The Applicability of Neutrophil-Lymphocyte Ratio in Predicting The Survival of Nasopharyngeal Cancer: An Evidence Based Case Report (original) (raw)
Related papers
Journal of Turgut Ozal Medical Center, 2016
Purpose: Neutrophil to lymphocyte ratio (NRL) is an immunological parameter which indicates inflammatory response, as well as anti-tumor immunity and solid tumor recurrence. The most significant results of the NLR ratio related prognostic state of the patients were found in colorectal, and renal cancers. Our study will investigate whether this ratio could be a useful marker of progression free survival and prognosis in nasopharyngeal cancer patients (NPC). Materials and Methods: The study including 133 patients with valid samples diagnosed with nasopharyngeal carcinoma were evaluated retrospectively. We included only the patients diagnosed pathologically with non-metastatic, locally advanced nasopharyngeal carcinoma who were treated with induction chemotheraphy. Blood parameters and neutrophil to lymphocyte ratios (NLR) were taken into account for interpretation. Results: The results indicated that the mean neutrophil to lymphocyte ratio was 2.78, showing high variance within the cohort. (0.5-30.5 confidence interval). Among this group, the distribution of the patients falling into each percentile of the NLR (which are <2.1, 2.1-2.77, 2.77-3.85 and >3.86 was found to be as follows: 24.8%, 25.6%, 24.8% and 24.8%.). PFS and OS rates were not istatistically significiant in each percentile of the NLR (p:0.86 and p:0.54). Conclusion: According to literature NLR was found not only an independent prognostic factor, also a predictor of response to chemoradiotherapy. Opposite to this, in our study NLR seems not to be a parameter to predict progression free survival and prognosis in nasopharyngeal carcinoma.
European Journal of Cancer, 2016
A high preoperative neutrophil-lymphocyte ratio (NLR) has been shown in several studies as a predictor of worse survival in many solid neoplasms, including esophageal cancer, but its impact remains unclear. The goal of this systematic review was to gain all the evidence about NLR in order to analyse its potential in predicting survival in esophageal cancer. Therefore, we conducted a systematic literature search of all relevant studies reporting data on NLR as prognostic marker in esophageal cancer patients. We considered overall survival (OS) as primary outcome, disease-free survival (DFS) and progression-free survival (PFS) as secondary outcomes. We included studies with a directly or indirectly available hazard ratio (HR), furthermore we used both fixed effect model and random effect model depending on heterogeneity. We included a total of 20 studies, published between 2011 and 2017, consisting of 6,457 patients. The NLR cutoff value ranges from 1.7 to 5. The HR for OS of all included studies was 1.60. The HR for DFS and PFS was 1.75 and 1.66 respectively. The survival sub-analysis about tumor characteristics, treatment modality, blood sample timing also confirmed NLR prognostic relevance with statistically significant results. The meta-analysis showed that high preoperative NLR is associated with worse survival in esophageal cancer, as shown in several solid tumors, but its use in the clinical practice is still underestimated. Highquality studies are needed to assess the most effective cutoff in survival prognostication and NLR relevance on postoperative complications.
Prognostic role of neutrophil–lymphocyte ratio in nasopharyngeal carcinoma: A meta-analysis
PLOS ONE
Background Inflammatory markers are used to predict prognosis of nasopharyngeal carcinoma (NPC). Previous reports of neutrophil-to-lymphocyte ratio (NLR) and NPC mortality are inconsistent. This study aimed to quantify the prognostic impact of NLR on NPC. Methods The primary outcome was overall survival (OS), and the secondary outcomes were disease-specific survival (DSS), progression-free survival (PFS) and distant metastasis-free survival (DMFS). We systematically searched electronic databases, identified articles reporting an association between NLR and NPC prognosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted, and pooled HRs for each outcome were estimated using random effect models. Results Nine studies enrolling 5397 patients were included in the analyses. NLR greater than the cutoff value was associated with poor overall survival (
Journal of B.U.ON. : official journal of the Balkan Union of Oncology, 2020
PURPOSE To investigate the prognostic value of pre-treatment neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and hemoglobin level in patients treated with definitive chemoradiotherapy (CRT) for nasopharyngeal carcinoma. METHODS We retrospectively analyzed 97 patients who received definitive CRT for nasopharyngeal cancer. An NLR cut-off value of 4.42 was identified using receiver operating characteristic curve (ROC) analysis, an PLR cut-off value of 128.6 was identified using ROC analysis and a hemoglobin cut-off value of 13g/dl was identified using ROC analysis with overall survival (OS) as an endpoint. RESULTS The 5-year progression-free survival (PFS) and overall survival (OS) for all patients were 67.1% and 72.6%, respectively. The patients with a high NLR (20.6%) had a significantly lower 5-year OS than those with a low NLR (79.4%) (OS: 46.9% vs. 79.7%, p<0.001). The patients with a high PLR (66.3%) had a borderline significant lower 5-year OS than those wi...
Oncotarget
Background: Inflammatory response markers plays an important role in tumor progression. The aim of this analysis was to evaluate whether the neutrophil-tolymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) could predict the prognosis of nasopharyngeal carcinoma(NPC). Materials and Methods: 247 patients who underwent Intensity Modulated Radiation Therapy(IMRT)were enrolled from January 2012 and December 2012. NLR, and PLR were calculated from peripheral blood cell counts taken at pre-treatment. Optimal cutoff values of NLR and PLR were determined on the basis of receiver operating characteristic curve analysis. Overall survival (OS), progression-free survival(PFS), distant metastasis-free survival (DMFS) and loco-regional recurrencefree survival (LRFS) rates were compared according to NLR and PLR level respectively. Multivariate analysis was performed to assess the prognostic value of NLR and PLR. Results: The 5-year estimated OS, PFS, LRFS and DFS were 87.2, 77.8, 96.9, and 86.2%, respectively. Our results shows that the NLR was significantly associated with T-stage (P < 0.05), N-stage (P < 0.05) and tumor stage(P < 0.05). PLR was significantly associated with T-stage (P < 0.05) and tumor stage(P < 0.05). NLR was an independent prognostic indicator for OS (HR: 3.259, P = 0.004), PFS (HR:7.093, P < 0.001), DMFS (HR: 6.576, P = 0.003), except for PLR. In subgroup analysis, adjuvant chemotherapy had no significantly improved survival for patients with high NLR. Conclusions: NLR is a strong prognostic factor for NPC patients. NLR might not be a useful indicator for selection of treatment strategies for loco-regionally advanced NPC.
European Archives of Oto-Rhino-Laryngology, 2019
Purpose We designed this retrospective study to identify predictive value of prognostic nutritional index (PNI) and albumin-globulin ratio (AGR) in nasopharyngeal cancer patients (NPC). Methods 95 non-metastatic NPC patients were included in the study. AGR was calculated as the absolute counts between albumin and globulin measurements. (Globulin values were obtained via excluding albumin counts from total protein counts). PNI was calculated using the following formula: [10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count] in the peripheral blood (per mm 3). Results The statistically significant cutoff value of PNI was identified as 45.45 (area under the curve (AUC): 0.636, p = 0.03) for overall survival. The 5-year OS rate for patients with PNI ≤ 45.45 and PNI > 45.45 were 52.9% and 79.0%, respectively. There were statistically significant difference between groups (p = 0.03).The statistically significant cutoff value of AGR was identified as 1.19 (AUC: 0.689, p < 0.01) for overall survival. The 5-year OS rate for patients with AGR ≤ 1.19 and AGR > 1.19 were 57.7% and 82.0%. There were statistically significant differences between the groups (p = 0.04). 5-year OS rate was 42.9% in the high-risk group (low-PNI and low-AGR patients), it was 80.3% in the intermediate group (low PNI and high AGR or high PNI and low AGR) and it was 80.9% in low-risk group (high PNI and high AGR) (p = 0.004). In the multivariate analysis, age and PNI were independent prognostic factors for poorer OS (HR 2.70, 95% CI 1.091-6.719, p = 0.32 and HR 2.44, 95% CI 1.009-5.940, p = 0.48). Conclusions Low PNI is independent prognostic factor for poorer OS. Patients with low-PNI and low-AGR have worse survival than patients with high PNI and high AGR.
Annals of Surgical Oncology, 2020
Background. Neutrophil-to-lymphocyte ratio (NLR) has been identified as a biomarker for multiple malignancies. There is emerging evidence that implicates neutrophils in cancer progression. Alterations of neutrophil counts and NLR during treatment may reflect a change in oncologic outcome that is more important than baseline values. The aim of this study is to investigate the prognostic role of NLR changes during the treatment trajectory of patients with esophageal adenocarcinoma. Patients and Methods. NLR values of patients with esophageal adenocarcinoma who underwent surgery between 2005 and 2016 were measured at baseline and in the late postoperative period. Primary outcomes were overall survival (OS) and disease-free survival (DFS). The secondary outcome was pathological response to neoadjuvant chemotherapy. Results. 330 patients were included; mean age was 65.6 years, and 82% were male. Most patients had cT3 (74.8%), cN-positive (59.7%) disease. Two-thirds (65.2%) received neoadjuvant chemotherapy. The independent predictors of OS were pathological N-stage, size of primary tumor, and delta NLR (late-baseline NLR). Patients with persistently elevated NLR did worse than those with decreasing NLR trends between baseline and postoperative time points (3-year OS 43.4% versus 71.3%, p \ 0.0001, 3-year DFS 29.7% versus 61.9%, p \ 0.0001). High baseline and postoperative NLR were associated with significantly worse OS and DFS. Patients with complete pathological response had lower mean baseline NLR. Conclusion. Dynamic changes in NLR during treatment are associated with survival and may be more informative than static baseline values. Y. Al Lawati and J. Cools-Lartigue contributed equally to this manuscript and should both be considered as first coauthors.
Journal of Cancer Research and Clinical Oncology, 2019
Background The neutrophil to lymphocyte ratio (NLR) is known to be prognostic for patients with advanced cancers treated with immune checkpoint inhibitors (ICI), but has generally been evaluated as a single threshold value at baseline. We evaluated NLR at baseline and within first month during treatment in patients who received ICI for advanced cancer to evaluate the prognostic value of baseline and of changes from baseline to on-treatment NLR. Methods A retrospective review of patients with advanced cancer treated with ICI from 2011 to 2017 at the Ohio State University was performed. NLR was calculated at the initiation of ICI and repeated at median of 21 days. Overall survival (OS) was calculated from the initiation of ICI to date of death or censored at last follow-up. Significance of Cox proportional hazards models were evaluated by log-rank test. Calculations were performed using the survival and survminer packages in R, and SPSS. Results 509 patients were identified and included in the analysis. Patients with baseline and on-treatment NLR < 5 had significantly longer OS (P < 0.001). The change in NLR overtime was a predictor of OS and was observed to be non-linear in nature. This property remained statistically significant with P < 0.05 after adjusting for age, body mass index, sex, cancer type, performance status, and days to repeat NLR measurement. Patients with a moderate decrease in NLR from baseline had the longest OS of 27.8 months (95% CI 21.8-33.8). Patients with significant NLR decrease had OS of 11.4 months (95% CI 6.1-16.7). Patients with a significant increase in NLR had the shortest OS of 5.0 months (95% CI 0.9-9.1). Conclusions We confirmed the prognostic value of NLR in patients with advanced cancer treated with ICIs. We found that change in NLR over time is a non-linear predictor of patient outcomes. Patients who had moderate decrease in NLR during treatment with ICI were found to have the longest survival, whereas a significant decrease or increase in NLR was associated with shorter survival. To our knowledge, this is the first study to demonstrate a non-linear change in NLR over time that correlates with survival.
Design of a prognostic index score for metastatic nasopharyngeal carcinoma
European Journal of Cancer, 2003
The survival outcome of patients with systemic cancer differs significantly between individuals even within the same tumour type. We set out to illustrate this by analysing the factors determining survival in patients with metastatic disease from nasopharyngeal carcinoma (NPC) and to design a scoring system based on these prognostic factors. Patients referred between January 1994 and December 1999 were retrospectively analysed. Factors analysed included patient (age group, gender, performance status (BS) at diagnosis of metastases), disease (number of metastatic sites, specific metastatic sites, disease-free interval (DFI), metastases at presentation, presence of locoregional recurrence), and laboratory factors (leucocyte count, haemoglobin level, albumin level). Univariate and multivariable analyses were performed using the Cox proportion hazards model. A numerical score was derived from the regression coefficients of each independent prognostic variable. The prognostic index score (PIS) of each patient was calculated by totalling up the scores of each independent variable. Independently significant, negative prognostic factors were liver metastasis, lung metastasis, anaemia, poor PS, distant metastasis at initial diagnosis, and a DFI of <6 months. Three prognostic groups based on the PIS were obtained: (i) good risk (PIS=0–6); (ii) intermediate risk (7–10); (iii) poor risk (⩾11). The median survivals for these groups were 19.5, 10, and 5.8, months, respectively, (log rank test: P<0.0001). The variable prognosis of patients with disseminated NPC can be assessed by using easily available clinical information (patient, disease and laboratory factors). The PIS system will need to be validated on prospectively collected data of another cohort of patients.
Translational Lung Cancer Research, 2021
Background: Advanced non-small cell lung cancer (NSCLC) patients with poor performance status (PS) are likely to receive programmed cell death 1 (PD-1) inhibitors, despite limited evidence. The aim of the present study was to report the clinical outcomes and potential prognostic biomarkers in advanced NSCLC patients with poor PS receiving PD-1 inhibitors. Methods: We conducted a retrospective study enrolling 101 advanced NSCLC patients from our hospital. Data of patients with poor PS 2-4 receiving PD-1 inhibitors were retrieved from medical records. Patients were stratified based on dichotomized baseline neutrophil-to-lymphocyte ratio (NLR), change in NLR (ΔNLR; 6 weeks post-treatment NLR minus baseline NLR), and their combination. The receiver-operating characteristic curve was used to assess the best cutoff for NLR. Multivariate Cox analysis was used to evaluate the prognostic value of NLR and ΔNLR for patients' survival. Results: The optimal cutoff for NLR was 4.5. The median follow-up was 25.7 months, baseline NLR ≥4.5, and ΔNLR ≥0, which were independently and significantly associated with shorter overall survival (both P=0.002) and progression-free survival (P=0.004 for NLR and P<0.001 for ΔNLR). Furthermore, simultaneous elevation of the 2 factors was associated with worsened prognosis; patients with both NLR ≥4.5 and ΔNLR ≥0 had significantly increased risk of death [hazards ratio (HR): 10.79, 95% confidence interval (