Pretreatment Neutrophil-lymphocyte Ratio Research Articles

Increased neutrophil-lymphocyte ratio independently predicts poor survival in non-metastatic triple-negative breast cancer patients.

Inflammation plays an important role in tumor initiation, progression, and metastasis. The neutrophil-lymphocyte ratio (NLR) is widely used to evaluate global inflammation in various tumor types. However, the prognostic role of NLR in non-metastatic triple-negative breast cancer (TNBC) patients was poorly known. The aim of this study was to explore the association between pre-treatment NLR and survival in TNBC patients. Data were collected for patients with stages I-III TNBC from 2006 to 2013 at Linyi Central Hospital to analyze pre-treatment NLR and survival. Overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method, and Cox analysis was performed to determine clinicopathological parameters for their prognostic relevance. A total of 406 patients were eligible. Patients with NLR lower than 2.85 exhibited significantly higher OS (P < 0.001) and DFS (P < 0.001) than patients with higher NLR. Higher pre-treatment NLR was independently correlated with poor OS and DFS, with hazard ratios of 2.69 (95% confidence interval [CI]: 1.94-3.72, P = 0.001) and 2.13 (95% CI: 1.68-2.65, P = 0.008), respectively, in the Cox proportional multivariate hazard model. In conclusion, our results indicate that pre-treatment NLR may be correlated with OS and DFS in early-stage TNBC patients, and that it may have considerable clinical applications. © 2018 IUBMB Life, 70(6):529-535, 2018.

189P Are pretreatment neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and advanced lung cancer inflamation index (ALI) levels useful in predicting the outcomes of patients with advanced non-small cell lung cancer?

189P Are pretreatment neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and advanced lung cancer inflamation index (ALI) levels useful in predicting the outcomes of patients with advanced non-small cell lung cancer?

The role of the blood platelet-lymphocyte ratio, neutrophil–lymphocyte ratio and platelets in prognosis of metastatic renal cell carcinoma (mRCC).

670 Background: Renal cell carcinoma (RCC) accounts for 2–3% of all malignant diseases in adults. In some studies, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and PLT have been demonstrated to be closely related to poor prognosis of patients with RCC. The objective of this study was to evaluate the blood platelet-lymphocyte ratio (PLR), neutrophil–lymphocyte ratio (NLR) and platelets (PLT) for its prognostic value in patients with metastatic renal cell cancer (mRCC). Methods: We retrospectively reviewed 141 (49 women and 92 men) patients diagnosed with mRCC previously treated with tyrosine kinase inhibitors from MSC Memorial Cancer and Institute of Oncology, Gliwice Branch in years 2006 - 2016. We assessed the prognostic value (overall survival and progression free survival) of pretreatment PLR, NLR and PLT based on univariate analysis. The cut-off value of NLR was ‘elevated’ as &gt; 3.68 and PLR cut-off value was ‘elevated’ as &gt; 144.4. Results: Median time of overall survival (OS) and progression free survival (PFS) were 34.1 months (from 1 to 109 months) and 8.3 months (from 0.4 to 109 months), respectively. The median PFS was shorter in NLR &gt; 3.68 in comparison to NLR &lt; = 3.68 (11.5 vs. 3.6 months, HR = 2.69; 95%CI, 1.76 to 4.12). Similarly, the median OS was lower in NLR &gt; 3.68 (7.8 vs. 36.1 months, p = 0.00003; HR = 3.39; 95%CI, 2.09 to 5.50). The median PFS was shorter in PLR &gt; 144.4 in comparison to PLR &lt; = 144.4 (5.7 vs. 17.6 months; p = 0.00001; HR = 2.62; 95%CI, 1.76 to 3.90). Similarly, OS was worse for PLR &gt; 144.4 (16.6 vs. 71.2 months; p = 0.00001; HR = 3.31; 95%CI, 1.98 to 5.52). Higher value of PLT ( &gt; 400 G/l) was associated with shorter OS median (7.2 vs. 35.3 months; p = 0.001) than standard level of PLT (150-400G/l). Similarly, patients with higher neutrophil level had shorter OS (8.0 vs. 36.1 months, p = 0.0001) and PFS (3.6 vs. 11.5 months, p = 0.0001). Conclusions: Elevated pre-treatment NLR ( &gt; 3.68) and PLR ( &gt; 144.4) are associated with shorter OS and PFS in patients with mRCC treated with kinase inhibitors independently of other prognostic factors. Higher level of PLT ( &gt; 400 G/l) and higher level of neutrophil ( &gt; 6.0 x 103/ul) were also negative prognostic factors.

The Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Are Prognostic Factors in Patients with Locally Advanced Pancreatic Cancer Treated with Chemoradiotherapy.

Background/AimsWe investigated whether inflammatory markers such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) independently and in combination would be significant prognostic factors for survival in patients with locally advanced pancreatic cancer.MethodsA total of 497 patients with locally advanced pancreatic cancer who received neoadjuvant or definitive chemoradiotherapy from 2005 to 2015 were evaluated. We divided the patients into groups according to the median values of NLR and PLR: NLR<1.89 (n=156), NLR≥1.89 (n=341), PLR <149 (n=248) and PLR≥149 (n=249).ResultsFor NLR <1.89 and ≥1.89 groups, respectively, the 1-year overall survival (OS) rates were 73.2% and 60.8% (p<0.001) and 1-year progression-free survival (PFS) rates were 43.9% and 31.3% (p<0.001). For PLR <149 and ≥149 groups, respectively, the 1-year OS rates were 68.1% and 61.3% (p=0.029) and 1-year PFS rates were 37.9% and 32.5% (p=0.027). Patients with both high NLR and high PLR showed the worst OS and PFS rates compared with those with both lower NLR and lower PLR.ConclusionsElevated pretreatment NLR and PLR independently and in combination significantly predicted poor OS and PFS.

Pretreatment Neutrophil-Lymphocyte Ratio as a Predictor in Bladder Cancer and Metastatic or Unresectable Urothelial Carcinoma Patients: a Pooled Analysis of Comparative Studies

Background/Aims: Emerging studies have shown that the neutrophil-lymphocyte ratio (NLR) is a potential predictor in various tumors. Our study was conducted to assess the prognostic value of the pretreatment NLR in bladder cancer and metastatic or unresectable urothelial carcinoma (mUC or uUC) patients up to July 2017. The correlation between the pretreatment NLR and pathological characteristics was also evaluated in bladder cancer patients. Methods: The hazard ratio (HR) and odds ratio (OR) with the 95% confidence interval (CI) were extracted or calculated from the included studies for further pooled analysis. A total of 21 studies were included in a pooled analysis. Results: The pooled results indicated that a high pretreatment NLR was associated with reduced overall survival (OS) (HR=1.27, 95% CI=1.12-1.43), relapse-free survival (RFS) (HR=1.41, 95% CI=1.23-1.60), progression-free survival (PFS) (HR=1.75, 95% CI=1.36-2.15), disease-specific survival (DSS) and cancer-specific survival (CSS) (HR=1.27, 95% CI=1.19-1.35) in the bladder cancer patients. Additionally, an elevated pretreatment NLR suggested a worse OS rate in the mUC or uUC patients (HR=1.63, 95% CI=1.34-1.91). The pooled ORs and 95% CIs showed that a high pretreatment NLR could be a risk indicator for certain pathological features, such as lymphovascular invasion, a positive margin status and advanced tumor stage. Conclusions: our results showed that a high pretreatment NLR predicted poor prognosis in bladder cancer, mUC and uUC patients.

High blood neutrophil-lymphocyte ratio associated with poor outcomes in miliary tuberculosis.

It is difficult to predict the prognosis of miliary tuberculosis (TB). We hypothesized that blood neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status to reflect independent prognostic significance in patients with miliary TB. The aim of this study is to investigate the relationship between NLR and outcome in miliary TB. We retrospectively collected data from patients diagnosed with miliary TB in a tertiary referral hospital between January 1995 and January 2016. A total of 96 patients were enrolled. Seventeen patients (18%) died during hospitalization due to miliary TB, and 9 (9%) died additionally during the 1-year follow-up period. Eighteen patients (19%) were diagnosed with acute respiratory distress syndrome (ARDS). In multiple logistic regression analyses, increased NLR was associated with ARDS [adjusted odds ratio, 1.15; 95% confidence interval (CI), 1.03-1.28]. By multivariate Cox regression analysis with adjustment of known prognostic factors including age, sex, body mass index, serum aspartate aminotransferase (AST), and hemoglobin, NLR was an independent predictor of in-hospital mortality [adjusted hazard ratio (aHR), 1.08; 95% CI, 1.03-1.13] and 1-year mortality (aHR, 1.08; 95% CI, 1.05-1.12). Pre-treatment NLR at admission may be a useful biomarker for mortality and development of ARDS in patients with miliary TB.

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

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

Pretreatment neutrophil&amp;ndash;lymphocyte ratio: useful prognostic biomarker in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common liver malignancy and the third most common cause of cancer-related deaths. Liver resection (LR) and liver transplantation (LT) are the only curative modalities for HCC. Despite recent advances and the adoption of the Milan and University of California, San Francisco, criteria, HCC recurrence after LR and LT remains a challenge. Several markers and prognostic scores have been proposed to predict tumor aggressiveness and supplement radiological data; among them, neutrophil–lymphocyte ratio (NLR) has recently gained significant interest. An elevated NLR is thought to predispose to HCC recurrence by creating a protumorigenic microenvironment through both relative neutrophilia and lymphocytopenia. In the present review, we attempted to summarize the published work on the role of pretreatment NLR as a prognostic marker for HCC following LR and LT. A total of 13 LT and 18 LR studies were included from 2008 to 2015. Pretransplant NLR was most often predictive of HCC recurrence, recurrence-free survival, and overall survival. NLR was, however, more variably and less clearly associated with worse outcomes following LR.

Prognostic role of neutrophil-lymphocyte ratio in multiple myeloma: a dose-response meta-analysis.

BackgroundThe neutrophil–lymphocyte ratio (NLR), a biomarker for systematic inflammation, has been recently identified as a prognostic factor for various types of both solid and hematologic malignancies. Our study presented here was the first meta-analysis assessing the prognostic role of NLR in multiple myeloma (MM).MethodsWe systematically searched PubMed, Embase, and ISI Web of Science for relevant studies. Odds ratios (ORs) or hazards ratios (HRs) with corresponding 95% CIs are pooled to estimate the association between NLR and clinicopathological parameters or survival of MM patients.ResultsSeven trials with 1,971 MM patients were enrolled in the meta-analysis, and the results indicated that elevated pretreatment NLR was significantly associated with advanced tumor stages (International Staging System [ISS] III vs ISS I–II: OR 2.427, 95% CI: 1.268–4.467; and Durie–Salmon III vs Durie–Salmon I–II: OR 1.738, 95% CI: 1.133–2.665). Moreover, increased NLR also predicted poorer overall survival (HR 2.084, 95% CI: 1.341–3.238) and progression-free survival (HR 1.029, 95% CI: 1.016–1.042). And two-stage dose–response meta-analysis revealed linear association between increased NLR and risk of mortality in MM patients.ConclusionWe can conclude that MM patients with higher NLR are more likely to have poorer prognosis than those with lower NLR.

Pretreatment blood neutrophil/lymphocyte ratio is associated with metastasis and predicts survival in patients with pancreatic cancer

The predictive value of systemic inflammatory markers has been explored in various types of cancer. In the present study, we aimed to investigate the association between pretreatment neutrophil/lymphocyte ratio (NLR) and tumor metastasis in pancreatic cancer, and the values of NLR as a prognostic factor of overall survival. Clinical and laboratory data from 256 consecutive pancreatic cancer patients were analyzed retrospectively. The NLR was recorded before treatment and analyzed along with clinicopathological characteristics and overall survival of pancreatic cancer patients. Multivariate analysis revealed that pretreatment NLR (HR: 2.393; 95% CI: 1.326-4.320; P=0.004) was an independent risk factor for distant metastasis. Furthermore, COX regression analysis showed that in addition to pretreatment NLR (HR: 1.871; 95% CI: 1.413-2.477; P<0.001), metastasis and stage were independent prognostic factors. Pretreatment NLR values were significantly associated with distant metastasis in pancreatic cancer patients. Higher NLR values were detected in metastatic disease and may be an independent prognostic factor of overall survival in pancreatic cancer patients.

The pretreatment neutrophil-lymphocyte ratio may predict prognosis of patients with liver cancer: A systematic review and meta-analysis.

At present, several studies have reported that the pretreatment neutrophil-lymphocyte ratio (NLR) may be associated with the prognosis of liver cancer. Nevertheless, their conclusions remain controversial. Thus, we performed a meta-analysis of 54 studies to evaluate the prognostic value of NLR. Databases including PubMed, Embase, Cochrane Library, and Web of Science were searched to July 2017. A total of 54 studies including 12979 patients were included in this meta-analysis. Elevated NLR had a close relationship with the overall survival (OS) (HR 1.52; 95% CI 1.39-1.67), recurrence-free survival (RFS) (HR 1.84; 95% CI 1.48-2.30), and disease-free survival (DFS) (HR 1.71; 95% CI 1.39-2.11) of liver cancer, respectively. In addition, elevated NLR was associated with the presence of tumor vascular invasion (OR 2.35; 95% CI 1.93-2.86), multiple tumors (OR 1.38; 95% CI 1.15-1.66), alpha-fetoprotein ≥400ng/mL (OR 1.51; 95% CI 1.15-1.98), presence of HbsAg (+) (OR 0.68; 95% CI 0.51-0.90), and cirrhosis (OR: 0.59; 95% CI 0.44-0.80). This meta-analysis indicated that elevated NLR may be an effective and noninvasive indicator for prognosis of patients with liver cancer.

Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio as Prognostic Factors for Locally Advanced Pancreatic Cancer Patients

It is well known that locally advanced pancreatic cancer patients have a poor prognosis. Outcomes of these patients are not only determined by tumor characteristics but also by host-related factors. Recently, hematologic markers showing systemic inflammatory status such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have aroused much attention due to its potential to predict patient survival. In this study, we investigated whether pre-treatment NLR and PLR independently and combination of NLR and PLR would be significant prognostic factors for survival in locally advanced pancreatic cancer patients. A total of 497 locally advanced (borderline resectable and unresectable) pancreatic cancer patients who received neoadjuvant or definitive chemoradiotherapy (CCRT) between January 2005 and December 2015 were included in this study. NLR and PLR prior to the start of treatment within 2 weeks were defined as pre-treatment NLR and PLR. We divided the patients with the median values of pre-treatment NLR and PLR; NLR < 2.44 group (n = 248), NLR ≥ 2.44 group (n = 249), PLR < 149 group (n = 248) and PLR ≥ 149 (n = 249) group. Overall survival (OS) and progression-free survival (PFS) were compared between each group for NLR and PLR. Additionally, we grouped the patients into 3 groups concerning both factors. Patients with NLR < 2.44 and PLR < 149 (n = 175), either NLR ≥ 2.44 or PLR ≥ 149 (n = 146), and NLR ≥ 2.44 and PLR ≥ 149 (n = 176) were evaluated for OS and PFS. Median overall survival was 15.7 months (range, 2.3-128.5 months). For NLR, the OS, PFS rates were significantly lower in the NLR ≥ 2.44 group, with 1-year OS rates of 67.9% and 61.5% (p = 0.003) and 1-year PFS rates of 38.1% and 32.4% (p = 0.003), for NLR < 2.44 and ≥ 2.44 group, respectively. The PLR ≥ 149 group also showed significantly poorer OS and PFS than PLR < 149 group. The 1-year OS rates were 68.1% and 61.3% (p = 0.029) and 1-year PFS rates were 37.9% and 32.5% (p = 0.027), for PLR < 149 and ≥ 149 group, respectively. When multivariate analysis was performed, NLR ≥ 2.44 remained as a significant adverse factor for OS (p=0.007) and PFS (p=0.026). PLR > 149 also proved to be a significant factor for poorer OS (p=0.03) and PFS (0.007). When both NLR and PLR were taken into account, NLR ≥ 2.44 and PLR ≥ 149 group showed the worst OS (p=0.008) and PFS (p=0.002) compared to the other two groups and remained significant after multivariate analysis for both OS (p=0.003) and PFS (p=0.003). Elevated pre-treatment NLR and PLR independently and in combination significantly predicted poor OS and PFS. The NLR or PLR can be easily measured using peripheral blood samples. Pre-treatment NLR and PLR could be useful prognostic factors for OS and PFS in locally advanced pancreatic cancer patients.

THE RELATIONSHIP BETWEEN NEUTROPHİL / LYMPHOCYTES RATIO AND PLATELET / LYMPHOCYTES RATIO WITH PROGNOSIS IN OPERATED STAGE 1-2 OF NON- SMALL CELL LUNG CANCER DISEASE: ONE CENTRAL EXPERIENCE

Aim: The relationship between neutrophil / lymphocyte ratio (NLR) and platelet / lymphocyte ratio (PLR) and the prognosis of various cancers has been demonstrated. However, the impact of NLR and PLR on the prognosis of non-small cell lung cancer (NSCLC) remains controversial. The aim of this study was to investigate the prognostic value of NLR and PLR before surgery in stage 1-2 NSCLC patients undergoing radical resection in our hospital. Materials and Methods: We included 59 patients with stage 1-2 NSCLC undergoing radical resection at our center between 2001 and 2014. The follow-up files of the patients were reviewed and necessary informations were obtained. Receiver operating curve (ROC) analysis was used for the optimal cut-off value of NLR and PLR (4.7 for NLR, 199 for PLR). The Kaplan-Meier univariate analysis was used to examine the effect of NLR and PLR on overall survival (OS) and disease-free survival (DFS). Results: There was no relationship between NLR and PLR classifications and clinical parameters except for age. OS mean was 53 months, DFS mean was 43 months in the group with NLR < 4.7, OS mean was 44 months and DFS mean was 28 months in the group with NLR> 4.7 (p = 0.031 for OS, p = 0.126 for DFS). OS mean was 55 months, DFS mean was 39.5 months in the group with PLR < 199, OS mean was 42 months, DFS mean was 30.6 months in the group with PLR > 199 (p=0,020 for OS, p=0,856 for DFS). Discussion and Conclusion: High pretreatment NLR and PLR values are independent predictors of poor prognosis in patients with opere lung cancer. Preoperative NLR and PLR values can be used as a prognostic parameter before radical resection in patients with stage 1-2 NSCLC.

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

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

Immunological Status May Predict Response to Nivolumab in Non-small Cell Lung Cancer without Driver Mutations.

It remains challenging to select patients with non-small cell carcinoma (NSCLC) for nivolumab monotherapy. We evaluated whether early termination of nivolumab monotherapy correlated with pretreatment neutrophil/lymphocyte ratio (NLR) and prognostic nutritional index (PNI). Twenty patients received nivolumab monotherapy for NSCLC with wild-type epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) during 2016. Early termination and continued therapy were defined as ≤5 and ≥6 cycles of monotherapy, respectively. Early termination and continued therapy groups included 9 and 11 patients, respectively. High pretreatment NLR and low pretreatment PNI were significantly associated with early termination of nivolumab, both in an overall analysis (p<0.001 and p=0.016) and in subgroup analyses of patients with performance scores of 0-1 and ≥30 days of pretreatment drug holidays. High NLR and low PNI were associated with early termination of nivolumab monotherapy, suggesting they might be useful biomarkers for treatment selection.

Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in non-metastatic breast cancer patients from a Hispanic population.

High values of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been associated with poor prognosis in certain tumors. Nevertheless, few data exist regarding these prognostic variables in breast cancer patients from Hispanic populations. In this study, we aimed to determine the prognostic value of these two estimates and to establish the best cutoff to categorize patients according to their risk. We retrospectively reviewed 172 consecutive breast cancer patients treated in our center. Pre-treatment NLR and PLR, as well as clinical variables were collected from medical records. Univariate and multivariate Cox regression analyses were performed to assess the relationship between NLR, PLR, overall survival (OS) and disease free survival (DFS), adjusted for potential confounders. The best cut-off point was determined based on the maximization of the Log-rank test statistic. Median follow-up time was 71.3months. The optimal cut-off for NLR and PLR was 3 and 250, respectively. In univariate analysis, a NLR 3 was associated with poor DFS (Hazard Ratio (HR): 3.92; 95% Confidence Interval (CI): 1.98-7.77; p < 0.001) and reduced OS (HR: 4.20; 95%CI: 2.10-8.38; p < 0.001). Similarly, a PLR 250 was associated with worse DFS (HR: 5.01; 95%CI: 2.33-11.1; p < 0.001) and poorer OS (HR: 5.35; 95%CI: 2.43-11.76; p < 0.001). However, after adjustment for potential confounders, only the PLR was independently associated with worse outcomes. A NLR greater than 3 and a PLR greater than 250 were associated with worse OS and DFS in Hispanic patients with breast cancer.

Clinical implications of pretreatment inflammatory biomarkers as independent prognostic indicators in prostate cancer.

Research on the relationship between inflammatory biomarkers and malignant tumors has become a hotspot. Many studies have demonstrated that neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) could act as independent prognostic indicators for several solid tumors. This study aimed to evaluate the clinical implications of pretreatment inflammatory biomarkers, including NLR, PLR, and RDW as independent prognostic indicators in prostate cancer (PCa). A total of 226 PCa patients who were diagnosed at our institution from 2011 to 2016 were analyzed retrospectively. We compared the clinicopathological features, survival curves, and prognosis of the PCa patients between the high and low groups according to the cutoffs of NLR, PLR, and RDW. The pretreatment NLR, PLR, and RDW values were significantly higher in the patients with PCa than those in the controls (P<.05). Increased NLR and PLR values were significantly associated with high risk of progression, including higher Gleason scores, cell proliferation antigen 67 (Ki-67) indexes, and prostate-specific antigen (PSA) levels (P<.05), whereas an elevated RDW was only associated with an older age. An increased NLR was correlated with both overall survival (OS) (P=.025) and disease-free survival (DFS) (P=.017). In addition, a higher PLR only showed a significantly worse DFS (P=.040). Pretreatment NLR was an independent prognostic indicator of DFS. The pretreatment NLR and PLR might be beneficial to predict the progression and prognosis of PCa. Furthermore, NLR was more effective than PLR acting as an independent prognostic indicator for PCa.

Pretreatment combination of platelet counts and neutrophil-lymphocyte ratio predicts survival of nasopharyngeal cancer patients receiving intensity-modulated radiotherapy.

BackgroundIncreased cancer-related inflammation has been associated with unfavorable clinical outcomes. The combination of platelet count and neutrophil–lymphocyte ratio (COP-NLR) has related outcomes in several cancers, except for nasopharyngeal carcinoma (NPC). This study evaluated the prognostic value of COP-NLR in predicting outcome in NPC patients treated with intensity-modulated radiotherapy (IMRT).Materials and methodsWe analyzed the data collected from 232 NPC patients. Pretreatment total platelet counts, neutrophil–lymphocyte ratio (NLR), and COP-NLR score were evaluated as potential predictors. Optimal cutoff values for NLR and platelets were determined using receiver operating curve. Patients with both elevated NLR (>3) and platelet counts (>300×109/L) were assigned a COP-NLR score of 2; those with one elevated or no elevated value were assigned a COP-NLR a score of 1 or 0. Cox proportional hazards model was used to test the association of these factors and relevant 3-year survivals.ResultsPatients (COP-NLR scores 1 and 2=85; score 0=147) were followed up for 55.19 months. Univariate analysis showed no association between pretreatment NLR >2.23 and platelet counts >290.5×109/L and worse outcomes. Multivariate analysis revealed that those with COP-NLR scores of 0 had better 3-year disease-specific survival (P=0.02), overall survival (P=0.024), locoregional relapse-free survival (P=0.004), and distant metastasis-free survival (P=0.046). Further subgrouping by tumor stage also revealed COP-NLR to be an unfavorable prognostic indicator of 3-year failure-free survival (P=0.001) for locally advanced NPC.ConclusionCOP-NLR score, but not NLR alone or total platelet count alone, predicted survival in NPC patients treated with IMRT-based therapy, especially those with stage III/IVA, B malignancies.

Are pretreatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio useful in predicting the outcomes of patients with small-cell lung cancer?

ObjectivesThe neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) have been proved to affect the prognosis of various types of cancers. However, the prognostic role of NLR and PLR in patients with small-cell lung cancer (SCLC) remains controversial. The objective of this study is to assess the prognostic values of NLR, PLR and other potential prognostic indexes in SCLC patients.ResultsThe optimal cutoff levels were 2.65 for NLR, 125 for PLR and 210 for LDH by ROC curves analysis. Patients in the NLR ≥ 2.65 and LDH ≥ 210 groups were significantly correlated with worse PFS and OS. However, patients in the PLR < 125 group presented longer PFS time than patients in the PLR ≥ 125 group. Multivariate analysis showed that NLR ≥ 2.65 was an independent risk factor for both PFS (HR = 1.38; 95% CI 1.04–1.83; P = 0.027) and OS (HR = 1.35; 95% CI 1.02–1.79; P = 0.039). LDH and the clinical stage were independent prognostic factors for PFS in SCLC patients. LDH, surgery history, thoracic RT and PCI were independent prognostic factors for OS.Materials and Methods320 patients with SCLC were enrolled in this research from 2007 to 2014. Data was acquired through patients’ medical records and follow-ups. Receiver operating curve (ROC) was used to determine the optimal cut-off levels of NLR, PLR and lactate dehydrogenase (LDH). The Kaplan-Meier univariate analysis and multivariate Cox regression analysis were used to evaluate the impact of the NLR, PLR and other potential prognostic factors on overall survival (OS) and progressive-free survival (PFS).ConclusionsPretreatment elevated NLR and LDH were independent factors for poor prognosis in SCLC patients. High PLR was associated with poor PFS, but it was not an independent prognostic factor for PFS and OS.

Prognostic significance of neutrophil-to-lymphocyte ratio in biliary tract cancers: a systematic review and meta-analysis.

BackgroundInflammation was considered to perform crucial roles in the development and metastasis of malignancies. A heightened neutrophil-lymphocyte ratio has been described to be associated with detrimental survivals in different malignancies. Debate remains over the impact of heightened neutrophil-lymphocyte ratio on survivals in biliary tract cancer. The review evaluated the prognostic value of neutrophil-lymphocyte ratio in biliary tract cancer.MethodsMEDLINE, the Cochrane Library, EMBASE, and the Chinese SinoMed were systematically searched for relevant articles. Associations between neutrophil-lymphocyte ratio and long-term outcomes were expressed as the hazard ratios and 95% confidence intervals. The odds ratio was utilized to assess the association between neutrophil-lymphocyte ratio and clinicopathological parameters.ResultsFourteen studies consisting of 3217 patients were analyzed: 1278 (39.73%) in the high pretreatment neutrophil-lymphocyte ratio group and 1939 (60.27%) in the low pretreatment neutrophil-lymphocyte ratio one. The results proved that heightened pretreatment neutrophil-lymphocyte ratio was significantly associated with detrimental overall survival and relapse free survival for biliary tract cancer patients. In addition, elevated neutrophil-lymphocyte ratio was positively correlated with higher carbohydrate antigen 19-9 levels, advanced TNM staging and greater lymph node involvement.ConclusionThis meta-analysis marked that an increased pretreatment neutrophil-lymphocyte ratio was significantly linked with detrimental long-term outcomes and clinicopathological parameters for patients with biliary tract cancer.