Assessment of the prognostic role of neutrophil-to-lymphocyte ratio following complete resection of thymoma

Abstract

BackgroundThe introduction of the new TNM staging system for thymic epithelial malignancies produced a significant increase in the proportion of patients with stage I disease. The identification of new prognostic factors could help to select patients for adjuvant therapies based on their risk of recurrence. Neutrophil-to-lymphocyte ratio (NLR) has recently gained popularity as reliable prognostic biomarker in many different solid tumors. The aim of this study is to assess the utility of NLR evaluation as a prognostic marker in patients with surgically-treated thymoma.MethodsA retrospective analysis was conducted among patients who underwent resection for thymoma in a single center. Patients were divided in two groups, under (low-NLR-Group = 47 patients, 60%) and above (high-NLR-Group = 32 patients, 40%) a ROC-derived NLR cut-off (2.27). Associations with clinical-pathological variables were analyzed; disease-free survival (DFS) was identified as the primary endpoint.ResultsBetween 2007 and 2017, 79 patients had surgery for thymoma. Overall 5-year DFS was 80%. Univariate survival analysis demonstrated that NLR was significantly related to DFS when patients were stratified for TNM stage (p = 0.043). Five-year DFS in the low-NLR-Group and in the high-NLR-Group were respectively 100 and 84% in stage I-II, and 66 and 0% in stage III. TNM stage resulted as the only independent prognostic factor at multivariate analysis, with hazard ratio of 3.986 (95% CI 1.644–9.665, p = 0.002).ConclusionsHigh preoperative NLR seems to be associated to a shorter DFS in patients submitted to surgery for thymoma and stratified for TNM stage.

Nomogram Predict Overall Survival of Patients with Thymic Epithelial Tumors After Surgery

“…This is the same as other people's research results. [6,27] In addition, a higher preoperative serum ALB level can often result in a more satisfactory prognosis, which is consistent with the ndings of other studies reporting better prognosis in patients with thymic epithelial tumors with higher ALB levels. [15] In predicting the prognosis of certain cancers, nomograms have been developed and proven to be more accurate than traditional staging systems.…”

Thymic epithelial tumors: Do we know all the prognostic factors?

“…demonstrated a statistically significant correlation between neutrophil‐to‐lymphocyte ratio (NLR) and disease‐free survival (DFS) in patients stratified by TNM ( P = 0.0043). A five‐year DFS rate in patients with low NLR compared to high NLR was 100% and 84% in stage I–II, according to TNM and 66% and 0% in stage III, respectively 11 . Anemia was not shown to be an independent prognostic factor.…”

“…Additionally, resection radicality, clinical stage and histological type are, together with the initial tumor size, the risk factors for disease recurrence after surgery 9 . There have also been reports of the prognostic value of the so‐called circulating biomarkers (C Reactive Protein – CRP and lactate dehydrogenase – LDH), 10 as well as the importance of the neutrophil‐to‐lymphocyte ratio (NLR) 11 for survival and prognosis.…”

Prognostic Value of Systemic Inflammatory Markers and the Nutrition Status in Thymic Epithelial Tumors with Complete Resection

“…In recent years, many studies have reported that a high NLR or MLR is associated with a poor survival in patients with various malignant tumors, including gastric cancer, colorectal cancer, lung cancer, esophageal cancer, and breast cancer [5][6][7][8][9]. To our knowledge, there have been only ve reports examining the association of the NLR with the prognosis of TETs, and the present one is the secondlargest study [23][24][25][26][27]. The cut-off values used in those reports ranged from 1.96 to 4.10, and the value used in the present study was 4.3, which was similar to the values in the previous ve reports.…”