Preoperative Platelet-to-lymphocyte Ratio Research Articles

Prediction of Sentinel Lymph Node Metastasis Using the Platelet-to-lymphocyte Ratio in T1 Breast Cancer.

The host's systemic inflammatory response is thought to affect the progression of cancer and the antitumor effects of chemotherapy. Meta-analyses have reported that the peripheral blood platelet-to-lymphocyte ratio (PLR) is a prognostic indicator of this effect. Therefore, we hypothesized that PLR may differ, depending on sentinel lymph node metastasis (SLNM) in patients diagnosed with cT1N0M0 breast cancer by preoperative imaging. This study investigated the ability of preoperative PLR to predict SLNM in patients diagnosed with cT1N0M0 breast cancer. This study included 475 patients with cT1N0M0 breast cancer diagnosed by preoperative imaging. Peripheral blood was obtained at diagnosis, i.e., before surgery. PLR was calculated from preoperative blood tests, by dividing the absolute platelet count by the absolute lymphocyte count. The probability of SLNM was significantly higher (p=0.002) in cases where the tumor diameter was larger than 10 mm. The incidence of SLNM was significantly high in the high (preoperative) PLR group (p=0.031). Multivariate analysis revealed that high PLR [compared to low PLR, p=0.021, odds ratio (OR)=1.815, 95% confidence interval (CI)=1.093-3.090] and large tumor size (compared to small tumor size, p=0.001, OR=2.688, 95%CI=1.524-4.997) were independent factors influencing SLNM. PLR may act as a predictor of SLNM in cT1N0M0 breast cancer.

Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and prognostic nutritional index for predicting clinical outcomes in T1\u20132 rectal cancer

BackgroundInflammation-related parameters have been revealed to have prognostic value in multiple caners. However, the significance of some inflammation-related parameters, including the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) and prognostic nutritional index (PNI), remains controversial in T1–2 rectal cancer (RC).MethodsClinical data of 154 T1–2 RC patients were retrospectively reviewed. The cut-off values for NLR, PLR, LMR, and PNI were determined by receiver operating characteristic curves. The relationships of these parameters with postoperative morbidities and prognosis were statistically analysed.ResultsThe optimal cut-off values for preoperative NLR, PLR, LMR and PNI were 2.8, 140.0, 3.9, and 47.1, respectively. Significant but heterogeneous associations were found between NLR, PLR, LMR and PNI and clinicopathological factors. In addition, high NLR, high PLR, and low PNI were correlated with an increased postoperative morbidity rate. Patients with high NLR/PLR or low LMR/PNI had lower OS and DFS rates. On multivariate analysis, only high NLR was identified as an independent risk factor for poor DFS.ConclusionsNLR, PLR, and PNI are valuable factors for predicting postoperative complications in T1–2 RC patients. A preoperative NLR of more than 2.8 is an independent prognostic factor for poor DFS in T1–2 RC patients.

Preoperative Platelet-to-Lymphocyte Ratio Is Not Associated With Postoperative Atrial Fibrillation

Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) and is associated with increased short-term and long-term mortality. While the precise etiology of POAF remains unclear, inflammation is a known contributing factor. Preliminary studies have suggested that an elevated preoperative platelet-to-lymphocyte ratio (PLR), an inexpensive and readily available novel inflammatory biomarker, may be associated with increased incidence of POAF after CABG. This study sought to further investigate this hypothesis. The study cohort included all patients undergoing isolated CABG, with no prior history of arrhythmia, who were operated on between August 1, 2010, and December 31, 2018, at a major Australian tertiary center (n= 1457). Patients were divided into low (<86) or high (≥86) PLR groups based on an optimal cutoff derived from receiver-operating characteristic curve analysis. The incidence of POAF was then compared. Categorical variables were analyzed using the chi-square test and continuous variables using logistic regression. Of 1457 patients, 495 (34.0%) developed POAF. There was no statistically significant difference in the incidence of POAF between patients in the high-PLR and low-PLR groups (34.8% vs 31.0%; P= .22). Using multivariable logistic regression analysis, high PLR was not independently associated with POAF (odds ratio, 1.04; P= .78). Elevated preoperative PLR is not independently associated with POAF in patients undergoing isolated CABG. The findings of this study differ from those of 2 previous smaller studies.

Association of the Preoperative Inflammation-Based Scores with TNM Stage and Recurrence in Patients with Papillary Thyroid Carcinoma: A Retrospective, Multicenter Analysis.

BackgroundThe neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) have been reported to be prognostic biomarkers in various cancers. Our study evaluated whether the preoperative NLR, PLR and PNI predicted tumor-node-metastasis (TNM) stage and recurrence in papillary thyroid carcinoma (PTC) patients.MethodsA total of 1873 patients with PTC from 9 centers in mainland China were retrospectively assessed. Receiver operating characteristic (ROC) curves were generated, and Kaplan-Meier analyses were performed to evaluate the prognostic value of inflammation-based scores. Univariate and multivariate analyses were conducted to identify risk factors for recurrence.ResultsA decreased PNI and an increased PLR were predictive of TNM stage (p=0.005 and p=0.030, respectively), while a decreased NLR was predictive of recurrence (p=0.040). Univariate and multivariate analyses indicated that N1 status (odds ratio (OR), 1.898; 95% confidence interval (CI), 1.253–2.874; p=0.002), NLR≤1.6 (OR, 1.596; 95% CI, 1.207–2.111; p=0.001) and PNI≤53.1 (OR, 1.511; 95% CI, 1.136–2.009; p=0.005) were independent factors that predicted recurrence.ConclusionThe NLR, PLR and PNI have predictive value for TNM stage and recurrence in patients with PTC, but their predictive efficiency is limited. Caution should be used when considering clinical applications of inflammation-based scores.

Does the preoperative platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio predict morbidity after gastrectomy for gastric cancer?

BackgroundGastric cancer is the 2nd most common cause of cancer-related deaths, and the morbidity rate after surgery is reported to be as high as 46%. The estimation of possible complications, morbidity, and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit. This study aimed to determine the prognostic value of the preoperative platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) and their relations with clinical outcomes and complications after gastrectomy for gastric cancer.MethodsThis single-center, retrospective cohort study evaluated the data of 292 patients who underwent gastrectomy with curative intent between January 2015 and June 2018 in a tertiary state hospital in Ankara, Turkey. A receiver operating characteristic curve was generated to evaluate the ability of laboratory values to predict clinically relevant postoperative complications. The area under the curve was computed to compare the predictive power of the NLR and PLR. Then, the cutoff points were selected as the stratifying values for the PLR and NLR.ResultsThe area under the curve values of the PLR (0.60, 95% CI 0.542–0.657) and NLR (0.556, 95% CI 0.497–0.614) were larger than those of the other preoperative laboratory values. For the PLR, the diagnostic sensitivity and specificity were 50.00 and 72.22%, respectively, whereas for the NLR, the diagnostic sensitivity and specificity were 37.50 and 80.16%, respectively. The PLR was related to morbidity, whereas the relation of the NLR with mortality was more prominent. This study demonstrated that the PLR and NLR may predict mortality and morbidity via the Clavien-Dindo classification in gastric cancer patients. The variable was grade ≥ 3 in the Clavien-Dindo classification, including complications requiring surgical or endoscopic interventions, life-threatening complications, and death. Both the PLR and NLR differed significantly according to Clavien-Dindo grade ≥ 3. In this analysis, the PLR was related to morbidity, while the NLR relation with mortality was more intense.ConclusionBased on the results of the study, the PLR and NLR could be used as independent predictive factors for mortality and morbidity in patients with gastric cancer.

Prognostic values of preoperative platelet-to-lymphocyte ratio and platelet-related indices in advanced hypopharyngeal squamous cell carcinoma.

To investigate the prognostic values of preoperative platelet-to-lymphocyte ratio (PLR) and platelet-related indices in advanced hypopharyngeal squamous cell carcinoma (HPSCC). The data of 247 eligible advanced HPSCC patients were reviewed retrospectively. Pretreatment haematological parameters were categorised into two groups based on the result of X-tile, and several variates were assessed using chi-square test, Kaplan-Meier method, Cox univariate and multivariate analysis. The optimal cut-off points of 171.4 for PLR, 260×109 /L for platelet, 10.4 fL for mean platelet volume (MPV) and 16.5% for platelet distribution width were defined. The haematological parameters PLR and MPV, postoperative metastasis and internal jugular vein invasion were statistically significant in OS and DFS analyses (P<.05). The high PLR (>171.4) or high MPV (>10.4fL) was significantly associated with worse OS and DFS (P<.05). The preoperative levels of PLR and MPV could be considered as independent prognostic predictors in patients with advanced HPSCC.

The Predictive Value of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Patients with Recurrent Idiopathic Granulomatous Mastitis.

The aim of this study was to investigate the relationship between the inflammatory parameters including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the prognosis of idiopathic granulomatous mastitis (IGM). In this retrospective study, a total of 41 patients with IGM who had no malignant disease or inflammatory pathologies were included between January 2010 and December 2017. The patients were divided into two groups according to presence or absence of recurrence. Subsequently, the relationship between patient characteristics, pre- and postoperative NLR and PLR levels and disease recurrence were evaluated. With a mean follow-up period of 28.4 months, 19.5% of patients were found to have recurrent IGM. Age, body mass index, patient characteristics such as oral contraceptive use, smoking status, and family history, surgical treatment and postoperative NLR, preoperative PLR, and postoperative PLR were not statistically significant between groups. However, only preoperative NLR was significantly associated with a recurrent IGM (p=0.024). Preoperative NLR predicted recurrence with a sensitivity of 62.5% and specificity of 84.8%. These results demonstrated that a high level of NLR was predictive of poor outcome in patients with IGM.

Preoperative platelet to lymphocyte ratio as a prognostic factor for resectable pancreatic cancer: A systematic review and meta-analysis

Background: Recent studies show that various inflammatory markers can have prognostic role in patients with resectable pancreatic cancer. While there are systematic reviews and meta-analyses analyzing importance of other blood markers, prognostic value of preoperative platelet to lymphocyte ratio (PLR) is still controversial. Our aim was to perform systematic review and meta-analysis of PLR as a preoperative prognostic factor for resectable PC. Material & Methods: Systematic literature search of PubMed, Cochrane and Lippincott Williams & Wilkins databases was conducted for studies, assessing PLR influence as a preoperative prognostic factor in resectable PC patients. Random effects model was used for pooling hazard ratios (HRs) and 95% confidence intervals (CIs) related to overall survival (OS) and disease-free survival. Results: A total of 102 publications were analyzed and 14 articles with 2743 patients were included in our study. The analysis showed that high PLR had no correlation with decreased OS (HR=1.00; 95% CI”Š=“Š0.99-1.01; P=0.39; I2=83%). Due to high heterogeneity between selected studies subgroup analysis was performed: high PLR was not associated with decreased OS in Caucasian patients (HR=1.00; 95% CI”Š=“Š1.00-1.01; P=0.76), patients with pancreaticoduodenectomy performed (HR=1.02; 95% CI”Š=“Š0.90-1.15; P=0.79), or patients with preoperative PLR >150 (HR=1.00; 95% CI=“Š1.00-1.01; P=0.64). However, better OS was associated with low PLR in Asian patients (HR=1.53; 95% CI=1.17-2.00; P=0.002) and in patients with preoperative PLR<150 (HR=1.32; 95% CI=1.04-1.68; P=0.02). Low PLR was associated with significantly better disease-free-survival (HR=1.60; 95% CI”Š=“Š1.03-2.49; P=0.04). Conclusions: Platelet to lymphocyte ratio is not a reliable overall survival prognostic factor in patients with resectable pancreatic cancer. However, low PLR might be a predictive factor of better disease-free survival.

Impact of Antiplatelet and Anticoagulant Therapies on Platelet-related Prognostic Markers in Patients With Esophageal Cancer.

In recent years, platelet-related markers were recognized as useful prognostic factors in various malignancies. We investigated the relationship between platelet-related prognostic markers and anti-platelet or anti-coagulant therapies for survival outcomes in esophageal squamous cell carcinoma. Preoperative platelet-related prognostic markers were evaluated from peripheral blood testing and statistical analyses were performed to evaluate the prognostic value of these markers and reveal the effects of antiplatelets and/or anticoagulants regarding their prognostic relevance. In all 176 patients, preoperative platelet-to-lymphocyte ratio (PLR) was not found to be a predictor of overall survival (OS). However, in patients without antiplatelet or anticoagulant therapies, PLR was significantly associated with a poor OS (p=0.03). Although platelet large cell ratio (P-LCR) was not associated with the prognosis in patients with antiplatelet and/or anticoagulant therapies, higher P-LCR was associated with a poor prognosis in patients without antiplatelet or anticoagulant therapies (p<0.0001). Researching detailed antiplatelet and anticoagulant therapies could reinforce the prognostic value of platelet-related prognostic markers in ESCC.

Re: The Predictive Value of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio in Patients with Recurrent Idiopathic Granulomatous Mastitis.

Objective The aim of this study was to investigate the relationship between the inflammatory parameters including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and the prognosis of idiopathic granulomatous mastitis (IGM). Materials and methods In this retrospective study, a total of 41 patients with IGM who had no malignant disease or inflammatory pathologies were included between January 2010 and December 2017. The patients were divided into two groups according to presence or absence of recurrence. Subsequently, the relationship between patient characteristics, pre- and postoperative NLR and PLR levels and disease recurrence were evaluated. Results With a mean follow-up period of 28.4 months, 19.5% of patients were found to have recurrent IGM. Age, body mass index, patient characteristics such as oral contraceptive use, smoking status, and family history, surgical treatment and postoperative NLR, preoperative PLR, and postoperative PLR were not statistically significant between groups. However, only preoperative NLR was significantly associated with a recurrent IGM (p=0.024). Preoperative NLR predicted recurrence with a sensitivity of 62.5% and specificity of 84.8%. Conclusion These results demonstrated that a high level of NLR was predictive of poor outcome in patients with IGM.

A Novel Systemic Inflammatory Score Combined With Immunoinflammatory Markers Accurately Reflects Prognosis in Patients With Esophageal Cancer.

To establish a novel systemic inflammatory score (SIS) combined with neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein/albumin ratio (CAR) and to validate its prognostic value and relation with serum cytokine levels in patients who underwent esophagectomy for esophageal cancer (EC). Preoperative NLR, PLR, and CAR were evaluated in 102 patients undergoing esophageal resection for EC from 2009 to 2014. Receiver operating characteristic (ROC) curves censored for 5-year survival were plotted to determine the cutoff values of each measure. Each measure was scored 1 if it was above the cutoff value (NLR >3.12, PLR >230, and CAR >0.085) and scored 0 if it was below that. The SIS was defined as the sum of these values and was divided into the two groups: High SIS (SIS=2-3) and low SIS (SIS=0-1). Univariate and multivariate analyses were used to determine the prognostic significance. The area under the ROCs (AUROC) was compared to verify the discriminative power of survival prediction. In addition, we analyzed the relationship between SIS and perioperative serum interleukin (IL)-6 and IL-10 levels. In the clinicopathological findings, only tumor depth was significantly related to SIS (p=0.004). At 0.732, the AUROC of SIS was the highest (NLR=0.618, PLR=0.545), and CAR=0.712). The high-SIS group had a significantly poorer prognosis than the low-SIS group (p=0.011). SIS was identified as an independent prognostic factor in the multivariate analysis (hazard ratio=1.96, 95% confidence intervaI=1.11-3.41, p=0.020). The preoperative serum interleukin-6 level was significantly low (p=0.046) and postoperative serum interleukin-10 level was significantly high in the high-SIS group (p=0.047). SIS was a superior predictor of prognosis compared with existing immunoinflammatory markers and closely reflected the fluctuation of peripheral inflammatory cytokines in patients with EC.

621 Preoperative Platelet to Lymphocyte Ratio as a Predictor for Readmission to ICU and ICU Length of Stay in Patients undergoing Coronary Artery Bypass Graft Surgery

Platelet to lymphocyte ratio (PLR) is emerging as a prognostic marker for cardiovascular outcomes. In this study, we examined the prognostic value of elevated PLR in predicting poor outcomes in a population of patients undergoing coronary artery bypass grafting (CABG). We included 525 eligible patients undergoing CABG at St Vincent’s Hospital Melbourne from May 2012 to December 2019. High and low PLR groups were defined as patients having preoperative PLR values in the highest quartile (≥165.7) and lower three quartiles (<165.7) respectively. The high PLR group was significantly associated with readmission to ICU (p=0.01), and ICU length of stay (p=0.01). The high PLR group had mean (±SD) ICU time of 54.2 (±67.1) hours versus 43.1 (±67.9) hours for the low PLR group. On multivariate logistic regression analysis, the high PLR group independently predicted readmission to ICU (OR 3.1; p=0.04) after adjustment for theoretically and statistically significant risk factors for ICU stay. There was no significant association with 30-day mortality, 30-day readmission and major adverse cardiovascular events (MACE). PLR independently predicted ICU readmission and ICU length of stay in CABG patients. The longer ICU time has clear implications to patient health and financial burdens. Detailed assessment of this easily accessible biomarker is warranted as a prognostic marker in CABG patients.

626 The Paradoxical Association of Preoperative PLR as a Predictor of Coronary Artery Disease

Platelet to lymphocyte ratio (PLR) is a haematological biomarker which increases with inflammation and vascular oxidative stress. Many studies have explored the role of inflammatory pathways in the development and progression of coronary artery disease (CAD). This study sought to investigate the previously known positive association between PLR and CAD and validate it our cardiothoracic surgery patients. A total of 768 patients undergoing coronary angiography at St Vincent’s Hospital Melbourne were analysed between May 2012 and December 2019. 528 (69%) patients were found to have CAD. CAD was defined as >50% stenosis in one or more coronary arteries. PLR was associated with CAD (p=0.001) on bivariate analysis. PLR remained significantly associated after adjusting for traditional cardiovascular risk factors (OR 0.996; p=0.037) in multivariate logistic regression. Additionally, the results showed increasing age (OR 1.02; p=0.054), male gender (OR 3.08; p<0.001), smoking (OR 1.605; p=0.031), hypertension (OR 2.153; p=0.002), increasing HbA1c (OR 1.784; p<0.001), total cholesterol (OR 0.665; p<0.001) and increasing TG:HDL ratio (OR 1.671; p<0.001) also independently correlated with CAD. PLR was not significantly associated with congestive heart failure and aortic stenosis. PLR was inversely correlated with angiographic CAD. These results are in contrast with previous studies showing a higher PLR to be associated with CAD. Further investigation of this association is warranted.

Validation and clinical usefulness of pre- and postoperative systemic inflammatory parameters as prognostic markers in patients with potentially resectable pancreatic cancer

BackgroundSeveral preoperative systemic inflammatory parameters, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), prognostic nutritional index (PNI), and Glasgow prognostic score, have been reported to be associated with the prognosis of solid tumors. In this study, we compared pre- and postoperative hematological inflammatory parameters and validated their prognostic significance in pancreatic cancer patients who underwent surgical resection. MethodsClinical records from 211 consecutive pancreatic cancer patients who underwent surgical resection at our institution were retrospectively analyzed. The optimal cutoff values of hematological inflammatory parameters, including lymphocyte count, NLR, PLR, LMR, and PNI, were determined by time-dependent receiver-operating characteristic analysis. ResultsThe postoperative neutrophil count and serum albumin level were significantly decreased in patients who underwent pancreatoduodenectomy (PD group) and in those who underwent distal pancreatectomy (DP group) compared to the levels at baseline. The postoperative lymphocyte count, monocyte count, and platelet count were significantly increased in the DP group compared to those at baseline. As a result, the postoperative NLR and PNI significantly decreased in both groups. The multivariate analysis identified intraoperative peritoneal washing cytology, administration of adjuvant therapy, tumor size, extrapancreatic nerve plexus invasion, and preoperative PLR as independent prognostic factors for overall survival. ConclusionsSystemic inflammatory responses were altered after pancreatic resection in pancreatic cancer patients. Preoperative PLR may be a useful prognostic marker in pancreatic cancer patients undergoing surgical resection.

Stratification of Prognosis in Patients With Ampullary Carcinoma After Surgery by Preoperative Platelet-to-lymphocyte Ratio and Conventional Tumor Markers.

The platelet-to-lymphocyte ratio (PLR) has recently been suggested as a new predictor of the prognosis in several carcinoma types. However, the clinical impact remains controversial in patients with ampullary carcinoma. Thus, the aim of this study was to investigate other useful biomarkers for identifying poor prognosis in patients with ampullary carcinoma. Forty-one patients with ampullary carcinoma underwent pancreaticoduodenectomy (PD) with curative resection between April 2000 and April 2017. Various clinicopathological findings of the patients and their tumors were evaluated as potential prognostic factors which might enable better stratification of prognosis. Platelet-to-lymphocyte ratio, as well as other markers, was found to be a prognostic factor in patients with ampullary carcinoma. The 2-year disease-free survival percentage was significantly higher in the group with low PLR than in the high PLR group (70.2% vs. 28.6%; p=0.005). Combinational analysis of the PLR and conventional TMs enabled us to stratify prognosis of the patients more clearly than by each marker alone. PLR was a useful prognostic factor for patients with ampullary cancer. The combination of preoperative PLR and conventional TMs markers may be powerful predictive factors for postoperative prognosis in patients with ampullary carcinoma following PD.

The Practical Use of White Cell Inflammatory Biomarkers in Prediction of Postoperative Delirium after Cardiac Surgery.

Introduction: Postoperative delirium (POD) is associated with unfavorable outcomes. It may result from neuroinflammation and oxidative stress. The aim of this study was to evaluate the role of routinely available inflammatory markers derived from white blood cell count (WBC), for prognostic value in diagnosing delirium after cardiac surgery. Methods: We performed an analysis of data collected from patients undergoing planned coronary artery bypass grafting (CABG). Differential WBC and CRP (C-reactive protein) concentration were evaluated preoperatively (T0) and postoperatively at day 1 (T1), 3 (T3), 5 (T5) after CABG. Differences in neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet-to-WBC ratio (PWR) between patients with (Del +) and without delirium (Del −) were evaluated. Patients were screened using CAM-ICU. Results: We included 968 patients in the study. Incidence of delirium was 13.3%. In the group with POD, the majority of patients were men (87/129, 67.44%), and the mean age was 72 years. Preoperative WBC (8.21 ± 3.04 G/l vs. 7.55 ± 1.86 G/l, p = 0.029) were higher and mean platelet count was lower (217.7 ± 69.07 G/l vs. 227.44 ± 59.31 G/l, p = 0.031) in patients with POD. Lower pre-operative PLR values (109.87 ± 46.38 vs. 120.36 ± 52.98, p = 0.026) and PWR values (27.69 ± 7.50 vs. 31.32 ± 9.88 p < 0.001) were found in patients with POD. Association was strongest for PWR and remained significant at T1 (p < 0.001), T3 (p < 0.001) and T5 (p < 0.001). Basing on coefficients of logistic regression a model for optimal prediction of POD was calculated: CARDEL Index (CARdiac DELirium Index) = 0.108 × Age + 0.341 × HBA1C − 0.049 × PWR with AUC of 0.742 (p < 0.001). Conclusions: The results of this study show that lower pre-operative levels of PLR and PWR were associated with POD after cardiac surgery. Pre-operative PWR showed strongest correlation with POD and may be a potential new biomarker associated with postoperative delirium. CARDEL prognosis index composed of age, HbA1c and PWR is good at predicting development of delirium after CABG.

Platelet-to-lymphocyte ratio is an independent prognosticator in patients with esophageal squamous cell carcinoma receiving esophagectomy.

Systemic inflammation response is a crucial prognostic factor for various cancers. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are two inflammation-based prognostic scores. The significance of preoperative NLR and PLR in patients with esophageal squamous cell carcinoma (ESCC) receiving curative esophagectomy remains largely undefined. Hence, this study aimed to evaluate the significance of preoperative NLR and PLR in patients with ESCC receiving curative esophagectomy in southern Taiwan. A consecutive group of 107 patients with ESCC undergoing esophagectomy between January 2001 and December 2012 were retrospectively reviewed. The NLR and PLR of these 107 patients were calculated and correlated with clinicopathological parameters, overall survival (OS), and disease-free survival (DFS). NLR ≥2.5 was significantly correlated with higher T classification (P=0.006) and advanced clinical AJCC 7th stage (P=0.047). PLR ≥150 was significantly associated with higher T classification (P=0.009). Univariate survival analysis showed that NLR ≥2.5 and PLR ≥150 were associated with poor OS (P=0.009 and P=0.007, respectively) and poor DFS (P=0.006 and P=0.005, respectively). On multivariate comparison, PLR ≥150 was independently associated with poor OS [P=0.001, hazard ratio (HR): 2.475] and poor DFS (P<0.001, HR: 2.509). The 5-year overall and DFS rates were, respectively, 33.3% and 25.0% in patients with PLR ≥150, and 54% and 46% in patients with PLR <150. The PLR is an independent prognosticator for patients with ESCC undergoing esophagectomy in southern Taiwan.

A combination of platelet-to-lymphocyte ratio and carbohydrate antigen 19-9 predict early recurrence after resection of pancreatic ductal adenocarcinoma.

Early recurrence (ER) after surgical resection is an important factor that impacts the survival of patients with pancreatic ductal adenocarcinoma (PDA). We examined risk factors for ER after PDA resection. One hundred and thirteen PDA patients who underwent R0 or R1 resection were retrospectively analyzed. Thirty-four patients (30.1%) received neoadjuvant chemotherapy (NAC) for borderline resectable (BR) (n=13) or initially unresectable (n=21) disease. ER was defined as that diagnosed within 6 months after surgery. Receiver operating characteristic analysis was performed for each variable to determine the optimal cutoff value. ER occurred in 21 patients (18.6%). In univariate analysis, preoperative platelet-to-lymphocyte ratio (PLR) ≥144, carbohydrate antigen (CA) 19-9 ≥162 U/mL, and pathological tumor size ≥3 cm were significantly associated with ER. High PLR and CA19-9 were independent risk factors for ER by multivariate analysis. Area under the curve (AUC) for predicting ER from a combination of PLR and CA19-9 was 0.765 (95% confidence interval: 0.664-0.866), which increased the AUC compared to that for each risk factor alone. Patients with both risk factors had a significantly worse overall survival than those with one or no risk factors. When 24 patients with BR-PDA were considered, NAC was associated with a reduced likelihood of having risk factors and with a low ER rate. A combination of PLR and CA19-9 is a useful predictor of ER after macroscopic curative resection for PDA. NAC may reduce the risk of ER in selected patients.

Systemic immune response in squamous cell carcinoma of the head and neck: a comparative concordance index analysis.

The objective of this study was to investigate the prognostic role of three inflammatory markers: the neutrophil to lymphocyte ratio (NLR), the lymphocyte to monocyte ratio (LMR), and the platelet to lymphocyte ratio (PLR) as prognostic indicators in squamous cell carcinoma of the head and neck (HNSCC). Patients with HNSCC treated with primary surgery, with or without adjuvant radiochemotherapy were enrolled. The preoperative NLR, LMR, and PLR were recorded. Confounding variables were also recorded: age, sex, BMI, comorbidities, performance status, AJCC T and N stage and HPV status. Endpoints were overall survival (OS) and event-free survival (EFS). Survival analysis was performed using Kaplan-Meier analysis, and multivariable analysis was performed using Cox proportional hazards regression. Survival models were evaluated using Harrell's concordance index (c-index). NLR (p = 0.2413), PLR (p = 0.1593), and LMR (p = 0.0552) were not significantly associated with OS in the multivariable analysis. With regard to EFS, low LMR (HR = 2.95, 95% CI 1.54-5.65, p = 0.001), high PLR (HR = 2.68, 95% CI 1.42-5.09, p = 0.003), and high NLR (HR = 3.37, 95% CI 1.7-6.69, p < 0.001) were associated with EFS. The multivariable c-index was highest for LMR (0.762), followed by NLR (0.761) and PLR (0.739). The LMR, PLR, and NLR were not associated with OS, but were associated with EFS in HNSCC. These markers are easily obtainable, and in the age of individualized patient care and precision medicine, they might represent further risk stratification tools for HNSCC patients.

Preoperative neutrophil-to-lymphocyte ratio predicts malignancy and recurrence-free survival of solid pseudopapillary tumor of the pancreas.

Systemic inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to be prognostic for many types of pancreatic malignancy. The aim of this study was to evaluate the prognostic role of these markers in patients with solid pseudopapillary tumor of the pancreas (SPTP). Patients who underwent surgical resection for histologically confirmed SPTP were retrospectively reviewed in our institution. Preoperative NLR and PLR were calculated. Clinicopathologic data were correlated with the presence of malignant potential and recurrence-free survival (RFS). A total of 113 patients with SPTP were included in this study. Of them, 23 were men and 90 were women, with a median age of 35 years (interquartile range, 25-44). The optimal cut-off values for malignant SPTP were 3.22 for NLR, and 75.5 for PLR, respectively. Univariate analysis showed that high NLR (>3.22) and white blood cell count more than 9.96 × 109 /L were predictive of a malignant SPTP. Meanwhile, high NLR (P = 0.001) and age more than 35 years (P = 0.026) were associated with worse RFS. On multivariable analyses, high NLR was the only independent predictor of malignant SPTP (odd ratio 6.871; 95% confidence interval [CI], 1.482-31.864; P = 0.014) and RFS (hazard ratio 12.633; 95% CI, 1.758-90.790; P = 0.012). This study highlights the supportive role of preoperative NLR in predicting malignancy and RFS of SPTP patients. Further studies including a larger cohort of patients are needed to corroborate our findings.