Preoperative Neutrophil-to-Lymphocyte Ratio as a Prognostic Factor in Uterine Sarcoma

Abstract

Background: Recent studies have demonstrated that the tumor microenvironment, known to be influenced by inflammatory cells, plays a crucial role in cancer progression and clinical outcome of patients. The objective of the present study was to investigate prognostic values of preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for disease-free survival (DFS) and overall survival (OS) of uterine sarcoma patients. Methods: Ninety-nine patients with uterine sarcoma treated in eight multicenter institutions over the last 20 years were retrospectively analyzed. Curves of DFS and OS were calculated using the Kaplan–Meier method, and univariate and multivariate analyses of various prognostic factors were performed using a Cox proportional hazard regression model. Results: High NLR was significantly associated with worse DFS (p = 0.007) and OS (p = 0.039). Advanced stage (p = 0.017) and high mitotic index (p = 0.036) retained their prognostic significance for DFS. Other clinical variables, including PLR, CA125, and lactate dehydrogenase (LDH) failed to show significant impact. Conclusions: Our findings showed that an elevated preoperative NLR was associated with poor clinical outcome in uterine sarcoma patients. Our results suggest that high NLR in early-stage uterine sarcoma patients might indicate that such patients need more intensive treatments.

Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma

“…29 On the other hand, lymphocytes are involved in cell-mediated response to tumor infiltration, and a low lymphocyte count might result in inadequate immune response, and thus, be associated with unfavorable outcomes. 11 In the present study, lymphocyte counts were similar in LMS and LM, but WBC and neutrophil counts were higher in LMS patients (Tables 1 and 3), which is in accord with previous studies that reported an elevated neutrophil count was associated with a preoperative diagnosis of LMS. 4,18,30 The cutoffs of WBC and ANC in this study are in the normal range.…”

“…32,34 Regarding gynecologic malignancies, high NLR is associated with poor clinical outcomes in ovarian, endometrial, and cervical cancer, and in uterine sarcoma. 11,32,33,35 In a metaanalysis conducted by Wu et al in cervical cancer, an elevated NLR was found to be closely associated with poor clinical outcomes and unfavorable clinicopathological factors. 36 Similarly, Jeong et al reported that an elevated preoperative NLR (≥2.60) was associated with poor clinical outcomes in uterine sarcoma patients.…”

“…Recent studies indicate that NLR might be a useful diagnostic and prognostic marker for different cancers. 11,[32][33][34][35][36] A high NLR represents an increase in immunosuppressive status, and reportedly, is associated with poor survival in esophageal, gastric, colorectal, lung, breast cancer, and urologic cancers. 32,34 Regarding gynecologic malignancies, high NLR is associated with poor clinical outcomes in ovarian, endometrial, and cervical cancer, and in uterine sarcoma.…”

“…[5][6][7][8][9] Other researchers have also reported that systemic inflammatory markers have prognostic and diagnostic values in various malignancies. 10,11 However, the values of preoperative hematological parameters for the differentiation of LMS and LM have not been fully determined.…”

The clinical impact of three validated PD-L1 immunohistochemistry assays as a prognostic factor in small cell lung cancer

“…This result is consistent with our findings. Furthermore, positive SP142 assay was found to be a more significant independent prognostic factor than the NLR, which has been reported as a prognostic factor in patients with various types of cancer (32,33). Interestingly, the survival subgroup analysis of ES patients indicating that positive results of each PD-L1 assay showed more distinct differences than with the analysis of LS patients.…”