Prognostic value of neutrophil-lymphocyte ratio during palliative chemotherapy in patients with unresectable gallbladder adenocarcinoma.
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253 Background: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) is a valuable prognostic marker in several kinds of solid tumors. This study aimed to evaluate the NLR, PLR and change of NLR and PLR over time as a prognostic marker in unresectable gallbladder cancer (GBC) which is treated with palliative chemotherapy. Methods: A total of 163 patients with pathologically confirmed unresectable GBC were enrolled. Baseline and post 1-cycle chemotherapy NLR and PLR were used in analysis. The changes in NLR and PLR were defined as the ratio of post chemotherapy value to baseline value. The relation between survival time and NLR and PLR changes were analyzed. Results: NLR and PLR had AUC value of 0.679, 0.660 in predicting 1-year overall survival (OS) and NLR 1.96 and PLR 111 were the optimal cutoff value with the highest sum of sensitivity and specificity. NLR change and PLR change had AUC value of 0.517, 0.519 in predicting 1-year OS and NLR change 0.4, PLR change 0.6 were the optimal cutoff value. Patients with NLR lower than 1.96 had better OS (16.1 months vs. 9.5 months, p < 0.001) and similarly patients with PLR lower than 111 had better OS (17.3 months vs. 9.5 months, p < 0.001). However, NLR change lower than 0.4 didn’t show better OS (9.2 months vs. 11.6 months, p = 0.178), and the same with PLR change lower than 0.6 (8.5 months vs. 11.3 months, p = 0.138). Conclusions: Baseline NLR and PLR is a valuable predictor of overall survival in unresectable GBC undergoing palliative chemotherapy, whereas NLR and PLR change over time is not.Keywords:
Gallbladder Cancer
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The Neutrophil-to-lymphocyte-ratio has recently gained increased attention as a prognostic marker for malignant disease and short term outcomes. There is little data available in patients with Crohn's disease, thus the present study was conducted to correlate preoperative Neutrophil-to-lymphocyte-ratio values with disease phenotype and postoperative course. We comprised 373 patients, who underwent intestinal resection for symptomatic Crohn's disease at an academic tertiary referral centre between 2000 and 2014. Preoperative Neutrophil-to-lymphocyte-ratio values were calculated and analyzed in regard to disease phenotype and 30-day morbidity rate. All relevant data were obtained from the institutional database and individual chart review. Male patients had significantly higher preoperative Neutrophil-to-lymphocyte-ratio values compared to female patients (5 vs. 4; p = 0.0075). A higher Neutrophil-to-lymphocyte-ratio was also found in patients with an acute indication for surgery (6.15 vs. 4.3; p = 0.0374), presenting with abscesses (5.36 vs. 4.28; p = 0.0254), inflammatory masses (5.23 vs. 4.08; p = 0.0294) or malignancy in the resected specimen (9.06 vs. 4.35, p = 0.0231). Surprisingly, patients developing postsurgical complications showed significantly lower Neutrophil-to-lymphocyte-ratio values (3.77 vs. 4.67; p = 0.0461). Elevated preoperative Neutrophil-to-lymphocyte-ratio in symptomatic Crohn's disease is not predictive for complications. However, Neutrophil-to-lymphocyte-ratio showed a significant correlation with specific disease phenotypes. Most strikingly, Neutrophil-to-lymphocyte-ratio was highly elevated in patients with a colorectal cancer in the resected specimen, which needs to be addressed in future studies.
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PURPOSE: To evaluate the neutrophil-to-lymphocyte ratio (NLR) levels to predict the severity of infl ammation in thyroid ophthalmopathy (TO).METHODS: Fifty-six patients with TO and 40 healthy subjects were included in this study.TO patients were divided into two groups according to clinical activity score (CAS).Group 1 included 24 active TO patients and Group 2 included 32 inactive TO patients.The thyroid status, white blood cell (WBC), neutrophil, and lymphocyte counts were performed.NLR was calculated by dividing the neutrophil count by the lymphocyte count.RESULTS: The mean age was 53.6 ± 5.4 in active TO group, 54.2 ± 5.6 in inactive TO group, and 52.7 ± 5.2 in the control group.The WBC, neutrophil, lymphocyte and NLR levels were higher in patients with TO than in the control group (p < 0.05).A signifi cant difference in NLR was found between the inactive and active TO groups (p < 0.05).CONCLUSION: NLR values were found to be higher in patients with TO than in controls.NLRvalues were also found higher in active TO patients than in inactive TO patients (Tab.3, Ref. 26).
Absolute neutrophil count
White blood cell
Complete blood count
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Adenomyomatosis (ADM) of the gallbladder is a condition characterized by the proliferation of Rokitansky-Aschoff sinus (RAS), in which the epithelium of the gallbladder extends into the muscular layer, causing a thickening of the gallbladder wall. Although ADM is generally considered not to be a precancerous lesion of gallbladder cancer, there are some reports of cases of gallbladder cancer from ADM. Therefore, the relationship between ADM and gallbladder cancer remains controversial. We herein report a case of early-stage gallbladder cancer, BilIN3 (high grade), arising from ADM that was positive for ALDH1A1, an important marker of stem cells and cancer stem cells.
Adenomyomatosis
Gallbladder Cancer
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Neutrophil-to-lymphocyte ratio (NLR) refers to the ratio of neutrophil to lymphocyte in peripheral blood.NLR is a new inflammation index which has attracted more and more attention in recent years.It reflects the dynamic balance between neutrophil and lymphocyte in peripheral blood and has been applied to the diagnosis, severity and prognosis of many diseases.This article reviews the research progress of NLR in common pulmonary diseases in order to improve clinicians′understanding of NLR.
Key words:
Lung diseases; Neutrophil-to-lymphocyte ratio
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Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS) in the diagnosis of gallbladder cancer.Methods Twenty patients with gallbladder cancer and thirty-seven patients with benign gallbladder disease underwent conventional ultrasound and real-time CEUS.The enhancement patterns including types of time-intensity curve,centripetal fill-in,homogeneity and intensity of enhancement were analyzed.Results The focus and gallbladder wall in gallbladder cancers were enhanced at the same time,hepatic artery phase was mainly highly enhanced,hepatic portal vein phase was mairdy lowly enhanced.The percentages of those lesions that exhibited hyper-enhancement or iso-enhancement in the early phase and turned to hypo-enhancement within 35 s after contrast agent administration were 95.0%(19 /20) in gallbladder cancers and 16.2%(6 /37) in benign lesions(P = 0.000).Inhomogeneous enhancement was found 80.0%(16 /20) in gallbladder cancers and 23.3%(7 /30) in benign lesions (P =0.000).Destruction of the integrality of gallbladder wall was found 85.0%(17/20) in gallbladder cancers and none(0.0%,0 /37) in benign lesions(P = 0.000).The diagnose accordance rate、sensitivity and specificity of benign and malignant gallbladder diseases by CEUS was were 92.98% 、95.00% and91.83%,respectively.Conclusion CEUS can improve the diagnosis rates of gallbladder cancer and the ability of differentiating diagnosis between benign and malignant gallbladder diseases compared with conventional ultrasound.
Contrast-enhanced ultrasound
Gallbladder Cancer
Gallbladder disease
Adenomyomatosis
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Purpose: Our aim was to study the value of neutrophil lymphocyte Ratio (NLR) and platelet lymphocyte ratio(PLR) to predict cancer related survival among patients with colorectal cancer (CRC) after exclusion of: a) patients who died in the first 6-month of the follow-up period and b) those patients that presented with bowel obstruction. Methods: We have used our database of 1534 patients diagnosed with CRC between 2005 and 2009. Patients were included if they had documented complete blood count (CBC) before any modality of treatment (surgery or chemotherapy). Patients with bowel obstruction on presentation and those died within 6-month of the date of diagnosis were excluded. Two independent physicians have reviewed the charts for the demographic, presentation, laboratory, pathological, management and outcome variables. The primary variables were WBC parameters (total WBC, neutrophil, lymphocyte, monocyte and NLR). Patients were divided into three equal tertiles according to their pretreatment NLR [1st NLR tertile (NLR <2.8) = 73 patients, 2nd NLR tertile (NLR 2.8-5.0) = 76 patients and the 3rd NLR tertile (NLR >5.0) = 75 patients]. Similarly, patients were divided to PLR tertiles [1st PLR tertile (PLR <150) = 77 patients, 2nd LPLR tertile (PLR 150-250) = 78 patients and the 3rd PLR tertile (PLR >250) = 69 patients]. Results: We had 367 patients with pre-treatment blood differential count with 224 patients presented as non-obstructed and survived 6-month after the reported baseline differential blood count. The 1st NLR tertile had a significant lower 4-year mortality compared to the 3rd NLR tertile (15/73=20.5% vs. 30/75=40%, p=0.012 according to Fisher's exact two-tailed test). The 1st PLR tertile had a lower 4-year mortality compared to the 3rd PLR tertile (19/77=24.6% vs. 24/69=34.8%, p=0.2) that was not statistically significant (Figure 1).Figure: [546] The 4-year cancer-related mortality according to pretreatment neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) tertiles in the colorectal cancer patients.Conclusion: NLR is a predictor of long-term cancer specific survival among colorectal cancer patients. This finding was noted in patients who survived beyond 6-months of the reported NLR in non-obstructed colorectal cancer patients. This suggests that inflammation plays a major role in cancer progression rather than just a mere marker of acute inflammatory status.
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Gallbladder cancer (GBC) has a high incidence in certain geographical regions. Morphologically, GBC presents as a mass replacing the gallbladder, a polypoidal lesion, or wall thickening. The incidence of preoperative diagnosis of wall thickening type of GBC is less well studied. The patterns of mural involvement and extramural spread are not well described in the literature. Additionally, wall thickening in the gallbladder does not always indicate malignancy and can be secondary to inflammatory or benign gallbladder diseases and extracholecystic causes and systemic pathologies. Objective reporting of gallbladder wall thickening will help us appreciate GBC's early features. In this review, we illustrate the imaging patterns of wall thickening type of GBC.
Gallbladder Cancer
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Systemic inflammatory biomarkers are promising predictive and prognostic factors for solid cancers. The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio are used to predict inflammation and used as biomarker in several malignancies.The purpose of this study was to demonstrate the diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasms.A retrospective study was conducted on medical records involving 229 patients with benign, premalignant and malignant laryngeal neoplasms between 2002 and 2015. The diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were evaluated using uni- and multivariate analysis.The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were not statistically different between patients with benign, premalignant and malignant laryngeal neoplasms. Both neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were predictive factors for stage, lymph node metastasis, and distant metastasis. Patients with high neutrophil-lymphocyte ratio value (≥4) had a poor prognosis when compared with patients with low neutrophil-lymphocyte ratio value (5 year, Overall Survival: 69.0% vs. 31.1%, p<0.001; 5 year, disease free survival: 70.0% vs. 32.7%, p˂0.001; 5 year, locoregional recurrence free survival: 69.7% vs. 32.0%, p<0.001). Furthermore, neutrophil-lymphocyte ratio was an independent prognostic factor for 5 year: Overall survival (HR=2.396; 95% CI 1.408-4.077; p=0.001), Disease free survival (HR=2.246; 95% CI 1.322-3.816; p=0.006) and locoregional recurrence free survival (HR=2.210; 95% CI 1.301-3.753; p=0.003).Pretreatment neutrophil-lymphocyte ratio is a useful and reliable predictive and prognostic biomarker for patients with laryngeal carcinoma.
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The similarity of gallbladder cancer and benign gallbladder lesions brings challenges to diagnosing gallbladder cancer (GBC). This study investigated whether a convolutional neural network (CNN) could adequately differentiate GBC from benign gallbladder diseases, and whether information from adjacent liver parenchyma could improve its performance.Consecutive patients referred to our hospital with suspicious gallbladder lesions with histopathological diagnosis confirmation and available contrast-enhanced portal venous phase CT scans were retrospectively selected. A CT-based CNN was trained once on gallbladder only and once on gallbladder including a 2 cm adjacent liver parenchyma. The best-performing classifier was combined with the diagnostic results based on radiological visual analysis.A total of 127 patients were included in the study: 83 patients with benign gallbladder lesions and 44 with gallbladder cancer. The CNN trained on the gallbladder including adjacent liver parenchyma achieved the best performance with an AUC of 0.81 (95% CI 0.71-0.92), being >10% better than the CNN trained on only the gallbladder (p = 0.09). Combining the CNN with radiological visual interpretation did not improve the differentiation between GBC and benign gallbladder diseases.The CT-based CNN shows promising ability to differentiate gallbladder cancer from benign gallbladder lesions. In addition, the liver parenchyma adjacent to the gallbladder seems to provide additional information, thereby improving the CNN's performance for gallbladder lesion characterization. However, these findings should be confirmed in larger multicenter studies.
Gallbladder Cancer
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