Elevated preoperative neutrophil/lymphocyte ratio is associated with poor prognosis in soft-tissue sarcoma patients

Szkandera, Joanna; Absenger, Gudrun; Liegl‐Atzwanger, Bernadette; Pichler, Martin; Stotz, Michael; Samonigg, Hellmut; Glehr, Mathias; Zacherl, Mathias J.; Stojaković, Tatjana; Gerger, Armin; Leithner, Andreas

doi:10.1038/bjc.2013.135

Cited by 130 publications

(122 citation statements)

References 31 publications

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“…To the best of our knowledge, in STS patients, up to now a potential prognostic value have been only investigated for the N/L ratio. 21,22 Therefore, we evaluated the prognostic significance of other previously reported potentially prognostic cellular ratios including N/L ratio, L/M ratio and P/L ratio regarding three different endpoints on a large training set and to confirm the findings, on a large validation set. In general, before a prognostic parameter can be implemented into a clinical setting for patients' surveillance or recruitment strategies to adjuvant treatment modalities, an independent external validation is a prerequisite.…”

Section: Discussionmentioning

confidence: 88%

The lymphocyte/monocyte ratio predicts poor clinical outcome and improves the predictive accuracy in patients with soft tissue sarcomas

et al. 2014

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Increasing evidence indicates the involvement of inflammation and coagulation in cancer progression and metastases. Inflammatory biomarkers hold great promise for improving the predictive ability of existing prognostic tools in cancer patients. In the present study, we investigated several inflammatory indices with regard to their prognostic relevance for predicting clinical outcome in soft tissue sarcoma (STS) patients. Three hundred and forty STS patients were divided into a training set (n 5 170) and a validation set (n 5 170). Besides well-established clinico-pathological prognostic factors, we evaluated the prognostic value of the neutrophil/lymphocyte (N/L) ratio, the lymphocyte/monocyte (L/M) ratio and the platelet/lymphocyte (P/L) ratio using Kaplan-Meier curves and univariate as well as multivariate Cox regression models. Additionally, we developed a nomogram by supplementing the L/M ratio to the well-established Kattan nomogram and evaluated the predictive accuracy of this novel nomogram by applying calibration and Harrell's concordance index (c-index). In multivariate analysis, a low L/M ratio was significantly associated with decreased CSS and DFS (HR 5 0.41, 95% CI 5 0.18-0.97, p 5 0.043; HR 5 0.39, 95% CI 5 0.16-0.91, p 5 0.031, respectively) in the training set. Using the validation set for confirmation, we found also in multivariate analysis an independent value for CSS (HR 5 0.33, 95% CI 5 0.12-0.90, p 5 0.03) and for DFS (HR 5 0.36, 95% CI 5 0.16-0.79, p 5 0.01). The estimated c-index was 0.74 using the original Kattan nomogram and 0.78 when the L/M ratio was added. Our study reports for the first time that the pre-operative L/M ratio represents a novel independent prognostic factor for prediction the clinical outcome in STS patients. This easily determinable biomarker might be helpful in improved individual risk assessment.Soft tissue sarcomas (STS) account for nearly 11,280 cases per year and are responsible for about 3,900 deaths in the United States annually, mainly due to local recurrence or metastatic disease. 1 Therefore, it is crucial to understand the biological mechanisms that contribute to tumor progression and to identify novel prognostic markers to generate individualized treatment and follow-up schedules. In a large retrospective study of 2,136 STS patients, Kattan et al. developed a postoperative prognostic model that predicts sarcomaspecific death, based on traditional prognostic factors such as age at diagnosis, tumor size, histologic grade, histologic subtype, tumor depth and site. 2 This nomogram is useful for general risk assessment and has potential value in determining surgical strategy and adjuvant management. Nevertheless, novel prognostic factors might be helpful in improving its predictive ability. Current approaches in cancer research have focused on the characterization of novel biomarkers, which ideally should be easily accessible, highly reproducible, cheap and most importantly, identify patients at high risk for disease-recurrence and death. Increasing evidence su...

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Section: Discussionmentioning

confidence: 88%

The lymphocyte/monocyte ratio predicts poor clinical outcome and improves the predictive accuracy in patients with soft tissue sarcomas

et al. 2014

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“…1,9 Resection margins were classified according to Enneking et al 2,13 Tumorstage was generated according to AJCC criteria 14 grading (i.e., G1-G3 according to the French Federation of Cancer Centres Sarcoma Group (FNCLCC) grading system).…”

Section: Methodsmentioning

confidence: 99%

“…4,5 Several types of liposarcoma were described by Fletcher et al, 1,4,[6][7][8] with the histologic subclassification being a key prognostic factor for survival. 2,4,9,10 While atypical lipomatous tumor (ALT) only carry a risk of local recurrence, the pleomorphic and dedifferentiated liposarcomas are high grade malignancies with a substantial risk of metastatic disease. 4,11 Several prognostic markers have been associated with overall survival (OS) in STS, such as tumor size and depth, site, grade, and resection margins.…”

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confidence: 99%

Hemoglobin, alkalic phosphatase, and C‐reactive protein predict the outcome in patients with liposarcoma

Panotopoulos

Posch

Alici

et al. 2015

Journal Orthopaedic Research

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Data on prognostic biomarkers in soft tissue sarcomas are scarce. The aim of the study was to define prognostic markers in patients with a liposarcoma, a subtype of sarcoma derived from adipose tissue. We restrospectively reviewed 85 patients with liposarcoma treated at our department from May 1994 to October 2011. Kaplan-Meier curves, uni-, and multivariable Cox proportional hazard models and competing risk analysis were performed to evaluate the association between putative biomarkers with diseasespecific and overall survival. We observed a significant association between both alkalic phosphatase (ALP; subhazard ratio [SHR] per 1 unit increase: 1.35; 95%CI 1.10-1.65; p ¼ 0.005) and C-reactive protein (CRP; SHR per 1 mg/dl increase: 2,57; 95%CI 1.36-4,86; p ¼ 0.004) with disease-specific survival. Hemoglobin (Hb) (HR per 1 g/dl increase: 065; 95%CI 0.48-0.87; p ¼ 0.003) was associated with overall survival. These associations prevailed after multivariable adjustment for AJCC tumor stage. This study identifies CRP and ALP as novel independent predictors of disease-specific survival in patients with liposarcoma. ß

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“…The tumor cells then produce chemokines, cytokines, and prostaglandins, which recruit inflammatory cells, which then subsequently trigger cancer‐related inflammation and further facilitate various tumor‐promoting effects 7. The neutrophil : lymphocyte (N/L) ratio has been shown to reflect the immune response and has been identified as a prognostic marker in many cancers, including gastrointestinal tract malignancy, non‐small cell lung cancer, cervical cancer, hepatocellular carcinoma, pancreatic cancer, ovarian cancer, and soft‐tissue sarcoma, reflecting a consistently decreased survival in patients with a high N/L ratio 8, 9, 10, 11, 12, 13, 14, 15. In addition, N/L ratio is reportedly correlated to incidental microcarcinoma in thyroid goiters, further indicating its potential as a diagnostic marker 16.…”

Section: Introductionmentioning

confidence: 99%

Elevated preoperative neutrophil : lymphocyte ratio as a preoperative indicator of mature cystic teratoma with malignant transformation

Nanki

Chiyoda

Kataoka

et al. 2017

J of Obstet and Gynaecol

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AimTo examine the usefulness of the neutrophil : lymphocyte (N/L) ratio as a cost‐effective and simple diagnostic marker of mature cystic teratoma (MCT) with malignant transformation (MT).MethodsA retrospective chart review was performed between 1998 and 2013 of 12 MCT patients with MT and between 2009 and 2013 of 130 patients with benign MCT. Data were collected on age, tumor size, white blood cell count with differential counts, tumor marker levels, and presenting features.ResultsOlder age, greater tumor size, higher CA19‐9 or CA125, higher neutrophil count, and higher N/L ratio were associated with MT on univariate analysis. White blood cell count; lymphocyte count; and the tumor marker squamous cell carcinoma antigen were not associated with MT. Older age (≥median), larger tumor size (≥10 cm), and high N/L ratio (≥5.0) were predictors of MT (hazard ratio, 11.51, 5.87, and 11.11, respectively). Six of 12 patients were diagnosed with MT on preoperative magnetic resonance imaging and five of 12 had an N/L ratio ≥5.0.ConclusionsNeutrophil : lymphocyte ratio is a potential preoperative diagnostic marker of MT. The optimal cut‐off should be determined in future large‐scale studies.

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Elevated preoperative neutrophil/lymphocyte ratio is associated with poor prognosis in soft-tissue sarcoma patients

Cited by 130 publications

References 31 publications

The lymphocyte/monocyte ratio predicts poor clinical outcome and improves the predictive accuracy in patients with soft tissue sarcomas

The lymphocyte/monocyte ratio predicts poor clinical outcome and improves the predictive accuracy in patients with soft tissue sarcomas

Hemoglobin, alkalic phosphatase, and C‐reactive protein predict the outcome in patients with liposarcoma

Elevated preoperative neutrophil : lymphocyte ratio as a preoperative indicator of mature cystic teratoma with malignant transformation

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