Value of inflammatory index in blood routine on the prognosis of hepatocellular carcinoma
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Monocyte
e15505 Background: Inflammation seems to be significant factor in carcinogenesis and tumor progression of numerous cancers. Blood calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), lactate dehydrogenase (LDH), international normalized ratio (INR) can be evaluated as systemic inflammation markers and prognostic biomarker for many aims: survival outcomes, lymph node metastasis and recurrence, treatment responses in a variety of cancers. The purpose of this study was to investigate baseline associations between blood test parameters (NLR, PLR, LDH, CRP, INR) and their prognostic biomarker role for patient with metastatic gastric cancer, undergoing first-line chemotherapy Methods: Potential baseline inflammatory markers (platelets, neutrophils, lymphocytes, the platelet-lymphocyte ratio, the neutrophil-lymphocyte ratio, the serum C-reactive protein [CRP], the serum LDH, INR) were retrospectively analyzed in 32 patients with metastatic gastric cancer, IV stage (median of age – 60,50). Multivariate analyses were used to identify prognostic factors for overall survival (OS). Baseline values were compared with tumor characteristic and median survival times (MSTs). Results: Multivariate analysis identified due to Cox proportional-hazards regression showed significant longest OS in patients with: localization of primary tumor in antral part of gastric (HR 0,45, 95% CI 0,25-0,80, p = 0,0065); low baseline’s level of WBC (HR 1,17, 95% CI 1.02 - 1,35, p = 0,0219); low baseline’s level of neutrophil (HR 1,18, 95% CI 1.02 - 1,34, p = 0,0251). Level of LDH, CRP, INR didn’t show significant ratio for this cohort of patient. Peritoneum metastatic also didn’t significant affect on OS in patient with metastatic gastric cancer. Patients with low baseline’s platelet to lymphocyte ratio (HR 1,004, 95% CI 1,0009-1,0072, p = 0,0125) and low (from 0 to 3,0) neutrophil to lymphocyte ratio (HR 1,81, 95% CI 1,09-2,99, p = 0,0212) had a significantly longest OS time. Conclusions: Inflammatory markers can predict overall survival in stage IV gastric cancer. Simple and useful.
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Related studies have been confirmed that tumor-associated inflammation is associated with tumor progression and prognosis in a variety of tumors. As an inflammatory biomarker, lymphocyte-monocyte ratio shows significant value in predicting the prognosis of malignant tumors. It can not only be appropriate for patients with cancer risk stratification, but also provide the basis for the subsequent development of individua-lized treatment programs.
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Lymphocytes; Monocytes; Neoplasms; Prognosis
Monocyte
Risk Stratification
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Abstract EGFR-TKIs have been widely used in the first-line treatment of NSCLC patients harboring EGFR mutations. However, the prognosis indicators are limited. In the present study, the prognostic value of systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) were assessed in EGFR-Mutant lung adenocarcinoma patients treated with first-generation EGFR-TKIs. Two hundred three patients were included in this retrospective analysis. SII was calculated as platelet counts × neutrophil counts / lymphocyte counts. Receiver operating characteristic (ROC) curve was used to evaluate the optimal cut-off value for SII, NLR, and PLR. Univariate and multivariate survival analysis were performed to identify factors correlated with PFS and OS. Applying cut-offs of ≥1066.935 (SII), ≥4.40 (NLR), and ≥182.595 (PLR), higher NLR was associated with worse Eastern Cooperative Oncology Group performance status (ECOG PS) ( P = .006), and higher brain metastasis rate ( P = .03), higher PLR was associated with smoking history ( P = .037), and worse ECOG PS ( P = .001), and higher SII groups were associated with worse ECOG PS ( P = .002). In univariate analysis, higher NLR ( P < .001), higher PLR ( P = .002), and higher SII ( P < .001) were associated with worse PFS. Higher NLR ( P < .001), and higher SII ( P < .001) were associated with worse OS. In multivariate analysis, NLR (HR 1.736;95%CI:1.020–2.954; P = .03), PLR (HR 1.823; 95%CI:1.059–3.137; P = .04), and SII (HR2.577; 95%CI:1.677–3.958; P < .001) were independently correlated with PFS. While only SII (HR 2.802; 95%CI:1.659–4.733; P < .001) was independently correlated with OS. The present study demonstrated that SII is an independent prognostic factor for poor survival of advanced EGFR-Mutant lung adenocarcinoma patients treated with first-generation TKIs.
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Abstract Background Hepatocellular carcinoma (HCC) is an inflammation-related cancer, where nonresolving inflammation contributes to its development and progression. Peripheral inflammatory cells have been shown to be associated with the prognosis of various types of cancer. The present study investigated the utility of pretreatment peripheral inflammatory cells in the prognosis of patients with HCC. Methods We retrospectively analyzed data regarding peripheral inflammatory cell, and patient and tumor characteristics from patients with HCC who were diagnosed between November 2008 and March 2018. Baseline data, including peripheral inflammatory cell counts, were recorded before treatment. The relationships between overall survival (OS) and study variables were assessed. Results A total of 1681 patients who were diagnosed with HCC were included. In univariate and multivariate analyses, individual neutrophil, lymphocyte and monocyte cell counts were found as independent indicators of poor OS. High neutrophil (≥3100 × 10 6 /L) and, monocyte (≥470 × 10 6 /L) counts and low lymphocyte counts (< 1640 × 10 6 /L) significantly associated with reduced OS ( p < 0.05). Neutrophil and, monocyte cell counts rose and lymphocyte counts decreased in association with advancing the Barcelona Clinic Liver Cancer stage ( P < 0.001). Conclusions Pretreatment peripheral neutrophils, lymphocytes, and monocytes are independently associated with outcomes of patients with HCC. These cells provides a noninvasive, low-cost, easy, and reproducible biomarker that can be used in routine clinical practice to predict the prognosis of patients with HCC.
Monocyte
Surgical oncology
Peripheral blood cell
Univariate analysis
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Criteria for liver transplantation (LT) for hepatocellular carcinoma (HCC) and post-LT indicators of prognosis are historically based on the measurement of the tumor mass.Recently, high throughput technologies have increased the prediction of recurrence, but these tools are not yet routinely available.The interaction between HCC and the immune system has revealed an imbalance of lymphocyte phenotypes in the peritumoral tissue, and the increase of regulatory T cells with respect to cytotoxic lymphocytes has been linked to a higher rate of post-LT HCC recurrence.Moreover, some inflammatory markers have shown good reliability in predicting cancer reappearance after surgery, as a result of either a systemic inflammatory response or a decreased capacity of the organism to control the tu-mor growth.Among these markers, the neutrophil-tolymphocyte ratio appears to be the most promising and easily available serum parameter able to predict HCC recurrence after LT and following other types of treatment, although the exact mechanisms determining its elevation have not been clarified.Post-LT immunosuppression may impact on cancer control, and the exposure to high levels of calcineurin inhibitors or other immunusuppressants has recently emerged as a negative prognostic factor for HCC recurrence and patient survival.Despite the absence of prospective randomized trials, inhibitors of the mammalian target of rapamycin have been shown to be associated with lower rates of tumor recurrence compared to other immunosuppressors, suggesting their use especially in patients with HCC exceeding the conventional indication criteria for LT.
Immunosuppression
Liver Cancer
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Systemic inflammatory response has a major role in the development and progression of cancer, and increased systemic inflammatory response usually correlates with poorer survival. Recently the eva-luation index of systemic inflammatory response including neutrophil-lymphocyte ratio, C-reactive protein, glasgow prognostic score, platelet-lymphocyte ratio. Several previous studies show that these indexes are the independent prognostic factors for esophageal cancer. Research on the systemic inflammatory markers may also be valuable for the clinical treatment and prognosis of esophageal cancer.
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Esophageal neoplasms; Prognosis; Systemic inflammatory response
Inflammatory response
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AIM:To investigate the significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) in the prognosis of patients with gastric cancer (GC). METHODS:The clinical data of 291 GC patients were analysed retrospectively; these patients were divided into two groups according to their preoperative NLR: a high-NLR group (NLR ≥ 3.5, 131 cases) and a low-NLR group (NLR < 3.5, 160 cases).The clinicopathological characteristics and five-year survival rates of the two groups were compared.The NLR and other clinicopathological factors were subjected to univariate and multivariate survival analysis to evaluate the effects of the NLR on the prognosis of GC patients. RESULTS:The lowest preoperative NLR among the 291 patients was 0.56, whereas the highest preoperative NLR was 74.5.The mean preoperative NLR was 5.99 ± 8.98.Age, tumour size, T staging, tumour-node-metastasis (TNM) staging and platelet count were significantly different between the highand low-NLR groups (P < 0.05).The five-year survival rate of the high-NLR group was 17.0%, which was significantly lower than that of the low-NLR group (43.6%; 17.0% vs 43.6%, P < 0.05).The univariate analysis results showed that the five-year survival rate was related to age, tumour size, T staging, N staging, TNM staging, carcinoembryonic antigen value and NLR (P < 0.05).Multivariate analysis results showed that the NLR was an independent risk factor that likely affected the five-year survival rate of GC patients (P = 0.003, HR = 0.626, 95%CI: 0.460-0.852). CONCLUSION:The preoperative NLR could be used as a prognostic factor for GC patients; in particular, a high NLR corresponded to poor prognosis of GC patients.
Carcinoembryonic antigen
Univariate analysis
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Background Several studies have shown that neutrophil lymphocyte ratio (NLR) may be associated with the prognosis of gastric cancer (GC), but the results are controversial. Methods This study was performed to evaluate the prognostic implications of neutrophil lymphocyte ratio of GC in all available studies. We surveyed 2 medical databases, PubMed and EMBASE, to identifyall relevant studies. Data were collected from studies comparing overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS) in patients with GC. Results Ten studies (n = 2,952) evaluated the role of NLR as a predictor of outcome were involved for this meta-analysis (10 for OS, 3 for DFS, and 2 for PFS). Overall and disease-free survival were significantly better in patients with low NLR value and the pooled HRs was significant at 1.83 ([95% CI], 1.62–2.07) and 1.58 ([95% CI], 1.12–2.21), respectively. For progression-free survival, the pooled hazard ratio of NLR was significant at 1.54 ([95% CI], 1.22–1.95). No evidence of significant heterogeneity or publication bias for OS and DFS was seen in any of the included studies. Conclusion This meta-analysis indicated that elevated NLR may be associated with a worse prognosis for patients with GC.
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Introduction: Several studies have shown the role of inflammatory markers, especially the neutrophil-to-lymphocyte Ratio (NLR), as indicators of poor prognosis in various 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 hepatocellular carcinoma (HCC). Methods: We retrospectively reviewed the charts of 73 patients with HCC treated at the King Hussein Cancer Center from 2012 to 2019. 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 presence of baseline distant metastases. Results: The mean age was 60.7 ± 10.9 years, and males comprised 82.1% of the patients. The ROC value of 5.0 was determined as the cutoff value for NLR. High NLR (NLR > 5.0 µL) was significantly associated with the presence of distant metastasis at diagnosis (p = 0.042). Other parameters as ANC (ANC > 5275.2 µL), AMC (AMC > 630 µL), and AEC (AEC > 109.5 µL) were also associated with the presence of baseline distant metastasis (p = 0.046, 0.007, and 0.002, respectively). Multivariable analysis showed that high NLR (p < 0.001, HR: 1.25, 95% CI: 1.15 to 1.36), as well as age > 62 years at diagnosis (p = 0.045, HR: 0.56, 95% CI: 0.32 to 0.98), were independent risk factors for distant metastasis at presentation. Conclusion: High NLR, PLR, MLR, ANC, and AMC were associated with poor OS (p < 0.001). Simple laboratory tests as complete blood counts can be used as markers of poor prognosis and poor OS in patients with HCC.Figure 1.: Kaplan-Meier curve for overall survival in patients with High NLR (A), PLR (B), MLR (C), ANC (D), and AMC (E).
Absolute neutrophil count
Cut-off
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