Evaluation of neutrophil‑to‑lymphocyte ratio and calcitonin concentration for predicting lymph node metastasis and distant metastasis in patients with medullary thyroid cancer

Abstract

The aim of the present study was to investigate potential predictive factors of lymph node metastasis (LNM) and distant metastasis (DM) of medullary thyroid cancer (MTC). A total of 61 patients newly diagnosed with MTC at the General Hospital of the Chinese People's Liberation Army between January 2001 and January 2016 were enrolled and divided into two groups according to the results of preoperative examinations and surgical histopathology as follows: Group NM (without metastases), and group M (with metastases). Univariate logistic regression analysis demonstrated that sex, tumor size, preoperative peripheral blood neutrophil-to-lymphocyte ratio (NLR), and concentration of carcinoembryonic antigen (CEA) and calcitonin (Ctn), were significantly associated with LNM and DM. The multivariate analysis revealed that a Ctn concentration of >500 pg/ml [odds ratio (OR)=21.422; 95% confidence interval (CI): 2.611-175.731] and the NLR (OR=5.918; 95% CI: 1.147-30.541) were positively correlated with LNM and DM. The optimal cutoff value of the NLR for predicting LNM and DM obtained from receiver operating characteristic curve analysis was 1.784 (sensitivity 68.3% and specificity 80%), and the area under the curve was 0.717. In conclusion, the findings of the present study strongly suggest that inflammation and immune activation of MTC cells promote LNM and DM, and that higher values of NLR and Ctn concentration confer a high risk of metastasis.

The Immune Landscape of Thyroid Cancer in the Context of Immune Checkpoint Inhibition

“…Preoperative NLR was not associated with clinicopathological characteristics in PTC patients [159,160]. By contrast, other studies reported that the preoperative NRL was correlated with the size and lymph node metastasis of PTC patients [161,162,163,164]. In conclusion, the diagnostic and prognostic significance of NLR in different types of TC remains uncertain.…”

Prognostic value of the postoperative neutrophil-lymphocyte ratio in solid tumors: A meta-analysis

“…Recent studies have demonstrated that the NLR represents the balance between antitumor immune function and the inflammatory response [41]. Increased preoperative NLR was associated with lymph node metastasis and distant metastasis [42] as well as treatment resistance [43]. We suspect that the postNLR may play an important role in the activation of micrometastases and resistance to treatment.…”

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).…”