Baseline neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) correlate with advanced stages in cutaneous squamous cell carcinoma

Abstract

Background The neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) at diagnosis have been shown to correlate with advanced disease and to be prognostic factors in many tumors. However, their role as a prognostic factor for cutaneous squamous cell carcinoma (cSCC) has not yet been studied.Objective Therefore, the aim of our study was to evaluate the correlation of NLR and RDW with stages of disease in patients with cSCC in order to define whether or not higher values of these two markers correlate with a more aggressive disease.Methods We retrospectively analyzed the NLR and RDW in a total of 51 newly diagnosed cSCC patients. NLR and RDW were calculated using data obtained from the complete blood count (CBC). ResultsMedian NLR among patients with the non-advanced disease (in situ and stage I) was 2.2, whereas median NLR for patients with advanced disease was 4.87. Median RDW among patients with early stage disease was 13.7%, while median RDW in patients with advanced disease was 15.81%. Statistical analysis showed positive associations of advanced cSCC stages with NLR or RDW higher than 3.07 or 14.5%, respectively.Conclusions Therefore, our analysis demonstrated how both NLR and RDW represent cheap and easily available factors that could be used as markers for advanced cSCC.They could help to identify patients with advanced stages disease that requires a strict follow-up.

Role of Neutrophil-to-Lymphocyte Ratio (NLR) in Patients with Mycosis Fungoides

“…Among the non-melanoma skin cancers, a retrospective analysis of newly diagnosed cutaneous squamous cell carcinoma patients showed that the median NLR among patients with early stage disease (in situ and stage I) was 2.2, while the median NLR for patients with advanced disease was 4.87. These data demonstrate how high NLRs correlate with higher stages of disease, requiring a strict follow-up and an early treatment for those patients with cutaneous squamous cell carcinoma and a high NLR [50]. Furthermore, in a single-center retrospective case series, Maeda et al, in a previous analysis, analyzed the relationship between the NLR and survival in individuals with squamous cell carcinoma of the skin; furthermore, they studied the correlation between the NLR and sentinel lymph node positivity.…”

“…These findings can be applied also in solid cancers where an elevated NLR is correlated to a dismal prognosis [47][48][49][50]. Recently, some authors have also demonstrated how activated neutrophils can produce the neutrophil extracellular traps (NETs) that are net-like structures composed of DNA-histone complexes and proteins [51].…”

“…The neutrophil-tolymphocyte ratio as a prognostic indicator in visceral malignancies has been analyzed in previous reports, underlining an association between inflammation and tumorigenesis that nowadays is commonly recognized [48]. Many authors have implied that an elevated neutrophil-to-lymphocyte ratio (NLR) has a prognostic meaning for inferior outcomes in patients with cutaneous malignancies, such as melanoma, cutaneous squamous cell carcinoma, and Merkel cell carcinoma [50,67,68]. In a retrospective analysis of 97 consecutive patients with metastatic melanoma who received treatment with the anti PD-1 nivolumab, those patients who had NLRs ≥ 5 at diagnosis had considerably lower overall survival and progression-free survival compared to patients with NLRs < 5, demonstrating how the NLR was associated with improved survival when baseline levels were lower than the cut-off values [67].…”

The Neutrophil-to-Lymphocyte Ratio as a Biomarker in Cutaneous Oncology: A Systematic Review of Evidence beyond Malignant Melanoma

“…In a retrospective study with 51 newly diagnosed cSCC patients, Di Raimondo et al [ 43 ] evaluated the correlation of NLR with the stage of the disease. With a median NLR = 2.2, the NLR values were significantly lower in non-advanced disease stages (in situ and stage I), compared to more advanced (stages > I) of cSCC (NLR = 4.87).…”

Spectrum of malignant and premalignant skin lesions in 505 adult subjects at risk of skin cancers

“…PLR, similar to NLR and ELR, is a simple blood biomarker that has previously been linked to systemic inflammation and cancer of many types [ 29 ]. Many studies have shown connections in these biomarkers in MM and cutaneous SCC, yet evidence on BCC is sparse [ 19 , 30 , 31 ]. Inflammation and immunity have commonly been accepted to play a role in carcinogenesis, and these blood biomarkers could serve as a minimally invasive and inexpensive method in skin cancer risk assessment.…”