Pretreatment Neutrophil-lymphocyte Ratio Research Articles

Prognostic Role of Blood Markers in Primary Central Nervous System Lymphoma Patients Treated With High-Dose Methotrexate-Based Therapy.

Purpose: Primary central nervous system lymphoma (PCNSL) is a rare type of extra-nodal non-Hodgkin lymphoma, but the prognostic value of blood parameters indicating systemic inflammation and nutritional status remains unknown. We aim to explore the prognostic role of blood parameters in PCNSL.Methods: All PCNSL patients diagnosed at West China Hospital between February 2011 and February 2020 were retrospectively screened. For patients who were initially treated with high-dose methotrexate (HD-MTX)-based therapy, clinical data were collected. Survival analyses were performed using the Kaplan–Meier method and multivariable Cox proportional regression. The accuracies of different multivariate models were assessed by Harrell's C statistical analysis (C-index).Results: Sixty patients were included. Median overall survival (OS) was 4.8 ± 3.7 years, and median progression-free survival (PFS) was 1.9 ± 1.3 years. In the multivariate analysis, hemoglobin (Hb) (HR 3.940, p = 0.013), neutrophil–lymphocyte ratio (NLR) (HR 10.548, p = 0.034), and total bilirubin (TBIL) (HR 3.429, p = 0.004) had independent prognostic values for PFS, while lymphocyte–monocyte ratio (LMR) (HR 6.195, p = 0.039), systemic immune-inflammation index (SII) (HR 5.144, p = 0.012), and TBIL (HR 3.892, p = 0.009) were independently related to OS. The C-index of the Memorial Sloan-Kettering Cancer Center (MSKCC) score increased from 0.57 to 0.72 when SII and TBIL were combined.Conclusions: Our study indicated that pretreatment Hb, NLR, SII, LMR, and TBIL were convenient prognostic factors in PCNSL. Adding SII and TBIL to the MSKCC score can better predict the survival of PCNSL based on HD-MTX regimens.

Prognostic utility of pretreatment neutrophil-lymphocyte ratio in survival outcomes in localized non-small cell lung cancer patients treated with stereotactic body radiotherapy: Selection of an ideal clinical cutoff point

Background and purposeNeutrophil-lymphocyte ratio (NLR) has been associated with overall survival (OS) in non-small cell lung cancer (NSCLC). We aimed to assess the utility of NLR as a predictor of lung cancer-specific survival (LCS) and identify an optimal, pretreatment cutoff point in patients with localized NSCLC treated with stereotactic body radiotherapy (SBRT) within the Veterans Affairs’ (VA) national database. Materials and methodsIn the VA database, we identified patients with biopsy-proven, clinical stage I NSCLC treated with SBRT between 2006 and 2015. Cutoff points for NLR were calculated using Contal/O’Quigley’s and Cox Wald methods. Primary outcomes of OS, LCS, and non-lung cancer survival (NCS) were evaluated in Cox and Fine-Gray models. ResultsIn 389 patients, optimal NLR cutoff was identified as 4.0. In multivariable models, NLR > 4.0 was associated with decreased OS (HR 1.44, p = 0.01) and NCS (HR 1.68, p = 0.01) but not with LCS (HR 1.32, p = 0.09). In a subset analysis of 229 patients with pulmonary function tests, NLR > 4.0 remained associated with worse OS (HR 1.51, p = 0.02) and NCS (HR 2.18, p = 0.01) while the association with LCS decreased further (HR 1.22, p = 0.39). ConclusionNLR was associated with worse OS in patients with localized NSCLC treated with SBRT; however, NLR was only associated with NCS and not with LCS. Pretreatment NLR, with a cutoff of 4.0, offers potential as a marker of competing mortality risk which can aid in risk stratification in this typically frail and comorbid population. Further studies are needed to validate pretreatment NLR as a clinical tool in this setting.

Predictive Value of Combining Biomarkers for Clinical Outcomes in Advanced Non-Small Cell Lung Cancer Patients Receiving Immune Checkpoint Inhibitors

IntroductionA high tumor mutational burden (TMB) (≥10 mut/Mb) has been associated with improved clinical benefit in non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICI) and is a tumor agnostic indication for pembrolizumab across tumor types. We explored whether combining TMB with programmed cell death ligand 1 (PD-L1) and pretreatment neutrophil-lymphocyte ratio (NLR) was associated with improved outcomes in ICI-treated NSCLC. MethodsWe retrospectively analyzed patients treated with ICI with Foundation One genomic testing, including TMB. Optimal cutoff for prediction of response by TMB was determined by receiver operating characteristic analysis, and area under the curve (AUC) was calculated for all 3 biomarkers and combinations. Cox model was used to assess prognostic factors of overall survival (OS) and time to progression (TTP). Survival cutoffs calculated with Kaplan-Meier survival curves were TMB ≥10 mut/Mb, PD-L1 ≥50%, NLR <5, and combined biomarkers. ResultsData from 88 patients treated were analyzed. The optimal TMB cutoff was 9.24 mut/Mb (AUC, 0.62), improving to 0.74 combining all 3 biomarkers. Adjusted Cox model showed that TMB ≥10 mut/Mb was an independent factor of OS (hazard ratio [HR], 0.31; 95% confidence interval; 0.14-0.69; P = .004) and TTP (HR, 0.46; 95% CI, 0.27-0.77; P = .003). The combination of high TMB with positive PD-L1 and low NLR was significantly associated with OS (P = .038) but not TTP. ConclusionsTMB has modest predictive and prognostic power for clinical outcomes after ICI treatment. The combination of TMB, PD-L1, and NLR status improves this power.

Neutrophil-lymphocyte ratio as a prognostic tool for the evaluation of laryngeal carcinoma

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;The objective of the study was to review the neutrophil lymphocyte ratio (NLR) as a prognostic tool in carcinoma larynx.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who were fulfilling inclusion criteria after screening were selected for study. On the basis of cutoff pretreatment NLR (&amp;lt;3 or &amp;gt;3) divided into two groups high pretreatment NLR and low pretreatment NLR. Patient undergo chemo or radiotherapy and at the end of follow up these two group NLR were compared with tumor negative prognostic score, survival at the end of follow up, resolving of symptoms, staging change, tumor regression and overall prognosis at the end of follow up were assessed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean value of tumor negative prognostic score of early carcinoma with low NLR, early carcinoma with high NLR, late carcinoma with low NLR and late carcinoma with High NLR were 13.833±2.80, 24.04±4.5538, 37.833±8.68 and 55.33±6.429 respectively. 10 (17.5%) patients with high NLR show more than 50% tumor regression while 17 (29.82%) with high NLR show &amp;lt;50% tumor regression. 26 (45.61%) patients with low NLR show &amp;gt;50% tumor regression and 4 (7.01%) show &amp;lt;50% tumor regression.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It was concluded in our study that pretreatment NLR is an acceptable prognostic tool in carcinoma larynx. High NLR was associated with poor prognosis and low NLR was associated with better prognosis.&lt;/p&gt;

Blood Cell Count Biomarkers Predicting Efficacy of Pembrolizumab as Second-line Therapy for Advanced Urothelial Carcinoma.

To investigate the blood markers for predicting pembrolizumab efficacy in advanced urothelial carcinoma (UC). This study included 91 advanced UC patients. The relationship between prognosis and markers from peripheral blood cell counts, including the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI=monocytes × neutrophils/lymphocytes), was evaluated. Multivariate analysis indicated that pretreatment NLR and the 1-month-change NLR were both significantly associated with overall survival (OS) after pembrolizumab initiation. When the patients were divided into four groups according to calculated cutoffs using Cox proportional hazard model, the pretreatment NLR <2.9 and 1-month change NLR <+43% groups had a significantly better OS than the pretreatment NLR ≥2.9 and 1-month-change NLR ≥+43% groups. NLR, MLR, PLR and SIRI before pembrolizumab and 1-month-change NLR in advanced UC correlated with OS after pembrolizumab treatment.

Neutrophil-Lymphocyte Ratio as a Prognostic Parameter in NSCLC Patients Receiving EGFR-TKIs: A Systematic Review and Meta-Analysis.

Objective To research the impact of neutrophil-lymphocyte ratio (NLR) as a prognostic parameter in non-small-cell lung cancer (NSCLC) patients treated with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Methods We searched the databases such as the American Society of Clinical Oncology (ASCO), EMBASE, PubMed, the European Society of Medical Oncology (ESMO), Wanfang, and CNKI for articles illustrating the impact of pretreatment NLR on survival data in NSCLC patients undergoing EGFR-TKIs treatment. We did a meta-analysis for overall survival (OS) and progression-free survival (PFS). Results We recruited 10 studies in our meta-analysis. Our study suggested that patients with low NLR had better PFS (hazard ratio (HR) = 1.67, 95% confidence interval (CI) = (1.16–2.39), and P value = 0.005) and OS (HR = 1.66, 95% CI = (1.08–2.55), and P value = 0.02) in comparison to patients with high NLR. Conclusion In conclusion, our meta-analysis revealed that lower NLR predicted a better survival (PFS and OS) in patients receiving the treatment of EGFR-TKIs.

Prognostic value of combined pretreatment fibrinogen and neutrophil-lymphocyte ratio in digestive system cancers: a meta-analysis of 17 retrospective studies

BackgroundSeveral epidemiological studies have reported the relationship between the combined pretreatment fibrinogen and neutrophil-lymphocyte ratio (F-NLR) and prognosis of digestive system cancers (DSCs). However, the results are controversial. We aimed to assess the prognostic value of F-NLR in patients with DSCs.MethodsA comprehensive search for relevant studies was conducted until June, 2020. Studies that evaluated the association of the F-NLR score with survival outcome in patients with any DSCs were included. The hazard ratio (HR) and 95% confidence interval (CI) were calculated using a fixed-effects model. All data analyses were performed using the STATA 12.0 software.ResultsA total of 17 studies involving 5,767 participants were included in the meta-analysis. We found that high F-NLR score was significantly associated with poor overall survival (OS) in patients with DSCs (HR =2.0; 95% CI, 1.78–2.24). In addition, patients with high F-NLR score had poor disease-free survival/progression-free survival/recurrence-free survival (DFS/PFS/RFS) (HR =2.01; 95% CI, 1.47–2.74) and DFS (HR =1.97; 95% CI, 1.35–2.87). Sensitivity analyses for OS confirmed that the results were stable.ConclusionsHigh F-NLR score is significantly associated with poor prognostic outcomes in patients with DSCs and can serve as an effective prognostic indicator for the Asian population.

Prognostic Utility of Pretreatment Neutrophil-Lymphocyte Ratio in Advanced Larynx Cancer.

Purpose:Neutrophil-lymphocyte ratio has been explored as a prognosticator in several cancer types, but its association with larynx cancer outcomes is not well known. We aimed to identify an optimal NLR cutoff point and examine the prognostic utility of this biomarker in patients with locoregionally advanced larynx cancer treated with curative intent.Methods:In the Veterans Affairs’ (VA) national database, we identified patients with locoregionally advanced (T3-4N0-3M0) laryngeal squamous cell carcinoma diagnosed between 2000 and 2017 and treated with curative intent. NLR cutoff points were calculated using Contal/O’Quigley’s method. Outcomes of larynx cancer-specific survival (CSS), overall survival (OS), and non-larynx cancer survival (NCS) were evaluated in multivariable Cox and Fine-Gray models.Results:In 1047 patients, the optimal pretreatment NLR cutoff was identified as 4.17 - 722 patients with NLR ⩽ 4.17, 325 patients with NLR > 4.17. The elevated NLR cohort had a higher proportion of T4 disease (39.4% vs 28.4%), node positive disease (52.3% vs 43.1%), and surgical treatment (43.7% vs 35.2%). In multivariable analysis, NLR > 4.17 was independently associated with worse OS (HR 1.31, 95% CI 1.12-1.54, P = .001) and worse CSS (HR 1.46, 95% CI 1.17-1.83, P < .001), but not with NCS (HR 0.94, 95% CI 0.75-1.18, P = .58).Conclusion:In locoregionally advanced larynx cancer treated with curative intent, we identified elevated NLR to be associated with inferior OS and CSS. Further prospective studies are needed to investigate pretreatment NLR and our identified 4.17 cutoff as a potential larynx cancer-specific marker for this high risk population.

The Prognostic Significance of Combined Pretreatment Fibrinogen and Neutrophil-Lymphocyte Ratio in Various Cancers: A Systematic Review and Meta-Analysis.

Purpose The prognostic value of a new scoring system, termed F-NLR, that combines pretreatment fibrinogen level with neutrophil-lymphocyte ratio has been evaluated in various cancers. However, the results are controversial. The purpose of this study was to comprehensively analyze the prognostic value of F-NLR score in patients with cancers. Methods An integrated search of relevant studies was conducted by screening the PubMed and Embase databases. Pooled hazard ratios, with 95% confidence intervals (CIs), for overall survival (OS) and disease-free survival (DFS)/progression-free survival (PFS) were calculated to estimate the prognostic significance of F-NLR score in patients with various tumors. A random effects model was used for comprehensive analysis, and subgroup and meta-regression analyses were used to explore sources of heterogeneity. Results Thirteen articles reporting data from of 4747 patients were included in the study. Pooled analysis revealed that high F-NLR score was significantly associated with poor OS (HR = 1.77; 95% CI, 1.51–2.08) and poor DFS/PFS (HR = 1.63; 95% CI, 1.30–2.05). Subgroup and meta-regression analyses did not alter the prognostic role of F-NLR score in OS and DFS/PFS. Conclusions Increased F-NLR score is significantly associated with poor prognosis in patients with cancers and can serve as an effective prognostic indicator.

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.

Value of preoperative neutrophil-lymphocyte ratio and human epididymis protein 4 in predicting lymph node metastasis in endometrial cancer patients.

To investigate the value of pretreatment neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), serum cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in predicting lymph node metastasis in patients with endometrial cancer. A retrospective analysis of 145 patients with endometrial cancer who were treated at the Peking University Cancer Hospital and Institute between October 2010 and November 2013 was performed. Preoperative NLR, PLR, serum CA125 and HE4 were assessed. Clinicopathological parameters were evaluated for LN metastasis using logistic regression. Receiver operating characteristic (ROC) curves were plotted and the optimal cut-off values of NLR, PLR, CA125 and HE4 were calculated for predicting lymph node metastasis. The levels of NLR, PLR, serum CA125 and HE4 were significantly higher in patients with lymph node metastasis than those without lymph node metastasis. Multivariate analysis showed that only the higher NLR and HE4 were independent predictors for lymph node metastasis (odds ratio, OR = 3.509, P = 0.016; OR = 1.446, P = 0.016). The optimal cut-off values of NLR and HE4 for predicting lymph node metastasis were 2.50 (area under the curve, AUC = 0.809) and 80.4 pmol/L (AUC = 0.713). The sensitivity and specificity were 75.0% and 84.9% for NLR, 86.7% and 73.8% for HE4, respectively. When HE4 was combined with NLR to predict lymph node metastasis, the sensitivity and specificity were significantly improved. Preoperative higher NLR and serum HE4 are predictors of lymph node metastasis in endometrial cancer, and the predictive value was superior to that of serum CA125.

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.

Impact of Pre-treatment Immunologic Parameters on the Outcomes of Early-Stage Non-Small Cell Lung Cancer (NSCLC)

Evaluate the association of pre-treatment immunologic parameters on the outcomes of early-stage non-small-cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT). All early-stage NSCLC treated with SBRT between Jan 2010 and Dec 2017 were included for analysis. Patients with a history of malignancy apart from skin malignancy (excluding melanoma) were excluded. The pre-treatment neutrophil-lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) were calculated. Overall survival (OS) and recurrence-free survival (RFS) were calculated. Univariate and multivariate analyses were performed accounting for NLR, PLR, MLR, ECOG, ITV volume, age and gender as covariates. Stepwise Cox regression analyses were used and results were considered significant if the p-value was less than 0.05. Multivariable models including ECOG and ITV volume as predictors were constructed and the Akaike Information Criteria (AIC) values were captured. NLR, PLR, and MLR were added separately to the multivariable model and the delta AIC between the two models were calculated. A total of 61 patients were identified in the current cohort and 41(67%) were females. The median age was 77.5 years, with an interquartile range (IQR) of 72-82 years. The median tumor size was 2.1 cm, with an IQ range of 1.6-2.8 cm. The median ITV and PTV volumes were 11.15 and 35.6 cm3, respectively. The median neutrophil count at baseline was 5.4 ×109/L (IQR: 4.17 – 7.05 ×109/L). Median lymphocyte count was 1.63 ×109/L (IQR: 1.29 – 2.10 ×109/L), median monocyte count was 0.65 ×109/L (IQR: 0.54 – 0.83 ×109/L), median platelet count was 260.0 ×109/L (IQR: 211.0 – 302.0 ×109/L). The median NLR was 3.42 (IQR: 2.38 – 5.04), median MLR was 0.39 (IQR: 0.31 – 0.53), and median PLR was 156.4 (IQR: 117.2 – 197.5). Univariate and multivariate analysis was performed for NLR, PLR, MLR, ECOG, ITV volume, age and gender. On univariate analysis, higher NLR was associated poorer OS (P = 0.009; HR-1.27; 95% CI 1.06-1.53) and poorer RFS (P = 0.01; HR-1.08; 95% CI 1.01-1.1.17). Multivariable models including ECOG and ITV volume showed higher NLR was associated with poorer OS (P = 0.01; HR-1.26; 95% CI 1.04-1.53). The delta AIC between the two multivariable models was 3.4, suggesting a moderate impact on OS. The relationship between NLR and RFS was nonlinear and a polynomial function was used. In multivariable analysis, higher NLR was associated with poor RFS (P = 0.001; NLRˆ1 HR 0.36; 0.17-0.78; NLRˆ2 HR-1.16; 95% CI 1.06-1.26). The delta AIC between the two multivariable models was 16.2, suggesting a strong impact on RFS. In our cohort MLR and PLR were not associated with RFS or OS in multivariable models. For MLR and PLR the delta AIC was less than 2, suggesting weak or no impact. Elevated NLR predicts poorer RFS and OS. Further validation could help identify patients at the risk of early failures.

Neutrophil Lymphocyte Ratio: A Predictor of Disease Severity in Nasal Polyposis and Allergic Fungal Rhinosinusitis.

To evaluate Neutrophil Lymphocyte ratio (NLR) as a predictor of disease severity in Nasal Polyposis and Allergic Fungal Rhinosinusitis (AFRS). This was a prospective non-randomized interventional study. Disease severity was graded based on endoscopic and CT scoring. Patients were given pre-operative oral steroids for two weeks and taken up for surgery. The pre-treatment neutrophil lymphocyte ratios were calculated from the differential leucocyte counts and compared with the disease severity and post-operative values. In the interventional arms, the disease severity correlated with the NLR. The mean pre-treatment NLR showed a statistically significant change after the intervention at eight weeks. The NLR normalized in patients with nasal polyposis and continued to be higher in patients with AFRS. NLR correlated to the disease severity and showed a linear correlation with the extent of the disease. NLR could be a potential cost-effective marker for disease severity and prognostication. Level of Evidence: Individual Cohort Study (2b).

Effect of cyclo-oxygenase inhibitor use during checkpoint blockade immunotherapy in patients with metastatic melanoma and non-small cell lung cancer

BackgroundImmune checkpoint inhibitors (ICIs) improve survival outcomes in metastatic melanoma and non-small cell lung cancer (NSCLC). Preclinical evidence suggests that overexpression of cyclo-oxygenase-2 (COX2) in tumors facilitates immune evasion through...

Prognostic value of pre-treatment neutrophil-lymphocyte and platelet-lymphocyte ratio in diffuse large B-cell lymphoma: a single-center experience

Prognostic value of pre-treatment neutrophil-lymphocyte and platelet-lymphocyte ratio in diffuse large B-cell lymphoma: a single-center experience

High neutrophil-lymphocyte ratio is not independently associated with worse survival or recurrence in patients with extremity soft tissue sarcoma

BackgroundSoft tissue sarcomas are a heterogenous group of neoplasms without well-validated biomarkers. Cancer-related inflammation is a known driver of tumor growth and progression. Recent studies have implicated a high circulating neutrophil-lymphocyte ratio as a surrogate marker for the inflammatory tumor microenvironment and a poor prognosticator in multiple solid tumors, including colorectal and pancreatic cancers. The impact of circulating neutrophil-lymphocyte ratio in soft tissue sarcomas has yet to be elucidated. MethodsWe performed a retrospective analysis of patients undergoing curative resection for primary or recurrent extremity soft tissue sarcomas at academic centers within the US Sarcoma Collaborative. Neutrophil-lymphocyte ratio was calculated retrospectively in treatment-naïve patients using blood counts at or near diagnosis. ResultsA high neutrophil-lymphocyte ratio (≥4.5) was associated with worse survival on univariable analysis in patients with extremity soft tissue sarcomas (hazard ratio 2.07; 95% confidence interval, 1.54–2.8; P < .001). On multivariable analysis, increasing age (hazard ratio 1.03; 95% confidence interval, 1.02–1.04; P < .001), American Joint Committee on Cancer T3 (hazard ratio 1.89; 95% confidence interval, 1.16–3.09; P = .011), American Joint Committee on Cancer T4 (hazard ratio 2.36; 95% confidence interval, 1.42–3.92; P = .001), high tumor grade (hazard ratio 4.56; 95% confidence interval, 2.2–9.45; P < .001), and radiotherapy (hazard ratio 0.58; 95% confidence interval, 0.41–0.82; P = .002) were independently predictive of overall survival, but a high neutrophil-lymphocyte ratio was not predictive of survival (hazard ratio 1.26; 95% confidence interval, 0.87–1.82; P = .22). ConclusionTumor inflammation as measured by high pretreatment neutrophil-lymphocyte ratio was not independently associated with overall survival in patients undergoing resection for extremity soft tissue sarcomas.

Lymphocyte-monocyte ratio as a predictive marker for pathological complete response to neoadjuvant therapy in esophageal squamous cell carcinoma.

BackgroundThe hematological markers of systemic inflammation has been proved to be significantly associated with clinical outcomes in esophageal cancer. This retrospectively study was to evaluate the value of the hematological markers in predicting pathological complete response (pCR) and overall survival (OS) in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC) who received neoadjuvant chemoradiotherapy (nCRT).MethodsA total of 87 patients with newly diagnosed LA-ESCC were retrospectively analyzed. The pretreatment lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were selected as hematological markers.ResultsAfter nCRT, 26 (29.9%) patients achieved pCR and 61 (70.1%) patients had non-pCR. The LMR was significantly higher in patients who achieved pCR compared to that in patients who did not achieve pCR (4.35±1.68 vs. 3.33±1.13, P=0.002). Based on the receiver operating characteristic (ROC) curve, the optimal cut off value of LMR that predicted pCR was 3.73 [area under the curve: 0.712; 95% confidence interval (CI): 0.594–0.830; P=0.002], with a sensitivity of 65.4% and specificity of 77.0%. The pCR rate of patients with LMR ≥3.73 was 53.1%, while the pCR rate of patients with LMR <3.73 was only 16.4% (P<0.001). The univariate and multivariate logistic regression analysis confirmed that LMR was an independent predictor of pCR [odds ratio: 5.093; 95% CI: 1.658–15.646; P=0.004]. However, in the prediction of OS, a multivariate Cox proportional hazard model revealed that only clinical stage [hazard ratio (HR): 1.970; 95% CI: 1.144–3.391; P=0.014] and pCR (HR: 0.469; 95% CI: 0.237–0.928; P=0.030) were independent prognostic factors.ConclusionsPre-treatment LMR may predict pCR in LA-ESCC patients who were treated with nCRT. Having pCR is an independent prognostic factor for prolonged survival.

Utility of neutrophil to lymphocyte ratio in predicting colorectal cancer prognosis at a VA hospital: Do stage and sidedness matter?

e16110 Background: Pretreatment neutrophil-lymphocyte ratio (pNLR) has been shown to associate with prognosis in patients with colorectal cancer (CRC). We asked if pNLR equally predicted prognosis in CRC regardless of stage and tumor location. We also asked if pNLR changed with time, especially within one year of diagnosis. Methods: Retrospective clinical data including age at diagnosis, pathological stage, location of tumors, treatments, disease free survival, NLR at one week, three months, and one year (if available) pretreatment of 934 veterans treated for CRC at one Veteran Affair Medical Center between July 1995 and December 2011 were collected. Disease-free survival (DFS) were analyzed using Kaplan-Meier analysis and compared using the log-rank test. pNLRs were grouped into three categories: less than or equal to three, greater than three and less than or equal to five, and greater than five. Univariate and multivariate Cox regression analyses were used to identify the prognostic value of pNLR. Boxplot analysis was used to evaluate the changes in pNLR over time. Results: In patients with stage 1 or stage 4 CRC, pNLRs of more than 5 and not between 3 and 5 predicted worse prognosis. In patients with stage 2 or 3 CRC, pNLRs did not correlate with prognosis. Interestingly, for patients with recurrent CRC after curative treatment, NLRs obtained prior to treatment of recurrent disease of more than 3 associated with worse prognosis. In subgroup analysis, we found that in patients with stage 1 or 4 left side colon or rectal cancer (LCRC), pNLRs of more than 5 but not between 3 and 5 predicted worse prognosis. In patients with stage 2 or 3 LCRC, NLRs obtained prior to treatment of recurrent disease did not correlate with prognosis. Similarly, for patients with recurrent LCRC after curative treatment, NLRs obtained prior to treatment of recurrent disease of more than 3 associated with worse prognosis. pNLRs did not correlate with prognosis in patients with right side colon cancer (RCC) regardless of stage. When comparing NLRs obtained at 1 year, 3 months, and 1-week pretreatment, boxplots showed a gradual increase leading up to the time of treatment suggesting that NLR changes according to the time of collection. Conclusions: In our large retrospective study, the role of pNLR in predicting oncologic prognosis differed according to the stage and the sidedness of the CRC. In addition, the value of pNLR varied depending on the time of collection. These findings suggested a complex relationship between immunologic parameters and oncologic survival.

Genomic biomarkers to determine survival in Multicenter Study of RAS mutations (MURAS) in patients with colorectal liver metastases receiving Y90 radioembolization treatment.

e16119 Background: Assessment of the clinical outcomes and prognostic value of genomic mutations in colorectal liver metastases treated with Y90 radioembolization. Methods: Multi-institution retrospective study of patients who underwent Y-90 radioembolization treatment after tumor genotyping was completed for CRLM. Patients treated between 2008 and 2019 were included from 7 institutions within the United States and Europe. Patient demographics, tumor characteristics, pre- and post- treatment regimens, serum laboratory evaluation and overall survival were analyzed between patients with differing histopathologic and genomic status. Tumor genotyping was obtained for KRAS, BRAF, PIK3CA, AKT, MEK, NRAS and MMR genes. Kaplan-Meier survival estimation and multivariate Cox regression were analyzed. Results: 434 patients treated with Y90 radioembolization fulfilled the inclusion criteria. Of the total cohort, 399 patients were available who had sufficient documented tumor profiling data. Average age at diagnosis was found to be 58.8 years for all patients (60.1% male, 39.9% female). Decreased survival post Y-90 treatment was shown in those patients with increased number of documented tumor mutations (n = 0,1 or ≥2 mutations: median OS 9.63 mos vs. 6.2 mos vs. 5.3 mos; p &lt; 0.0001). Additionally, the median survival in patients with mutated BRAF was 5.0 months, as compared to 9.4 months in those patients with wild-type BRAF (p = 0.0009). Primary colon cancer sidedness was also shown to demonstrate significant difference in survival post-Y90 treatment with left sided primaries showing improved median overall survival (left = 7.5 mos vs. right = 6.3 mos; p = 0.04.) Patient demographics including gender, age and race were not shown to be significant in overall survival post-Y90 treatment (p-values &gt; 0.05). Number of tumor mutations (p &lt; 0.0001, HR = 1.69 CI: 1.39-2.05), BRAF status (p = 0.02, HR = 2.6 CI:1.20-4.9), primary sidedness (p = 0.01, HR = 0.65 CI:0.47-0.90), pre-treatment neutrophil-lymphocyte ratio (p = 0.04, HR = 1.42 CI: 1.02-1.98) and KRAS mutation status (p &lt; 0.0001, HR = 1.81 CI: 1.45-2.26) all persisted as significant predictors of survival on multivariate analysis. Conclusions: Number of tumor mutations, BRAF mutation status, primary tumor sidedness, neutrophil-lymphocyte ratio and KRAS mutation status are all shown to be significant prognostic factors in patients with colorectal liver metastases receiving Y90 radioembolization.