Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis

BackgroundNeutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with poor prognosis in numerous solid malignancies. Here, we quantify the prognostic value of NLR in rectal cancer patients undergoing curative-intent surgery, and compare it with platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR).MethodsA comprehensive search of several electronic databases was performed through January 2021, to identify studies evaluating the prognostic impact of pretreatment NLR in patients undergoing curative rectal cancer resection. The endpoints were overall survival (OS), disease-free survival (DFS), and clinicopathologic parameters. The pooled hazard ratio (HR) or odds ratio with 95% confidence interval (CI) were calculated.ResultsThirty-one studies comprising 7553 patients were assessed. All studies evaluated NLR; thirteen and six evaluated PLR and LMR, respectively. High NLR was associated with worse OS (HR 1.92, 95% CI 1.60–2.30, P < 0.001) and DFS (HR 1.83, 95% CI 1.51–2.22, P < 0.001), and the results were consistent in all subgroup analyses by treatment modality, tumor stage, study location, and NLR cut-off value, except for the subgroups limited to cohorts with cut-off value ≥ 4. The size of effect of NLR on OS and DFS was greater than that of PLR, and similar to that of LMR. Finally, high NLR was associated with lower rate of pathologic complete response.ConclusionsIn the setting of curative rectal cancer resection, pretreatment NLR correlates with tumor response to neoadjuvant therapy, and along with LMR, is a robust predictor of poorer prognosis. These biomarkers may thus help risk-stratify patients for individualized treatments and enhanced surveillance.     

Preoperative NLR and PLR in the middle or lower ESCC patients with radical operation

Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) had been analysed in many kind of tumours, but its role of predict the oesophageal squamous cell carcinoma (ESCC) patients’ prognosis was not reach a consensus. Relationship between NLR, PLR and ESCC located in the middle or lower segment was evaluated. 317 patients with ESCC who underwent attempted curative oesophagectomy were analysed in this study. 157 and 98 patients had elevated NLR and PLR respectively (NLR >3.3 and PLR >150). The median overall survival time (OS) and disease‐free survival (DFS) was 34.1 and 19.2 months respectively. Multivariate analysis found PLR >150 (P = 0.018, HR 1.426, 95%CI 1.063–1.912) accompanied by male, lymphatic metastases, tumour size more than 3 cm, tumour located at middle segment and poor differentiation were associated with significantly worse DFS. Meanwhile, gender, lymphatic metastases, tumour location and differentiation along with PLR >150 (P = 0.003, HR 1.595, 95% CI 1.172–2.170) and NLR>3.3 (P = 0.039, HR 1.367, 95% CI 1.015–1.840) were all independent prognostic factors for OS. Preoperative NLR and PLR might be used as predictive factors in patients with ESCC. For DFS, elevated PLR compared to NLR may have an advantage to indicate poor prognosis.     

Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratioin predicting survival for patients with stage Ⅰ-Ⅱgastric cancerCSCD

Background:The preoperative neutrophil-to-lymphocyte ratio(NLR) and the platelet-to-lymphocyte ratio(PLR) are associated with poor prognosis of gastric cancer.We aimed to determine whether the combination of NLR and PLR(NLR-PLR) could better predict survival of patients after curative resection for stage Ⅰ-Ⅱ gastric cancer.Methods:We collected data from the medical records of patients with stage Ⅰ-Ⅱ gastric cancer undergoing curative resection between December 2000 and November 2012 at the Sun Yat-sen Cancer Center.The preoperative NLRPLR was calculated as follows:patients with both elevated NLR(≥2.1) and PLR(≥ 120) were given a score of 2,and patients with only one or neither were given a score of 1 or 0,respectively.Results:Kaplan-Meier analysis and log-rank tests revealed significant differences in overall survival(OS) among patients with NLR-PLR scores of 0,1 and 2(P < 0.001).Multivariate analysis showed that OS was independently associated with the NLR-PLR score[hazard ratio(HR) = 1.51,95%confidence interval(CI) 1.02-2.24,P = 0.039]and TNM stage(HR = 1.36,95%CI 1.01-1.83,P= 0.041).However,other systemic inflammation-based prognostic scores,including the modified Glasgow prognostic score,the prognostic nutritional index,and the combination of platelet count and NLR,were not.In TNM stage-stratified analysis,the prognostic significance of NLR-PLR was maintained in patients with stage Ⅰ(P < 0.001) and stage Ⅱ cancers(P= 0.022).In addition,the area under the receiver operating characteristic curve for the NLR-PLR score was higher than those of other systemic inflammation-based prognostic scores(P = 0.001).Conclusion:The preoperative NLR-PLR score is a useful predictor of postoperative survival in the patients with stage l-ll gastric cancer and may help identify high-risk patients for rational therapy and timely follow-up.     

Nomograms for predicting prognostic value of inflammatory biomarkers in colorectal cancer patients after radical resection

Increasing evidence indicates that inflammation plays a vital role in tumorigenesis and progression. However, the prognostic value of inflammatory biomarkers in colorectal cancer (CRC) has not been established. In this study, a retrospective analysis was conducted in patients with CRC in Fudan University Shanghai Cancer Center (FUSCC) between April 1, 2007 and April 30, 2014, and 5,336 patients were identified eligible. Neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), lymphocyte‐to‐monocyte ratio (LMR), and albumin/globulin ratio (AGR) were analyzed. Kaplan‐Meier analysis was used to calculate the 5‐year overall survival (OS) and disease‐free survival (DFS). Cox regression analysis was performed to assess the prognostic factors. Nomograms were established to predict OS and DFS, and Harrell's concordance index (c‐index) was adopted to evaluate prediction accuracy. As results, the 5‐year OS was 79.2% and the 5‐year DFS was 56.0% in the cohort. Patients were stratified into 2 groups by NLR (≤2.72 and >2.72), PLR (≤219.00 and >219.00), LMR (≤2.83 and >2.83) and AGR (<1.50 and ≥1.50). Patients with NLR > 2.72, PLR > 219.00, LMR ≤ 2.83 and AGR < 1.50 were significantly associated with decreased OS and DFS (p < 0.001). Multivariate analysis indicated that NLR, LMR and AGR were independent factors of OS (p = 0.047, p = 0.008 and p < 0.001, respectively) and DFS (p = 0.009, p < 0.001 and p = 0.008, respectively). In addition, nomograms on OS and DFS were established according to all significant factors, and c‐indexes were 0.765 (95% CI: 0.744–0.785) and 0.735 (95% CI: 0.721–0.749), respectively. Nomograms based on OS and DFS can be recommended as practical models to evaluate prognosis for CRC patients.     

Prognostic significance of preoperative inflammatory response biomarkers in patients undergoing curative thoracoscopic esophagectomy for esophageal squamous cell carcinoma

Background

Recent studies have revealed significant relationships between the lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) and survival in various cancers. The purpose of this study was to confirm whether the LMR, NLR, and PLR have prognostic values, independent of clinicopathological criteria, in patients undergoing curative resection for esophageal cancer.

血液学指标对鼻咽癌患者预后意义的系统评价

目的:评估血液学指标在鼻咽癌患者预后中的意义,指标包括中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与单核细胞比值（LMR）、血小板与淋巴细胞比值（PLR）、血浆纤维蛋白原水平、C-反应蛋白/白蛋白比值（CRP/ALB）、高密度脂蛋白胆固醇（HDL-C）。方法:计算机检索Medline、Embase、Cochrane Library、中国知网（CNKI）数据库、万方数据库、中国生物医学数据库（CBM）,收集有关血液学相关指标与鼻咽癌患者预后相关的研究,主要观察指标为总生存期（OS）,次要观察指标为无进展生存期（PFS）、无病生存期（DFS）、无远处转移生存期（DMFS）。结果:共纳入23项研究,NLR升高的患者OS、PFS均显著降低（HR=1.46,95％CI=1.30~1.63,P<0.000 01;HR=1.67,95％CI=1.36~2.07,P<0.000 01）,PLR升高OS降低（HR=1.62,95％CI=1.32~1.98,P<0.000 01）。LMR升高则有益于患者预后（HR=0.50,95％CI=0.43~0.58,P<0.000 01）。CRP/ALB和血浆纤维蛋白原水平升高的患者预后差（P<0.000 01）。HDL-C水平与患者的OS无关（HR=1.22,95％CI=0.52~2.86,P=0.65）。结论:淋巴细胞、中性粒细胞、血小板、单核细胞、蛋白质（ALB,CRP）和纤维蛋白原可能是鼻咽癌患者预后的预测因素。     

淋巴细胞相关炎性反应指标与乳腺癌预后的相关性

目的 探讨治疗前中性粒细胞淋巴细胞比（NLR）、淋巴细胞单核细胞比（LMR）、血小板淋巴细胞比（PLR）与乳腺癌患者临床病理特征及预后的关系。 方法 回顾性分析189例乳腺癌患者的临床资料,应用ROC曲线获得NLR、LMR、PLR的临界值。根据临界值将患者分为高低两组,分析NLR、LMR、PLR与临床病理特征及预后的相关性。结果 NLR、LMR、PLR最佳临界值分别为2.4、5.4、113。高低NLR组患者的新辅助化疗和手术治疗差异有统计学意义（均P<0.05）,高低LMR组和PLR组患者在各临床病理特征方面差异无统计学意义（均P>0.05）。单因素分析结果显示,TNM临床分期、PR表达、NLR、LMR、PLR、手术以及内分泌治疗均与OS有关（均P<0.05）;TNM临床分期、HER2表达、NLR、手术以及内分泌治疗均与PFS有关（均P<0.05）。多因素分析结果显示,TNM临床分期（P=0.003）和NLR（P=0.033）是OS的独立危险因素;TNM临床分期（P=0.002）和手术治疗（P=0.040）是PFS的独立影响因素。结论 治疗前NLR、LMR、PLR与乳腺癌的预后存在显著相关性,但仅NLR是独立危险因素,LMR、PLR尚不能作为独立预测因子。     

A nomogram to predict prognostic values of various inflammatory biomarkers in patients with esophageal squamous cell carcinoma

Background: Inflammation plays an important role in cancer progression and prognosis. However, the prognostic values of inflammatory biomarkers in esophageal cancer (EC) were not established. In the present study, therefore, we initially used a nomogram to predict prognostic values of various inflammatory biomarkers in patients with esophageal squamous cell carcinoma (ESCC). Methods: A total of 326 ESCC patients were included in this retrospective study. Glasgow prognostic score (GPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and lymphocyte monocyte ratio (LMR) were analyzed in the current study. Kaplan-Meier method was used to calculate the cancer-specific survival (CSS). Cox regression analysis was also performed to evaluate the prognostic factors. A nomogram was established to predict the prognosis for CSS. Results: Patients were divided into 3 groups according to GPS (GPS 0, 1 and 2) and 2 groups according to NLR (≤3.45 and >3.45), PLR (≤166.5 and >166.5) and LMR (≤2.30 and >2.30). The 5-year CSS in patients with GPS 0, 1 and 2 were 49.2%, 26.8% and 11.9%, respectively (P<0.001). In addition, patients with NLR (>3.45), PLR (>166.5) and LMR (≤2.30) were significantly associated with decreased CSS, respectively (P<0.001). Multivariate analysis revealed that GPS (P<0.001), PLR (P=0.002) and LMR (P=0.002) were independent prognostic factors in patients with ESCC. In addition, a nomogram was established according to all significantly independent factors for CSS. The Harrell’s c-index for CSS prediction was 0.72. Conclusion: GPS, PLR and LMR were potential prognostic biomarkers in patients with ESCC. The nomogram based on CSS could be used as an accurately prognostic prediction for patients with ESCC.     

Prognostic value of the neutrophil-to-lymphocyte ratio for overall and disease-free survival in patients with surgically treated esophageal squamous cell carcinoma

Although increasing evidence indicates that cancers are associated with inflammation, the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in patients with esophageal squamous cell carcinoma remains controversial. We determined the prognostic roles of NLR and PLR in patients with esophageal squamous cell carcinoma who underwent surgical treatment. We retrospectively reviewed 119 patients with esophageal squamous cell carcinoma who underwent surgical resection and complete lymph node dissection from 2004 to 2012. The preoperative NLR and PLR were measured. The patients included 112 (94.1 %) males (mean age, 63.64?±?8.42 years) of whom 37 (31.1 %) were pathological stage I, 33 (27.7 %) were stage II, and 49 (41.2 %) were stage III. The median follow-up period was 28.68 months. Recurrence was reported in 48 (40.3 %) patients. Mean NLR and PLR were 2.35?±?1.39 and 140.77?±?70.47, respectively. A multivariate analysis revealed that NLR was a risk factor for disease-free survival (DFS) (hazard ratio [HR], 1.194; p?=?0.031) and overall survival (OS) (HR, 1.230; p?=?0.011), whereas PLR was not a risk factor for DFS or OS. The 3-year OS rates were 51.0 % in low-NLR (<2.97) patients and 17.4 % in high-NLR (≥2.97) patients (p?=?0.007). Akaike’s information criterion decreased when the NLR was included in the multivariate model compared to the multivariate model without NLR. A high NLR was a significant prognostic factor for OS and DFS in patients with surgically treated esophageal squamous cell carcinoma, whereas PLR showed no prognostic significance.     

Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios are associated with the efficacy of immunotherapy in stage III/IV non-small cell lung cancer

Peripheral serological indicators are novel markers associated with prognosis in multiple malignant tumors. In the present study, platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were selected to construct a model that predicts long-term survival of patients with stage IIIB-IV non-small cell lung cancer (NSCLC) who received treatment with an anti-programmed cell death protein-1 (PD-1) monoclonal antibody. A total of 133 patients were eligible for the present retrospective study (January 2019-February 2021). The area under the receiver operating characteristic curve was used to compare the diagnostic value of PLR and NLR, and combined PLR and NLR. The objective response rate and disease control rate of each group were obtained and the differences were compared using the χ² test. The prognostic value of these indicators was assessed using the Kaplan-Meier method. Cox regression analysis was used to evaluate risk factors associated with long-term survival. Statistically significant parameters were included in the nomogram. Based on the median PLR and NLR values, the patients were divided into high PLR (H-PLR) (PLR >200.00, 67 patients) and low PLR (L-PLR) (PLR ≤200.00, 66 patients), and high NLR (H-NLR) (NLR >3.56, 65 patients) and low NLR (L-NLR) (NLR ≤3.56, 68 patients) groups. Immune-related adverse events (irAEs) occurred in 22 patients (16.5%) during the observation period, including 18 grade 2–3 irAEs and 4 grade 4 cases. H-NLR and H-PLR were associated with poor progression-free (PFS) and overall survival (OS) in the present study. NLR was an independent prognostic factor for PFS [hazard ratio (HR): 0.201, 95% confidence interval (CI): 0.060-0.670; P=0.009) and OS (HR: 0.413, 95% CI: 0.226-0.754; P=0.004) in this patient group. Therefore, NLR may be used in the prognostication of patients with stage IIIB-IV NSCLC treated with PD-1 inhibitors. These serological markers may be used in combination with established immunomarkers to help predict outcomes.     

术前纤维蛋白原联合淋巴细胞与单核细胞比值对非小细胞肺癌患者预后的评估价值

  目的  探讨术前纤维蛋白原（fibrinogen,Fbg）联合淋巴细胞与单核细胞比值（lymphocyte to monocyte ratio,LMR）评分（FLMR）与非小细胞肺癌（non-small cell lung cancer,NSCLC）患者预后的相关性。  方法  回顾性分析2006年1月至2009年12月天津医科大学肿瘤医院行根治性手术切除的589例NSCLC患者的临床病例资料。根据受试者工作特征（ROC）曲线判定Fbg及LMR的界限值,根据F-LMR评分原则将患者分为3组:F-LMR 0分、F-LMR 1分、F-LMR 2分。通过χ2检验分析其与患者临床病理因素的关系,Kaplan-Meier法进行生存分析,运用Log-rank法进行差异性检验,Cox比例风险模型进行单因素与多因素回归分析。  结果  根据ROC曲线,3.48 g/L、3.23分别作为Fbg和LMR的界值。F-LMR 0分215例、F-LMR 1分228例、F-LMR 2分146例,术前F-LMR评分与年龄、性别、吸烟史、肿瘤位置、手术类型、病理分期、病理类型、肿瘤大小有显著相关（P < 0.05）。单因素分析显示:肿瘤位置、手术类型、病理分期、肿瘤大小、F-LMR评分、LMR及Fbg水平是影响NSCLC患者预后的危险因素（P < 0.05）;多因素分析结果表明:病理分期（DFS:HR:1.700,95%CI:1.483~1.950,P < 0.001;OS:HR:1.703,95%CI:1.486~1.952,P < 0.001）和F-LMR评分（DFS:HR:1.264,95%CI:1.077~1.484,P=0.004;OS:HR:1.301,95%CI:1.107~1.528,P=0.001）是影响患者预后的独立危险因子。  结论  术前F-LMR评分可作为预测行根治性切除的非小细胞肺癌患者预后的指标。      

Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer: The prognostic impact of baseline neutrophil-lymphocyte,platelet-lymphocyte and lymphocyte-monocyte ratios

PurposeIn this retrospective analysis we sought to determine if the preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) were predictive of both operability and survival in those patients presenting with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).MethodsAnalysis included all patients admitted between 2009 and 2017 with PC from CRC who were treated with curative intent by CRS-Mitomycin C-HIPEC. Patients were assessed pre- and intra-operatively by the PC index (PCI) and by a completeness of cytoreduction (CC) score with calculation of Kaplan-Meier survival curves and multivariate analysis of prognostic factors. Discrimination was made for NLR >3.5, PLR >168.8 and LMR >4.4.ResultsWe identified 98 CRC patients undergoing 105 CRS-HIPEC procedures. There were no associations detected between NLR/PLR/LMR and the rates of incomplete or abandoned CRS cases. Overall survival (OS) after CRS-HIPEC was worse with high versus low NLR (19.9 mths vs. 45.7 mths, respectively; P = 0.009) and also with low versus high LMR (27.1 mths vs. 53.2 mths, respectively; P = 0.01). On multivariate analysis, a low LMR (P = 0.008), the preoperative CT PCI value (P = 0.004), poor tumor differentiation (P = 0.023) and the preoperative CEA level (P < 0.001) were all independent variables associated with a worse OS after surgery.ConclusionsThe baseline LMR value may have potential value as a selection tool for CRS-HIPEC in patients with CRC-related PC.     

Re-challenge with catumaxomab in patients with malignant ascites: results from the SECIMAS study

Accumulating evidences indicate cancer-triggered inflammation plays a pivotal role in carcinogenesis. Systematic inflammatory response biomarkers are considered as potential prognostic factors for improving predictive accuracy in colorectal cancer (CRC). Preoperative neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (d-NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte- to-monocyte ratio (LMR) were investigated and compared in 205 surgical CRC patients. ROC curve was applied to determine thresholds for four biomarkers, and their prognostic values were assessed using Kaplan–Meier curve, univariate and multivariate COX regression models. Moreover, a number of risk factors were used to form nomograms for evaluating risk of survival, and Harrell’s concordance index (c-index) was used to evaluate predictive accuracy. Results showed that elevated NLR was significantly associated with diminished recurrent-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) in surgical CRC patients. Moreover, multivariate COX analysis identified elevated NLR as an independent factor for poor RFS (P < 0.001, HR 2.52, 95 % CI 1.65–3.83), OS (P < 0.001, HR 2.73, 95 % CI 1.74–4.29) and CSS (P < 0.001, HR 2.77, 95 % CI 1.72–4.46). Additionally, predictive nomograms including NLR for RFS, OS and CSS could be more effective in predicting RFS (c-index: 0.810 vs. 0.656), OS (c-index: 0.809 vs. 0.690) and CSS (c-index: 0.802 vs. 0.688) in surgical CRC patients, respectively. These findings indicate that preoperative elevated NLR can be considered as an independent prognostic biomarker for RFS, OS and CSS. Nomograms containing NLR provide improved accuracy for predicting clinical outcomes in surgical CRC patients under surgery resection.     

Prognostic value of pre-operative systemic immune-inflammation index and platelet to lymphocyte ratio in peritoneal carcinomatosis of ovarian origin

Background and objectivesThe aim of this study was to investigate the impact of systemic immune-inflammation index (SII), platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR) on the survival outcomes of patients who underwent to cytoreductive surgery (CRS) and HIPEC for ovarian peritoneal carcinomatosis.MethodsA retrospective analysis of 68 cases following surgery at our department between 2015 and 2020 was performed. Receiver Operating Characteristic (ROC) curve was used with Youden index to calculate the optimal cutoff values for SII, PLR and NLR.ResultsUnivariate analysis revealed that high preoperative values of SII, PLR and NLR were correlated with worse overall survival (OS) and disease-free survival (DFS) in these patients. In the multivariable analysis, high SII was recognized as an independent prognostic factor for OS (CI 95%: 0.002- 3.835, p = 0.097) and high PLR was recognized as an independent prognostic factor for DFS (CI 95%: 0.253–2.248, p = 0.007).ConclusionSII and PLR could be useful prognostic tools to predict outcomes of patients who underwent to CRS and HIPEC for ovarian peritoneal carcinomatosis.     

胃癌患者术前血小板／淋巴细胞比值的预后意义

目的 探讨术前外周血血小板／淋巴细胞比值（PLR）对胃癌患者预后的影响。方法选取2008年9月至2009年12月在本院收治的184例胃癌患者作为研究对象,根据PLR是否＜150,将患者分为低PLR组（＜150）125例和高PLR组（≥150）59例,比较两组的临床病理特征和术后1、2、5年生存率及无病生存率,采用Cox风险回归模型评估影响胃癌患者预后的因素。结果 与低PLR组相比,高PLR组的肿瘤浸润深度深、淋巴结转移数多、TNM分期晚、白蛋白低（P＜0.05）。高PLR组和低PLR组1、2、5年生存率分别为74.6％、54.2％、37.3％ 和89.6％、77.6％、57.6％,两组差异有统计学意义（P=0002）。高PLR组和低PLR组1、2、5年无病生存率分别为52.56％、42.4％、23.7％ 和84.8％、72.0％、49.5％,两组差异有统计学意义（P＜0.001）。单因素分析显示,PLR、肿瘤浸润深度、淋巴结转移、TNM分期、年龄及白蛋白与总生存期（OS）和无病生存期（DFS）有关（P＜0.05）。Cox多因素分析显示,TNM分期是影响OS的独立预后因素（HR=6.344,95％CI：4.125～9.757,P＜0001）;TNM分期、PLR和白蛋白是影响DFS的独立预后因素（HR=4.600,95％CI：3.272～6.468,P＜0.001;HR=1.630,95％CI：1.070～2.483,P=0.023;HR=0.470,95％CI：0.259～0.853,P=0.013）。结论 术前PLR是影响胃癌DFS的独立预后因素,OS的预后意义需进一步研究。     

Inflammatory markers and overall survival in older adults with cancer

Background

Our aim was to evaluate the prognostic impact of three inflammatory markers - neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and lymphocyte monocyte ratio (LMR) - on overall survival (OS) in older adults with cancer.

血小板与淋巴细胞比值预测三阴性乳腺癌临床预后及与免疫球蛋白表达的关系

目的:探讨血小板与淋巴细胞比值（platelet to lymphocyte ratio,PLR）对三阴性乳腺癌的临床预后影响及与免疫球蛋白表达的关系。方法:回顾性分析2006年1月至2012年12月于我院乳腺外科住院治疗的134例三阴性乳腺癌患者。临床独立预后因素采用单因素和多因素Cox回归模型分析。术后生存时间和生存曲线比较采用Kaplan-Meier和log-rank方法。结果:PLR是三阴性乳腺癌的独立预后因素,最佳临界值为155.00。PLR＜155.00组,术后中位DFS为35.51月,中位OS为55.24月;PLR≥155.00组,术后中位DFS为25.07月,中位OS为35.17月。两组术后DFS和OS比较,差异具有统计学意义（P＜0.05）。结论:PLR是三阴性乳腺癌的独立预后因素,具有重复性强、非侵袭性、方便实用等特性,可用于预测三阴性乳腺癌临床预后。     

Absolute lymphocyte count and C-reactive protein-albumin ratio can predict prognosis and adverse events in patients with recurrent esophageal cancer treated with nivolumab therapy

Predicting the prognosis and adverse events (AEs) of nivolumab therapy for recurrent esophageal cancer is very important. The present study investigated whether a simple blood biochemical examination could be used to predict prognosis and AEs following nivolumab treatment for relapse of esophageal cancer. A total of 41 patients who received nivolumab treatment for recurrent esophageal cancer after esophagectomy were analyzed. The absolute lymphocyte count (ALC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) and C-reactive protein-albumin ratio (CAR) were assessed at the time of nivolumab induction as indices that can be calculated by blood biochemical examinations alone. Median values were 1,015 for ALC, 3.401 for NLR, 242.6 for PLR, 0.458 for MLR and 0.119 for CAR, and patients were divided into two groups according to values. A high ALC, low NLR, low PLR, low MLR and low CAR were associated with a better response to nivolumab. In addition, patients with the aforementioned indices, with the exception of low PLR, or better response were more likely to develop AEs in univariate analysis. In multivariate analysis, a high ALC [odds ratio (OR): 4.857, P=0.043] and low CAR (OR: 9.099, P=0.004) were identified as independent risk factors for AEs. Survival analysis revealed that overall survival and progression-free survival (PFS) rates after nivolumab treatment differed significantly between the high and low groups of ALC, NLR, PLR, MLR and CAR. The multivariate analysis identified a low ALC [hazard ratio (HR): 3.710, P=0.003] and high CAR (HR: 2.953, P=0.007) as independent poor prognostic factors of PFS. In conclusion, ALC and CAR have potential as biomarkers for outcomes of recurrent esophageal cancer following nivolumab treatment.     

术前炎症指标对肝细胞癌肝切除术患者的预后预测价值

目的  探讨术前炎症指标中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和预后营养指数（PNI）在肝细胞癌（HCC）肝切除术后患者预后中的预测价值。方法 本研究为回顾性队列研究。选择2015年6月—2018年3月于本院行肝切除术的HCC患者为研究对象,随访截至2021年1月。主要研究指标为总生存期（OS）。采用限制性立方样条、Cox比例风险回归模型、时间依赖的受试者工作特征（ROC）曲线以及列线图评估术前NLR、PLR及PNI的预后预测价值。结果 共77例患者符合标准纳入分析,其中男性59例;中位年龄51岁。限制性立方样条分析结果显示,NLR、PLR、PNI与HCC患者的死亡风险均呈线性关系（非线性P>0.05）,Cox比例风险回归模型结果显示,NLR、PLR、PNI、肿瘤分化程度及肿瘤包膜是否完整是影响HCC患者OS的因素。NLR、PLR、PNI等炎症指标构建的列线图模型预测1年、3年总生存率的AUC均大于NLR、PLR、PNI（均P<0.05）,且联合预后影响因素肿瘤分化程度和肿瘤包膜是否完整后AUC进一步提高（均P<0.05）。结论 术前炎症指标NLR、PLR、PNI在预测肝细胞癌肝切除术患者预后中具有良好效能,联合临床因素可进一步提高预测效能。     

Prognostic Value of Baseline Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Local and Advanced Gastric Cancer Patients

Background: We aimed to investigate the prognostic value of baseline neutrophil, lymphocyte, and plateletcounts along with the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in local andadvanced gastric cancer patients. Materials and Methods: In this retrospective cross-sectional study, a total of103 patients with gastric cancer were included. For all, patient characteristics and overall survival (OS) timeswere evaluated. Data from a complete blood count test including neutrophil, lymphocyte, monocyte, white bloodcell (WBC) and platelet (Plt) count, hemoglobin level (Hb) were recorded, and the NLR and PLR were obtainedfor every patient prior to pathological diagnosis before any treatment was applied. Results: Of the patients, 53had local disease, underwent surgery and were administered adjuvant chemoradiotherapy where indicated. Theremaining 50 had advanced disease and only received chemotherapy. OS time was 71.6±6 months in local gastriccancer patients group and 15±2 months in the advanced gastric cancer group. Univariate analysis demonstratedthat only high platelet count (p=0.013) was associated with better OS in the local gastric cancer patients. Incontrast, both low NLR (p=0.029) and low PLR (p=0.012) were associated with better OS in advanced gastriccancer patients. Conclusions: This study demonstrated that NLR and PLR had no effect on prognosis in patientswith local gastric cancer who underwent surgery and received adjuvant chemoradiotherapy. In advanced gastriccancer patients, both NLR and PLR had significant effects on prognosis, so they may find application as easilymeasured prognostic factors for such patients.