Predictive Value Of Neutrophil-to-lymphocyte Ratio Research Articles

Clinical significance of neutrophil-to-lymphocyte ratio in assessing response to cardiac resynchronization therapy in elderly patients

Objective To investigate the clinical significance of neutrophil-to-lymphocyte ratio(NLR)in assessing response to cardiac resynchronization therapy(CRT)in elderly patients. Methods Clinical data of 105 elderly patients with chronic heart failure(CHF)who had received CRT at our hospital from January 2006 to January 2017 were retrospectively analyzed, and patients were divided into a no-response group(n=42)and a response group(n=63)according to CRT outcomes after 6 months.General clinical data were compared between the two groups.Factors influencing response to CRT were analyzed by logistic regression model analysis.The receiver-operating characteristic(ROC)curve was used to assess the predictive value of NLR in response to CRT. Results Compared with the response group, the no-response group had increased baseline levels of initial QRS width, serum creatinine(Scr)and uric acid(UA)(P 0.05). After 6 months of CRT, the LVEDD, NYHA functional class, neutrophil count and NLR were higher, and LVEF and lymphocyte count were lower in the no-response group than in the response group(P<0.05). The difference in NLR between 6 months after CRT and before CRT(ΔNLR)was higher in the no-response group than in the response group(P<0.05). Multi-factor Cox regression analysis showed that NLR(OR=1.895, 95%CI: 1.538~5.284, P=0.031)and ΔNLR(OR=2.579, 95%CI: 2.110~8.329, P=0.005)were independent risk factors for CRT(HR=1.590, 95%CI: 1.215~2.146, P=0.013). ROC curve analysis showed that ROCAUC of ΔNLR in the no-response group was 0.891, 95%CI: 0.832~0.937, which was higher than that at 6 months after CRT(0.813, 95%CI: 0.765~0.864)(Z=2.712, P<0.05). Conclusions The increase in NLR after CRT may be an early sign for no-response to CRT, and dynamic monitoring of NLR should be promoted to assess the prognosis of patients undergoing CRT. Key words: Neutrophil; Lymphocyte; Heart failure

Neutrophil to lymphocyte ratio predicts intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke

BackgroundThe development of intracranial hemorrhage (ICH) in acute ischemic stroke is associated with a higher neutrophil to lymphocyte ratio (NLR) in peripheral blood. Here, we studied whether the predictive value of NLR at admission also translates into the occurrence of hemorrhagic complications and poor functional outcome after endovascular treatment (EVT).MethodsWe performed a retrospective analysis of consecutive patients with anterior circulation ischemic stroke who underwent EVT at a tertiary care center from 2012 to 2016. Follow-up scans were examined for non-procedural ICH and scored according to the Heidelberg Bleeding Classification. Demographic, clinical, and laboratory data were correlated with the occurrence of non-procedural ICH.ResultsWe identified 187 patients with a median age of 74 years (interquartile range [IQR] 60–81) and a median baseline National Institutes of Health Stroke scale (NIHSS) score of 18 (IQR 13–22). A bridging therapy with recombinant tissue-plasminogen activator (rt-PA) was performed in 133 (71%). Of the 31 patients with non-procedural ICH (16.6%), 13 (41.9%) were symptomatic. Patients with ICH more commonly had a worse outcome at 3 months (p = 0.049), and were characterized by a lower body mass index, more frequent presence of tandem occlusions, higher NLR, larger intracranial thrombus, and prolonged rt-PA and groin puncture times. In a multivariate analysis, higher admission NLR was independently associated with ICH (OR 1.09 per unit increase, 95% CI (1.00–1.20, p = 0.040). The optimal cutoff value of NLR that best distinguished the development of ICH was 3.89.ConclusionsNLR is an independent predictor for the development of ICH after EVT. Further studies are needed to investigate the role of the immune system in hemorrhagic complications following EVT, and confirm the value of NLR as a potential biomarker.

Meta-analysis of the prognostic value of the neutrophil-to-lymphocyte ratio in oral squamous cell carcinoma.

A number of studies have assessed the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in oral squamous cell carcinoma (OSCC), but their results regarding the predictive value of NLR in OSCC are inconsistent. We therefore performed a meta-analysis to clarify the association between NLR and clinical outcome in OSCC. We searched the MEDLINE and Web of Science to identify potential studies investigating the association between NLR and survival in OSCC. A total of 10 studies, enrolling 2135 patients with OSCC, were included. A higher NLR was a negative predictor for both disease-specific survival (hazard ratio [HR]=1.93, 95% CI: 1.47-2.54) and overall survival (HR=1.56, 95% CI: 1.28-1.90). This suggests a higher NLR is predictive of a poorer prognosis in OSCC. Because determination of NLR is non-invasive and cost-effective, it could be widely used for predicting prognosis in OSCC.

Predictive value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio for acute deep vein thrombosis after total joint arthroplasty: a retrospective study

BackgroundDeep vein thrombosis (DVT) is a common and severe complication of total joint arthroplasty (TJA). Inflammation has been proved to play a role in DVT. The neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) are biomarkers for systemic inflammation. The aim of the study is to investigate the predictive value of NLR and PLR for acute TJA-induced DVT.MethodA total of 773 patients who underwent primary TJA in our hospital were included in this retrospective study. Venography was performed routinely after the surgery to define acute DVT. NLR and PLR before and after operation were calculated according to the blood routine test. Multiple logistic regression analyses and ROC curve analyses were performed to assess the association of NLR and PLR with TJA-induced DVT.ResultsOne hundred twenty out of 773 patients (15.5%) were diagnosed with DVT by venography. In patients with DVT, preoperative NLR (P = 0.030) and postoperative NLR (P = 0.015) were significantly higher but postoperative PLR (P = 0.002) was significantly lower. Multiple logistic regression analyses indicated that age (OR = 1.05, P < 0.005), gender (OR = 0.47, P = 0.005), BMI (OR = 1.06, P < 0.014), preoperative NLR (OR = 1.11, P < 0.035), postoperative NLR (OR = 1.20, P < 0.001), and PLR (OR = 0.99, P < 0.001) were independently associated with DVT. However, the ROC curve analysis demonstrated the specificity and sensitivity of NLR or PLR in predicting DVT were low.ConclusionAlthough the present study demonstrated significant association of perioperative NLR or PLR with acute TJA-induced DVT, NLR or PLR cannot predict TJA-induced DVT accurately.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictors of survival after heart transplantation.

AimsThe aim of this study was to evaluate whether neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) predict outcome in heart failure (HF) patients undergoing heart transplantation (HTX).Methods and resultsData from 111 HF patients undergoing HTX 2010–2015 were retrospectively reviewed. NLR and PLR were calculated before HTX, immediately after HTX, and at 6 and 24 hours. Primary endpoint was in‐hospital mortality, and secondary endpoints were 1 year mortality and renal replacement therapy (RRT). Prognostic factors were assessed by multivariate analysis, and the predictive values of NLR and PLR for mortality were compared. The discriminatory performance for predicting in‐hospital mortality was better for NLR [area under the receiver operating characteristic curve (AUC) = 0.644, 95% confidence interval 0.492–0.797] than for PLR (AUC = 0.599, 95% confidence interval 0.423–0.776). Best cut‐off value was 2.41 for NLR (sensitivity 86%, specificity 67%) and 92.5 for PLR (sensitivity 86%, specificity 68%). When divided according to best cut‐off value, in‐hospital mortality was significantly higher in the high NLR group (17.5% vs. 3.2%, P < 0.05), but not in the high PLR group (16.5% vs. 6.3%, P = ns). One year mortality was not significantly higher for either group (37.5% vs. 6.5% for NLR; 36.7% vs. 9.4% for PLR, P = ns for both), while RRT was significantly higher in both the NLR and PLR high groups (33.8% vs. 0%; 32.9% vs. 3.1%, respectively, P < 0.001). Multivariate analysis indicated that only high NLR (hazard ratio = 3.403, P < 0.05) and pre‐transplant diabetes (hazard ratio = 3.364, P < 0.05) were independent prognostic factors for 1 year mortality.ConclusionsHigh NLR was a predictor for in‐hospital mortality, and an independent prognostic factor for 1 year mortality. Both high NLR and high PLR were predictors for RRT.

Prognostic significance of pre-treatment neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in locally advanced esophageal cancer.

172 Background: The prognosis for esophageal cancer remains poor despite advances in therapeutic modalities. Elevations of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to be associated with poorer prognosis in several types of solid cancer. However, their prognostic value remains controversial in esophageal cancer. The aim of this study was to assess the prognostic value of NLR and PLR in esophageal and gastroesophageal junction (GEJ) cancer. Methods: We retrospectively reviewed the database of 77 patients who underwent neoadjuvant chemoradiation and potentially curative resection for esophageal cancer in our institute, between July 2006 and December 2011. NLR and PLR were calculated from laboratory data obtained prior to the start of chemoradiation. The predictive value of NLR and PLR was assessed using Kaplan-Meier curves and Cox regression models for an association with pathologic response to chemoradiation, relapse-free survival, and overall survival. Results: A total of 77 patients were identified with a median age at diagnosis of 62.5 years. In univariate analysis, neither NLR nor PLR were shown to be significantly associated with the pathologic response (p = 0.87, p = 0.89, respectively), relapse-free survival (p = 0.5, p = 0.4, respectively), or overall survival (p = 0.55, p = 0.44, respectively). Conclusions: The present study failed to confirm NLR and PLR as significant predictors of pathologic response to chemoradiation, relapse-free survival, and overall survival in patients with locally advanced esophageal and GEJ cancer undergoing neoadjuvant chemoradiation and surgical resection.

Neutrophil-to-lymphocyte ratio predicts prostatic carcinoma in men undergoing needle biopsy

Neutrophil-to-lymphocyte ratio (NLR), a simple marker of systemic inflammatory response, has been demonstrated as an independent prognosticator for some solid malignancies, including prostate cancer. In the present study, we evaluated the role of NLR in men who underwent prostate needle biopsy for their initial diagnosis of prostatic carcinoma. Both complete blood counts and free/total (F/T) prostate-specific antigen (PSA) ratio were examined in a total of 3,011 men in our institution. Of these, 1,207 had a PSA level between 4 and 10 ng/mL, and 357 of 810 who subsequently underwent prostate needle biopsy were found to have prostatic adenocarcinoma. NLR value was significantly higher in men with PSA of ≥ 20 ng/mL than in those with PSA of < 20 ng/mL (p < 0.001). NLR was also significantly higher in men with positive biopsy than in those with negative biopsy (p < 0.001). Using NLR cut-off point of 2.40 determined by the AUROC curve, positive/negative predictive values of NLR alone and NLR combined with F/T PSA ratio (cut-off: 0.15) were 56.6%/60.8% and 80.7%/60.1%, respectively. Multivariate analysis revealed that not only F/T PSA ratio (HR = 3.13) but also NLR (HR = 2.21) was an independent risk factor for prostate cancer. NLR is thus likely elevated in patients with prostate cancer. Accordingly, NLR, with or without combination with F/T PSA ratio, may function as a new biomarker to predict prostate cancer in men undergoing prostate needle biopsy.

MP26-16 NEUTROPHIL TO LYMPHOCYTE RATIO, A NEW PROGNOSTIC FACTOR IN NON MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Non-invasive I1 Apr 2015MP26-16 NEUTROPHIL TO LYMPHOCYTE RATIO, A NEW PROGNOSTIC FACTOR IN NON MUSCLE INVASIVE BLADDER CANCER Vincenzo Favilla, Tommaso Castelli, Daniele Urzì, Sebastiano Cimino, Salvatore Privitera, Eugenia Fragalà, Giorgio Ivan Russo, and Giuseppe Morgia Vincenzo FavillaVincenzo Favilla More articles by this author , Tommaso CastelliTommaso Castelli More articles by this author , Daniele UrzìDaniele Urzì More articles by this author , Sebastiano CiminoSebastiano Cimino More articles by this author , Salvatore PriviteraSalvatore Privitera More articles by this author , Eugenia FragalàEugenia Fragalà More articles by this author , Giorgio Ivan RussoGiorgio Ivan Russo More articles by this author , and Giuseppe MorgiaGiuseppe Morgia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1138AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An elevated neutrophil to lymphocyte ratio (NLR) was associated with a worse overall and disease free survival in a variety of different malignancies, including muscle invasive bladder cancer. The predictive value of NLR in non muscle invasive bladder cancer (NMIBC) has not been well prospectively studied. The aim of our study was to evaluated whether NLR predict disease recurrence and progression in NMIBC. METHODS The NLR, defined as the absolute neutrophil count divided by the absolute lymphocyte count, was prospectively evaluated in 178 consecutive, newly diagnosed, patients with NMIBC treated with transurethral resection of the bladder tumor (TURB), between the years 2009 and 2013. Patients with hematologic disorders or conditions that may have influenced blood cell lines such as autoimmune disease, presence of an active infection and/or immunodeficiency virus infection at the time of surgical intervention, prior or concomitant intravescical therapy with BacilleCalmette– Guérin (BCG), prior blood transfusion, and the presence of other cancer types or prior chemotherapy were excluded. Cutoff points for NLR were tested separately for recurrence and progression using the standardized cutoff-finder algorithm. Univariate and multivariate Cox regression analyses were used to evaluated the association between NLR and disease recurrence and progression RESULTS The study cohort comprised 148 male and 30 female patients. The median age of all 178 patients enrolled in the study was 69.27, with a median follow-up of 53 months (IQR: 33.0-76.25). Median NLR was 2.55 (IQR: 1.90-3.62) Patients with NLR <3 were older (74.45 vs. 67.94; p=0.02) and exhibited significant differences in term of pathological stage (p=0.03) and no. of tumours (p=0.04) if compared with those with NLR ≥3. During the follow-up study, 14 (23.3%) and 44 (37.9%) (p=0.04) patients respectively with NLR <3 and ≥3 experienced recurrence and 2 (3.3%) and 14 (11.9%) experienced progression (p=0.06). At the multivariate Cox regression analysis, NLR < 3 was associated with low disease recurrence (HR: 0.34 [IQR: 0.17-0.68]; p<0.01). Pathological stage pT1 (p<0.01), high grade (p<0.01), no. of tumours (p<0.01) and smoking status (p<0.01) were independently predictors of disease recurrence. No association was found between NLR ≥ 3 and disease progression at the multivariate Cox regression analysis. The 5 years recurrence free survival was 49% and 62% in patients with NLR ≥ 3 and < 3 (p=0.04). The 5 year progression free survival was 77% and 93% in patients with NLR ≥ 3 and < 3 (p=0.69). CONCLUSIONS NLR is an independent predictor of disease recurrence but no of progression in patients with newly diagnosed NMIBC. These findings could offer a new contribution to find new biomarkers of recurrence in NMIBC patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e299-e300 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vincenzo Favilla More articles by this author Tommaso Castelli More articles by this author Daniele Urzì More articles by this author Sebastiano Cimino More articles by this author Salvatore Privitera More articles by this author Eugenia Fragalà More articles by this author Giorgio Ivan Russo More articles by this author Giuseppe Morgia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of survival and metastasis for recurrent hepatocellular carcinoma after transarterial chemoembolization.

PurposeTo evaluate whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) predict survival and metastasis in patients after transarterial chemoembolization (TACE) for recurrent hepatocellular carcinoma (RHCC).Materials and MethodsClinical and laboratory data from 132 RHCC patients treated with TACE from January 2003 to December 2012 were retrospectively reviewed. Prognostic factors were assessed by multivariate analysis, and the predictive values of NLR and PLR for overall survival (OS) and extrahepatic metastases were compared.ResultsPretreatment mean NLR and PLR were 3.1 and 137, respectively. The 0.5-, 1-, and 2-year OS rates were 93.7%, 67.1%, and 10.1% in the low NLR group and 81.1%, 18.9%, and 3.8% in the high NLR group, respectively (P = 0.017). The corresponding OS rates in the low and high PLR groups were 92.5%, 58.1%, and 9.7% and 84.6%, 23.1%, and 2.6%, respectively (P = 0.030). The discriminatory performance predicting 1-year survival probability was significantly poorer for NLR (area under the curve [AUC] = 0.685, 95% confidence interval [CI] 0.598–0.763) than for PLR (AUC = 0.792, 95% CI 0.712–0.857; P = 0.0295), but was good for both ratios for predicting post-TACE extrahepatic metastasis. Multivariate analysis indicated that high PLR (hazard ratio [HR] = 0.373, 95% CI = 0.216-0.644, P < 0.001, vascular invasion (HR = 0.507, 95% CI = 0.310–0.832, P = 0.007), and multiple tumors (HR= 0.553, 95% CI = 0.333–0.919, P = 0.022) were independent prognostic factors for OS.ConclusionsHigh NLR and PLR were both associated with poor prognosis and metastasis in RHCC patients treated with TACE, but high PLR was a better predictor of 1-year OS. High PLR, vascular invasion, and multiple tumors were independent, unfavorable prognostic factors.

Neutrophil to lymphocyte ratio (NLR) as a predictive marker of response to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) in EGFR mutation-positive non-small cell lung cancer (NSCLC).

e19117 Background: NLR has prognostic value in different types of cancers including NSCLC. EGFR TKI’s have conferred survival benefit to patients (pts) with advanced NSCLC harboring EGFR TK mutations (EGFRm+), although response and duration of clinical benefit varies. The predictive value of NLR in this setting is unknown. Methods: We conducted a retrospective study on 42 pts with EGFR TKI-naive advanced EGFRm+ NSCLC. The objective of the study was to explore the correlation between NLR with response to EGFR TKI therapy. Pretreatment NLR was calculated from complete blood count (CBC) before the pts were started on Erlotinib and post treatment NLR was calculated from CBC after being on Erlotinib at the end of 2 months (mo) and 4 mo. Pts were classified into two groups, High NLR ≥ 5 or Low NLR < 5 . Response evaluation using RECIST 1.1 was based on imaging done at the end of 4 months of therapy. Fisher exact test was used for analysis. Results: The mean age of pts was 65y. Male: Female ratio was 1:2. 23 pts...

Association of the neutrophil to lymphocyte ratio with survival patients with in metastatic breast cancer.

e11544 Background: Identification of simple and measurable prognostic factors is an important issue in treatment evaluation of breast cancer. Although various markers are considered while making a decision to treatment modality, clinicians investigate for new prognostic factors for reason of highly variable responses of individuals. Therefore, this study estimates the survival probability of the neutrophil to lymphocyte ratio (NLR) for patients with metastatic breast cancer. Methods: We included the patients with metastatic breast carcinoma who were treated for metastasis. NLR were calculated and patients were divided into four quartiles (25th, 50th and 75th NLR; the lowest being the 1st quartile, the highest being 4th quartile ). Survival status was retrieved from our cancer registry. Survival analysis, stratified by NLR quartiles, was used to evaluate the predictive value of NLR. Results: Eighty-one patients with metastatic breast cancer were included in this study. Median age of diagnosis of the patients was 47 (26-83), the majority of them had grade II (%37) and grade III (%29.6) tumors and were metastatic at the time of their initial diagnosis. ER (+), PR (+) and HER2 (+) percentages were confirmed as 82%, 73% and 24% ,respectively. Ten percent of the patients were triple negative. Median follow-up time was 26 months and 29 patients died during the follow up period. We analyzed the overall survival among NLR quartiles. When we compared the quartiles with the highest and lowest NLR values, the quartile with the lowest NLR values had longer median overall survival than the quartile with the highest NLR values (212 vs. 27 months; p=0.01). The second and third quartiles, however, showed no statistically significant difference of overall survival between four quartiles. Conclusions: NLR can be a prognostic factor for overall survival in metastatic breast cancer patients.