High neutrophil/lymphocyte ratio at cancer diagnosis predicts incidence of stroke in cancer patients

Abstract

Although cancer increases the incidence and severity of ischemic stroke, there is no reliable method for predicting ischemic stroke in cancer patients. To evaluate the prognostic capacity of the neutrophil-to-lymphocyte ratio at cancer diagnosis for predicting the incidence of ischemic stroke, we used a hospital-based cancer registry that contained clinical data from all patients treated for cancer at Osaka University Hospital between 2007 and 2015. The neutrophil-to-lymphocyte ratio was calculated after dividing absolute neutrophil counts by absolute lymphocyte counts. These counts were obtained within 1 month after cancer diagnosis. The primary endpoint was new-onset ischemic stroke within 2 years after cancer diagnosis. Of the 18,217 included cancer patients (median age: 65.2 years), 69 (0.38%) had ischemic stroke. Unadjusted Cox regression analysis stratified by cancer site demonstrated that each 1-unit increase in the neutrophil-to-lymphocyte ratio was associated with a significant 7.2% increase in the risk of an ischemic stroke event (95% confidence interval 1.041–1.103, P<0.001). Survival tree analysis and the Kaplan–Meier method suggested that patients with and without atrial fibrillation who had increased neutrophil-to-lymphocyte ratios had a higher risk of ischemic stroke. Multivariate Cox proportional hazard models, adjusted for cancer site and stage, revealed that patients with high neutrophil-to-lymphocyte ratios (>15) had higher ischemic stroke risk than patients with low neutrophil-to-lymphocyte ratios (<5). This was true among cancer patients both with (hazard ratio 11.598; 95% confidence interval 0.953–141.181) and without (hazard ratio 7.877; 95% confidence interval 2.351–26.389) atrial fibrillation. The neutrophil-to-lymphocyte ratio at cancer diagnosis is associated with the incidence of ischemic stroke among cancer patients and might thus be useful for identifying patients at high risk of ischemic stroke, allowing us to guide future preventive interventions. Kawano et al. report that the elevated neutrophil-to-lymphocyte ratio at cancer diagnosis is associated with the incidence of ischemic stroke within 2 years after cancer diagnosis, suggesting that neutrophil-to-lymphocyte ratio at cancer diagnosis might be useful for identifying patients at high risk of ischemic stroke.

Predictive value of neutrophil to lymphocyte ratio for ischemic stroke in patients with atrial fibrillation: A meta-analysis

“…NLR is also an important predictor of AF prognosis ( 7 ). It has been reported that NLR can be used to assess stroke risk and prognosis in AF patients ( 8 – 10 ), but there are also studies that suggest that NLR is not an independent biomarker for predicting stroke ( 11 ). Therefore, the ability of NLR to independently assess or predict stroke risk in AF patients remains unclear.…”

Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer

“…Lower body mass index and marginally less obese patients can be found with a preoperative PLR > 160[ 53 ], NLR of patients with T2DM or hypertension do not differ from those without the two conditions[ 54 ], LMR combined with carbohydrate antigen 19-9 has good predictive value on postoperative recurrence in CRC + T2DM patients[ 55 ], and PLR is significantly higher in CRC patients with metabolic syndrome[ 56 ]. Furthermore, colorectal adenoma, which has a high risk to develop into CRC[ 57 ], has an increased prevalence in metabolic syndrome patients with higher NLR values[ 23 ], and higher NLR at the diagnosis of CRC may be a sign of stroke within 2 years after cancer diagnosis[ 58 ]. We found that preoperative RPR was marginally and significantly higher in those CRC patients with T2DM and previous major CV event in their medical history, respectively.…”

The Index of Esophageal Cancer Related Ischemic Stroke: A Retrospective Patient Control Study

“…Previous studies have made a variety of efforts, and these studies have evaluated several factors, such as increased levels of DD, C-reactive protein and neutrophil/lymphocyte ratio in the blood and the presence of multiple ischemic lesions in neuroimaging, which have been used as biomarkers of cancer-related ischemic stroke. [27][28][29][30] However, due to the lack of specific substances or measures, the precise measures to identify cancer-related cerebral infarction are still unclear. In this study, considering that the three independent risk factors for ECIS may play their own roles or may play a role together as a factor in the development of ECIS, we established an ROC curve to identify the factors that play the greatest role in the development of ECIS.…”