Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Blood to Distinguish Lung Cancer Patients from Healthy Subjects

Abstract

Objective. Inflammation-driven markers play a crucial role in tumorigenesis and tumor progression. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in blood are systemic inflammatory response markers. Some reports have showed that NLR and PLR are related to a poor prognosis in patients with lung cancer. However, little studies have reported whether NLR and PLR can be diagnostic markers for lung cancer. The aim of the current study is to investigate the roles of NLR and PLR in diagnosing lung cancer. Methods. This study analyzed data from lung cancer patients and healthy individuals in Wuxi People’s Hospital Affiliated with Nanjing Medical University. The Mann–Whitney U test was performed to compare differences between the lung cancer group and the control group. Based on white blood cell (WBC) counts, both lung cancer patients and healthy individuals were divided into the low-level group, moderate-level group, and high-level group. The Kruskal-Wallis test was applied to compare differences of NLR and PLR among those groups with different WBC counts. Spearman correlation analysis was used to assess correlations. Receiver operating characteristic (ROC) curves were performed to determine diagnostic accuracy. Results. 210 patients diagnosed with lung cancer and 261 healthy subjects were enrolled in this study. Levels of NLR and PLR increased in the lung cancer group compared with the control group ( P < 0.001 ). For the lung cancer group, NLR levels could rise with the increasing of WBC levels ( P < 0.001 ) while PLR levels had no significant variation with the increasing of WBC levels ( P = 0.206 ). For the control group, NLR levels could rise with the increasing of WBC levels ( P < 0.001 ) while PLR levels would decline with the increasing of WBC levels ( P < 0.001 ). In the lung cancer group, both NLR and PLR had no significant correlations with aspartate transaminase, urea, and glucose. The area under the curve (AUC) with 95% confidence interval (95% CI) of NLR and PLR to distinguish lung cancer patients from healthy subjects was, respectively, 0.684 (0.634-0.735) and 0.623 (0.571-0.674). When NLR and PLR were combined, AUC (95% CI) increased to 0.691 (0.642-0.740). Conclusions. NLR and PLR alone have moderate ability to distinguish lung cancer patients from healthy subjects. Furthermore, combination forms of NLR and PLR can improve diagnostic ability.

The response prediction and prognostic values of systemic inflammation response index in patients with advanced lung adenocarcinoma

“…However, there was no obvious difference between healthy patients and benign lung disease patients, which to some extent confirmed the role of inflammatory indicators in the progression of LUAD. Zhu et al 33 also reported that NLR and PLR could be used as diagnostic markers for lung cancer patients to distinguish healthy subjects. In addition, we found that serum albumin and LDH were significantly different among the three groups, suggesting the role of albumin and LDH in the occurrence and development of pulmonary disease, especially LUAD.…”

Quantification of fibrinogen-to-pre-albumin ratio provides an integrating parameter for differential diagnosis and risk stratification of early-stage colorectal cancer

“…Inflammation induces carcinogenic mutagenesis and regulates carcinogenesis of CRC [ 25 – 27 ]. Common inflammatory ratios such as neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio show moderate diagnostic efficacies in distinguishing glioma, lung cancer, and healthy subjects, respectively [ 28 , 29 ]. Our previous study also found that circulating FPR was superior to AFR and NLR in diagnosing stage I–IV CRC in healthy individuals [ 30 ].…”

Pre-transplant platelet-to- lymphocyte ratio predicts outcome after allogeneic hematopoietic stem cell transplantation

“…Most of these criteria are based on disease status, comorbidities or other pre-HSCT parameters. Recently, parameters reflecting the inflammatory status such as NLR, MLR and PLR have been recognized to play an important role to identify patients with higher risk of NRM, relapse and impaired OS especially in solid cancers or solid organ www.nature.com/scientificreports/ transplantation settings 6,7,[18][19][20][21] . Data in hematological diseases, especially in autologous or allogeneic stem cell transplantation are rare or missing.…”