Elevated neutrophil-to-lymphocyte ratio is an independent poor prognostic factor in patients with intrahepatic cholangiocarcinoma

Abstract

We investigated whether elevated neutrophil-to-lymphocyte ratio (NLR) was associated with poor anti-tumor immunity and prognosis in patients with intrahepatic cholangiocarcinoma (ICC). Clinicopathologic data of 102 patients with ICC who underwent hepatectomy was retrospectively analyzed. The Kaplan-Meier method and Cox regression model were used to analyze the survival and prognosis. The percentage of overall lymphocytes, T cells and CD8+ T cells in the high NLR group was lower than that in the low NLR group. The percentage of PD-1+CD4+ and PD-1+CD8+ T cells was higher and the percentage of IFN-γ+CD4+ and IFN-γ+CD8+ T cells was lower in the high NLR group than that in the low NLR group (p = 0.045, p = 0.008; p = 0.012, p = 0.006). Density of tumor-infiltrating CD3+ T cells in the high NLR group was lower than that in the low NLR group (p < 0.001). Elevated NLR was an independent predictor for poor overall survival (OS; p = 0.035) and recurrence-free survival (RFS; p = 0.008). These results indicate that elevated NLR is associated with poor anti-tumor immunity and could be a poor biomarker for prognosis in patients with ICC.

Surgical Margins and Lymphoid Infiltrate in Cholangiocarcinoma: When a Surgical Technique "Pushes" Tumor Biology to Provide Answer

“…Finally, some recent papers investigated the prognostic impact of circulating neutrophils (neu), lymphocytes (lymph) and platelets (PLT), and their ratios. In MFCCC patients, neu/lymph and PLT/lymph ratios have been associated with survival (53)(54)(55)(56). However, we are not having confirmatory results in this sense, since neu/lymph and the PLT/lymph seem associated neither with LI at pathology nor with prognosis.…”

Inflammatory markers in intrahepatic cholangiocarcinoma: Effects of advanced liver disease

“…The exact mechanism of how the NLR ratio affects survival is unclear. Lin et al examined 102 patients with ICC and saw that higher PD‐1+CD4+ and PD‐1+CD8+ T cells were found in the high‐NLR group while higher amounts of IFN+CD4+ and IFN+CD8+ T cells were seen in the low‐NLR group. Furthermore, the high‐NLR group experienced an increased density of tumor‐infiltrating CD3+T cells.…”

“…The neutrophil‐to‐lymphocyte ratio (NLR) has been studied as a biomarker in multiple solid tumors, such as hepatocellular carcinoma, renal, breast, and metastatic melanoma . Several researchers have also investigated the NLR in ICC; however, little work has been done on the relative importance of the NLR, the platelet‐to‐lymphocyte ratio (PLR), and the systemic immune‐inflammation index (SII). Furthermore, this study seeks to examine the interplay between inflammatory markers and underlying liver disease in ICC, with the hypothesis that chronic inflammation may affect the prognostic value of these biomarkers.…”

Neutrophils in cancer

“…The neutrophil‐to‐lymphocyte ratio (NLR) was introduced more recently to represent probably, at least in most cases, the same phenomenon, and this appears to be an even better predictor for poor disease and treatment outcome (reviewed in ). Different types of cancer where a high NLR correlates with poor survival, and in some cases also a worse response to treatment, include melanoma , hepatocellular carcinoma , non–small cell lung cancer , colorectal cancer , nasopharyngeal carcinoma , breast cancer , intrahepatic cholangiocarcinoma , prostate cancer , pancreatic cancer , and gastric cancer . The NLR appears in most cases a reflection of the systemic inflammatory response that occurs as a consequence of the cancer in patients, and it makes sense that this response is most pronounced in advanced cancer .…”