Lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio independently predict survival in resected small bowel adenocarcinoma.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 426-426
Author(s):  
Brandon M. Huffman ◽  
Shruti Patel ◽  
Siddhartha Yadav ◽  
Zhaohui Jin ◽  
Amit Mahipal
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Small Bowel ◽  
Tumor Size ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stage I ◽  
Small Bowel Adenocarcinoma ◽  
Lymphocyte Ratio ◽  
Lymphocyte To Monocyte Ratio ◽  
Resected Small Bowel

426 Background: Small bowel adenocarcinoma is a rare malignancy affecting approximately 2,000 patients per year. There is a paucity of evidence prognosticating patients with small bowel adenocarcinoma. We aimed to evaluate multiple factors in patients with resected small bowel adenocarcinoma to determine any association with survival outcomes. Methods: Ninety three patients who underwent resection for stage I-III small bowel adenocarcinoma were retrospectively identified utilizing the pathology database at a single tertiary referral institution. All patients had complete follow up data and were included in the survival analysis. JMP software was used for statistical analysis. Overall survival was performed utilizing Kaplan-Meier method, and log-rank tests were used for statistical comparisons. Cox proportional hazards were performed to control for age, gender, location of tumor, tumor size, tumor stage, and adjuvant therapy. Sensitivity analysis was performed to establish best cutoff points for continuous variables. All tests were two sided and a P value of < 0.05 was considered significant. Results: The median age at diagnosis was 65 years (range 32-90). 61% were male. Median tumor size was 4.5 cm. There were 20, 36, and 37 patients with stage I, stage II, and stage III disease, respectively. Median overall survival (OS) was 151 months, 104 months, and 44 months for stages I, II, and III disease. In a multivariate analysis, independent predictor factors included presurgical lymphocyte to monocyte ratio (LMR) > 4.0, with a Hazard Ratio (HR) 0.13 (95% CI 0.007-0.69, p = 0.01), presurgical neutrophil to lymphocyte ratio (NLR) < 8.0, HR 0.39 (95% CI 0.17-0.96, p = 0.04), and tumor size < 7.5 cm, HR 0.22 (95% CI 0.07-0.85, p = 0.03). Stage, age, T stage, and N stage influenced overall survival in univariate analysis, but were not statistically significant on multivariate analysis. Conclusions: LMR and NLR independently predict survival in patients with resected small bowel adenocarcinoma.

Validation of lymphocyte to monocyte ratio in resected small bowel adenocarcinoma as a predictor of survival.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15799-e15799
Author(s):  
Brandon M. Huffman ◽  
Zhaohui Jin ◽  
Siddhartha Yadav ◽  
Shruti Patel ◽  
Amit Mahipal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Small Bowel ◽  
Predictive Value ◽  
P Value ◽  
Small Bowel Adenocarcinoma ◽  
Training Set ◽  
Lymphocyte To Monocyte Ratio ◽  
Negative Prognostic Factor ◽  
Resected Small Bowel

e15799 Background: Lymphocyte to monocyte ratio (LMR) has been described as a prognostic factor in many solid tumors including colorectal adenocarcinoma. LMR has not been investigated as a prognostic factor in small bowel cancers. In this study, we aimed to evaluate prognostic factors in resected small bowel adenocarcinoma including LMR. Methods: Two hundred forty-one patients who underwent resection for stage I-III small bowel adenocarcinoma were retrospectively identified utilizing the pathology database at a single tertiary referral institution from 1994 to 2015. All patients had complete follow up data and were included in the survival analysis. One hundred sixty-nine patients had preoperative peripheral blood counts available for analysis. Plot of martingale residuals against LMR were used to establish best cutoff points for LMR. A training set for LMR included consecutively identified patients from 2006 to 2015, and a validation cohort including patients identified from 1994 to 2005 was used. Overall survival was performed utilizing Kaplan-Meier method, and Wilcoxon tests were used for statistical comparisons. Cox proportional hazards were performed and all tests were two sided. P value of < 0.05 was considered significant. Results: Median overall survival for the entire group was 54.5 months (95% CI: 37.2-81.2 months) with 5- and 10-year overall survival of 48% and 35%. The training set for LMR included 81 patients, and the validation set included 88 patients. The cutoff of 1.56 was chosen based on most significant p value (p = 0.002). When combined, the overall area under the curve (AUC) for LMR was 0.63, p < 0.01, (specificity 37.3%, sensitivity 90.1%, positive predictive value 33.1%, and negative predictive value 92.2%). There were 126 patients with LMR > 1.56 and 43 patients with LMR < 1.56 in the entire cohort. In multivariate analysis, LMR under 1.56 was a negative prognostic factor, HR = 2.20 (95% CI: 1.27-3.84, p < 0.01). In addition to LMR, age > 60 years and advanced T stage were independently negative predictors of overall survival in all patients. Conclusions: Lymphocyte-to-monocyte ratio < 1.56 is a validated negative prognostic factor in resected small bowel adenocarcinoma.

scholarly journals Commentary on: Nomograms based on inflammatory biomarkers for predicting tumor grade and microvascular invasion in stage I/II hepatocellular carcinoma

2019 ◽  
Vol 39 (10) ◽  
Author(s):  
Liang Xiao ◽  
Furong Zeng ◽  
Guangtong Deng
Keyword(s):  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Tumor Size ◽  
Tumor Grade ◽  
Microvascular Invasion ◽  
Stage I ◽  
Inflammatory Biomarkers ◽  
Independent Dataset ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

Abstract Some doubts were generated during the reading of nomograms based on inflammatory biomarkers for preoperatively predicting tumor grade and microvascular invasion in stage I/II hepatocellular carcinoma (HCC). We would like to highlight and discuss with authors. First, neutrophil-lymphocyte ratio (NLR) and derived NLR (dNLR) should not be entered into multivariate analysis simultaneously. Second, authors should clarify how the cutoffs of these variables including lymphocyte-monocyte ratio (LMR), dNLR, age and tumor size were set. We insist that the type of variables should be consistent when we carry out the analysis and establish the nomogram. Last, we have to point out that Li et al.’s (Biosci. Rep. (2018), 38) study failed to validate nomograms using an independent dataset.

scholarly journals Preoperative Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and CEA as the Potential Prognostic Biomarkers for Colorectal Cancer

2022 ◽  
Vol 2022 ◽  
pp. 1-9
Author(s):  
Fu Ming-Sheng ◽  
Du Mei-Ling ◽  
Cai Xun-Quan ◽  
Hu Yuan-Xin ◽  
Zhang Wei-Jie ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Independent Predictor ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stage I ◽  
Prognostic Biomarkers ◽  
Stage Iii ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Low Bmi

Background. This study was to evaluate the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA) in colorectal cancer (CRC) patients and to identify the potential and easily accessible prognostic biomarkers for CRC. Methods. We retrospectively reviewed altogether the records of 330 CRC patients according to inclusion criteria. The clinical characteristics include age at diagnosis, body mass index (BMI), preoperative CEA level, neutrophil , lymphocyte, and platelet count, tumor primary site and size, clinical pathological TNM stage, and survival status were recorded through the review of medical records. The overall survival (OS) was calculated using the Kaplan–Meier method. The Cox proportional hazards model was used for the univariate and multivariate analysis to evaluate the prognostic factors of CRC. Results. A total of 330 patients were finally included in the current study. The mean follow-up duration was 32.8 ± 19.1 months (range, 0.1–67.7). Compared with the median OS, preoperative high NLR, PLR, and CEA, and low BMI had lower median OS. The NLR and PLR value rise indicates lower median OS in stage I-II CRC; however, the NLR value and CEA level rise indicates lower median OS in stage III-IV CRC. Preoperative high NLR, PLR, and CEA level and low BMI have poorer OS by univariate analysis. By multivariate analysis, the age, sex, N, M stage, and BMI demonstrated independently influence the OS of CRC. NLR was an independent predictor of stage I-II CRC, and the CEA level was an independent predictor of stage III-IV CRC. Conclusions. Our results show that preoperative high NLR, PLR, CEA, and low BMI had poorer OS, NLR was an independent predictor of stage I-II CRC, and the CEA level was an independent predictor of stage III-IV CRC.

Adjuvant chemotherapy impact on the overall survival of completely resected small bowel adenocarcinoma: An updated meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16806-e16806
Author(s):  
Philip A. Haddad ◽  
Dalia A. Hammoud ◽  
Kevin M. Gallagher
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Small Bowel ◽  
Survival Benefit ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Adjuvant Chemoradiotherapy ◽  
Small Bowel Adenocarcinoma ◽  
The Impact ◽  
Resected Small Bowel

e16806 Background: While the small intestine represents around 75% of the length and more than 90% of the gastrointestinal tract mucosal surface, it contributes around 2% of gastrointestinal tumors. Adenocarcinoma which constitutes 40% of all small bowel tumors is the most common histology. Complete surgical resection of early-stage small bowel adenocarcinoma (SBAC) is the only proven potentially curative therapy. Due to the rarity of this disease and the absence of randomized trials, the benefit of postoperative adjuvant chemotherapy (ACT) in patients with completely resected localized SBAC has been controversial. A meta-analysis conducted in 2018 found no survival benefit for adjuvant therapies in SBAC. However, this meta-analysis combined studies that used adjuvant chemotherapy and chemoradiotherapy and included studies contaminated by other less chemosensitive histologies and more advanced and sometimes metastatic disease. The purpose of this meta-analysis is to evaluate the impact of ACT on the overall survival (OS) of patients with completely resected SBAC incorporating more recent studies. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria consisted of resected small bowel adenocarcinoma, English language, publications from 2000 to the present, and comparative studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves of patients that underwent ACT versus those that did not. Adjuvant chemoradiotherapy studies and those that reported aggregate OS for a cohort with mixed histologies were excluded. A meta-analysis was conducted using an inverse variance method with a random-effects model. Results: Nine retrospective series which included 2082 patients were selected and analyzed. The majority of SBAC patients that received ACT belonged to stages II & III. ACT was found to be significantly associated with better OS in patients with completely resected SBAC (HR 0.66, 95%CI: 0.56-0.78, p < 0.001). Conclusions: This is the first meta-analysis to show that adjuvant chemotherapy is associated with a survival benefit in patients with completely resected small bowel adenocarcinoma. In the absence of randomized clinical trials, this meta-analysis represents the most compelling data supporting the use of ACT in this patient population.

The importance of the glucose-to-lymphocyte ratio in patients with hepatocellular carcinoma treated with sorafenib

2021 ◽  
Author(s):  
Ali Yılmaz ◽  
Melih Şimşek ◽  
Zekeriya Hannarici ◽  
Mehmet E Büyükbayram ◽  
Mehmet Bilici ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Prognostic Nutritional Index ◽  
Neutrophil To Lymphocyte Ratio ◽  
Advanced Hcc ◽  
Lymphocyte Ratio ◽  
Lymphocyte To Monocyte Ratio ◽  
Nutritional Index ◽  
Before And After ◽  
Immune Inflammation

Aim: To show the prognostic significance of the glucose-to-lymphocyte ratio (GLR) in hepatocellular carcinoma (HCC). Patients & methods: A total of 150 patients with advanced HCC who were treated with sorafenib in our center between January 2011 and December 2019 were included in the study retrospectively. Neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio, prognostic nutritional index and GLR were analyzed to assess their prognostic value using Kaplan–Meier and Cox regression analysis before and after propensity score matching (PSM). Results: In univariate analysis before and after PSM, albumin–bilirubin grade, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, lymphocyte-to-monocyte ratio, prognostic nutritional index, AFP level and GLR were found to be significantly associated with both progression-free and overall survival. In multivariate analysis before and after PSM, GLR, albumin–bilirubin grade and AFP were determined to be independent prognostic factors for progression-free and overall survival. Conclusion: The GLR prior to sorafenib treatment is a new prognostic biomarker that may predict survival in advanced HCC.

scholarly journals Does Preoperative Serum Neutrophil To Lymphocyte Ratio (NLR), Platelet To Lymphocyte Ratio (PLR) And Lymphocyte To Monocyte Ratio (LMR) Predict Prognosis Following Radical Surgery For Pancreatic Adenocarcinomas? - Results of A Retrospective Study.

2021 ◽  
Author(s):  
Vikas Bachelal Gupta ◽  
Vikram Chaudhari ◽  
Shailesh V. Shrikhande ◽  
Manish S. Bhandare
Keyword(s):  
Overall Survival ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Tnm Stage ◽  
Neutrophil To Lymphocyte Ratio ◽  
Survival Outcomes ◽  
P Value ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Lymphocyte To Monocyte Ratio

Abstract Background:Pretherapy serum neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) have been shown to predict prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). However, the published literature is conflicting, hence we aimed to evaluate their role in predicting survival outcomes in operated patients of PDAC.Methods: A retrospective analysis was done of all operated cases of PDAC who underwent curative resection between 2011 to 2018. The pretherapy NLR, PLR and LMR were calculated and analyzed with respect to pathological and survival outcomes Results:134 operated patients were included. The median overall survival for NLR of less than 2, 2.7 and 5 was 30.8, 27.2 and 27.5 months and for NLR more than 2, 2.7 and 5 was 22.9, 21.6 and 21.5 months respectively and was statistically insignificant (p-value- 0.32, 0.91, 0.34 respectively). Similarly, the PLR was not significant for a cut off of 150 (p-value- 0.27) and LMR was not significant for a cut off of 2.8 (p-value- 0.13) and 4.8( p-value -0.11). On Univariate analysis age, CA 19-9, perineural invasion, margin positivity, lymph node positivity and TNM stage were found to have significant correlation with overall survival. However, on multivariate analysis, only TNM stage was found to be significant. Conclusion:The NLR, PLR and LMR do not correlate with overall survival in operated patients with PDAC in this study. A combination of inflammatory markers or their dynamic testing might probably achieve prognostic significance.

scholarly journals Preoperative neutrophil-to-lymphocyte ratio behaves as an independent prognostic factor even in patients with postoperative complications after curative resection for gastric cancer

2022 ◽  
Author(s):  
Jaume Tur-Martínez ◽  
Javier Osorio ◽  
Noelia Pérez-Romero ◽  
Noelia Puértolas-Rico ◽  
Manuel Pera ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factor ◽  
Postoperative Complications ◽  
Gastric Adenocarcinoma ◽  
Independent Prognostic Factor ◽  
Neutrophil To Lymphocyte Ratio ◽  
Term Survival ◽  
Lymphocyte Ratio

Abstract Purpose The aim of this study was to determine if the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) could be modified by the presence of postoperative complications (POC) and their severity in patients with gastric adenocarcinoma resected with curative intent. Methods A retrospective study based on a prospective database of patients with resectable gastric adenocarcinoma treated with radical intention (R0) between January 1998 and February 2012. The primary endpoint was overall survival according to preoperative peripheral blood NLR and postoperative complications. Clinicopathological variables, preoperative blood tests, POC and its severity (Clavien–Dindo classification), type of POC (infectious or not infectious) and mortality were registered. A univariate and multivariate analysis (step forward Cox regression) was performed. The Kaplan–Meier method was used to assess overall survival. Results The 147 patients with gastric cancer who had undergone radical resection were included from an initial cohort of 209 patients. Univariant analysis: type of surgery, pT, pN, postoperative complications (Clavien–Dindo ≥ 3) and preoperative NLR ≥ 2.4 were significantly associated with survival (p < 0.05). Patients with POC showed worse long-term survival (p = 0.000), with no difference (p = 0.867) between infectious or non-infectious POC. NLR ≥ 2.4 was associated with infectious POC (p < 0.001). Patients with preoperative NLR ≥ 2.4 (p = 0.02) had a worse prognosis. Multivariate analysis: pN (p < 0.001), postoperative complications (p < 0.001) (HR 3.04; 95% CI: 1.97–4.70) and NLR ≥ 2.4 (p = 0.04) (HR = 1.55; 95% CI: 1.02–2.3) were independent prognostic factors. Conclusion The preoperative inflammatory state of patients with gastric cancer measured by NLR behaves as an independent prognostic factor, even in patients with POC.

scholarly journals Astragalus Polysaccharide Injection (PG2) Normalizes the Neutrophil-to-Lymphocyte Ratio in Patients with Advanced Lung Cancer Receiving Immunotherapy

2021 ◽  
Vol 20 ◽  
pp. 153473542199525
Author(s):  
Shih Ming Tsao ◽  
Tz Chin Wu ◽  
JiZhen Chen ◽  
Feichi Chang ◽  
Thomos Tsao
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Survival Data ◽  
Treatment Initiation ◽  
Checkpoint Inhibitors ◽  
Neutrophil To Lymphocyte Ratio ◽  
Advanced Lung Cancer ◽  
Control Group ◽  
Lymphocyte Ratio ◽  
Astragalus Polysaccharide

Objectives: The neutrophil-to-lymphocyte ratio (NLR) is a prognostic marker in patients with cancer receiving immunotherapy. Recent studies have shown that a high NLR was associated with a poor response and decreased survival. However, there is no intervention to reverse abnormally high NLR and improve clinical outcomes. Astragalus polysaccharide injection (PG2) is an immunomodulatory therapy for cancer-related fatigue. This study aimed to examine whether PG2 might normalize the NLR and affect the overall survival of patients with lung cancer treated with immunotherapy. Materials and Methods: We retrospectively examined the medical records of patients with lung cancer treated with immune checkpoint inhibitors (ICIs) between October 1, 2015 and November 30, 2019. All patients received ICI combination chemotherapies, and some similarly received PG2 (Control vs PG2). The NLR was assessed before treatment and 6 weeks after ICI initiation, and the survival data was collected at least 4 years after treatment initiation for the first enrolled patient. Results: Fifty-three patients were included. Six weeks after ICI initiation, 91.3% of the patients in the PG2 group exhibited a predefined “Decrease or no change” in the NLR, which was 28% higher than that in the Control group (63.3%) ( P = .028). The NLR significantly decreased by 31.60% from baseline in the PG2 group ( P = .012), whereas it increased by 5.80% in the Control group ( P = .572). Six weeks after ICI treatment initiation, both groups had a median NLR of 3.73, and the overall survival was also similar (PG2 vs Control, 26.1 months vs 25.4 months, respectively); however, the PG2 group had a higher median baseline NLR than the Control group (PG2 vs Control, 4.51 vs 2.81, respectively). Conclusion: This study demonstrated that PG2 could normalize the NLR in patients with lung cancer receiving ICI combination treatments.

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