Value Of Systemic Inflammatory Markers Research Articles

Association of body composition and systemic inflammation for patients with locally advanced cervical cancer following concurrent chemoradiotherapy.

Systemic inflammation and body composition are associated with survival outcomes of cancer patients. This study aimed to examine the combined prognostic value of systemic inflammatory markers and body composition parameters in patients with locally advanced cervical cancer (LACC). Patients who underwent concurrent chemoradiotherapy (CCRT) for LACC at a tertiary referral teaching hospital between January 2010 and January 2018 were enrolled. A predictive model was established based on systemic immune-inflammation index (SII) and computer tomography-derived visceral fat-to-muscle ratio (vFMR). Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method and Cox regression models. The model performance was assessed using discrimination, calibration, and clinical usefulness. In total, 212 patients were enrolled. The SII and vFMR were closely related, and both independently predicted survival (P < 0.05). A predictive model was established based on the above biomarkers and included three subgroups: high-risk [both high SII (>828) and high vFMR (>1.1)], middle-risk (either high SII or high vFMR), and low-risk (neither high SII nor high vFMR). The 3-year OS (PFS) rates for low-, middle-, and high-risk patients were 90.5% (86.0%), 73.9% (58.4%), and 46.8% (36.1%), respectively (P < 0.05). This model demonstrated satisfactory predictive accuracy (area under the curve values for predicting 3-year OS and PFS were 0.704 and 0.718, respectively), good fit (Hosmer-Lemeshow tests: P > 0.05), and clinical usefulness. Systemic inflammatory markers combined with body composition parameters could independently predict the prognosis of patients with LACC, highlighting the utilization of commonly collected indicators in decision-making processes. The SII and vFMR, as well as their composite indices, were promising prognostic factors in patients with LACC who received definitive CCRT. Future studies are needed to explore novel therapies to improve the outcomes in high-risk patients.

Abstract PO3-14-04: Prognostic value of systemic inflammatory markers in neoadjuvant chemotherapy for breast triple negative cancer with pembrolizumab: development of a nomogram

Abstract Introduction: Systemic inflammatory markers derived from peripheral blood cells, such as the neutrophil-lymphocyte ratio (NLR), derived neutrophil-lymphocyte ratio (dNLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR), have shown promise as prognostic markers for various cancer types. Inflammation plays a crucial role in cancer development, progression, metastasis, and resistance to treatment. However, only a few preoperative biomarkers have been identified as independent prognostic markers. Systemic inflammatory markers offer a reliable and easily accessible approach for prognosis evaluation. Materials and Methods: This study evaluated two groups of patients who received neoadjuvant chemotherapy for triple-negative breast cancer outside of clinical trials. The first group underwent neoadjuvant chemotherapy in 2021 with the EC X4 and weekly paclitaxel regimen, whereas the second group received neoadjuvant chemotherapy in 2022 following the KEYNOTE-522 study protocol with pembrolizumab. A total of 44 patients were included, with 23 patients in the pembrolizumab group. The NLR was defined as the absolute blood neutrophil count divided by the absolute lymphocyte count, and the derived neutrophil/lymphocyte ratio (dNLR) was defined as the absolute neutrophil count divided by the derived lymphocyte count (absolute leukocyte count —neutrophil count). The PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. The LMR was defined as the absolute lymphocyte count divided by the absolute monocyte count. The association between systemic inflammatory markers (NLR, dNLR, PLR, and LMR) and pathological complete response (pCR) was analyzed using statistical tests. Inflammatory markers were evaluated at the time of diagnosis, at the time of chemotherapy regimen change, and two weeks before surgery. The χ2 test or Fisher’s exact test was used to analyze the correlation between the inflammatory indices and clinicopathologic parameters. Student’s t-test was used to compare different groups of continuous parametric data. Results: The pCR rates were 67% in the standard therapy group and 87% in the pembrolizumab group. There were no significant differences in other clinical characteristics between the two groups. The NLR, dNLR, PLR, and LMR at 6 months showed statistically significant differences compared to baseline levels. This difference was more evident in patients undergoing pembrolizumab therapy. ROC curves for the pembrolizumab group demonstrated an area under the curve (AUC) of 0.737, indicating a strong correlation between these systemic inflammatory markers and pCR. Based on these data, a nomogram was constructed to predict the likelihood of achieving pCR in patients undergoing neoadjuvant pembrolizumab therapy. Conclusion: This study highlights the potential of systemic inflammatory markers as prognostic indicators in patients with TNBC undergoing neoadjuvant chemotherapy. The significant differences observed in the pembrolizumab group and the high AUC of the ROC curves suggest the utility of these markers in predicting treatment response. The developed nomogram provides a practical tool for clinicians to estimate the probability of pCR based on NLR, dNLR, PLR, and LMR. Further research and validation are required to confirm the clinical utility of these markers in larger patient cohorts. Nomogram –insert figure image– ROC curve –insert figure image– Citation Format: Filippo Giovanardi, Giancarlo Bisagni, Elisa Gasparini, Alessandra Bologna, Roberto Di Cicilia, Gabriella Moretti, Claudia Degli Esposti, Carmine Pinto. Prognostic value of systemic inflammatory markers in neoadjuvant chemotherapy for breast triple negative cancer with pembrolizumab: development of a nomogram [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-14-04.

The prognostic value and model construction of inflammatory markers for patients with non-small cell lung cancer

The aim of this study was to investigate and analyse the predictive value of systemic inflammatory markers based on peripheral blood biomarkers for the prognosis of non-small cell lung cancer (NSCLC) patients. Based on a retrospective monitoring cohort of 973 NSCLC patients from an Affiliated Tumor Hospital from 2012 to 2023. The log-rank test and Cox proportional risk regression model were used to identify independent prognostic inflammatory markers. Subsequently, a nomogram prediction model was constructed and evaluated. The results of multivariate Cox regression analysis showed that patients with high NLR group (HR = 1.238, 95% CI 1.015–1.510, P = 0.035), and high CAR group (HR = 1.729, 95% CI 1.408–2.124, P < 0.001) were risk factors affecting the prognosis of NSCLC patients. The nomogram that includes age, tumor stage, smoking history, BMI, NLR, and CAR can effectively predict the prognosis of NSCLC patients.The inflammatory markers NLR and CAR, which combine inflammatory and nutritional status, are effective predictors of the prognosis of NSCLC patients. The combination of clinical information and these easily accessible inflammatory markers has significant research value for prognostic assessment, clinical treatment, and follow-up monitoring of NSCLC patients.

The predictive value of systemic inflammatory markers in 902 patients with tunneled hemodialysis catheter

AimThis study aimed to assess the predictive role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and mean platelet volume, on catheter survival in chronic hemodialysis patients, analyzing both infectious and non-infectious complications.MethodsA retrospective analysis encompassed 1279 tunneled catheter insertion procedures involving 902 patients between March 2014 and October 2018. Patients were categorized into two main groups: (i) initial placement and (ii) exchange. The exchange group was further stratified into four subgroups: infection, dysfunction, displacement, and transitioning temporary hemodialysis catheters to long-term ones. Hematologic ratios were calculated from baseline hemogram data, including neutrophil, lymphocyte, monocyte, and platelet counts, while mean platelet volume was derived from the same hemogram.ResultsThe patients in the exchange group displayed significantly higher lymphocyte and monocyte values (p < 0.001), while lower values were noted for neutrophil–lymphocyte ratio and platelet-lymphocyte ratio (p < 0.001). The transition group displayed higher monocyte values and lower mean platelet volume and lymphocyte-monocyte ratio values (p < 0.05). In the infection-related exchange subgroup, higher neutrophil count, mean platelet volume, neutrophil–lymphocyte ratio, and platelet-lymphocyte ratio values were observed compared to other groups (p < 0.05). Cases related to catheter dysfunction exhibited increased lymphocyte-monocyte ratio but lower neutrophil, monocyte, neutrophil–lymphocyte ratio, and platelet-lymphocyte ratio values (p < 0.05).ConclusionThis study highlights the interest of specific inflammatory markers, particularly monocytes, neutrophil–lymphocyte ratio, and platelet-lymphocyte ratio, in the management of tunneled catheters, notably in patients undergoing exchanges. However, cut-off values, essential for constructing management algorithms, are currently lacking, and prospective multicenter studies are needed for further elucidation.Graphical abstract

Predictive value of platelet-to-lymphocyte and neutrophil-to-lymphocyte ratio in HCC treated with sorafenib and radioembolization

Herein we used data derived from the SORAMIC trial to explore the predictive value of systemic inflammatory markers (neutrophil-to-lymphocyte ratio [NLR] and platelet-to-lymphocyte ratio [PLR]) in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib monotherapy or the combination of selective internal radiation therapy (SIRT)/sorafenib. Patients randomized to sorafenib monotherapy or SIRT/sorafenib within the per-protocol population of the SORAMIC trial were evaluated in this exploratory post hoc analysis. The median baseline values of NLR and PLR were used as cut-off values to describe subgroups. Kaplan-Meier curves with log-rank tests were used to evaluate median survival in the sorafenib and SIRT/sorafenib arms in each subgroup. Multivariable Cox regression analysis was applied to eliminate the effect of confounding factors. A total of 275 patients with a median overall survival of 12.4 months were included in this analysis. The median NLR value of the cohort was 2.77 and the median PLR was 26.5. There was no significant difference in overall survival between the sorafenib and SIRT/sorafenib arms in patients with low NLR (p= 0.72) and PLR (p= 0.35) values. In patients with high NLR values, there was no statistically significant difference in median overall survival between SIRT/sorafenib and sorafenib cohorts (12.1 vs. 9.2 months, p= 0.21). In patients with high PLR values, overall survival in the SIRT/sorafenib arm was significantly longer than in the sorafenib arm (15.9 vs. 11.0 months, p= 0.029). This significant difference was preserved in the multivariable analysis (SIRT/sorafenib arm: hazard ratio 0.65, 95% CI 0.44-0.96, p= 0.03) incorporating age, Child-Pugh grade, and alpha-fetoprotein levels. PLR is a potential predictive factor of benefit from additional SIRT in patients with HCC receiving sorafenib therapy. The potential predictive value of PLR should be further evaluated in future trials. Systemic therapies are the mainstay of treatment in patients with hepatocellular carcinoma at advanced stages. However, not all patients respond well to these treatments. In our analysis, using blood test parameters showing systemic inflammation status, we were able to identify patients who would benefit more from combined treatment with a locoregional treatment of radioembolization (or selective internal radiation therapy).

Predictive value of systemic inflammatory markers for recurrence of papillary thyroid cancer.

Papillary thyroid cancer (PTC) is the most common type of differentiated thyroid cancer. Early identification of patients at higher risk of recurrence may allow to improve relevant follow-up strategies and plan tailored treatment. Inflammation play an important role in the prognosis of cancer. We aimed to explore the predictive value of systemic inflammatory markers in PTC recurrence. We retrospectively enrolled 200 consecutive patients who were diagnosed with PTC and underwent curative resection at Lianyungang Oriental Hospital between January 2006 and December 2018. Clinicopathological characteristics, preoperative hematologic results were analyzed. The optimal cutoff values were calculated using x-tile software. The multivariate logistic regression and univariable survival analysis were performed by SPSS. Multivariable analysis showed that lymph node metastases (odds ratio [OR] = 2.506, 95% confidence interval [CI]: 1.226-5.119, p = 0.012) and higher monocyte-to-lymphocyte ratio (MLR) (OR = 2.100, 95% CI: 1.042-4.233, p = 0.038) were independent prognostic factors for tumor recurrence. The cutoff value 0.22 of MLR significantly predicted recurrence at 53.3% sensitivity and 67.9% specificity. Patients with MLR ≥ 0.22 exhibited significantly poor long-term prognosis (46.8%) compared to the counterpart (76.8%, p = 0.0004). Preoperative MLR significantly predicted PTC recurrence after curative resection, which may provide clues for early identification of patients at higher risk of PTC recurrence.

S20 Prognostic Value of Systemic Inflammatory Markers in Patients With Pancreatic Adenocarcinoma

Introduction: Several studies have shown the role of inflammatory markers, especially the neutrophil-to-lymphocyte ratio (NLR), as indicators of poor prognosis in various gastrointestinal malignancies. We aimed to examine the prognostic value of NLR, among other markers, and their relationship with the presence of baseline distant metastasis in patients with pancreatic adenocarcinoma. Methods: We retrospectively reviewed the charts of 355 patients with pancreatic cancer treated at a tertiary cancer center from 2013 to 2018. We examined the relationship between absolute eosinophilic count (AEC), absolute lymphocyte count (ALC), absolute monocytic count (AMC), absolute neutrophil count (ANC), monocyte to lymphocyte ratio (MLR), NLR, and platelet to lymphocyte ratio (PLR) with the presence distant metastases, and overall survival (OS). We used multivariable logistic regression analyses to test the association between the variables and the presence of baseline distant metastases. Results: The median age was 60 years, and males comprised 59% of the patients. The ROC value of 3.3 was determined as the cutoff value for NLR. High NLR (NLR >3.3 µL) was significantly associated with the presence of distant metastasis at diagnosis (P-value < 0.0001, Odds Ratio (OR): 1.7, CI: 2.6–4.0). High baseline ANC (≥5500/μL), high AMC (≥600/μL), and high MLR (≥0.3) were also associated with baseline distant metastases (P-value: 0.02, 0.001, and <0.0001 respectively). Multivariable analysis showed that high NLR (P-value, 0.0003, OR 2.5 95% CI 1.5–4.1) was an independent risk factor for distant metastasis at presentation. High ANC, NLR, MLR, and PLR and low ALC were associated with poor OS (P-value: <0.0001, <0.0001, <0.0001, 0.04, and 0.01, respectively) (Figure 1). Conclusion: High systemic inflammatory markers are associated with poor prognosis (the presence of distant metastasis) and poor OS in patients with pancreatic cancer. Simple laboratory tests such as complete blood counts can be used as markers of poor prognosis and poor OS in patients with pancreatic cancer (Table 1). Table 1. - The association between systemic inflammatory markers with the presence of distant metastases Baseline distant metastases Present Absent p- value Odds Ratio 95% Confidence Interval ANC≥5500 113 (64%) 63 (36%) 0.024 1.65 (1.0-2.5) ANC< 5500 92 (52%) 85 (48%) ALC≥1680 99 (57%) 75 (43%) 0.65 0.9 (0.6-1.4) ALC< 1680 106 (59%) 73 (41%) AMC≥ 600 117 (66%) 59 (34%) 0.001 2.0 (1.3-3.0) AMC< 600 88 (50%) 89 (50%) AEC≥ 143 83 (62%) 51 (38%) 0.38 1.2 (0.7-2.0) AEC< 143 76(57%) 58 (43%) NLR≥3.3 126 (69%) 56 (31%) < .0001 2.6 (1.7-4.0) NLR< 3.3 79 (46%) 92 (54%) MLR≥0.3 130 (68%) 62 (32%) < .0001 2.4 (1.5-3.7) MLR< 0.3 75 (46%) 86 (54%) PLR≥0.15 108 (61%) 68 (39%) 0.2 1.3 (0.85-2.0) PLR< 0.15 97 (55%) 80 (45%) Figure 1.: Kaplan Meier curve for overall survival with NLRFigure 2.: Kaplan Meier curve for overall survival with ANCFigure 3.: Kaplan Meier curve for overall survival with ALC

S1604 Prognostic Value of Systemic Inflammatory Markers in Gastric MALT Lymphoma

Introduction: Several studies have shown the role of inflammatory markers, especially the neutrophil-to-lymphocyte Ratio (NLR), as indicators of poor prognosis in various gastrointestinal malignancies. We aimed to examine the prognostic value of NLR, among other markers, and their relationship with the presence of baseline distant metastasis in patients with MALT Lymphoma. Methods: We retrospectively reviewed the charts of 139 patients with Gastric MALT Lymphoma treated at a tertiary care cancer center from 2012 to 2018. We examined the relationship between absolute eosinophilic count (AEC), absolute lymphocyte count (ALC), absolute monocytic count (AMC), absolute neutrophil count (ANC), monocyte to lymphocyte ratio (MLR), NLR, and platelet to lymphocyte ratio (PLR) with the presence distant metastases, and overall survival (OS). We used multivariable logistic regression analyses to test the association between the variables and the presence of baseline distant metastases. Results: The median age was 55 years, and males comprised 67.6% of the patients. The ROC value of 3.4 was determined as the cutoff value for NLR. High NLR (NLR > 3.4 µL) was significantly associated with the presence of distant metastasis at diagnosis (P-value, 0.02, Odds Ratio (OR): 2.4, CI: 1.14- 5.10). High ALC ( >1819) was also associated with the presence of baseline distant metastasis (P-value, 0.04, OR: 0.46, CI: 0.22- 0.98). Multivariable analysis showed that high NLR (P-value, 0.02, OR 2.4 95% CI 1.1-5.1) was an independent risk factor for distant metastasis at presentation (Figure). High ANC, NLR, and PLR, were associated with poor OS, (P-value, 0.027, 0.016, and 0.011 respectively). Conclusion: High systemic inflammatory markers are associated with poor prognosis (the presence of distant metastasis) and poor OS in patients with Gastric MALT Lymphoma. To our knowledge, this is the first study examining the association between these inflammatory markers and the presence of distant metastases in MALT Lymphoma. Whether these markers could predict the response to treatment is unknown (Table).Figure 1.: (Top)Kaplan Meier curve for overall survival of patients with ANC (Middle). Kaplan Meier curve for overall survival of patients with NLR (Bottom). Kaplan Meier curve for overall survival of patients with PLR Table 1. - The association between systemic inflammatory markers and overall survival Parameter Median OS P-value Hazard Ratio 95% Confidence Interval ANC >5100 6.4 months 0.027 1.5 1.04–2.1 ANC≤5100 10.9 months ALC >1819 7.6 months 0.19 0.80 0.55–1.1 ALC≤1819 6.7 months AMC > 603 6.3 months 0.66 1.1 0.76–1.6 AMC≤ 603 7.8 months NLR > 2.75 6.2 months 0.016 1.5 1.1–2.2 NLR ≤ 2.75 12.2 months MLR >0.32 6.3 months 0.36 1.2 0.83–1.7 MLR≤0.32 10.5 months PLR >0.16 6.2 months 0.011 1.6 1.1–2.3 PLR≤0.16 10.9 months

S1586 Prognostic Value of Systemic Inflammatory Markers in Patients With Gastric Adenocarcinoma

S1586 Prognostic Value of Systemic Inflammatory Markers in Patients With Gastric Adenocarcinoma

The Predictive Value of Systemic Inflammatory Markers, the Prognostic Nutritional Index, and Measured Vessels' Diameters in Arteriovenous Fistula Maturation Failure.

Background: An arteriovenous fistula (AVF) is the first-line vascular access pathway for patients diagnosed with end-stage renal disease (ESRD). In planning vascular access, it is necessary to check the diameters of the venous and arterial components for satisfactory long-term results. Furthermore, the mechanism underlying the maturation failure and short-term patency in cases of AVFs is not fully known. This study aims to verify the predictive role of inflammatory biomarkers (the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), and C-reactive protein (CRP)), Ca-P product, the prognostic nutritional index (PNI), and the diameters of the venous and arterial components in the failure of AVF maturation. Methods: The present study was designed as an observational, analytical, and retrospective cohort study with a longitudinal follow-up, and included all patients with a diagnosis of ESRD that were admitted to the Vascular Surgery Clinic of the Targu Mures Emergency County Hospital, Romania, between January 2019 and December 2021. Results: The maturation of AVF at 6 weeks was clearly lower in cases of patients in the high-NLR (31.88% vs. 91.36%; p < 0.0001), high-PLR (46.94% vs. 85.55%; p < 0.0001), high-SII (44.28% vs. 88.89%; p < 0.0001), high-CRP (46.30% vs. 88.73%; p < 0.0001), high-Ca-P product (40.43% vs. 88.46%; p < 0.0001), and low-PNI (34.78% vs. 91.14%; p < 0.0001) groups, as well as in patients with a lower radial artery (RA) diameter (40% vs. 94.87%; p = 0.0009), cephalic vein (CV) diameter (44.82% vs. 97.14%; p = 0.0001) for a radio-cephalic AVF (RC-AVF), and brachial artery (BA) diameter (30.43% vs. 89.47%; p < 0.0001) in addition to CV diameter (40% vs. 94.59%; p < 0.0001) for a brachio-cephalic AVF (BC-AVF), respectively. There was also a significant increase in early thrombosis and short-time mortality in the same patients. A multivariate analysis showed that a baseline value for the NLR, PLR, SII, CRP, Ca-P product, and PNI was an independent predictor of adverse outcomes for all of the recruited patients. Furthermore, for all patients, a high baseline value for vessel diameter was a protective factor against any negative events during the study period, except for RA diameter in mortality (p = 0.16). Conclusion: Our findings concluded that higher NLR, PLR, SII, CRP, Ca-P product, and PNI values determined preoperatively were strongly predictive of AVF maturation failure, early thrombosis, and short-time mortality. Moreover, a lower baseline value for vessel diameter was strongly predictive of AVF maturation failure and early thrombosis.

The Predictive Value of Systemic Inflammation Markers for the Success of Labor Induction with Foley Catheter

Amaç: Sistemik inflamasyon belirteçlerinin foley kateter ile doğum indüksiyonu başarısını öngörmedeki değerini araştırmak. Gereç ve Yöntem: Retrospektif kohort çalışmaya foley kateter ile doğum indüksiyonu uygulanan ≥ 37 hafta, tek, canlı, verteks geliş olan düşük riskli gebeler dahil edildi. Doğum indüksiyonu sonrası sezaryen ile doğumun gerçekleşmesi indüksiyon başarısızlığı olarak kabul edildi. Çalışma popülasyonu doğum indüksiyonu sonrası vajinal doğum yapanlar ve sezaryen doğum yapanlar olarak iki gruba ayrıldı. İki grubun demografik ve klinik özellikleri, prepartum tam kan sayımı değerleri, nötrofil/lenfosit oranı ve platelet/lenfosit oranı karşılaştırıldı. Bulgular: Çalışmaya toplam 308 gebe dahil edildi. Olguların 159’unda (%51,6) doğum indüksiyonu sonrası vajinal yolla doğum gerçekleşirken, 149’unda (%48,4) sezaryen doğum ile gebelik sonlandı. Nulliparite oranı sezaryen ile doğum yapan olgularda (%68,5) vajinal yolla doğum yapanlara (%54,1) göre daha yüksek bulundu (p=0,01). Vajinal yolla doğum yapan ve sezaryen doğum gereksinimi olan olguların lökosit sayıları (9804,9 ± 3283,4 h/mm3’e karşı 10437,1 ± 4439,8 h/mm3), nötrofil/lenfosit oranı (4,7 ± 4,1’e karşı 4,4 ± 3,9) ve trombosit/lenfosit (149,3 ± 67,0’e karşı 139,3 ± 50,1) oranı arasında istatistiksel olarak anlamlı bir fark saptanmadı (p&amp;gt;0,05). Sonuç: Doğum indüksiyonu öncesi bakılan sistemik inflamasyon belirteçleri ile doğum indüksiyon başarısı arasında anlamlı ilişki bulunmadı. Bununla birlikte nulliparitenin foley kateter ile doğum indüksiyon başarısızlığı için bir risk faktörü olduğu saptandı.

Prognostic value of systemic inflammatory markers and the nutrition status in thymic epithelial tumors with complete resection.

BackgroundRecent studies have shown that several systemic inflammatory markers and the nutrition status, including the neutrophil‐to‐lymphocyte ratio (NLR), monocyte‐to‐lymphocyte ratio (MLR), platelet‐to‐lymphocyte ratio (PLR), and prognostic nutritional index (PNI), are useful prognostic factors in several malignant tumors. The present study explored the prognostic value of the NLR, MLR, PLR, and PNI in thymic epithelial tumor (TET) patients who underwent complete resection.MethodsA total of 158 TET patients who underwent complete resection were involved in the analysis. Their NLR, MLR, PLR, and PNI values were obtained from a blood examination within one month before the initiation of treatment. A receiver operating characteristic curve analysis was conducted to determine the optimal cutoff values.ResultsThe enrolled patients were stratified by cutoffs of 4.35 for the NLR, 0.22 for the MLR, 130.18 for the PLR, and 44.02 for the PNI. A univariate analysis revealed that high‐grade malignant TET, including type B2 and B3 thymoma, thymic carcinoma, and thymic neuroendocrine tumor; an advanced Masaoka stage; a high NLR; a high MLR; and a low PNI were significant predictors of a poor disease‐free survival (DFS). A multivariate analysis confirmed that an advanced Masaoka stage (HR = 5.5557, p = 0.0007) and a high MLR (HR = 3.3371, p = 0.0264) were independent predictors of a poor DFS.ConclusionsOur study demonstrated that the pretreatment MLR was an independent predictor of the DFS in patients with TETs who underwent complete resection.

Prognostic value of systemic inflammatory markers in first- and subsequent-line immunotherapy and durability of response in NSCLC.

e21210 Background: Treatment of advanced non-small cell lung cancer with immune checkpoint inhibitors (ICI) has been shown to yield durable responses. High neutrophil-to-lymphocyte ratios (NLR), low lymphocyte-to-monocyte ratios (LMR) and high platelet-to-lymphocyte ratios (PLRs) have been used as surrogates for increased levels of inflammation in the tumor microenvironment that can predict cancer progression and response to therapy. However, the comparative prognostic role of these markers account for when immunotherapy is utilized has not been explicitly determined. Methods: We performed a retrospective review of 233 patients with advanced stage NSCLC at the University of Miami / Sylvester Comprehensive Cancer Center who received ICI either as first-line (1L) or second-line (2L) therapy and for whom laboratory data, in particular absolute neutrophil, lymphocyte, monocyte, and platelet counts, were available pre-treatment and 4 weeks after initiation of immunotherapy. Results: Using receiver operating characteristic (ROC) curves, we identified cutoff values with optimal prognostic value for NLR (4), LMR (2), and PLR (200). Median age, histology, and smoking history were equivalent across each group. Improved OS was observed in our cohort for patients in which pre-treatment NLR &lt; 4 (54.4m vs. 35.9m, p = 0.0069), LMR &gt; 2 (54.4m vs. 32.3m, p = 0.0016), and PLR &lt; 200 (54.4m vs. 27.5m, p = 0.0007), while PFS was unaffected when looking strictly at these cutoffs. We then observed that PFS could be better predicted after stratifying NLR, LMR, or PLR when taking into account whether ICI was administered as 1L or 2L. We also determined that changes in (Δ) NLR or LMR (but not PLR) by at least 20% between baseline and 4 weeks after initiation of ICI could predict duration of response to ICI. Conclusions: In conclusion, the NLR, LMR, and PLR are powerful surrogates for the tumor microenvironment and can predict responses to ICI in advanced NSCLC when used in the context of previous lines of therapy and subsequent pro-inflammatory changes. Our study shows that ICI used in the first-line setting results in more durable responses, and can overcome an unfavorable tumor microenvironment. In addition, we demonstrate that in NSCLC, durability of responses can be predicted by changes in these systemic inflammatory response markers early after the initiation of ICI.[Table: see text]

Systemic immune-inflammation index predicts prognosis of sequential therapy with sorafenib and regorafenib in hepatocellular carcinoma

BackgroundRegorafenib has shown promising results as a second-line therapy for patients with hepatocellular carcinoma (HCC) who progressed on sorafenib. Although there have been several data regarding the efficacy of sequential therapy with sorafenib and that of regorafenib in real-life, specific inflammation markers for predicting the prognosis have not been studied. This study aimed to investigate prognostic value of systemic inflammatory markers in patients with HCC who received sorafenib-regorafenib sequential therapy.MethodsWe retrospectively analyzed medical data of patients who received regorafenib for the treatment of HCC after sorafenib failure. Progression free survival (PFS) and overall survival (OS) were assessed using the Kaplan–Meier survival curves. Univariate and multivariate analyses were performed to analyze the factors associated with survival.ResultsA total of 58 patients who received at least one dose of regroafenib and fulfilled the eligibility criteria, good performance status (Eastern Cooperative Oncology Group [ECOG] 0–1) and preserved liver function (Child-Pugh-A), were included in the analysis. The median PFS was 3 months (95% confidence interval [CI] = 0.981–5.019) and the median OS was 8 months (95% CI = 5.761–10.239). Elevated systemic immune-inflammation index (SII ≥340) was independently associated with poor OS. In multivariate analysis, the SII (hazard ratio [HR] = 2.211, 95% CI = 1.089–4.489, P = 0.028) and alpha-fetoprotein (AFP) (HR = 2.750, 95% CI = 1.259–6.010, P = 0.011) were independent predictors of OS.ConclusionElevated SII is associated with poor OS in patients with HCC who received sequential therapy with sorafenib and regorafenib. In addition, when selecting a treatment strategy, the SII can be used in combination with the AFP level as a promising prognostic tool for HCC.

The platelet to lymphocyte ratio predicts overall survival better than the neutrophil to lymphocyte ratio in metastatic renal cell carcinoma

Background/aim The prognostic values of systemic inflammatory markers, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) on overall survival (OS) of metastatic renal cell carcinoma patients (mRCC) treated with tyrosine kinase inhibitors (TKI) remain unclear. Thus, the present study aimed to investigate the prognostic impact of these markers on OS of mRCC patients. Materials and methods A total of 150 patients receiving TKIs were retrospectively analyzed. Progression-free survival and OS times were analyzed with the Kaplan–Meier method, and the log‐rank test was used for comparison. Univariable and multivariable Cox regression models evaluated the impact of NLR and PLR on OS of the patients. The receiver operating characteristic curve analysis determined that the optimal cut-off values of NL, and PLR in predicting OS were 2 and 204, respectively. Results Patient with PLR > 204 had significantly lower median OS time than those with PLR ≤ 204 (14.6 months vs. 31.6 months, P < 0.001). While the univariate analyses showed that both NLR and PLR associated with OS (NLR: P = 0.002; PLR: P < 0.001), PLR, not NLR, was an independent determinant for OS in the multivariate analyses (Hazard Ratio: 2.535, 95% CI: 1.564-4.108, P < 0.001). Additionally, the presence of brain metastases and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic scoring system were identified as independent prognostic factors for OS (brain metastases: P = 0.040; IMDC: P < 0.001). Conclusion The PLR is a readily and inexpensively obtained marker, which may predict OS in patients with mRCC treated with TKIs.

Prognostic Value of Sarcopenia and Systemic Inflammation Markers in Patients Undergoing Definitive Radiotherapy for Esophageal Cancer

ObjectiveTo determine the independent and combined prognostic value of sarcopenia and systemic inflammatory markers in esophageal cancer patients undergoing definitive radiotherapy.MethodsSarcopenia was diagnosed on the basis of the skeletal muscle index (SMI) as determined by the skeletal muscle area at the third lumbar (L3) region and body height. The optimal cutoff value of systemic inflammatory markers was determined by the receiver-operating curve (ROC). Logistic regression was used to analyze the correlation among different variables. Cox proportional hazards model was used to identify the factors significantly correlated to overall survival (OS). Based on the results of multivariate survival analysis, a nomogram was established to predict the survival rate. The accuracy of the nomogram was evaluated by the coordination index and the calibration curve.ResultsA total of 100 esophageal cancer patients were included, of which 77 exhibited sarcopenia. The lymphocyte–monocyte ratio (LMR) was significantly correlated to the risk of sarcopenia (OR = 0.637, 95% CI, 0.452–0.898, P = 0.010). In addition, sarcopenia (P = 0.002, HR = 3.991, 95% CI: 1.653–9.638) and LMR < 2.67 (P < 0.001, HR = 2.665, 95% CI: 1.563–4.543) were independent predictors of OS. Two nomograms with good predictive accuracy were established.ConclusionSarcopenia and LMR can independently predict the survival of patients with esophageal cancer receiving definitive radiotherapy and have good combined prognostic value.

Systemic Inflammatory Indicators as Prognosticators in Glioblastoma Patients: A Comprehensive Meta-Analysis.

Background: Inflammation plays an important role in tumorigenesis. Previous studies have reported the prognostic value of several peripheral inflammatory markers in glioma patients, including the neutrophil-to-lymphocyte ratio (NLR). However, it still remains unclear whether inflammatory markers can independently predict the prognosis of glioblastoma (GBM) patients. The present study aims to explore the prognostic value of systemic inflammatory markers, including neutrophils, lymphocytes, platelets, the NLR, and the platelet-to-lymphocyte ratio (PLR), in patients with GBM.Methods: A comprehensive systemic search and review was performed using the PubMed, EMBASE, and Cochrane Library databases to identify all the relevant literature (published before June 30, 2020) that evaluated the association between any of these inflammatory markers and survival in GBM.Results: There were 2 (634 patients), 3 (723 patients), 2 (237 patients), 8 (1,225 patients), and 3 (505 patients) studies examining the correlation of survival with neutrophils, lymphocytes, platelets, the NLR, and the PLR, respectively. An elevated NLR and elevated neutrophil and platelet counts were associated with worse overall survival (OS) in GBM patients (NLR: hazard ratio [HR] = 1.63, 95% confidence interval [CI]: 1.23–2.15, p = 0.0007; neutrophil count: HR = 1.46, 95% CI:1.16–1.83, p = 0.001; platelet count: HR = 1.58, 95% CI: 1.42–1.77, p < 0.00001). However, there was no significant association between the PLR or the absolute lymphocyte count and OS in GBM patients.Conclusion: The NLR and the absolute neutrophil and platelet counts may be valuable and convenient peripheral inflammatory markers to evaluate the prognosis of GBM patients. Further prospective studies are needed to verify its reliability.

The association between systemic inflammatory markers and sarcopenia: Results from the West China Health and Aging Trend Study (WCHAT)

BackgroundIncreased evidence suggests chronic inflammation is significant in the progression of sarcopenia in older adults. In this study, we aimed to compare the level of systemic inflammation markers (White blood cells, neutrophils, lymphocytes, platelets and their derived ratios) between sarcopenic and non-sarcopenic individuals and investigate the association of these inflammatory markers with sarcopenia. MethodsThis cross-sectional study included 4224 adults (1514 men and 2710 women) from the West China Health and Aging Trend (WCHAT) study. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS). The value of systemic inflammatory markers was based on laboratory data. Multiple logistic regression analysis was used to explore the association between inflammatory markers and sarcopenia after adjusting for covariates. ResultsAmong 4224 participants (mean age 62.3 ± 8.2 years, 64.2 % women), 814 (19.3 %) were diagnosed as sarcopenia. After adjusting for potential confounders, logistic regression analysis indicated that neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) were significantly associated with sarcopenia. Participants in the highest NLR, PLR and SII value group had higher odds for sarcopenia than those in the lowest value group (OR [95 %CI]: 1.233 [1.002,1.517], 1.455 [1.177,1.799] and 1.268 [1.029,1.561], respectively). ConclusionsHigher NLR, PLR, and SII level are associated with an increased prevalence of sarcopenia in middle-aged and older adults. Since these systemic inflammatory markers are inexpensive and can be obtained easily from routine blood tests, regular follow-up of NLR, PLR and SII may be an effective strategy in sarcopenia screening and management.

Prognostic value of systemic inflammatory markers for oral cancer patients based on the 8th edition of AJCC staging system

It has been recognized that systemic inflammatory markers (SIMs) are associated with patient survival in various types of cancer. This study aimed to determine the optimal cut-off values, and to evaluate the prognostic performance of SIMs for oral squamous cell carcinoma (OSCC) within the framework of the American Joint Committee of Cancer (AJCC) cancer staging manual, 8th edition. Records were collected for a total 291 patients who had had a peripheral blood test within 1 week prior to surgery and had undergone the surgical resection of OSCC in a single institution between 2005 and 2018. The cut-off values of SIMs were obtained, and the survival analyses for overall survival (OS) and disease-free survival (DFS) were performed. Multivariate analyses incorporating other clinicopathologic factors were performed to verify the independent risk factors for survival. The cut-off values of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were 2.23, 135.14 for OS and 2.16, 131.07 for DFS, respectively, demonstrating a significant association for OS and DFS in OSCC. AJCC pathologic regional lymph node category (pN) (P < 0.001), perineural invasion (PNI) (P < 0.001) and NLR (P < 0.001) were independent predictors for OS. Meanwhile, for DFS, AJCC pN (P = 0.018) and NLR (P = 0.015) were shown to be independent predictors. Before the curative surgery, NLR and PLR could be auxiliary parameters for OS and DFS in OSCC. And based on the 8th edition of AJCC staging system, elevated NLR will be a potential indicator of the worse OS or DFS along with pN or PNI in OSCC.

Preoperative blood neutrophil count predicts survival in hepatocellular carcinoma patients with living donor liver transplantation

BackgroundThe Milan criteria (MC) used to select patients for liver transplantation among patients with hepatocellular carcinoma (HCC) do not include tumor biology. Furthermore, systemic inflammatory markers have been identified to predict tumor biology. The present study investigated prognostic value of systemic inflammatory markers, including neutrophil count, in predicting the prognosis of patients with HCC undergoing living donor liver transplantation (LDLT).MethodsWe retrospectively analyzed data regarding peripheral blood inflammatory markers, as well as patient and tumor characteristics of patients with HCC who underwent LDLT. Univariate and multivariate analyses were performed to analyze variables associated with survival.ResultsA total of 103 patients with HCC who underwent LDLT were included. The 3- and 5-year recurrence-free survival (RFS) in patients with a high neutrophil count (>2,640/µL) were significantly lower than those in patients with a low neutrophil count (≤2,640/µL; 70.0% and 64.7% vs. 88.3% and 84.6%, respectively; P=0.02). Patients with a high neutrophil count also had lower 5-year overall survival (OS; 63.9% vs. 79.3%, P=0.03). In multivariate analysis, radiologic MC (hazard ratio [HR], 5.04; P=0.02) and neutrophil count (HR, 4.47; P=0.04) were independent factors predicting RFS. Among patients exceeding the MC, those with a high neutrophil count had significantly lower 5-year RFS than those with low neutrophil count (10% vs. 83%; P<0.01).ConclusionsWe demonstrated that high preoperative neutrophil count is associated with poor RFS and OS in patients with HCC undergoing LDLT.