Pretreatment Inflammatory Indexes as Prognostic Predictors of Survival in Patients Suffering From Synovial Sarcoma

Abstract

Background: Inflammatory indexes have been considered as important prognostic factors in various types of cancers. This study aimed to evaluate prognostic values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR) in patients with synovial sarcoma (SS).Methods: One hundred and three patients diagnosed with SS were collected during 2006–2017 and divided into high or low NLR, PLR, and LMR groups based on receiver operating characteristic curve analysis. Data of clinical variables were collected for univariate and multivariate analyses. The Kaplan–Meier method was used to analyze OS and PFS of SS patients and significance was evaluated by the log-rank test.Results: The optimal cut-off values of NLR, PLR, and LMR were 2.70, 154.99, and 4.16, respectively. Univariate analyses identified resection surgery, distant metastasis, NLR, PLR, and LMR as the potential predictors of progression-free survival (PFS) and overall survival (OS). In the multivariate analyses, NLR was independent predictors for OS (HR 5.074, 95% CI 1.200–21.463, p = 0.027). Resection surgery, metastasis and LMR was independent predictors for PFS (HR 5.328, p = 0.017; HR 3.114, p = 0.04 and HR 0.202, p = 0.025, respectively).Conclusion: Resection surgery, distant metastasis, NLR, and LMR were independent prognostic factors of PFS and OS in patients with synovial sarcoma. Surgery as an effective treatment strategy, other than radiotherapy and chemotherapy, can significantly prolong survival of synovial patients. Clinical utility of these inflammatory biomarkers should be validated in a larger sample size study.

Meta-Analysis of Hematological Biomarkers as Reliable Indicators of Soft Tissue Sarcoma Prognosis

“…Elevated PLR was clearly associated with poor OS (HR: 1.86, 95% CI: 1.32-2.64, P = 0.0004), however, significant heterogeneity was observed (I² = 85%; Figure 5). The effect of PLR and DFS was reported in five studies (21,25,28,34,40). The fixed-effect model illustrated that an elevated PLR correlated with poor DFS (HR: 1.61, 95% CI: 1.32-1.95, P < 0.00001) with no heterogeneity among the studies (I² = 0%; Figure 5).…”

“…The association between PLR and OS was demonstrated in seven studies (21,25,27,28,34,37,40). Elevated PLR was clearly associated with poor OS (HR: 1.86, 95% CI: 1.32-2.64, P = 0.0004), however, significant heterogeneity was observed (I² = 85%; Figure 5).…”

“…Six studies provided the data of NLR and DFS in STS (18,21,23,25,34,40). The combined analysis indicated that NLR had a significant prognostic effect on DFS (HR: 1.72, 95% CI: 1.43-2.08, P < 0.00001), and no heterogeneity was detected (I² = 0%; Figure 2).…”

“…The data on prognostic value of NLR for OS were reported in 10 studies holding 1,964 STS patients (18,21,22,25,27,28,33,34,37,40). Overall, elevated NLR was significantly associated with poor OS (HR: 2.08, 95% CI: 1.60-2.69, P < 0.00001), and due to the moderate heterogeneity observed, a random effect model was used (I² = 65%; Figure 2).…”

“…A total of four studies provided LMR data on OS in STS patients (21,25,34,40). The pooled data demonstrated that a low LMR had a visible prognostic effect on OS with an HR of 2.01 (95% CI: 1.65-2.45, P < 0.00001).…”