicopathological features of the patients with peripheral T cell lymphoma, unspecified (PTCL-U), and to explore the prognostic significance of PLR in these patients.Methods: The clinical characteristics and survival state of 163 patients diagnosed of PTCL-U in Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively. All patients were divided into low PLR group (PLR < 170, n = 80) and high PLR group (PLR ≥ 170, n = 83) based on the receiver operating characteristic (ROC) curve’s cut-off value. The relationship between pre-treatment PLR and the prognosis of these patients was analyzed. Results: In all 163 patients with PTCL-U, the 5-year overall sarvival (OS) and progression-free survival (PFS) rates of patients in low PLR group (76.3% and 60.0%, respectively) were higher than those in high PLR group (10.8% and 8.4%, respectively, both P < 0.05). Age, Eastern Cooperative Oncology Group performance status (ECOG PS), B symptoms, serum lactate dehydrogenase (LDH) level, platelet and PLR were remarkably relevant to OS (all P < 0.01). Age, serum LDH level, platelet and PLR were independent prognostic features for patients with PTCL-U (all P < 0.05). Conclusion: The peripheral blood PLR at pre-treatment is distinctly relevant to the prognosis of patients with PTCL-U. An elevated PLR predicts poor prognosis of these patients. DOI:10.3781/j.issn.1000-7431.2017.33.768

Low Pretreatment Lymphocyte-Monocyte Ratio and High Platelet-Lymphocyte Ratio Indicate Poor Cancer Outcome in Early Tongue Cancer

The white blood cell (WBC) indices have been reported to have a prognostic impact in cancer of multiple organs including head and neck cancer; however; site and stage stratification was not attempted, and compelling evidence has shown that early cancers have a different distribution and prognostic ability than late-stage cancers. We studied the prognostic importance of WBC indices in early oral tongue cancers. The retrospective data of primary pT1N0 to pT2N0 oral tongue cancers treated between 2009 and 2013 were charted. WBC indices such as the neutrophil count, lymphocyte count (LC), platelet count (PC), and monocyte count, along with derived indices such as the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR), were analyzed by multivariate analysis with other clinicopathologic prognostic factors. A total of 133 patients fulfilled the inclusion criteria; the minimum follow-up period for living patients was 36months. A total of 22 patients reported disease relapse, and 11 patients died of disease. Multivariate analysis showed LC (hazard ratio [HR], 0.206; 95% confidence interval [CI], 0.092 to 0.46; P < .001), PC (HR, 1.011; 95% CI, 1.001 to 1.021; P= .026), PLR (HR, 1.012; 95% CI, 1.008 to 1.016; P < .001), and LMR (HR, 0.721; 95% CI, 0.596 to 0.872; P= .001) are significant independent prognostic factors for disease-free survival. Distant metastasis (HR, 9.014; 95% CI, 2.303 to 38.914; P= .004), LC (HR,0.091; 95% CI, 0.015 to 0.558; P= .01), PC (HR, 1.023; 95% CI, 1.006 to 1.041; P= .009), PLR (HR, 1.016; 95% CI, 1.004 to 1.027; P= .002), and LMR (HR, 0.58; 95% CI, 0.387 to 0.868; P= .008) are significant independent prognostic factors for overall survival. Low pretreatment LMR and high PLR indicate poor survival in patients with early tongue cancer. We suggest close follow-up for this subgroup despite radical resection with clear margins.

Assessment value of preoperative platelet-lymphocyte ratio in the prognosis of patients with gastric mixed adenoneuroendocrine carcinoma

To explore the prognostic assessment value of preoperative blood platelet-lymphocyte ratio (PLR) in patients with gastric mixed adenoneuroendocrine carcinoma (gMANEC) treated with radical surgery. Clinical and pathological data of 84 gMANEC patients who underwent radical resection from 2006 to 2016 in Department of Gastric Surgery, Fujian Medical University Union Hospital were analyzed retrospectively. Receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the PLR for predicting prognosis. The Cox proportional hazards regression model was used to identify prognostic factors of gMANEC. All the patients underwent D2 lymph node dissection, including 26 cases of distal subtotal gastrectomy and 58 cases of total gastrectomy. The postoperative pathological TNM stage system(pTNM) demonstrated that the patients of stage I(, II(, and III( were 9(10.7%), 14(16.7%), and 61(72.6%) cases, respectively. The median follow-up time was 40(3 to 96) months. The recurrence rate was 41.7%(35/84). The median time to recurrence was 10 (1 to 40) months, and 82.9%(29/35) patients experienced recurrence within the first 2 years after operation. The median overall survival time was 27(3 to 39) month, and the median recurrence-free survival time was 21 (1 to 96) months. The 1-, 3-, and 5-year overall survival(OS) rates were 87.6%, 56.6%, and 47.4%, respectively, and the 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 70.5%, 50.7%, and 44.9%, respectively. The best cutoff value of the PLR for predicting prognosis was 133 through ROC curve, which categorized all the patients into low PLR group (≤133) comprising 28 patients and high PLR group (>133) comprising 56 patients. The tumor recurrence rate was significantly higher in high PLR group (50.0%, 28/56) than that in low PLR group(25.0%, 7/28)(P=0.028). The live metastasis rate was significantly higher in high PLR group(35.7%, 20/56) than that in low PLR group(10.7%, 3/28)(P=0.015). Cox regression analysis showed that only pTNM stage (P=0.003) was independent prognostic factors of OS, while both pTNM stage (P=0.000) and blood PLR (P=0.015) were independent prognostic factors of RFS. gMANEC patients with high preoperative PLR tend to present recurrence and metastasis, especially to present live metastasis, so they should be kept under surveillance more frequently after surgery.

Inverse Association between Platelet-Lymphocyte Ratio and Prognosis in Terminally Ill Cancer Patients: A Preliminary Study.

An elevated platelet-lymphocyte ratio (PLR) is an indicator for worse outcomes in cancer, but its significance at the end of life remains unclear. This study aimed to investigate the value of PLR as an independent prognostic factor in terminally ill cancer patients. This retrospective cohort study included 312 terminal cancer patients and was conducted in a palliative care unit of a tertiary cancer center. Patient demographic data, clinical information, and laboratory values, including complete blood cell count, were obtained. Survival was analyzed using the Kaplan-Meier method and log-rank test. The Cox proportional hazards model was used to identify independent prognostic factors for survival. Median survival was 16 days in patients with PLR ≥200 and 9 days in patients with PLR <200 (p = 0.008). Results of multivariate analysis showed that the following factors predicted worse survival: poor performance status (adjusted hazard ratio [aHR], 2.16; 95% confidence interval [CI], 1.50-3.09), azotemia (aHR, 1.43; 95% CI, 1.01-2.02), hypoalbuminemia (aHR, 1.55; 95% CI, 1.07-2.26), hyperbilirubinemia (aHR, 1.67; 95% CI, 1.23-2.29), elevated lactate dehydrogenase (aHR, 1.58; 95% CI, 1.11-2.26), high neutrophil-lymphocyte ratio (aHR, 1.49; 95% CI, 1.09-2.04), and low PLR (aHR, 1.46; 95% CI, 1.08-1.97). Although elevated PLR indicates worse outcomes in patients with solid tumors, decreased PLR was an independent prognostic factor for poor survival in cancer patients at the end of life.