Prognostic Significance Of Neutrophil-to-lymphocyte Ratio Research Articles

Prognostic Significance of NLR and PLR in COVID-19: A Multi-Cohort Validation Study.

Recent studies have highlighted the prognostic value of easily accessible inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for predicting severe outcomes in patients affected by Coronavirus disease 2019 (COVID-19). Our study validates NLR and PLR cut-off values from a prior cohort at IRCCS Policlinico San Matteo (OSM) of Pavia, Italy, across two new cohorts from different hospitals. This aims to enhance the generalizability of these prognostic indicators. In this retrospective cohort study, conducted at Milan's Ospedale Luigi Sacco (OLS) and IRCCS Ospedale Maggiore Policlinico (OMP) hospitals, we assess the predictive capacity of NLR and PLR for three main outcomes-non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) usage, invasive ventilation (IV), and death-in patients with COVID-19 at admission. For each outcome, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed separately for male and female cohorts. Distinct NLR and PLR cut-off values were used for men (7.00, 7.29, 7.00 for NLR; 239.22, 248.00, 250.39 for PLR) and women (6.36, 7.00, 6.28 for NLR; 233.00, 246.45, 241.54 for PLR), retrieved from the first cohort at OSM. A total of 3599 patients were included in our study, 1842 from OLS and 1757 from OMP. OLS and OMP sensitivity values for both NLR and PLR (NLR: 24-67%, PLR: 40-64%) were inferior to specificity values (NLR: 64-76%, PLR: 55-72%). Additionally, PPVs generally remained lower (< 63%), while NPVs consistently surpassed 68% for PLR and 72% for NLR. Finally, both PLR and NLR exhibited consistently higher NPVs for more severe outcomes (> 82%) compared to NPVs for CPAP/NIV. Consistent findings across diverse patient populations validate the reliability and applicability of NLR and PLR cut-off values. High NPVs emphasize their role in identifying individuals less likely to experience severe outcomes. These markers not only aid in risk stratification but also guide resource allocation in emergencies or limited-resource situations.

Correlation between Inflammatory and Hematologic Biomarkers and Cardiovascular Outcomes Among CCU and Post-CCU Patients Diagnosed with Acute Coronary Syndrome: A Retrospective Study

Background: Deaths associated with the Acute Coronary Syndrome (ACS) remain high among Cardiac/Coronary Care Unit (CCU) and post-CCU patients. Recently, researchers have looked for inexpensive and reliable prognostic indicators as alternatives to the expensive pro-Brain Natriuretic Peptide (proBNP) in ACS patients to predict adverse outcomes.&#x0D; Methods: We retrieved the Complete Blood Count (CBC) records of ACS patients and calculated values for plateletcrit (PCT), Mean Platelet Volume (MPV), and Neutrophil-to-Lymphocyte Ratio (NLR). We also recorded ACS diagnostic methods, duration of hospital stays (CCU and post-CCU), and therapeutic modalities. We considered outcomes such as death, positive or negative troponin, ST-elevation, ejection fraction &lt;45, and history of arrhythmia.&#x0D; Results: The multivariate model using forward stepwise logistic regression showed that the history of arrhythmia (OR=124.052, p= 0.001), positive troponin (OR=47.545, p=0.002), hospitalization period (OR=2.376, p=0.001), C-reactive protein (CRP) (OR=1.359, p=0.001), and PCT (OR=2.018, p=0.001) are independent predictors of mortality.&#x0D; Conclusion: CRP and PCT are considered independent predictors of mortality among CCU and post-CCU patients diagnosed with ACS. However, the prognostic significance of NLR and MPV needs to be confirmed by further investigations.

Prognostic Significance of NLR, PLR, LMR and Tumor Infiltrating T Lymphocytes in Patients Undergoing Surgical Resection for Hilar Cholangiocarcinoma.

ObjectiveThis study evaluated the prognostic significance of preoperative neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and tumor-infiltrating lymphocytes (TILs), and whether these preoperative blood inflammatory indicators were associated with TILs in hilar cholangiocarcinoma (HCCA).MethodsA total of 76 patients with HCCA who underwent radical resection were included. Data on their clinicopathologic characteristics, perioperative features, and survival outcomes were analyzed. The optimal cutoff levels for the NLR, PLR and LMR were defined by using the web application Cut-off Finder. The densities of specific immune cells (CD3+, CD4+, CD8+) within the tumor microenvironment were examined by immunohistochemical. The association of the number of CD3+, CD4+ and CD8+ T cells infiltration in the local tumor microenvironment with preoperative NLR, PLR and LMR level was analyzed. Survival curves were calculated using the Kaplan–Meier estimate. Univariate and multivariate logistic regression models were used to identify factors associated with overall survival.ResultsThe optimal cutoff value of preoperative NLR, PLR and LMR was 2.00, 117.60, and 4.02, respectively. NLR was significantly negatively correlated with CD3+ and CD8+ T cell infiltration, but not with CD4+ T cells. PLR had no correlation with CD3+, CD4+, or CD8+ T cell infiltration, while LMR had a significantly positive correlation with CD3+ T cells infiltration but not with CD4+ or CD8+ T cells. In the multivariate logistic regression model, T stage, lymph node metastasis, CA19-9 and LMR were independent risk factors associated with overall survival (OS). Survival curves indicated that HCCA patients with low CD3+ T cells infiltration and low preoperative LMR live shorter than others.ConclusionsLMR played as an independent factor for predicting the survival in patients with HCCA after R0 radical resection. A high LMR was associated with an accumulation of CD3+ T cells in HCCA.

Neutrophil-to-lymphocyte ratio as a prognostic marker for head and neck cancer with lung metastasis: a retrospective study.

The neutrophil-to-lymphocyte ratio (NLR) is the most widely biomarker used to assess the inflammatory system in various solid cancers. An elevated NLR has been reported to be associated with worse outcomes in head and neck squamous cell cancers (HNSCC). However, questions remain about the prognostic value of these findings in HNSCC patients with lung metastasis. This study aims to quantify the prognostic impact of NLR on HNSCC patients with lung metastasis. A retrospective chart review of 169 HNSCC patients was performed at the Otorhinolaryngology and the Stomatology and Maxillofacial Surgery Department (Saint-Pierre Hospital), between 2000 and 2017. All patients were divided into two subgroups. Patients who developed lung involvement were assigned to the lung-metastasis-group (LM-group) in contrast to no-lung-metastasis-group patients (NLM-group). The prognostic significance of NLR was evaluated using multivariable analysis adjusting for overall-survival (OS) and lung-metastasis-free-survival (LMFS). 95 patients were enrolled in the NLM-group while 74 were in the LM-group. Multivariable analysis highlights that patients with a higher NLR value had shortened OS in the NLM subgroup (HR 1.3; p = 0.024). However, this association was not found in the LM subgroup. When considering both subgroups, an elevated NLR was reported as a prognostic factor of poor LMFS (HR 1.65; p = 0.047). Our data revealed that pretreatment NLR is an independent prognostic factor of mortality and lung metastasis development. However, the prognostic value of NLR is not confirmed in patients who suffered from lung metastasis. Physicians should integrate these findings in their treatment algorithm approach.

High neutrophil-to-lymphocyte ratio predicts short survival in multiple system atrophy

The neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, can predict the prognosis of neurodegenerative diseases. However, the significance of NLR for the prognosis of multiple system atrophy (MSA) has not been reported. We aimed to examine the prognostic significance of NLR in MSA. A total of 169 MSA patients and 163 matched healthy controls (HCs) were enrolled. MSA patients were divided into three groups according to the tertiles of their NLR. Kaplan–Meier survival analysis and Cox regression model were used to assessing the effect of NLR on survival. An independent validation cohort of 56 consecutive patients with probable MSA who met the inclusion criteria was included. The NLR was significantly higher in patients with MSA than that in HCs. The survival duration in patients with MSA in group 3 was shorter than that in patients in the other two groups (P = 0.013). In the multivariable Cox regression model, a higher NLR increased the risk of mortality in patients with MSA after adjusting for confounding factors (HR = 1.922, P = 0.035). Additionally, a higher NLR increased the risk of mortality in MSA with predominant cerebellar ataxia (MSA-C) (HR = 2.398, P = 0.033) and in men (HR = 3.483, P = 0.027). The concordance index for the multivariate Cox regression model was more than 0.7 both in the primary cohort and external validation cohort. Patients with MSA had a higher NLR than did HCs. A high NLR increased the risk of mortality with MSA, especially in MSA-C and in men.

Prognostic Significance of NLR About NETosis and Lymphocytes Perturbations in Localized Renal Cell Carcinoma With Tumor Thrombus.

BackgroundNon-metastatic renal cell carcinoma (RCC) with tumor thrombus showed a greater tendency for developing metastases after surgery. Early identification of patients with high risk of poor prognosis is especially important to explore adjuvant treatment of improving outcomes. Neutrophil-to-lymphocyte ratio (NLR) was a systemic inflammation marker and outcome predictor in RCC, reflecting the chaos in systemic immune status in cancer as myeloid cell expansion and lymphatic cell suppression. Neutrophil extracellular traps (NET) formation (NETosis) is the process of neutrophils generating an extracellular DNA net-like structure. NETosis in tumor was demonstrated to conduce to the subsequent metastases of tumor. However, the role of NLR for systemic immune status and tumor local immune infiltration, especially for neutrophil-associated NETs, in non-metastatic RCC with thrombus remains unclear.Patients and MethodsIn our clinical cohort, we enrolled the clinical, pathologic, and preoperative laboratory parameters of 214 RCC patients with tumor thrombus who were treated surgically. The clinical endpoint was defined as cancer-specific survival (CSS). In our basic research cohort, RNA-seq, TCR-seq, and scRNA-seq data were analyzed. Patients who reached the endpoint as recurrence-free survival (RFS) were defined as the “High-risk” group. Otherwise, they were separated into the “Low-risk” group.ResultsIn the clinical cohort, NLR≥4 was an independent risk factor for 203 localized RCC with tumor thrombus. In the basic research cohort, tumor thrombi were separated into NETosis-thrombi belonging to the “High-risk” group and non-NETosis-thrombi to the “Low-risk” group. NETs induced by tumor-derived G-CSF in tumor thrombus has a mechanistic role in unfavorable prognosis. Besides, NETs-score from single sample GSEA (ssGSEA) algorithm was an independent prognostic factor validated in the TCGA data. Apart from the neutrophils-associated NETosis, systemic immune perturbations of lymphocytes occurred in the “High-risk” group, represented with decreased TCR diversity and increasingly high proportion of CD4-positive effector memory T (Tem) cells, which indirectly represented the state of lymphopenia.ConclusionsOur findings firstly demonstrated that neutrophils-associated NETosis and systemic lymphocytes perturbations were considered as tumor progression in patients of localized RCC with tumor thrombus, which reflected NLR≥4 as an independent risk factor for patients.

The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies -A Narrative Review.

Despite the presence of many hematological prognostic indexes, clinical course and overall survival are often highly variable even within the same patient subgroup. Recent studies suggest that simple, cost-effective, low-risk tests such as neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR) may be used to evaluate the prognosis. Their role has been well confirmed in diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL) and multiple myeloma (MM), but until now the prognostic significance of NLR and LMR in leukemias has not been widely reported. In this article, we analyze the literature data on prognostic value of NLR and LMR in haematological malignancies in the context of classic prognostic factors and clinical course.

Association of ascitic neutrophil to lymphocyte ratio with prognosis in patients with advanced gastric cancer

443 Background: Approximately 40% of metastatic gastric cancer patients develop peritoneal carcinomatosis, and this condition leads patients to grave prognosis. Blood neutrophil to lymphocyte ratio (NLR) is associated with prognosis in various solid tumors, such as non-small cell lung cancer, colorectal cancer, and gastric cancer. We performed this study to investigate the prognostic significance of NLR of ascitic fluid. Methods: This is retrospective study. Patients were consecutive included if they; 1) had histologically confirmed gastric adenocarcinoma, poorly cohesive carcinoma, or poorly differentiated carcinoma, 2) were relapsed after curative resection or initially metastatic, 3) had ascites due to peritoneal metastases of gastric cancer, 4) had received paracentesis at least once and the result of ascites exam is available. Patients with clinically active infection in the time of paracentesis is excluded. If multiple times of paracentesis was done, we used initial result. Results: From March 2012 to August 2018, total 157 patients who were visited in Pusan National University Yangsan Hospital met the inclusion criteria. Median age is 58 (29-86) years and male patients was 63% (n = 99). In 38.9% (n = 61) patients, gastric cancer was diagnosed in primary site and in ascites synchronously. At the time of first paracentesis, 47.1% (n = 74) of patients had already been received palliative chemotherapy due to metastatic gastric cancer. In the ascites, mean and median NLR is 2.2±6.8 and 0.3 (0-65). All except 3 patients were expired, and the median survival time form paracentesis was 47 (95% confidence interval 38.6-55.4) days. In the Kaplan-Meier survival analysis, patients with higher NLR (≥0.33) have shorter survival from paracentesis (39 days, 95% CI 32.5-45.4) in compared to lower NLR ( &lt; 0.33) (61 days, 95% CI 29.4-92.6, log-rank p = 0.011). In the additional analyses, higher neutrophil count (41 vs 72 days, p = 0.045) and lower protein level (32 vs 61 days, p = 0.018) of ascites are also poor prognostic factor. Conclusions: High NLR of malignant ascites is poor prognostic factor in patients with gastric cancer. The role of neutrophil in the malignant ascites should be tested in a new perspective.

Prognostic Value of the Pretreatment Neutrophil-to-Lymphocyte Ratio in Pediatric Parotid Cancer.

Objective: Our goal was to evaluate the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in pediatric patients with parotid cancer.Materials and Methods: Pediatric patients with primary parotid cancer were retrospectively enrolled from several clinical centers. The associations between the clinical-pathologic variables and NLR and the prognostic significance of NLR for recurrence-free survival (RFS) and disease-specific survival (DSS) were analyzed.Results: A total of 123 patients were included. The mean NLR was 2.51 and ranged from 1.7 to 6.1. The tumor stage and disease grade were significantly related to NLR. In patients with NLR < 2.51, the 10-year RFS rate was 97%, and in patients with NLR ≥ 2.51, the 10-year RFS rate was 84%; the difference was significant (p = 0.016). In patients with NLR < 2.51, the 10-year DSS rate was 98%, and in patients with NLR ≥ 2.51, the 10-year DSS rate was 83%; this difference was also significant (p = 0.035). Further Cox model analysis confirmed the independence of NLR in predicting the RFS and DSS rates.Conclusions: NLR is significantly associated with prognosis in pediatric patients with parotid cancer.

Prognostic Significance of Neutrophil to Lymphocyte Ratio (NLR) in Relapsed/Refractory Aggressive Lymphoma Salvage Chemotherapy — Analysis ofCanadian Cancer Trials Group (CCTG)ly.10 Trial

Background: The neutrophil to lymphocyte ratio (NLR) at the time of diagnosis has been shown as a prognostic marker to predict outcomes of treatment in patients with aggressive lymphoma in both non-Hodgkin (NHL) and Hodgkin lymphoma (HD). The growing evidence that tumor microenvironment, host immunity and inflammatory responses play an important role in progression of different malignancies supports this rationale. The prognostic significance of NLR has only been studied in the frontline setting in HD and NHL. Therefore the aim of this study is to evaluate correlation of NLR with response to salvage therapy in patients with relapsed or refractory aggressive lymphoma.Methods: This is a retrospective review of participants in the CCTG LY.10 trial, a phase 2 clinical trial evaluating treatment with Gemcitabine, Dexamethasone and Cisplatin (GDP) in patients with relapsed or refractory NHL and HD who are eligible for Autologous Stem Cell Transplantation (ASCT). Seventy-seven patients were treated with GDP, 23 with HD and 51 with NHL. The overall response rate (ORR) including complete and partial response to GDP salvage therapy was 69.5% in HD and 49% in NHL. NLR was calculated on all patients at the time of relapse. Biomarker Threshold Models (Chen et al, 2014, Computational Statistics and Data Analysis, V71, page 324-334) were applied to identify the optimal cut off point for NLR. Categorical variables were compared using Chi-square test and survival distributions were compared using KM curves and Log-rank test.Results:A NLR of 8.4 was determined to be the optimal cut-off for prognosis. Among the full cohort of 77 patients, ORR in those with a NLR of < 8.4 was 70.6%, as compared with 33.4% for those with a NLR of > 8.4 (p=0.005). In the HD cohort the RR was 86.7% vs 50% (P =0.059) and was 63.9% vs 26.7% in the NHL cohort (P =0.015). In NHL the ability to proceed to transplant was correlated with NLR of <8.4 with 52.7% vs 20% of patients proceeding to ASCT (P = 0.031). All patients with HD proceeded to transplant regardless of their NLR. Patients with NLR <8.4 had better progression free survival (PFS) at 12 months; 100% vs 71% in patients with HD (P = 0.028) and 27 % vs 11% in patients with NHL (P =0.05).Conclusion:NLR is a readily available marker correlated with outcomes (ORR, transplant rate and PFS) and can be used to identify high risk patients at the time of relapse of aggressive lymphoma. This easily measurable prognostic marker would be especially useful in the era of novel treatment options to identify higher risk patients. Further analysis on larger data sets are required to validate this finding. DisclosuresHay:Seattle Genetics: Research Funding; Roche: Research Funding; Janssen: Research Funding; Novartis: Research Funding; Amgen: Research Funding; Kite: Research Funding. Baetz:Merck: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Research Funding.

Prognostic role of neutrophil-to-lymphocyte ratio in unresectable hepatocellular cancer patients treated with trans-arterial chemoembolization

The neutrophil-to-lymphocyte ratio (NLR), a useful biomarker, reflects systemic inflammation responses which are closely associated with the prognosis of various malignancies. Nevertheless, the prognostic significance of NLR in patients with hepatocellular carcinoma (HCC) undergoing trans-arterial chemoembolization (TACE) remains controversial. The study was designed to determine the prognostic value of NLR in survival outcomes of HCC patients receiving TACE by systematical review of present literature. Medline, Embase, Web of Science and Cochrane library databases were searched according to a pre-specified inclusive strategy to identify studies concerning survival in HCC patients receiving TACE with high or low pre- or post-TACE NLR. An electronic Excel table was used to extract epidemiological information, clinical pathological characteristics as well as primary outcome data. Initially, 598 relevant articles were selected, of which, 13 articles including 1,648 unresectable HCC patients undergoing TACE were ultimately enrolled. Our review and meta-analysis demonstrated that a high pre-TACE NLR reflected unfavorable overall survival (OS) [pooled hazard ratio (HR): 1.53, pooled 95% confidence interval (CI): 1.29–1.78, P 0.05) and tumor response (P=0.088). A high post-TACE NLR was closely associated with metastasis (OR: 1.57, 95% CI: 0.732–3.382, P=0.246), but not with time to progression (TTP) (P=0.18) and tumor response (P=0.229), and controversial role with OS (P value: 0.001 vs . 0.342). The NLR change trend between pre-and post-TACE was not correlated with either tumor response to TACE (P=0.89) or hepatic progression (P=0.55), whereas its prognostic role with OS was also controversial (P>0.05 or <0.05). As a convenient, inexpensive and easily available inflammatory biomarker, NLR harbored its important value in prognostic prediction in patients with unresectable HCC undergoing TACE. However, the association of the changing trends of NLR and NLR at different stages with different prognostic endpoints in HCC patients undergoing TACE was still in controversy, therefore further large-scale, prospective studies are needed to confirm these findings.

Prognostic Value of Neutrophil-to-lymphocyte Ratio in Patients with Lung Adenocarcinoma Treated with Radical Dissection

背景与目的已有的研究表明中性粒细胞计数/淋巴细胞计数比（neutrophil-to-lymphocyte ratio, NLR）对胃癌、结直肠癌、胰腺癌等多种恶性肿瘤的预后有显著影响，但是其对可切除肺腺癌患者预后影响目前研究较少。本研究旨在分析NLR与肺腺癌患者术后临床病理特征及预后的关系。方法回顾性分析163例经病理确诊为肺腺癌并行肺腺癌根治切除术患者的临床随访病理资料。根据术前1周内化验结果计算NLR值。通过对受试者工作特征曲线（receiver operating characteristic curve, ROC）的分析得出NLR的临界值（cut-off值）。采用Kaplan-Meier生存曲线和Cox比例风险模型研究NLR对肺腺癌术后患者预后的影响。结果采用5年生存作为终点绘制NLR值的ROC曲线，当NLR值为2.96时，正确指数（Youden指数）最大，敏感度为77.5%，特异度为75.9%。低NLR组累计5年生存率显著高于高NLR组（P < 0.05）。单因素及多因素生存分析显示：TNM分期和NLR水平与生存率显著相关（P < 0.05）。结论NLR值作为一项便捷且有效的指标，可用于初步判断肺腺癌术后患者预后状况。

High neutrophil-to-lymphocyte ratio as an independent adverse prognostic factor in racial minorities with hepatocellular carcinoma.

218 Background: An elevated neutrophil-to-lymphocyte ratio (NLR) has been shown to portend poor prognosis in various types of cancer, including hepatocellular carcinoma (HCC). However, studies that evaluated the prognostic significance of NLR did not include large numbers of Blacks and Hispanics. This single-center, retrospective study conducted on a large, racially diverse cohort explores the utility of NLR in predicting outcomes in minority populations. Methods: We identified patients (pts) diagnosed with HCC at our institution between the years 2000 and 2016. We calculated NLR at the time of diagnosis and divided pts into two groups: high NLR (NLR &gt; 3) and low NLR (NLR ≤3). Demographics, clinical characteristics, MELD/MELD-Na scores, ALBI scores and AFP levels were collected. Survival analysis was conducted using the Kaplan-Meier method. Cox proportional-hazards model was used for multivariate analysis. Results: 751 pts with HCC were included in this study. 542 (72%) were male. Median age was 61 years. 43% were Hispanic, 33% Black, 22% White and 2% Other. NLR was high in 246 pts (32.7%, mean 6.0 ± 3.8) and low in 505 pts (67.2%, mean 1.69 ± 0.7). Overall survival (OS) was significantly lower in the high NLR group (median survival 25.4 vs 49.6 months, HR 1.75, 95% CI 1.41-2.17, P &lt; 0.01). Subgroup analysis showed differences remained significant in the Hispanic group (n = 259, HR 1.93, 95% CI 1.30-2.86, P &lt; 0.01) and the Black group (n = 194, HR 1.99, 95% CI 1.28-3.09, P &lt; 0.01). The high NLR group had significantly higher MELD scores (mean 12.1 ± 5.0 vs 10.1 ± 3.8, P &lt; 0.01), MELD-Na scores (13.9 ± 5.6 vs 11.3 ± 4.4, P &lt; 0.01), ALBI scores (-2.05 ± 0.7 vs -2.28 ± 0.6, P &lt; 0.01) and AFP levels (median 28.9 vs 46.9, P = 0.02). An NLR &gt; 3 on multivariate analysis remained significantly associated with worse OS (HR 1.31; 95% CI 1.03-1.68; P = 0.02) after adjusting for age, gender, AFP and MELD-Na. Conclusions: NLR &gt; 3 at the time of diagnosis had a strong correlation with poor OS in a large, racially diverse cohort of pts with HCC. This correlation held true for both Hispanic and Black patients, who have been previously underrepresented in similar studies. Our findings support the utility of NLR as a prognostic tool in HCC.

Meta-analysis of prognostic value of inflammation parameter in breast cancer.

Recently, increasing studies investigated the association between inflammation parameter such as neutrophil to lymphocyte ratio (NLR) and the prognosis of cancers. However, the clinical and prognostic significance of NLR in breast cancer remains controversial. This meta-analysis was conducted to establish the overall accuracy of the NLR test in the diagnosis of breast cancer. A comprehensive search of the literature was conducted using PubMed and Web of Science. Six studies dating up to July 2014 with 2267 patients were enrolled in the present study. STATA 11.0 software (STATA Corporation, College Station, TX, USA) was selected for data analysis. In order to evaluate the association between NLR and overall survival (OS), disease-free survival (DFS), recurrence-free survival or cancer-specific survival, the hazard ratios (HRs), and their 95% confidence intervals (CIs) were extracted. Subgroup analyses showed that NLR was a strong prognostic factor for OS in multivariate analysis (HR = 2.81, 95% CI = 2.13-3.71, PH = 0.992) and without metastasis (HR = 1.45, 95% CI = 0.37-5.66, PH < 0.001). Elevated NLR was associated with a high risk for DFS in subgroups of multivariate analysis (HR = 2.16, 95% CI = 1.67-2.80, PH = 0.977) and mixed metastasis (HR = 2.13, 95% CI = 1.38-3.30, PH = 0.84). In summary, NLR may be considered as a predictive factor for patients with breast cancer.

Prognostic value of neutrophil-to-lymphocyte ratio in advanced EGFR-mutated non-small cell lung cancer (NSCLC) treated with a tyrosine-kinase inhibitors: A retrospective analysis in a series of western patients.

e23045 Background: Several studies demonstrated that an elevated neutrophil-to-lymphocyte ratio (NLR) correlate with a poor prognosis both in early and advanced stage of NSCLC. The aim of this retrospective analysis was to investigate the correlation between NLR and prognosis in caucasian patients diagnosed with advanced EGFR-mutated NSCLC and treated with tyrosine kinase inhibitors (TKIs). Methods: A retrospective database was used to identify consecutive patients diagnosed with advanced EGFR-mutated NSCLC and treated with TKIs. From January 2011 to December 2015, 63 patients from five Institutions were enclosed in our series. NLR was derived from the absolute neutrophil and the absolute lymphocyte counts of a full blood count.Survival curves were calculated with Kaplan-Meier method and data were compared by log-rank test. Prognostic significance of NLR were assessed using a Cox regression analysis. Results: Sixty-three eligible patients were stratified according to the mean pretreatment NLR value (3.57 ± 2.42). The chosen cut-off for NLR was 3.5. Forty patients had NLR &lt; 3.5 while 23 patients had a value of NLR &gt; 3.5.A statistical significant difference, both in PFS and OS, was found in the NLR &lt; 3.5 group compared with the higher NLR group (PFS: p &lt; 0.01, OS: p &lt; 0.05). According to univariate analysis, histological type (adenocarcinoma vs non-adenocarcinoma) and NLR value correlate significantly with PFS and OS. In Cox multivariate analysis, only NLR ³ 3.5 resulted significantly associated as independent prognostic factor for worse PFS (HR 2.275, 95% CI 1.257-4.116, p &lt; 0.01) and OS (HR 2.699, 95% CI 1.187-6.137, p &lt; 0.05). Conclusions: Pre-treatment NLR seems to represent a reliable, simple, and easy to reproduce, laboratory tool to predict survival and outcome to therapies in western caucasian EGFR-mutated NSCLC patients. Further prospective trials are needed to definitively confirm its prognostic and predictive role.

Pre-treatment neutrophil to lymphocyte ratio (NLR) association with curative intent metastasectomy (MSX) in metastatic renal cell carcinoma (RCC).

e16051 Background: NLR is a marker of inflammation and when elevated is associated with poor outcome in many tumors, including RCC. Hereby we evaluate the association of NLR with the likelihood of curative intent MSX. Methods: We retrospectively studied 846 patients diagnosed with metastatic RCC between 2007 and 2016. 116 patients fulfilled inclusion criteria: previous nephrectomy, no sarcomatoid features and available tumor specimens from metastatic site. Regression tree for censored data method was used to find the best NLR cut-off value. NLR was examined baseline – prior to MSX or targeted therapy. Chi-square test was used to evaluate associations between variables. We estimated overall survival (OS) using Kaplan-Meier curves. Cox proportional hazards regression models were fitted to evaluate the prognostic significance of NLR in univariable and multivariable analysis. Results: The median OS for the whole cohort was 45 months (95% CI, 27.6 to 62.4 months), and the median follow-up was 78.2 months. The best cut-off NLR value was 4.07. Higher NLR was associated with shorter OS when compared to the lower NLR cohort (11.5 months vs 68.3 months HR = 0.26, 95% CI: 0.15 – 0.97, p ≤ 0.0001, respectively). Univariate analysis revealed that bone metastasis and poor IMDC criteria were associated with worse OS and that MSX and lower NLR were associated with better OS. On multivariate analysis MSX, lower NLR and favourable/intermediate group on IMDC criteria were associated with a decreased risk of death (HR = 0.41, 95% CI 0.19-0.85, p = 0.018 and HR = 0.45, 95% CI 0.22-0.90, p = 0.025, HR = 0.35, 95% CI 0.16-0.79, p = 0.012, respectively). We found a positive association of lower NLR and curative intent MSX (p = 0.002). Conclusions: NLR is a prognostic marker in metastatic RCC and a ratio ≤ 4,07 is associated with a higher likelihood of curative intent MSX.

The neutrophil to lymphocyte ratio as a prognostic factor among a diverse population with advanced pancreatic cancer.

e15729 Background: The neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammatory response, has been suggested as a prognostic marker in patients with pancreatic adenocarcinoma (PAC). Black and Hispanic patients have been underrepresented in studies evaluating the significance of NLR in PAC. We investigated the prognostic significance of NLR in patients with advanced PAC treated at the Montefiore-Einstein Center for Cancer Care (MECCC) in the Bronx, NY. Methods: We included patients who were chemotherapy naive and treated for unresectable or metastatic PAC at MECCC between 2006 and 2015. Demographics, clinical characteristics and treatment data were collected. Overall survival was determined by the Kaplan-Meier method and Cox proportional-hazards models were built to assess survival differences adjusting for clinically relevant and statistically significant variables. Results: 201 patients were included in the study. Median age was 65 (range 32, 90). 52% were male. 41 were White (19%), 71 Black (33%), 71 Hispanic (33%), and 33 Other (15.3%). 66 (30.6%) had unresectable disease and 135 (62.5%) metastatic disease. An NLR ≥ 4 was associated with a worse OS compared to an NLR ≤ 4 (median 10 vs. 16.4 months; HR 1.895; 95% CI 1.390, 2.585; P &lt; 0.0001). Predictors of worse OS on univariate analysis were ever smoker status (HR 1.365; P = 0.05), metastatic disease (HR 1.736; P = 0.001), and albumin ≤ 3.5 g/dL (HR 2.558; P&lt; 0.0001). An NLR ≥ 4 on multivariate analysis remained significantly associated with worse OS (HR 1.665; 95% CI 1.188, 2.334; P = 0.003) after adjusting for age, gender, ever smoker status, metastatic disease, and albumin. Conclusions: In a cohort with significant minority patient representation, an NLR ≥ 4 was associated with significantly worse overall survival in patients with advanced pancreatic cancer. An elevated NLR in advanced PAC may be an important independent predictor to risk stratify patients and predict poor OS in future analyses.

The prognostic value of baseline neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for predicting clinical outcome in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) treated with liposomal irinotecan (nal-IRI; MM-398) + 5-fluorouracil and leucovorin (5-FU/LV) vs 5-FU/LV.

e15795 Background: Increased NLR and PLR have been associated with poor survival in several malignancies. Here we report the association of NLR and PLR with overall survival (OS) and progression-free survival (PFS) in the NAPOLI-1 trial (NCT01494506), which evaluated nal-IRI+5-FU/LV for the treatment of mPDAC patients (pts) after disease progression following gemcitabine-based therapy. Methods: Pts missing baseline NLR/PLR data were excluded. Medians reflect Kaplan-Meier estimates; hazard ratios (HRs) reflect Cox regression analysis. P values in this exploratory analysis are descriptive. Results: Of 116 evaluable pts in the nal-IRI+5-FU/LV arm, 82 (71%) had NLR ≤5 and 44 (38%) had PLR ≤150 (data cutoff: Nov 16, 2015). Of 105 evaluable pts in the 5-FU/LV control arm, 73 (70%) had NLR ≤5 and 36 (34%) had PLR ≤150. In pts with baseline NLR ≤5 or PLR ≤150, median OS and PFS were significantly longer in the nal-IRI+5-FU/LV treatment arm vs the 5-FU/LV control arm (Table). In pts with baseline NLR &gt;5 or PLR &gt;150, median OS and PFS were numerically longer in the treatment vs control arm, but differences were less compelling (95% CIs for HRs included 1). Conclusions: Median OS and PFS were improved with nal-IRI+5-FU/LV vs 5-FU/LV in pts with baseline NLR ≤5 or PLR ≤150. This exploratory analysis extends the prognostic significance of NLR and PLR to the post-gemcitabine setting. Clinical trial information: NCT01494506. [Table: see text]

Significance of blood neutrophil-to-lymphocyte ratio for prognostic stratification of patients with gastroesophageal junction adenocarcinoma in the era of the 8th edition of the American Joint Committee on Cancer (AJCC8) staging.

The prognosis of patients with gastroesophageal junction (GOJ) adenocarcinoma depends mainly on the clinical staging, as described by the new AJCC8 (American Joint Committee on Cancer 8th edition). Evidence suggests that peripheral blood neutrophil-to-lymphocyte ratio (NLR) may be of prognostic significance in patients with upper gastrointestinal cancers. We examined the prognostic significance of NLR in the era of the new AJCC8 staging system. In this single-centre cohort study, retrospective data on patients with operable GOJ adenocarcinoma treated with perioperative chemotherapy were analysed. The prognostic significance of baseline NLR in combination with AJCC8 clinical staging and other patient characteristics was examined for both time-to-progression (TTP) and overall survival (OS). Of 316 patients, 245 (77.5%) underwent radical surgery. Fifty-one patients (16.2%) developed unresectable disease due to early disease progression. NLR was the only baseline factor independently associated with the development of early disease progression. AJCC8 clinical staging was significantly associated with TTP and OS. In addition, NLR≥3 was predictive of poorer TTP (p=0.001) and OS (p=0.002), confirmed in multivariate Cox-regression analysis. NLR≥3 was prognostic, especially in patients with clinical stage III for TTP (p=0.006) and OS (p=0.025) and in patients with clinical stage IVA for OS (p=0.017). NLR significantly improved the prognostic classification of patients by different AJCC8 clinical stages, with a c-index improved from 0.554 to 0.592 (p<0.001). NLR was confirmed to be an independent prognostic factor in this cohort and could be used in combination with AJCC8 clinical staging to improve the baseline prognostic stratification of patients with newly diagnosed resectable GOJ adenocarcinoma.

Prognostic impact of preoperative neutrophil-to-lymphocyte ratio after radical prostatectomy in localized prostate cancer.

Neutrophil-to-lymphocyte ratio (NLR) has a prognostic value in patients with metastatic castration-resistant prostate cancer receiving systemic therapy. However, the prognostic significance of NLR was never previously evaluated in patients who underwent radical prostatectomy (RP) for prostate cancer. In the present study, we investigated the influence of NLR on survival after a RP for prostate cancer. We retrospectively reviewed clinical data of 2301 patients with prostate cancer who underwent RP at our institution between 2000 and 2010. Among these patients, we considered only patients who had a preoperative complete blood count with differential result available. Patients who received neoadjuvant or postoperative adjuvant treatment (radiation, androgen deprivation therapy or both) and those without adequate medical record were excluded. A Kaplan-Meier analysis was performed to analyze biochemical recurrence-free survival (BCRFS), overall survival (OS) and prostate cancer-specific survival (CSS). Univariate and multivariate Cox regression models were used for each end point. In total, 2067 patients were evaluated; median follow-up time was 78 months (interquartile range (IQR) 65-96), median age at RP was 66 years (IQR 61-70) and median preoperative NLR was 1.76 (IQR 1.35-2.40). A Kaplan-Meier analysis showed a significant association between high NLR (⩾1.76) and decreased CSS (P=0.005) and OS (P=0.003) but not with BCRFS (P=0.223). In the univariate and multivariate regression analyses, a high NLR was a significant predictor of CSS (hazard ratio (HR) 2.012, 95% confidence interval (CI) 1.222-3.310, P=0.006) and OS (HR 1.650, 95% CI 1.127-2.416, P=0.010). This study shows that in patients with prostate cancer preoperative NLR is an independent prognostic factor for OS and CSS after a RP and suggests that a preoperative hematologic workup should be considered in the risk assessment of these patients.