An Increased Neutrophil-to-Lymphocyte Ratio Predicts Incomplete Response to Therapy in Differentiated Thyroid Cancer

Abstract

Background: Previously we have shown that an elevated baseline neutrophil-to-lymphocyte ratio (NLR) was associated with a high risk of recurrence in patients with differentiated thyroid cancer. The clinical significance of the longitudinal changes in NLR following treatment remained unestablished.Methods: Adults patients with differentiated thyroid cancer were included in the study if the follow-up NLR data at 6 to 18 months after initial treatment were available. The response to treatment was categorized as excellent, indeterminate, biochemical incomplete, and structural incomplete as per guidelines of the American Thyroid Association.Results: Among 151 patients with thyroid cancer, a significant decrease in NLR following treatment was observed in those with stage I disease, those with low risk of recurrence, and those with an excellent response to therapy. Patients with a structural incomplete response had a significant increase in NLR at follow-up (p = 0.012). On multivariate analysis, incomplete response to therapy was associated with male sex (odds ratio [OR] = 3.35), tumor size (OR = 1.63), lymph node metastasis (OR = 4.80), distant metastasis (OR = 12.95), and increased NLR (OR = 13.68).Conclusions: An increase in systemic inflammation following treatment as measured by NLR is independently associated with an incomplete response to therapy in differentiated thyroid cancer.

Is papillary thyroid microcarcinoma a biologically different disease? A propensity score‐matched analysis

“…A desmoplastic stromal reaction can be found in larger microcarcinomas with invasion or lymph node metastases . Using the neutrophil‐to‐lymphocyte ratio (NLR) as a surrogate marker of systemic inflammation, we reported that an increased NLR may predict an incomplete response to therapy in differentiated thyroid cancer . Of interest, microcarcinoma aggressiveness is associated with specific subsets of tumor‐infiltrating lymphocytes.…”

“…36 Using the neutrophil-to-lymphocyte ratio (NLR) as a surrogate marker of systemic inflammation, we reported that an increased NLR may predict an incomplete response to therapy in differentiated thyroid cancer. 37 Of interest, microcarcinoma aggressiveness is associated with specific subsets of tumorinfiltrating lymphocytes. Infiltration of FOXP3 + regulatory T cells may mediate peripheral immune tolerance and contribute to tumor progression in papillary thyroid microcarcinomas.…”

Value of preoperative neutrophil-to-lymphocyte ratio in predicting thyroid cancer in intermediate category fine needle aspiration pathology: retrospective study

“…The accuracy of NLR for different cut-off values is given in Table 3. Elevated preoperative NLR has been shown to be related with incomplete response to therapy [22], poor tumor differentiation [23], lymph node invasion [24], advanced stage [25] and higher thyroglobulin values [26] in thyroid malignancies. On the other hand, in 2016, a meta-analysis of 6 prospective cohorts with 6283 differentiated thyroid cancer patients revealed no difference in NLR 6 between patients with cancer and benign nodules with a mean difference of 0.19 (95% CI: -0.09-0.46, p<0.001).…”

Association between subjective symptoms and obesity and postoperative recurrence in differentiated thyroid cancer: a matched-pair analysis

“…Furthermore, adiposity is associated with a state of chronic inflammation. After the initial treatment of thyroid cancer, an increase in neutrophil-to-lymphocyte ratio suggests an incomplete response to therapy 39 . It is worth noting that bariatric surgery is associated with decreased risk of some hormone-related cancers 40 .…”