Post-treatment Neutrophil-lymphocyte Ratio Research Articles

Systemic Inflammation Predict Neurological Functional Outcome in Patients with Tuberculous Meningitis: A Multicenter Retrospective Cohort Study in China.

The predictors associated with clinical outcomes in patients with tuberculous meningitis (TBM) remain unclear. We aimed to analyse the relationship between systemic inflammation and clinical outcomes, as well as to explore whether systemic inflammation level influences the effectiveness of dexamethasone on treatment. Between January 2011 and December 2021, TBM patients admitted to five hospitals were observed consecutively. Baseline and post-treatment systemic inflammation levels were calculated using the neutrophil-lymphocyte-ratio (NLR). Generalized linear mixed models were employed to identify predictors of clinical outcomes. Propensity score matching and subgroup analyses were conducted to evaluate the effect of dexamethasone on treatment outcomes across different NLR levels. A total of 1203 TBM patients were included in the study. During the follow-up, 144 (13.6%) participants experienced early neurological deterioration within 7 days after admission, and 345 (28.67%) exhibited poor functional outcome at the 12-month follow-up. Multivariate analysis revealed that post-treatment NLR was significantly associated with early neurological deterioration (OR=1.25; 95% CI, 1.14-1.33; P<0.001), and poor outcome (OR=1.34; 95% CI, 1.26-1.45; P<0.001). After propensity score matching, dexamethasone treatment was not associated with early neurological deterioration (OR=0.83; 95% CI, 0.42-1.66; P=0.610) or poor outcome (OR=1.22; 95% CI, 0.49-2.11; P=0.490) in the highest quartile of post-treatment NLR. The effect of dexamethasone on treatment outcomes did not significantly vary with disease severity stratification. Elevated systemic inflammation is an independent risk factor for neurological outcome in TBM patients. Further studies are required to investigate systemic inflammation in more severely affected population to better predict the outcomes following anti-inflammatory therapies.

Evaluation of inflammatory biomarkers and the ratio of hemoglobin-red cell distribution width in patients with rheumatoid arthritis treated with tumor necrosis factor-alpha inhibitors.

The aim of this study was to examine pre-treatment and post-treatment hemogram-derived inflammatory biomarkers in patients with rheumatoid arthritis (RA) who received anti-tumor necrosis factor (TNF)-α treatment. The data of 1182 patients with RA were screened. Among them, 207 patients who met the eligibility criteria were included in the retrospective study. Demographic parameters, disease activity, and blood cell-derived indexes were evaluated. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and hemoglobin-red cell distribution width (Hb/RDW) rates were evaluated before treatment and at the third month of treatment in patients with RA who received anti-TNF-α treatment. According to the EULAR response criteria, 12.6% of the 207 patients responded to anti-TNF-α treatment as none, 21.3% as good, and 66.2% as moderate, respectively. Post-treatment NLR and PLR values were significantly lower than pre-treatment values (p < 0.001), whereas post-treatment LMR and Hb/RDW values were significantly higher than pre-treatment values (respectively, p = 0.001 and p = 0.012). The difference between pre-treatment and post-treatment values of LMR and Hb/RDW was significantly higher when compared to the moderate + good response groups than the none-response group (p = 0.002 and p = 0.014, respectively). However, in the receiver operating characteristic curve analysis, these parameters were not found to be significant in predicting treatment response. Significant changes were detected in hemogram-derived inflammatory markers of the groups responding to anti-TNF-α treatment. They can be used as a guide during treatment follow-up. Yet, they do not predict treatment response. Key Points • RA may manifest with periods of remission and activation, and regular follow-up is essential. • There is a demand for readily available, reproducible, and cost-effective parameters to assess treatment response. • Hemogram-derived inflammatory markers differ in relation to anti-TNF-α treatment response in RA. • None of those markers demonstrate an acceptable predictive performance in distinguishing patients based on their response to TNF-α inhibitors.

Evaluation of tadalafil supplementation on the neutrophil/lymphocyte and the platelet/lymphocyte ratios in patients with erectile dysfunction: A prospective study.

We aimed to evaluate the effect of daily 5 mg tadalafil on the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR) in patients with erectile dysfunction (ED). 30 subjects with ED were given tadalafil as well as 30 subjects with ED who were not receiving tadalafil were recruited. 30 healthy individuals served as controls. Receiver operating characteristic curve (ROC) showed that the best cut off point of pre-treatment and post treatment NLR in the ED treatment group was found <1.51, <1.51, sensitivity of 68.3%, 58.3%, specificity of 53.3%, 53.3%, lower bound of 0.558, 0.517, upper bound of 0.789, 0.757, total accuracy of 67.4%, 63.7% and p 0.003, 0.0025, respectively. Additionally, the best cut off point of pre-treatment and post treatment PLR in the ED treatment group was found <5.89, <5.99, sensitivity of 65%, 63.3%, specificity of 63.3%, 53.3%, lower bound of 0.515, 0.435, upper bound of 0.755, 0.687, total accuracy of 63.5%, 56.1% and p 0.027, 0.341, respectively. Daily 5 mg Tadalafil supplementation significantly improves erectile function through decreasing these markers as well as depression and anxiety.

Post-treatment Neutrophil/Lymphocyte Ratio Is a Prognostic Factor in Head and Neck Cancers Treated With Nivolumab.

Inflammation and nutrition-based biomarkers, such as the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), C-reactive protein/albumin ratio (CAR), prognostic nutritional index (PNI), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI), have prognostic value for several types of malignancies. Markers that precisely reflect the prognosis of patients with head and neck cancers (HNCs) treated with immune-checkpoint inhibitors remain unclear. This retrospective study aimed to investigate the prognostic value of hematological markers before and after treatment with nivolumab in patients with recurrent or metastatic HNC (RM-HNC). We evaluated the clinical data of 44 patients with recurrent/metastatic head and neck squamous cell carcinoma treated with nivolumab between April 2017 and April 2023 at Shinshu University Hospital. Values of hematological biomarkers (NLR, LMR, PLR, CAR, PNI, SII, and SIRI) were calculated before and 4-6 weeks after nivolumab initiation. Receiver operating characteristic curves were constructed to determine the cutoff values of pre- and post-treatment markers for overall survival (OS) and progression-free survival (PFS). Among all pre- and post-treatment markers, post-treatment NLR showed the highest area under the curve (AUC=0.702). A high post-treatment NLR (cutoff value, 4.01) was associated with a poor OS (p=0.027) and a tendency for shorter PFS (p=0.117). Multivariate analysis showed that a high post-treatment NLR was significantly associated with poor OS (p=0.026). A high post-treatment NLR was associated with poor response to nivolumab in head and neck cancers.

High Neutrophil-Lymphocyte Ratio and Delta Neutrophil-Lymphocyte Ratio Are Associated with Increased Mortality in Patients with Hepatocellular Cancer.

The neutrophil-lymphocyte ratio (NLR) has been proposed as a prognostic biomarker for cirrhosis and non-liver malignancies. We aimed to evaluate the prognostic value of NLR in a diverse cohort of patients with hepatocellular carcinoma (HCC). We performed a retrospective study of patients diagnosed with HCC between 2008 and 2017 at two large US health systems. We used Cox proportional hazard and multivariable ordinal logistic regression models to identify factors associated with overall survival and response to first HCC treatment, respectively. Primary variables of interest were baseline NLR and delta NLR, defined as the difference between pre- and post-treatment NLR. Among 1019 HCC patients, baseline NLR was < 5 in 815 (80.0%) and ≥ 5 in 204 (20.0%). Patients with NLR ≥ 5 had a higher proportion of infiltrative tumors (36.2% vs 22.3%), macrovascular invasion (39.6% vs 25.5%), metastatic disease (20.6% vs 11.4%), and AFP > 200ng/mL (45.6% vs 33.8%). Baseline NLR ≥ 5 was independently associated with higher mortality (median survival 4.3 vs 15.1months; adjusted HR 1.70, 95%CI 1.41-2.06), with differences in survival consistent across BCLC stages. After adjusting for baseline covariates including NLR, delta NLR > 0.26 was also independently associated with increased mortality (HR 1.42, 95%CI 1.14-1.78). In a secondary analysis, high NLR was associated with lower odds of response to HCC treatment (20.2% vs 31.6%; adjusted OR 0.55, 95%CI 0.32-0.95). In a large Western cohort of patients with HCC, high baseline NLR and delta NLR were independent predictors of mortality. NLR is an inexpensive test that may be a useful component of future HCC prognostic models.

Association of Pre- and Posttreatment Neutrophil-Lymphocyte Ratio With Recurrence and Mortality in Locally Advanced Non-Small Cell Lung Cancer.

ObjectivesNeutrophil–lymphocyte ratio (NLR) has been associated with mortality in non-small cell lung cancer (NSCLC), but its association with recurrence in locally advanced NSCLC (LA-NSCLC), specifically, is less established. We hypothesized pre- and posttreatment NLR would be associated with recurrence and mortality.MethodsWe studied the association of pretreatment NLR (pre-NLR) and posttreatment NLR at 1 (post-NLR1) and 3 months (post-NLR3) with outcomes in patients with LA-NSCLC treated with chemoradiation. Pre-NLR was dichotomized by 5, an a priori cutoff previously shown to be prognostic in LA-NSCLC. Post-NLR1 and post-NLR3 were dichotomized by their medians.ResultsWe identified 135 patients treated with chemoradiation for LA-NSCLC between 2007 and 2016. Median follow-up for living patients was 61.1 months. On multivariable analysis, pre-NLR ≥ 5 was associated with worse overall survival (HR = 1.82; 95% CI 1.15 – 2.88; p = 0.011), but not with any recurrence, locoregional recurrence, or distant recurrence. Post-NLR1 ≥ 6.3 was not associated with recurrence or survival. Post-NLR3 ≥ 6.6 was associated with worse overall survival (HR = 3.27; 95% CI 2.01– 5.31; p < 0.001), any recurrence (HR = 2.50; 95% CI 1.53 – 4.08; p < 0.001), locoregional recurrence (HR = 2.50; 95% CI 1.40 – 4.46; p = 0.002), and distant recurrence (HR = 2.53; 95% CI 1.49 – 4.30; p < 0.001).ConclusionPretreatment NLR is associated with worse overall survival and posttreatment NLR is associated with worse survival and recurrence. These findings should be validated independently and prospectively studied.

Impact of Thoracic Vertebral Body Dose on Post-Treatment Neutrophil Lymphocyte Ratio in Locally Advanced Non-Small Cell Lung Cancer

Neutrophil-lymphocyte ratio (NLR) has been associated with mortality for non-small cell lung cancer (NSCLC), but its association with recurrence in locally advanced NSCLC, specifically, is less established. We hypothesized that pre- and post-treatment NLR would be associated with increased recurrence and mortality and further that increasing radiation dose to the thoracic vertebral bodies (TVB) during chemoradiation would be associated with increased post-treatment NLR. We used Cox proportional hazards and Kaplan-Meier analysis to study the association of pre- and post-treatment NLR with overall survival and recurrence in patients with locally advanced NSCLC treated with chemoradiation. Pre- and post-NLR were analyzed as continuous and dichotomized variables. Pre-treatment NLR was dichotomized by a value of 5, an a priori cutoff previously shown to be prognostic in locally advanced NLR. Post-treatment NLR was dichotomized by the median. We subsequently performed linear and logistic regression to correlate TVB dose with NLR at 3 months post treatment. We identified 144 patients with available survival data (88 with recurrence data) treated with chemoradiation for locally advanced NSCLC between 2007 and 2016. Median follow up for living patients was 14.9 months. On multivariable analysis, pre-treatment NLR ≥ 5 was associated with worse overall survival (HR = 2.56; 95% CI 1.53 – 4.30; p < 0.001), any recurrence (HR = 2.13; 95% CI 1.10 – 4.12; p = 0.026) and locoregional recurrence (HR = 2.64; 95% CI 1.12 – 6.23; p = 0.026), but not distant recurrence (HR = 1.85; 95% CI 0.76 – 4.51; p = 0.18). There was a statistically significant increase in NLR after treatment (p < 0.001). Three-month median post-treatment NLR ≥ 6.6 was associated with worse overall survival (HR = 3.16; 95% CI 1.70 – 5.86; p < 0.001), any recurrence (HR = 2.96; 95% CI 1.54 – 5.69; p = 0.001), and locoregional recurrence (HR = 6.53; 95% CI 2.44 – 17.44; p < 0.001). There was a trend toward significant association with distant recurrence (HR = 2.16; 95% CI 0.92 – 5.05; p = 0.077). On linear regression, there was a statistically significant correlation of post-treatment NLR at 3 months with thoracic vertebral body volume receiving 5, 10, 20, 30, 40, and 50 Gy. On logistic regression, there was a direct correlation of 3-month post-treatment NLR ≥ 6.6 with V5 (p = 0.13), V10 (p = 0.023), V50 (p = 0.045), and V60 (p = 0.042). We found that both pre-treatment NLR and post-treatment NLR are associated with worse overall survival and locoregional recurrence. Additionally, we found that post-treatment NLR is correlated with TVB. These findings suggest that limiting dose to the TVB is important for not only reducing acute hematologic toxicity but also for improving disease outcomes, and these results should be validated in an independent, ideally prospectively studied cohort.

Predictive value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in advanced hepatocellular carcinoma patients treated with anti-PD-1 therapy.

BackgroundCurrently, there are no recognized or validated biomarkers to identify hepatocellular carcinoma patients (HCC) likely to benefit from anti–PD‐1 therapy. We evaluated the relationship between neutrophil‐lymphocyte ratio (NLR) and platelet‐lymphocyte ratio (PLR) and survival outcomes, pretreatment and after three doses (posttreatment) of nivolumab in HCC patients.MethodsMedical records of HCC patients treated with nivolumab between June 2016 and July 2018 were reviewed. Kaplan‐Meier analysis and the log‐rank test were used to calculate and compare overall survival between NLR < 5 Vs ≥ 5 and among PLR tertiles.ResultsA total of 103 patients were identified. Median age was 66 (29‐89) years. Median treatment duration was 26 (2‐149) weeks. Sixty‐four (62%) patients had Child‐Pugh class A (CP‐A) liver function. Barcelona Clinic Liver Cancer stage was B in 20 (19%) and C in 83 (81%) patients. CP‐A patients who achieved a partial or complete response had significantly lower posttreatment NLR and PLR (P < .001 for both) compared to patients who had stable disease or progression of disease. No relationship was observed between response and pretreatment NLR and PLR. NLR < 5 was associated with improved OS compared to NLR ≥ 5 both pretreatment (23 Vs10 months, P = .004) and posttreatment (35 Vs 9 months, P < .0001). Survival also differed significantly among PLR tertiles both pre‐ (P = .05) and posttreatment (P = .013). In a multivariable model, posttreatment NLR (HR = 1.10, P < .001) and PLR (HR = 1.002, P < .001) were strongly associated with survival. In a composite model of posttreatment NLR and PLR, a combination of high NLR and PLR was associated with an eightfold increased risk of death (HR = 8.3, P < .001).ConclusionsThis study suggests a strong predictive role of these inflammatory cell ratios in the posttreatment setting in HCC patients treated with anti anti–PD‐1 therapy and should be evaluated in a larger cohort.

The dynamic change of neutrophil to lymphocyte ratio is predictive of pathological complete response after neoadjuvant chemotherapy in breast cancer patients.

The pre-treatment neutrophil-lymphocyte ratio (NLR) has been reported to be a predictive factor for pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) in breast cancer patients. However, whether the dynamic change of post-treatment neutrophil to lymphocyte ratio (delta-NLR) can better predict the same outcome remains unclear. We retrospectively analyzed 242 consecutive patients affected by breast cancer and candidates of NACT. The complete blood cell counts before and after NACT were evaluated to calculate NLR. The relationships between delta-NLR and pCR, along with other clinical-pathological characteristics were analyzed. Univariate and multivariate analyses were performed using a logistic regression model. Of the 242 patients, 65 (26.9%) achieved a pCR. Pre-treatment NLR and post-treatment NLR were not significantly associated with pCR if analyzed separately in multivariate analyses. However, when combining together, patients with delta-NLR < 0 profile achieved a significantly higher rate of pCR compared to those with delta-NLR ≥ 0 (OR 2.84, 95% CI 1.35-5.96, p = 0.006). Additionally, the predictive value of delta-NLR was independent from common prognostic factors such as Ki-67, and molecular subtypes. Delta-NLR, rather than pre-treatment or post-treatment NLR is associated with pCR rate, suggesting that the dynamic change of NLR may be an important factor predicting the response to NACT in breast cancer patients.

Neutrophil-Lymphocyte Ratio Dynamics Is Useful to Distinguish between Recurrence and Pseudoprogression in High-Grade Gliomas

Distinguishing recurrence and pseudoprogression is a major challenge in the clinical practice of treatment for high-grade gliomas (HGGs). Neutrophil–lymphocyte ratio (NLR) had been reported to be closely related with survival in HGGs. We aimed to assess the predictive value of NLR in the differential diagnosis of recurrence and pseudoprogression. 135 patients with histologically confirmed HGGs were studied. All patients underwent focal radiotherapy and concomitant temozolomide (TMZ), followed by 6 cycles of TMZ if MRI showed no progressive enlargement of contrast-enhancing lesion. MRI evaluation was taken 4 weeks after concurrent chemoradiotherapy and then every 2 months later. NLR was calculated at 4 time points of pretreatment, 1 month after operation, 4 weeks following completion of RT-TMZ and MRI showed lesion enlarged or treatment completed. Forty-seven (34.8%) in 135 patients were found to be pseudoprogression (PsPD) and 28 (20.7%) were early disease progression (ePD). The mean pretreatment and post-treatment NLR was 4.2±2.1 and 5.1±3.5 respectively. The median overall survival in PsPD group (25.2 months) was significantly longer than ePD (15.4 months) and no progression group (nPD) (21.6 months) (p<0.001). Overall survival was significantly shorter in NLR>=4 cohort compared with NLR<4 (p=0.03), but no significant difference was found between PsPD and ePD (p=0.197). Patients with decreased NLR showed significantly longer survival than no decreased group (p<0.001) and decreased NLR was found significant difference between PsPD and ePD (p=0.022). Univariate and multivariate logistic regression analyses suggested that decreased NLR was an independent prognosis factor (p=0.031). Decreased NLR is an independent prognostic factor and useful to distinguish between recurrence and pseudoprogression in HGGs.

Neutrophil-lymphocyte ratio dynamics are useful for distinguishing between recurrence and pseudoprogression in high-grade gliomas.

ObjectiveDistinguishing recurrence and pseudoprogression is a major challenge in the clinical practice of treatment for high-grade gliomas (HGGs). The neutrophil–lymphocyte ratio (NLR) has been reported to be closely related to survival in HGGs. We aimed to assess the predictive value of NLR in the differential diagnosis of recurrence and pseudoprogression.Materials and MethodsA total of 135 patients with histologically confirmed HGGs were studied. All patients underwent focal radiotherapy and concomitant temozolomide (TMZ), followed by 6 cycles of TMZ if MRI showed no progressive enlargement of contrast-enhancing lesions. MRI evaluation was taken 4 weeks after concurrent chemoradiotherapy and then every 2 months later. NLR was calculated at 4 time points of preoperation, before concurrent RT-TMZ (pretreatment), 4 weeks following completion of RT-TMZ, and MRI showed lesion enlarged or treatment completed.ResultsIn 135 patients, 47 (34.8%) were found to be pseudoprogression (PsPD), and 28 (20.7%) were early disease progression (ePD). The mean pretreatment and post-treatment NLR were 4.2±2.1 and 5.1±3.5, respectively. The median overall survival in the PsPD group (25.2 months) was significantly longer than in the ePD (15.4 months) and no progression group (nPD) (21.6 months) (p<0.001). Overall survival was significantly shorter in the baseline NLR≥4 cohort compared with NLR<4 (p=0.03), but no significant difference was found between PsPD and ePD (p=0.197). Patients with decreased NLR showed significantly longer survival than no decreased group (p<0.001), and decreased NLR was found to be a significant difference between PsPD and ePD (p=0.022). Univariate and multivariate logistic regression analyses suggested that decreased NLR was an independent prognosis factor (p=0.031).ConclusionDecreased NLR is an independent prognostic factor and is useful for distinguishing between recurrence and pseudoprogression in HGGs.

A reliable and feasible way to predict the benefits of Nivolumab in patients with non-small cell lung cancer: a pooled analysis of 14 retrospective studies

ABSTRACT Objective: Nivolumab has been used for treating non-small cell lung cancer (NSCLC) worldwide. Whether neutrophil-lymphocyte ratio (NLR) can predict the prognosis of NSCLC treated with Nivolumab is still under debate. This meta-analysis was to assess the significance of NLR as a predictive factor in NSCLC patients receiving Nivolumab. Methods: Databases including PubMed, Embase, and the Cochrane library were searched to identify eligible studies evaluating the role of NLR in predicting prognosis of NSCLC treated with Nivolumab until March 2018 without language restrictions. The meta-analysis was performed using hazard ratio (HR) of progression free survival (PFS) and overall survival (OS) in NSCLC patients with various NLR. Results: A total of 14 retrospective studies consisting of 1225 NSCLC patients were included. The combined results showed that relatively higher baseline NLR was associated with poor PFS (HR = 1.44; 95% confidence interval (CI):1.18–1.77; p < 0.05) and OS (HR = 1.75; 95% CI: 1.33–2.30; p < 0.05) after treatment of Nivolumab. Subgroup analysis suggested that NLR ≥ 5 was more reliable for PFS (HR = 1.73; 95%CI: 1.14, 2.62; p < 0.05) and OS (HR = 1.76; 95%CI: 1.47, 2.10; p < 0.05). In addition, post-treatment NLR also had predictive roles for PFS (HR = 3.17; 95%CI: 1.48, 6.82; p < 0.05) and OS (HR = 2.26; 95%CI: 1.05, 4.86; p < 0.05). Conclusion: Our findings suggest that NLR can be used as a prognostic biomarker for NSCLC treating with Nivolumab, and the recommended cutoff value of NLR is 5.

Hematologic Markers of Lung Metastasis in Stage IV Colorectal Cancer.

Many studies showed an association between absolute neutrophil count (ANC), absolute monocyte count (AMC), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) with poor overall survival (OS) in patients with cancer. However, only a few studies were conducted to further investigate this association in colorectal cancer (CRC). Clinical data from 299 stage IV CRC patients treated at King Hussein Cancer Center from 2004 to 2012 have been retrospectively reviewed. We examined the association between ANC, AMC, MLR, PLR, and NLR with lung metastasis in stage IV CRC. Receiver Operating Characteristic (ROC) curve analysis was operated to determine the optimal NLR cutoff value. Univariate and multivariate analysis were performed. The ROC value of 3.4 was determined as the cutoff value of NLR to study the association. Univariate and multivariate analysis showed that patients with high baseline NLR (≥ 3.4) had more baseline lung metastasis than patients with low NLR (< 3.4) (p = 0.0001, p = 0.0151, respectively). Also, baseline NLR correlated significantly with the presence of lymphovascular invasion (p = 0.001). In patients with no baseline lung metastasis, high post-treatment NLR was associated with consequent development of lung metastasis (p = 0.0227). Other markers including ANC, AMC, MLR, and PLR were significantly associated with lung metastasis at time of diagnosis (p = 0.0006, p = 0.0006, p = 0.0187, and p = 0.001, respectively). Results are suggesting that different hematologic markers obtained from a cheap test (CBC) could potentially be used to predict the likelihood of lung metastasis in stage IV CRC. Prospective studies are needed to further assess the immune cells' role in tumor metastasis promotion.

P3.02c-061 Neutrophil/Lymphocyte Ratio Predicts the Efficacy of Anti-PD-1 Antibody in Patients with Advanced Lung Cancer: Topic: IT Biomarkers

Therapeutic antibodies to programmed death receptor 1 (PD-1) have shown clinical activity in lung cancer. The aim of this study is to investigate the clinical factors, including inflammatory markers such as neutrophil/lymphocyte ratio (NLR), to predict response to anti-PD-1 antibody in advanced lung cancer patients. We retrospectively analyzed 51 patients who had advanced lung cancer and had been treated with anti-PD-1 antibodies between 2013 and 2015. The values of NLR were assessed at two time points: at baseline (pre-treatment) and at 6 week after the start of treatment (post-treatment). NLR of 5 was used as the cutoff value. The median age of the patients was 68 years; 76.5% were male, and 27.5% were never smokers. Most patients had adenocarcinoma (n = 28); 17 had squamous cell carcinoma, and 6 had others. Eighteen of 51 patients (35.3%) had clinical objective response to anti-PD-1 antibody. Non-adenocarcinoma histology and low post-treatment NLR was significantly associated with clinical response, while gender, smoking history, line of treatment and pre-treatment NLR were not predictive of response. Liver metastasis, brain metastasis, and high post-treatment NLR were significantly associated with worse tumor response. Patients with a high post-treatment NLR had significantly shorter PFS (median 1.3 months vs. 6.1 months, p < 0.001). Multivariable analysis demonstrated that high post-treatment NLR (hazard ratio [HR] 20.1, 95% confidence interval [CI] 5.5 - 73.9, p < 0.001), presence of liver metastasis (HR 5.5, 95% CI 2.1 - 14.6, p = 0.001), and CNS metastasis (HR 2.9, 95% CI 1.1 - 7.4, p = 0.027) were independent predictive factors for short PFS. Clinical factors including post-treatment NLR at 6 week might be predictive of clinical benefits from anti-PD-1 antibody therapy in lung cancer.

Analysis of the albumin level, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio in Guillain-Barré syndrome.

The purpose of this study was to investigate the prognostic value of the pretreatment and post-treatment albumin level, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) in subtypes of Guillain-Barré syndrome (GBS). A retrospective analysis of 62 patients with GBS treated between 2011 and 2015 in Dicle University Hospital, Turkey, was carried out. The pretreatment and post-treatment albumin, NLR, and PLR were documented, together with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy, motor sensory axonal neuropathy, and Hughes' scores. Post-treatment albumin levels in GBS were significantly reduced, and albumin level was negatively correlated with the Hughes scores. Elevated pretreatment NLRs and PLRs were significantly associated with AIDP. There were no correlations between the Hughes scores, NLR, and PLR. The results point to a negative correlation between albumin levels and GBS disability and suggest that the NLR and PLR may be promising blood biomarkers of AIDP.

Prognostic value of posttreatment neutrophil-lymphocyte ratio in head and neck squamous cell carcinoma treated by chemoradiotherapy.

An inflammatory-immunological marker, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), was evaluated as a predictive marker of advanced head and neck cancer patients receiving chemoradiotherapy. This study included 104 patients with treatment-naïve head and neck cancer who underwent definitive chemoradiotherapy. An inflammatory marker was measured at baseline and after 1 month of treatment. Univariate and multivariate analyses using Cox proportional hazards model were used to identify predictors of progression-free survival (PFS) and overall survival (OS). A univariate analysis revealed that T,N-stage, the pre- and posttreatment NLRs were significant predictors of progression after the chemoradiotherapy. However, the posttreatment NLR remained an independent predictor of PFS in the multivariate analysis (HR=2.23, 95% CI 1.15-2.321; P=0.001). A high posttreatment NLR was significantly associated with an increased risk of death (HR=1.87, 95% CI 0.89-3.31; P=0.037). A high posttreatment NLR is associated with poor prognostic factor. An early reduction in the NLR after treatment may indicate survival improvement in the patients.

Neutrophil lymphocyte ratio (NLR) change after systemic treatment as a predictive factor of cancer specific survival in stage IV breast cancer.

29 Background: Inflammatory response exacerbates mechanisms linked to tumor growth and dissemination. As an index of systemic inflammatory status, neutrophil lymphocyte ratio (NLR) may be a predictive biomarker of both prognosis and response to therapy. We evaluated initial pre-treatment NLR and post-treatment NLR change to assess whether initial and change in NLR would be predictive of disease outcome in stage IV breast cancer patients. Methods: This study included 250 stage IV breast cancer patients diagnosed at Asan Medical Center between 1997 and 2012. The NLR was calculated from the differential count by dividing neutrophil percentage by lymphocyte percentage. All initial (pre-treatment) NLR was evaluated at the first visit day in Asan medical center. Post-treatment NLR was obtained at the first follow-up visit at the outpatient department after first treatment (chemotherapy first: about after 3weeks/endocrine therapy: after 3~6 months). The initial (pre-treatment) NLR was divided by quartile, and the NLR change was calculated by dividing post-treatment NLR by pre-treatment NLR. If the value was ≥ 1.2, NLR change was increased; if not, it was not changed or decreased. We evaluated prognostic value of NLR by comparison with Cancer Specific Survival (CSS). Results: When comparing pre-treatment NLR and post-treatment NLR, the NLR was increased in 85 patients (34%) and stationary or decreased in 165 patients (66%). There was no significant difference between two groups in baseline characteristics. On the other hand, in CSS, the difference between two groups are shown, but does not have statistical significance (log rank p = 0.052). The 1, 3, 5 year CSS rate was 78.8%, 35.7%, 20.5% in increased NLR group, and 87.1%, 49.3%, 26.9% in the other group. Multivariate analysis suggested that increased NLR change (Post/Pre NLR ≥ 1.2) had statistical significance as prognostic factor of stage IV breast cancer patients after treatment (HR = 1.750, 95% CI 1.130-2.709, p-value = 0.012). Conclusions: After start of treatment, increased NLR can be correlated with poor cancer specific survival in stage IV breast cancer. The NLR change might be an index of response of systemic treatment.

Post-treatment neutrophil-lymphocyte ratio independently predicts amputation in critical limb ischemia without operation

OBJECTIVES:Limited information is available concerning the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients who receive conservative therapy. Accordingly, this study was designed to evaluate the predictive value of the post-treatment neutrophil-lymphocyte ratio in critical limb ischemia patients without surgery.METHOD:From January 2009 to January 2011, critical limb ischemia patients were admitted to a vascular center. The demographic data, patient histories, comorbidities and risk factors were documented, and the differential cell count was determined at admission and seven days later after conservative therapy. The cutoff value of the post-treatment neutrophil-lymphocyte ratio was determined by an ROC curve. Patients were divided into groups A and B according to the cutoff value. Amputation-free survival was compared between groups. Univariate and multivariate analyses were used to identify independent risk factors.RESULT:A total of 172 patients were identified with a mean age 71.98±10.09 years; among them, 122 were male. A value of 3.8 was identified as the cutoff value of the post-treatment neutrophil-lymphocyte ratio. Groups A (post-treatment neutrophil-lymphocyte ratio ≥3.8) and B (post-treatment neutrophil-lymphocyte ratio <3.8) showed a significant difference in amputation-free survival (P<0.001). The 1-year, 2-year and 3-year amputation-free survival rates were 79.6%, 55.6% and 46.3%, respectively, in group A; however, in group B, these values were 89.7%, 79.3% and 75.9%, respectively. The post-treatment neutrophil-lymphocyte ratio was identified as an independent predictive factor for amputation in critical limb ischemia patients (P<0.001).CONCLUSION:The post-treatment neutrophil-lymphocyte ratio is an independent predictive factor for amputation in critical limb ischemia patients. Patients with a post-treatment neutrophil-lymphocyte ratio ≥3.8 are likely to suffer from amputation; amputation-free survival usually occurs in patients with a post-treatment neutrophil-lymphocyte ratio <3.8.