Prognostic and diagnostic impact of fibrinogen, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio on thymic epithelial tumors outcome

// Stefan Janik 1, 2 , Thomas Raunegger 1, 2 , Philipp Hacker 1, 2 , Bahil Ghanim 1 , Elisa Einwallner 3 , Leonhard Mullauer 4 , Ana-Iris Schiefer 4 , Julia Moser 5 , Walter Klepetko 1 , Hendrik Jan Ankersmit 1, 2, 6 and Bernhard Moser 1 1 Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Vienna, Austria 2 Christian Doppler Laboratory for Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Vienna, Austria 3 Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria 4 Clinical Institute of Pathology, Medical University Vienna, Vienna, Austria 5 Departments of Dermatology and Venereology and Karl Landsteiner Institute of Dermatological Research, Karl Landsteiner University of Health Sciences, St. Polten, Austria 6 Head FFG Project “APOSEC“, FOLAB Surgery, Medical University Vienna, Vienna, Austria Correspondence to: Bernhard Moser, email: bernhard.moser@meduniwien.ac.at Keywords: thymic epithelial tumors; thymoma; thymic carcinoma; fibrinogen; NLR Received: September 24, 2017      Accepted: March 22, 2018      Published: April 24, 2018 ABSTRACT Background: Peripheral blood-derived inflammation-based markers, such as Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Fibrinogen have been identified as prognostic markers in various solid malignancies. Here we aimed to investigate the prognostic and diagnostic impact of NLR, PLR, and Fibrinogen in patients with thymic epithelial tumors (TETs). Results: Pretreatment Fibrinogen serum concentrations, NLRs and PLRs were highest in patients with TCs and advanced tumor stages. High pretreatment Fibrinogen serum concentration (≥452.5 mg/dL) was significantly associated with worse cause specific survival (CSS; p = 0.001) and freedom from recurrence (FFR; p = 0.043), high NLR (≥4.0) with worse FFR ( p = 0.008), and high PLR (≥136.5) with worse CSS ( p = 0.032). Longitudinal analysis revealed that compared to patients without tumor recurrence, patients with tumor recurrence had significantly higher NLR (11.8 ± 4.0 vs. 4.70 ± 0.5; p = 0.001) and PLR (410.8 ± 149.1 vs. 228.3 ± 23.7; p = 0.031). Conclusion: Overall, Fibrinogen serum concentrations, NLRs, and PLRs were associated with higher tumor stage, more aggressive tumor behavior, recurrence, and worse outcome. Prospective multicenter studies of the diagnostic and prognostic potential of Fibrinogen, NLR, and PLR are warranted. Methods: This retrospective analysis included 122 patients with TETs who underwent surgical resection between 1999-2015. Fibrinogen serum concentrations, NLRs, and PLRs were measured in patients preoperatively, postoperatively, and later during follow-up. These markers were analyzed for association with several clinical variables, including tumor stage, tumor subtype, FFR, and CSS and to evaluate their prognostic and diagnostic impact for detecting tumor recurrence.