[Significance of the granulocyte-to-lymphocyte ratio as a prognostic predictor in patients with stage IV colorectal cancer undergoing chemotherapy].
Hisashi OnozawaMinoru FukuchiOkihide SuzukiSatoshi HatanoTakeaki MatsuzawaKoki KuwabaraToru IshiguroJun SobajimaYouichi KumagaiHiroyuki BabaKeiichiro IshibashiErito MochikiHideyuki Ishida
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The aim of this study was to evaluate the clinical significance of the granulocyte-to-lymphocyte(G/L)ratio as a prognostic predictor in patients with Stage IV colorectal cancer. A total of 83 patients who underwent oxaliplatin-based chemotherapy for Stage IV colorectal cancer were enrolled in the study. Univariate analysis indicated that the G/L ratio; number of involved organs(more than one organ); performance status ≥1; noncurability; and levels of hemoglobin, C-reactive protein, albumin, alkaline phosphatase, carbohydrate antigen 19-9, and lactate dehydrogenase before chemotherapy were significant prognostic factors. Noncurability was identified to be an independent, unfavorable factor for survival on multivariate analysis. When patients were divided into 2 groups according to the G/L ratio(the median was considered the cut-off value), the median survival time of patients with a high G/L ratio(≥3.0)was significantly worse than that of patients with a low G/L ratio(<3.0; 16.1 months vs 25.4 months, p=0.03). Further studies with more patients are required to examine whether the G/L ratio is a convenient biomarker affecting survival in patients with Stage IV colorectal cancer.Keywords:
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Background: The purpose of this study is to determine and compare the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate-aminotransferase-to-lymphocyte ratio (ALRI), systemic-inflammation index (SII) and lymphocyte count to predict oncologic outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). Materials and Methods: A single-center retrospective review of 296 patients who were treated for 457 HCCs was performed. Pre- and post-treatment laboratory and treatment outcome variables were collected. Objective radiologic response (ORR), progression-free survival (PFS), and overall survival (OS) were evaluated. Patients were categorized into above and below median scores and compared. Results: The median pretreatment NLR, PLR, ALRI, SII, and lymphocyte count were 2.7 (range: 0.4– 55), 88.3 (range: 0.1– 840), 71.8 (range: 0.1– 910), 238.1 (range: 0.1– 5150.8), and 1 (range: 0.1– 5.2) 10 3 /μL, respectively. Patients with above median ALRI scores were less likely to achieve an ORR as compared to those with below median ALRI values (132 (132/163, 81%) vs 150 (150/163, 92%), p = 0.004). On univariate analysis, patients with above median pretreatment NLR (HR 1.41, 95% CI: 1.09– 1.83, p = 0.01) and below median lymphocyte count (HR 0.69, 95% CI: 0.53– 0.92, p = 0.01) had significantly worse PFS. The relationship between PFS and NLR ( p = 0.08) as well as lymphocytes ( p = 0.20) no longer remained on multivariate analysis. On univariate analysis, below median pretreatment NLR (HR 1.72, 95% CI: 1.2– 2.45, p = 0.003) and ALRI (HR 1.52, 95% CI: 1.05– 2.2); p = 0.03) as well as above median lymphocyte count (HR 0.48, 95% CI: 0.34– 0.7, p < 0.0001) were associated with improved OS. The significant relationship between lymphocytes and OS remained on multivariate analysis (HR 0.50, 95% CI: 0.28– 0.9, p = 0.02), but the relationship with NLR ( p = 0.94) did not persist. Conclusion: NLR is predictive of PFS and OS in patients with HCC undergoing TACE and may be superior to other inflammatory scores (PLR, ALRI, and SII) in this setting. However, lymphocyte count may be most predictive of OS. Keywords: hepatocellular carcinoma, chemoembolization, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, aspartate-aminotransferase-to-lymphocyte ratio, systemic-inflammation index
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Colorectal cancer is the third most commonly diagnosed cancer in males and the second in females, with over 1.2 million new cancer cases and 608,700 cancer related deaths in 2008 [1]. Despite the advances being made in early detection of colorectal cancer, approximately half of all patients develop metastatic disease [2]. The prognosis for these patients is poor, although palliative chemotherapy has been shown to be able to prolong survival and to improve the quality of life compared with the best supportive care [3]. Chemoresistance of cancer cells to chemotherapeutics is a main obstacle in chemotherapy to a successful outcome in first line therapy. It has been hypothesized that selection pressure resulting from tumor internal evolution can lead to subpopulations of cell clones, carrying certain cellular mechanism that can be summarized under the term “intrinsic chemoresistance.” Cellular mechanisms of intrinsic chemo resistance are mainly characterized by the fact that they lead to increased tolerance of cancer cells to chemotherapeutics. These cells are most likely to survive first line chemotherapy and arise as recurrence disease.
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Objective To investigate the clinical features and prognostic factors in 243 colorectal cancer cases. Methods The clinicopathologic informations about age,sex and size,gross findings,histological types,infiltrative conditions,Dukes' stage and lymph node metastasis of the tumor in 243 colorectal cancer cases were collected and analyzed by univariate and multivariate analysis. Results Univariate analysis revealed that age,Dukes' stage and lymph node metastasis were prognostic factors of patients with colorectal cancer. Multivariate analysis of COX model indicated that age and lymph node metastasis were two independent prognostic factors. Conclusion Age and lymph node metastasis were two independent prognostic factors of colorectal cancer.
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Background and purpose:Non-small cell lung cancer (NSCLC) is the most frequent histological type of the lung cancer. There are significant differences of prognoses among the patients with advanced NSCLC patients after chemotherapy. The purpose of this study was to explore the prognostic factors of advanced NSCLC patients after chemotherapy. Methods:204 advanced NSCLC patients after chemotherapy were enrolled in the Oncology Center of Shandong Provincial Hospital from Feb.1998 to Jul.2006. Kaplan-Meier method and Log-rank time series analysis for the univariate analysis and Cox proportional hazard model for the multivariate analysis were used. Results:The median survival time was 12 .2 months, 1 year survival rate was 54.9%. The univariate analysis suggested that TNM staging (P=0.0075), KPS scoring (P=0.0151), chemotherapy regiman (P=0.0325), the chemotherapy cycles (P=0.0298) and the status of patients’ immediate response to the treatment (P=0.0061) significantly influenced survival of NSCLC. Multivariate analysis suggested that KPS scoring (P=0.019), TNM staging (P=0.011), and the status of patients’ immediate response to the treatment (P=0.009) were the independent factors of survival. Conclusion:KPS scoring, TNM staging and the status of patients’ immediate response to the treatment are the independent prognostic factors for advanced NSCLC patients after chemotherapy.
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Numerous studies have generated promising but incomplete evidence for the prognostic value of pretreatment serum levels of lactate dehydrogenase (S-LDH) in nasopharyngeal carcinoma (NPC).Pretreatment serum levels of S-LDH in 601 patients with NPC were measured before treatment, and their associations with overall survival and tumor-free survival were studied. Univariate and multivariate analysis of subgroups was used to evaluate the prognostic value of S-LDH in early-stage and late-stage NPC separately.Pretreatment S-LDH levels were significantly lower in T1+2 patients than in T3+4 patients, lower in N0+1 patients than in N2+3 ones, and lower in stage I + II patients than in III + IV ones. Multivariate analysis showed that among patients with late-stage NPC, high pretreatment S-LDH levels >225 U/L were an independent predictor of poor overall survival and tumor-free survival. Among patients with early-stage NPC, pretreatment S-LDH levels >171 U/L, which overlap with the normal range, were an independent predictor of shorter overall survival and tumor-free survival.Pretreatment S-LDH levels may be a reliable biomarker for predicting the long-term prognosis of patients with early-stage or late-stage NPC.
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Abstract Objective An adequate lymph node harvest is necessary for accurate Dukes’ stage discrimination in colorectal cancer. The aim of this study is to identify the effect of variables, including the individual surgeon and pathologist, on lymph node harvest in a single institution. Method Three hundred and eighty one consecutive patients had resection for colorectal cancer, in a single unit. Factors influencing lymph node retrieval, including individual surgeon and reporting pathologist, were subjected to uni‐ and multivariate analysis. Actuarial survival of all patients with Dukes’ stage B and C disease was then calculated and survival compared between Dukes’ stage B and C at differing levels of lymph node harvest. Results The unit median lymph node harvest was 13 nodes/patient (95% CI 13.1–14.5). There was no difference in lymph node harvest between specialist colorectal surgeons and the pooled results of four nonspecialist consultant surgeons. However, there was a significant difference between reporting pathologists ( P < 0.001). On univariate analysis, operation type, operative urgency, Dukes’ stage, T‐stage, reporting pathologist and use of neoadjuvant therapy in rectal cancer, were found to significantly affect lymph node retrieval. On multivariate analysis, operation type, T‐stage, reporting pathologist and neoadjuvant therapy in rectal cancer remained significant variables. Patients with one or more lymph node metastasis had greater nodal harvests than those without (median 15 vs 12 P = 0.02). Survival of patients with Dukes’ stage B disease was found to improve as lymph node harvest increased. Conclusion Overall lymph node harvest, in this unit, varied according to the reporting pathologist but not operating surgeon. As lymph node harvest increased to 15 per patient, the probability of identifying a metastatic node increased.
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Objective The purpose of this study was to determine the prognostic significance of preoperative neutrophil-lymphocyte ratio for disease-free survival and overall survival in patients with stage II colorectal cancer. Summary of Background Data Previous reports have indicated an association between neutrophil-lymphocyte ratio and poor prognosis and tumor progression in patients with colorectal cancer. However, the role of neutrophil-lymphocyte ratio as a prognostic marker specifically in patients with stage II colorectal cancer has not been well studied. Methods A total of 124 patients with colorectal cancer were included in this study. The disease-free survival and overall survival of patients were compared using preoperative neutrophil-lymphocyte ratio. Univariate and multivariate analyses using the Cox proportional-hazards model were performed to determine the prognostic significance of neutrophil-lymphocyte ratio. Results The overall survival and disease-free survival rates of patients with a neutrophil-lymphocyte ratio ≥ 4.0 were significantly lower than those of patients with a neutrophil-lymphocyte ratio < 4.0. Multivariate analysis showed that a neutrophil-lymphocyte ratio ≥ 4.0, performance status ≥ 1, and depth of tumor invasion (T4) were independent prognostic factors for disease-free survival, whereas age > 80 years, a neutrophil-lymphocyte ratio ≥ 4.0, and performance status ≥ 1 were independent prognostic factors for overall survival. Conclusion Neutrophil-lymphocyte ratio is an independent poor prognostic factor in patients with stage II colorectal cancer undergoing curative resection.
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We investigated the prognostic significance of the neutrophil-to-lymphocyte ratio to predict recurrence in patients with nonmetastatic renal cell carcinoma.We retrospectively reviewed the records of 192 patients with nonmetastatic renal cell carcinoma (T1-4N0M0) who underwent nephrectomy between 1986 and 2000. Mean followup was 93 months (range 6 to 232) months. We assessed the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio, and other clinical and laboratory parameters on univariate and multivariate analysis.Presentation mode, tumor stage, C-reactive protein, lymphocyte count and the neutrophil-to-lymphocyte ratio significantly correlated with recurrence-free survival on univariate analysis. The recurrence-free survival rate in patients with a neutrophil-to-lymphocyte ratio of less than 2.7 was 93.7% at 5 years and 79.8% at 10 years, significantly higher than the 77.9% and 58.4%, respectively, in patients with a ratio of 2.7 or greater (p = 0.0205). Multivariate analysis revealed that T stage and the neutrophil-to-lymphocyte ratio were independent predictors of recurrence. The 10-year survival rate in patients at low risk (T2 or less and neutrophil-to-lymphocyte ratio less than 2.7), intermediate risk (T2 or less and ratio 2.7 or greater, or T3 or greater and ratio less than 2.7) and high risk (T3 or greater and ratio 2.7 or greater) was 82.0%, 63.6% and 33.0%, respectively, which were significantly different.An increased pretreatment neutrophil-to-lymphocyte ratio is an independent predictor of recurrence. The combination of T stage and the neutrophil-to-lymphocyte ratio can be used to stratify recurrence risk in patients with nonmetastatic renal cell carcinoma.
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Uncertainty exists about whether elderly patients benefit to the same extent as younger patients from the chemotherapy for colorectal cancer. Patients older than 75 years of age are usually excluded from metastatic colorectal cancer randomized studies. Some subset analyses with comparison of younger and elderly patients from these pooled data revealed the significance of the chemotherapy for elderly colorectal cancer patients. This article introduces the review of these subset analyses and JCOG1018 trial which is on-going study to clarify the efficacy of oxaliplatin combination first line chemotherapy for elderly metastatic colorectal cancer patients.
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