High Blood Neutrophil-to-Lymphocyte Ratio Is an Indicator of Poor Prognosis in Malignant Mesothelioma Patients Undergoing Systemic Therapy

Abstract

Purpose: Asbestos-induced chronic inflammation is implicated in the pathogenesis of malignant mesothelioma (MM). We have investigated blood neutrophil-to-lymphocyte ratio (NLR), an index of systemic inflammation, as a prognostic factor in MM patients.Experimental Design: Patients with MM who had systemic therapy at participating institutes were studied. Potential prognostic factors such as age, gender, performance status, histologic subtype, and baseline laboratory parameters, including NLR, were analyzed. Overall survival from commencement of therapy was determined by the Kaplan-Meier method. Multivariate analyses using Cox Regression model were performed with significant factors (P 0.05) to determine their independent effect.Results: A total of 173 MM patients undergoing systemic therapy including 119 patients receiving firstline therapy and 54 patients receiving second-or third-line therapy were included in this retrospective evaluation. Forty-two percent of patients had an elevated NLR at baseline. The following variables were predictive of survival: female gender (P ¼ 0.044), epithelioid histologic subtype (P < 0.001), baseline white blood cell count less than 8.3 Â 10 9 /L (P ¼ 0.008), baseline platelet count 400 Â 10 9 /L or less (P ¼ 0.05), and NLR of 5 or less (P < 0.001). After multivariate analysis, histologic epithelioid subtype [hazard ratio (HR) ¼ 2.0; 95% confidence interval (CI) ¼ 1.3-2.9; P ¼ 0.001], and NLR less than 5 (HR ¼ 2.7; 95% CI ¼ 1.8-3.9; P < 0.001) remained independent predictors. The 1-year survival rate was 60% versus 26%, whereas the 2-year survival rate was 34% versus 10% for NLR less than 5 and 5 or greater, respectively. In the separate analyses of chemotherapy-naive and previously treated patient groups, NLR was an independent predictor of survival in both groups.Conclusion: Our results indicate that NLR is an independent predictor of survival for patients with MM undergoing systemic therapy. Clin Cancer Res; 16(23); 5805-13. Ó2010 AACR.

Prognostic Role of C-reactive Protein in Gastric Cancer: A Meta-analysis

“…GPS is a combination of serum CRP and albumin concentrations (Forrest et al, 2003), which appears to reflect the systemic inflammatory response as well as nutritional status (Kao et al, 2010;Proctor et al, 2011). Nevertheless, in Hwang's study, where 402 patients with advanced gastric adenocarcinoma were included, poor GPS depended largely on elevated CRP level other than descending albumin level (Hwang et al, 2011).…”

Neutrophil Count and the Inflammation-based Glasgow Prognostic Score Predict Survival in Patients with Advanced Gastric Cancer Receiving First-line Chemotherapy

“…Previous studies used a cut-off point ranging from 2.5 to 5.0 for NLR (Yamanaka et al, 2007;Kao et al, 2010;Chua et al, 2011;Fox et al, 2013;Lee et al, 2013) and 150 to 300 for PLR (Aliustaoglu et al, 2010;Asher et al, 2011;He et al, 2013) in advanced malignancies. We used the medians of distribution as cut-off points for dichotomization.…”

Pretreatment Neutrophil-to-Lymphocyte Ratio in Metastatic Castration-Resistant Prostate Cancer Patients Treated With Ketoconazole: Association with Outcome and Predictive Nomogram

“…The neutrophil-to-lymphocyte ratio (NLR) is an easily measured, reproducible, and inexpensive marker of systemic inflammation [21][22][23][24] that is associated with outcome in different cancer types. The pretreatment NLR was found to be an independent predictor of outcome in patients treated with systemic therapies for malignant mesothelioma [21], colorectal liver metastases [22], advanced pancreatic cancer [23], ovarian cancer [24], gastric cancer [25], and renal cell carcinoma [26].…”

“…The pretreatment NLR was found to be an independent predictor of outcome in patients treated with systemic therapies for malignant mesothelioma [21], colorectal liver metastases [22], advanced pancreatic cancer [23], ovarian cancer [24], gastric cancer [25], and renal cell carcinoma [26].…”