Influence of blood neutrophil to lymphocyte ratio on oncologic outcomes in peritoneal carcinomatosis of appendiceal origin.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14184-e14184
Author(s):  
Kamran Idrees ◽  
Jason Luciano ◽  
Frances Austin ◽  
Magesh Sathaiah ◽  
Lekshmi Ramalingam ◽  
...  
Keyword(s):  
Overall Survival ◽  
Peritoneal Cancer Index ◽  
Inflammatory Marker ◽  
Multivariable Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Oncologic Outcomes ◽  
Peritoneal Cancer ◽  
Lymphocyte Ratio ◽  
The Impact ◽  
Systemic Inflammatory Marker

e14184 Background: The Neutrophil to lymphocyte ratio (NLR), a marker of systemic inflammatory response, is associated with prognosis in various cancers. The aim of this study is to evaluate the association of pre-operative NLR with oncologic outcomes in patients with appendiceal carcinomatosis. Methods: Clinico-pathological data were obtained from a prospectively maintained database of patients with appendiceal carcinomatosis who underwent cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemoperfusion (HIPEC) between 2001 and 2010. Pre-operative absolute neutrophil and lymphocyte counts were used to compute NLR, with elevated NLR defined a priori as >5. Logistic regression modeling and Kaplan-Meier analyses were performed on the available data. Results: 195 patients, with a median age of 54.5 years, underwent CRS and HIPEC. The median follow up time was 1.96 years. There were 41 patients (21%) who had elevated NLR preoperatively. Factors associated with overall survival (OS) were grade (p=0.01), simplified peritoneal cancer index (SPCI) (p=0.013), and age (p=0.02). In patients who did not undergo splenectomy at the time of CRS, elevated NLR, lymph node involvement, SPCI, age and pre-operative albumin were statistically significant predictors of OS on multivariable analysis. None of these factors were significant in patients who underwent splenectomy at the time of CRS. The 5-year overall survival was 57% vs. 31% in patients with NLR<5 compared to NLR>5 respectively (p<0.0001). Time to progression was 30 months compared to 14 months in patients with NLR<5 vs. >5 (p=0.001). Strikingly, the 5-year OS in patients with NLR<5 with or without splenectomy was 63% and 50% compared to patients with NLR>5 with or without splenectomy 37.5% vs. 23%, respectively (p=0.0001). Conclusions: In patients with appendiceal carcinomatosis, pre-operative NLR is a potential systemic inflammatory marker that independently predicts oncologic outcomes. The impact of NLR appears to be influenced by the performance of splenectomy at the time of CRS. Further studies will be required to prospectively validate this systemic inflammatory marker and its interaction with splenectomy.

The Impact of Ostomy Creation after Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy in a Newly Established Peritoneal Malignancy Program

2018 ◽  
Vol 84 (6) ◽  
pp. 776-782 ◽  
Author(s):  
Zachary E. Stiles ◽  
Nathan M. Hinkle ◽  
Gitonga Munene ◽  
Paxton V. Dickson ◽  
Andrew M. Davidoff ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Multivariable Analysis ◽  
Peritoneal Cancer ◽  
Prolonged Length ◽  
Stoma Formation ◽  
The Impact ◽  
Peritoneal Malignancy

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has improved outcomes for selected patients with peritoneal carcinomatosis and often requires ostomy creation. We examined the impact of ostomy creation in a newly established peritoneal malignancy program. A retrospective review was performed of CRS-HIPEC procedures from 2011 to 2016. Those who did and did not receive an ostomy were compared. Fifty-eight patients underwent CRS-HIPEC and an ostomy was created in 25.9 per cent. Median peritoneal cancer index (14 vs 16, P = 0.63) and multivisceral resection rates (87.9 vs 100.0%, P = 0.17) were similar between groups. Multivariable analysis revealed that bowel resection (OR 210.65, P = 0.02) was significantly associated with ostomy creation. Advanced age was noted to be inversely associated with stoma formation (OR 0.04, P = 0.04). Progression-free survival was significantly lower in the ostomy group (18 vs 23 months, P = 0.03). Those with an ostomy experienced prolonged length of stay (13.3 ± 7.4 vs 9.5 ± 3.7, P = 0.01). At follow-up, 6/10 temporary ostomies had undergone reversal and three patients experienced morbidity after reversal. Ostomy creation may occur during CRS-HIPEC and carries potential for morbidity. Ostomy creation may contribute to postoperative length of stay. Patients should be counseled preoperatively on the potential impact of ostomy placement during CRS-HIPEC.

Effect of cytoreductive surgery and HIPEC on survival in comparison to palliative chemotherapy for biliary carcinoma with peritoneal metastasis: A multi-institutional cohort from PSOGI and BIG RENAPE groups.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 418-418
Author(s):  
Frederic Mercier ◽  
Iris Amblard ◽  
David L. Bartlett ◽  
Edward Allen Levine ◽  
Dario Baratti ◽  
...  
Keyword(s):  
Overall Survival ◽  
Peritoneal Metastasis ◽  
Palliative Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Rank Test ◽  
Medical Group ◽  
Biliary Carcinoma ◽  
Peritoneal Cancer ◽  
The Impact ◽  
Surgical Group

418 Background: Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy. The objective was to evaluate the impact on survival of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC. Methods: A prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test. Results: Between 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the medical group. In the surgical group, median peritoneal cancer index was 9 (range 3-26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the medical group (35% vs. 18%, p= 0.001). Median OS was 21.4 and 9.3 months for surgical and medical group, respectively (p =0.007). Three-year overall survival was 30% and 10% for surgical and medical group, respectively. Conclusions: Treatment with CRS and HIPEC for cholangiocarcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy.

A retrospective analysis on the impact of preoperative neutrophil to lymphocyte ratio in stage II colon cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 794-794
Author(s):  
Deepna Jaiswal ◽  
Suparna Mantha ◽  
Lucas Wong ◽  
Luis Seija ◽  
Yolanda Munoz
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Critical Role ◽  
Univariate Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stage Ii ◽  
Lymphocyte Ratio ◽  
Stage Ii Colon Cancer ◽  
The Impact

794 Background: Inflammation has a critical role in tumor genesis and progression of cancer. The neutrophil to lymphocyte ratio (NLR) is an indication of balance between the immune systems pro and defense mechanism against cancer. Elevated NLR is of interest in many cancers, including colon cancer. Although surgery is the mainstay of treatment for early stage colon cancer, adjuvant chemotherapy for stage II colon cancer has remained debatable. We proposed to study the impact of the NLR in patients with stage II colon cancer and to identify high risk patients who would benefit from adjuvant chemotherapy. Methods: Three hundred and eighty patients diagnosed with Stage II colon cancer at our institution were included in this retrospective study. Kaplan-Meir curves and multivariate Cox-regression analyses were calculated for overall survival. Results: Univariate analysis showed NLR was not statistically significant as predictor of mortality (p-value=0.0857). However, after adjusting for recurrence, chemotherapy, age, white blood cell count, the NLR was predictive for survival, with a hazard ratio of 1.05 and 95% confidence interval of (1.006 - 1.1). Recurrence and age were also significant predictors of survival (p-values of <0.0001 for both), and HR of 3.1 (2.0 – 4.6) and 1.4 (1.2 – 1.5), respectively. Conclusions: The neutrophil to lymphocyte ratio might be an independent prognostic marker for overall survival in stage II colon cancer patients. Given the retrospective nature of our study, further studies are indicated to confirm our findings.

The Impact of Early Recurrence on Quality of Life after Cytoreduction with HIPEC

2017 ◽  
Vol 83 (6) ◽  
pp. 633-639 ◽  
Author(s):  
Nathan M. Hinkle ◽  
Vandana Botta ◽  
John P. Sharpe ◽  
Paxton Dickson ◽  
Jeremiah Deneve ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peritoneal Cancer Index ◽  
Disease Free Survival ◽  
Early Recurrence ◽  
Oncologic Outcomes ◽  
Low Grade ◽  
Peritoneal Cancer ◽  
Patients At Risk ◽  
The Impact

Improved oncological outcomes after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in highly selected patients have been well documented. The extensive nature of the procedure adversely affects quality of life (QoL). The aim of this study is to longitudinally evaluate QoL following CRS/HIPEC. This is a retrospective review of a prospectively maintained database of patients with peritoneal malignancies undergoing CRS/HIPEC. Clinicopathological data, oncologic outcomes, and QoL were analyzed preoperatively and post-operatively at 2 weeks, and 1, 3, 6, and 12 months. The Functional Assessment of Cancer Therapy-Colorectal instrument was used to determine changes in QoL after CRS/HIPEC and the impact of early recurrence (<12 months) on QoL. Thirty-six patients underwent CRS/HIPEC over 36 months. The median peritoneal cancer index score was 18 and the completeness of cytoreduction-0/1 rate was 97.2 per cent. Postoperative major morbidity was 16.7 per cent with one perioperative death. Disease-free survival was 12.6 months in patients with high-grade tumors versus 31.0 months in those with low-grade tumors (P = 0.03). QoL decreased postoperatively and improved to baseline in six months. Patients with early recurrence had a decrease in global QoL compared with preoperative QoL at 6 (P < 0.03) and 12 months (P < 0.05). This correlation was not found in patients who had not recurred. Patients who undergo CRS/HIPEC have a decrease in QoL that plateaus in 3 to 6 months. Early recurrence adversely impacts QoL at 6 and 12 months. This study emphasizes the importance of patient selection for CRS/HIPEC. The expected QoL trajectory in patients at risk for early recurrence must be carefully weighed against the potential oncological benefit of CRS/HIPEC.

A retrospective analysis on the impact of preoperative neutrophil to lymphocyte ratio in stage II colon cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15146-e15146
Author(s):  
Deepna Deepak Jaiswal ◽  
Suparna Mantha ◽  
Luis Seija ◽  
Yolanda Munoz ◽  
Lucas Wong
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Critical Role ◽  
Univariate Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stage Ii ◽  
Lymphocyte Ratio ◽  
Stage Ii Colon Cancer ◽  
The Impact

e15146 Background: Inflammation has a critical role in tumor genesis and progression of cancer. The neutrophil to lymphocyte ratio (NLR) is an indication of balance between the immune systems pro and defense mechanism against cancer. Elevated NLR is of interest in many cancers, including colon cancer. Although surgery is the mainstay of treatment for early stage colon cancer, adjuvant chemotherapy for stage II colon cancer has remained debatable. We proposed to study the impact of the NLR in patients with stage II colon cancer and to identify high risk patients who would benefit from adjuvant chemotherapy. Methods: Three hundred and eighty patients diagnosed with Stage II colon cancer at our institution were included in this retrospective study. Kaplan-Meir curves and multivariate Cox-regression analyses were calculated for overall survival. Results: Univariate analysis showed NLR was not statistically significant as predictor of mortality (p-value = 0.0857). However, after adjusting for recurrence, chemotherapy, age, white blood cell count, the NLR was predictive for survival, with a hazard ratio of 1.05 and 95% confidence interval of (1.006 - 1.1). Recurrence and age were also significant predictors of survival (p-values of < 0.0001 for both), and HR of 3.1 (2.0 – 4.6) and 1.4 (1.2 – 1.5), respectively. Conclusions: The neutrophil to lymphocyte ratio might be an independent prognostic marker for overall survival in stage II colon cancer patients. Given the retrospective nature of our study, further studies are indicated to confirm our findings.

scholarly journals Neutrophil to lymphocyte ratio influences impact of steroids on efficacy of immune checkpoint inhibitors in lung cancer brain metastases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Adam Lauko ◽  
Bicky Thapa ◽  
Mayur Sharma ◽  
Baha’eddin Muhsen ◽  
Addison Barnett ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Brain Metastases ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Significant Difference ◽  
The Impact

AbstractSteroids are often utilized to manage patients with non-small cell lung cancer brain metastases (NSCLCBM). Steroids and elevated neutrophil-to-lymphocyte ratio (NLR) have been associated with decreased overall survival (OS) in patients treated with immune checkpoint inhibitors (ICI). We retrospectively investigated patients treated with ICI after the diagnosis of NSCLCBM at a single tertiary care institution examing the impact of steroids and NLR. Overall survival (OS) and intracranial progression-free survival (PFS) were analyzed. 171 patients treated with ICI for NSCLCBM were included. Thirty-six received steroids within 30 days of the start of ICI, and 53 patients had an NLR ≥ 5 before the start of ICI. Upfront steroids was associated with decreased OS on multivariable analysis (median OS 10.5 vs. 17.9 months, p = .03) and intracranial PFS (5.0 vs. 8.7 months, p = .045). NLR ≥ 5 was indicative of worse OS (10.5 vs. 18.4 months, p = .04) but not intracranial PFS (7.2 vs. 7.7 months, p = .61). When NLR and upfront steroids are modeled together, there is a strong interaction (p = .0008) indicating that the impact of steroids depended on the patient’s NLR. In a subgroup analysis, only in patients with NLR < 4 was there a significant difference in OS with upfront steroids (26.1 vs. 15.6 months, p = .032). The impact of steroids on the efficacy of ICI in patients with NSCLCBM is dependent on the patient's NLR underscoring its importance in these patients. Patients with a low NLR, steroid use decreases the efficacy of ICI. These results can inform clinicians about the impact of steroids in patients treated with ICI.

Neutrophil-to-lymphocyte ratio as a predictor of oncologic outcomes in locally advanced non-metastatic clear cell renal carcinoma.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 661-661
Author(s):  
Gilberto Rodrigues ◽  
Pablo Sierra ◽  
Emanuel Albuquerque ◽  
Fabio Pescarmona Gallucci ◽  
Eder Nisi Ilario ◽  
...  
Keyword(s):  
Cox Regression ◽  
Clear Cell ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Nuclear Grade ◽  
Oncologic Outcomes ◽  
Receiver Operating Curve ◽  
Lymphocyte Ratio ◽  
Metastatic Setting

661 Background: An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with worse oncologic outcomes in several malignancies, its prognostic role in kidney cancer, specifically in the non metastatic setting is controversial. We aimed to evaluate if an elevated NLR in patients with locally advanced non metastatic clear cell renal cell carcinoma (CCRCC) is associated with a worse survival and/or a higher cancer recurrence rate. Methods: We retrospectively identified 880 nephrectomies performed between 01/2009 to 12/2016 in a single center, reviewed data from 478 consecutive radical nephrectomies (RN) for kidney tumors and identified 187 patients with locally advanced non-metastatic CCRCC patients (pT3-T4 N0M0). The cut-off point of NLR = 2.5 was obtained using the receiver operating curve analysis (ROC). NLR was obtained preoperatively and calculated by dividing absolute neutrophil count by absolute lymphocyte count. Overall survival (OS) and recurrence-free survival (RFS) were evaluated using the Kaplan-Meier method. Cox regression models were utilized to evaluate predictors of recurrence and survival. Results: Median follow up was 48.7 months. The 3 year OS was significantly lower for patients with NLR ≥ 2.5 than those with NLR < 2.5 (70% vs 85%, p = 0.049). In patients with a Fuhrman nuclear grade of differentiation of 3-4, the median time to recurrence was significantly shorter for patients with NLR ≥ compared to those with NLR < 4 (24 vs 55 months p 0.045). On multivariable analysis adjusted for NLR ≥ 2.5, microvascular invasion, sarcomatoid differentiation, tumor size and body mass index, only nuclear grade of differentiation was found to be an independent predictor for recurrence (hazard ratio= 2.18; 95% confidence interval [CI]: 1.07 – 4.92, p = 0.03). Conclusions: Patients with non-metastatic CCRCC with higher nuclear grade of differentiation and a high preoperative NLR have shorter RFS and worse OS compared to patients with lower NLR.

Neutrophil to lymphocyte ratio (NLR) and its effect on the prognostic value of the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model for patients treated with targeted therapy (TT).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 470-470 ◽  
Author(s):  
Arnoud J. Templeton ◽  
Daniel Yick Chin Heng ◽  
Toni K. Choueiri ◽  
David F. McDermott ◽  
André P Fay ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Value ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Added Value ◽  
P Value ◽  
Data Set ◽  
Lymphocyte Ratio ◽  
Proportional Hazards Regression

470 Background: The neutrophil to lymphocyte ratio (NLR) is a marker of host inflammation and appears to have prognostic value in many solid tumors. We have found in a pilot RCC study that a NLR > 2.5 was predictive of a lower likelihood of response to TT on a multivariable analysis. Here we aim to explore the added value of the NLR to improve the prognostic value of the established IMDC criteria (Heng et al JCO 2009). Methods: We included patients from 7 consortium sites where NLR data was available for patients treated with TT and compared NLR cutoff <= 2.5 vs. >2.5 (i.e. low vs. high NLR) and adjusted using proportional hazards regression for the known poor prognostic criteria (listed in Table). Results: Data from 859 patients were included. NLR values were: Mean 4.98, Median 3.51, Mode 2.5, 95%CI 1.42 – 14.0. Using Cutoff <=2.5 vs. >2.5 Median overall survival (OS) is 30.4 months (95%CI 24.9-37.0, n= 237) vs. 15.7 months (95%CI 13.0-17.2, n=622); log-rank p value <0.0001. If we adjust for all six IMDC poor prognosis criteria in a proportional hazards regression model: HR of death for high NLR is 1.506 (1.177-1.928) p=0.0011, demonstrating NLR is still an independent predictor of poor OS even after using IMDC criteria. Conclusions: The NLR is a simple clinical value and is independently associated with poor overall survival even after adjustment for IMDC factors, including neutrophilia. The updated data set will be presented. [Table: see text]

scholarly journals A Preliminary Study on the Prognostic Impact of Neutrophil to Lymphocyte Ratio of the Bronchoalveolar Lavage Fluid in Patients with Lung Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2201
Author(s):  
Woo Kyung Ryu ◽  
Yeonsook Moon ◽  
Mi Hwa Park ◽  
Jun Hyeok Lim ◽  
Young Sam Kim ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Factor ◽  
Bronchoalveolar Lavage ◽  
Peripheral Blood ◽  
Clinical Utility ◽  
Multivariable Analysis ◽  
Neutrophil To Lymphocyte Ratio ◽  
Prognostic Impact ◽  
Lymphocyte Ratio

The cumulative results indicate that the neutrophil to lymphocyte ratio of peripheral blood (pbNLR) is a useful prognostic factor in patients with various cancers. In contrast to peripheral blood, the bronchoalveolar lavage (BAL) fluid is in direct contact with the lung lesion. However, no study has reported on the clinical utility of the NLR of BAL fluid (bNLR) for patients with lung cancer. To investigate the clinical utility of the bNLR as a prognostic factor in patients with lung cancer, we conducted a retrospective review of the prospectively collected data. A total of 45 patients were classified into high bNLR (n = 29) and low bNLR (n = 16) groups. A high pbNLR and high bNLR were associated with a shorter overall survival (p < 0.001 and p = 0.011, respectively). A multivariable analysis confirmed that ECOG PS (p = 0.023), M stage (p = 0.035), pbNLR (p = 0.008), and bNLR (p = 0.0160) were independent predictors of overall survival. Similar to the pbNLR, a high bNLR value was associated with a poor prognosis in patients with lung cancer. Although further studies are required to apply our results clinically, this is the first study to show the clinical value of the bNLR in patients with lung cancer.

scholarly journals Elevated preoperative neutrophil‐to‐lymphocyte ratio predicts early adverse outcomes in uncomplicated type B aortic dissection undergoing TEVAR

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hongqiao Zhu ◽  
Lei Zhang ◽  
Taiping Liang ◽  
Yiming Li ◽  
Jian Zhou ◽  
...  
Keyword(s):  
Adverse Events ◽  
Aortic Dissection ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Neutrophil To Lymphocyte Ratio ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Independent Predictive Factor ◽  
Lymphocyte Ratio ◽  
Clinical Events

Abstract Background Thoracic aortic endovascular repair (TEVAR) of uncomplicated type B aortic dissection (uTBAD) has favorable long-term outcomes but higher early adverse events compared with the optimal medical treatment. Recently, clinical evidence concerning vascular surgery indicates that elevated preoperative systemic inflammatory response predicts adverse clinical events. The aim of our study was to evaluate the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR) and early outcomes of uTBAD patients undergoing TEVAR. Results 216 patients diagnosed with uTBAD were included in this retrospective study between January 2015 and December 2018. The median (IQR) follow-up period was 21 (15–33) months. An early adverse event was defined as occurring within 2 years after the procedure. Median patient age was 60 (IQR, 48–68) years and 78.7 % were male. Early adverse events occurred in 24 patients (11.1 %). In the multivariable analysis, preoperative NLR (HR per SD, 1.98; 95 % CI, 1.14–3.44; P = 0.015) was associated with 2-year adverse events. Conclusions NLR is an independent predictive factor of early adverse events in uTBAD patients undergoing TEVAR.

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