Pretreatment neutrophil-to-lymphocyte ratio and its dynamic change during neoadjuvant chemotherapy as poor prognostic factors in advanced ovarian cancer

Kim, Yun Ji; Lee, Inha; Chung, Yong Eun; Nam, Eun Ji; Kim, Sung Hoon; Kim, Sang Wun; Kim, Young Tae; Lee, Jung‐Yun

doi:10.5468/ogs.2018.61.2.227

Cited by 25 publications

(26 citation statements)

References 28 publications

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“…Although a continuous high inflammatory status may contribute to the progression of sarcopenia, further research is needed about the most appropriate serum inflammatory markers relating skeletal muscle loss. As demonstrated in previous studies, 4,5,24 the inflammatory markers ALC and NLR recovered during NAC, and the high inflammatory status after NAC was associated not with OS but with poorer PFS. Changes in skeletal muscle may have a stronger prognostic value for long-term survival than do serum inflammatory markers.…”

Section: Discussionsupporting

confidence: 76%

“…6 Recent studies have shown that serum inflammatory markers can be prognostic factors in EOC patients. 4,5,24 Aust et al reported that low mean muscle attenuation reflecting a state of cachexia is associated with serum levels of albumin and the cytokines eotaxin and IL-10. 18 However, the evidence linking serum inflammatory markers to skeletal muscle loss in advanced-stage EOC is still insufficient.…”

Section: Discussionmentioning

confidence: 99%

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Extreme skeletal muscle loss during induction chemotherapy is an independent predictor of poor survival in advanced epithelial ovarian cancer patients

Yoshino

Taguchi

Nakajima

et al. 2020

J of Obstet and Gynaecol

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Aim: Skeletal muscle loss is often observed in advanced cancer patients. This study investigates whether skeletal muscle loss is associated with survival outcomes of advanced epithelial ovarian cancer (EOC) patients after induction chemotherapy (IC) in a Japanese cohort. Whether serum inflammatory markers are associated with skeletal muscle changes is also addressed. Methods: We retrospectively reviewed 60 patients with stage III/IV EOC who underwent IC between 2010 and 2017. Skeletal muscle area (SMA) was measured at the third lumbar vertebrae level on a single axial computed tomography-scan image. Receiver operating curve analysis was used to determine cutoff values of pre-and post-IC SMA and SMA ratio (SMAR). Univariate and multivariate analyses of overall survival (OS) were conducted using the log-rank test and Cox proportional hazards regression model, respectively. Results: The SMA decreased significantly after IC (P = 0.019). The cutoff value between low and high SMAR was 0.96. High or low SMAR was observed in 34 (57%) and 26 (43%) patients, respectively. Univariate analysis revealed that low SMAR was associated with poor OS (P = 0.025). Multivariate analysis showed that incomplete resection during interval debulking surgery (hazard ratio, 0.30; 95% CI, 0.11-0.80; P = 0.016) and a low SMAR (hazard ratio, 3.17; 95% CI, 1.18-9.06; P = 0.022) were independent predictors of poor OS. Of the serum inflammatory markers investigated, only post-IC absolute neutrophil count correlated significantly with SMAR (P = 0.012). Conclusion: Low SMAR can be used to predict poor prognosis in advanced EOC patients who have undergone IC.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Extreme skeletal muscle loss during induction chemotherapy is an independent predictor of poor survival in advanced epithelial ovarian cancer patients

Yoshino

Taguchi

Nakajima

et al. 2020

J of Obstet and Gynaecol

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“…The prognostic power of SIR in relation to neoadjuvant therapies has been reported previously, involving rectal, ovarian, lung and breast cancers. A high mGPS was associated with poor response to NAC in rectal cancer (odds ratio (OR) 0·18, P = 0·006), and low NLR was associated with a good pathological response (OR 0·27, P = 0·046), although this did not retain independent significance in multivariable analysis.…”

Section: Discussionsupporting

confidence: 58%

Neutrophil to lymphocyte ratio as a predictor of response to neoadjuvant chemotherapy and survival in oesophageal adenocarcinoma

et al. 2020

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Background Inflammation has an important role in cancer survival, yet whether serum markers of inflammation predict response to potentially curative neoadjuvant chemotherapy (NAC) in oesophageal adenocarcinoma (OAC) is controversial. This study aimed to determine whether the systemic inflammatory response (SIR) is associated with response to NAC and survival. Methods Consecutive patients with OAC planned for surgery with curative intent received blood neutrophil and lymphocyte measurements at diagnosis to calculate the neutrophil to lymphocyte ratio (NLR). Pathological variables including pTNM stage, differentiation, vascular invasion and Mandard tumour regression grade (TRG) were recorded. TRGs 1 and 2 were taken to represent a good response, and the primary outcome was overall survival. Results During follow‐up of 136 patients, 36 patients (26·5 per cent) had recurrence and 69 (50·7 per cent) died. Receiver operating characteristic (ROC) curve analysis of NLR before NAC predicted poor TRG (area under the ROC curve 0·71, 95 per cent c.i. 0·58 to 0·83; P = 0·002). In univariable analysis, pT category (P < 0·001), pN category (P < 0·001), poor differentiation (P = 0·006), margin positivity (P = 0·001), poor TRG (P = 0·014) and NLR (dichotomized at 2·25; P = 0·017) were associated with poor overall survival, and NLR retained independent significance in multivariable analysis (hazard ratio 2·26, 95 per cent c.i. 1·03 to 4·93; P = 0·042). Conclusion The pretreatment NLR was associated with a pathological response to NAC and overall survival in patients with OAC. Antecedentes La inflamación juega un importante papel en la supervivencia por cáncer, aunque aún no se sabe si los marcadores séricos de inflamación predicen la respuesta a la quimioterapia neoadyuvante (neoadjuvant chemotherapy, NAC) potencialmente curativa en el adenocarcinoma de esófago (oesophageal adenocarcinoma, OAC). Este estudio se propuso determinar si la respuesta inflamatoria sistémica (systemic inflammatory response, SIR) estaba asociada con la respuesta a la NAC y a la supervivencia. Métodos A pacientes consecutivos con OAC en los que se planificó cirugía con intención curativa se les determinó neutrófilos y linfocitos en sangre en el momento del diagnóstico para calcular la tasa neutrófilo‐linfocito (neutrophil‐lymphocyte ratio, NLR). Se registraron variables patológicas que incluían el estadio pTNM, diferenciación tumoral, invasión vascular y grado de regresión tumoral (tumour regression grade, TRG) de Mandard. Los grados TRG 1 y 2 fueron considerados como una buena respuesta y el resultado primario fue la supervivencia global (overall survival, OS). Resultados Durante el seguimiento de 136 pacientes, 36 pacientes (26,5%) presentaron recidiva y 69 pacientes (50,7%) fallecieron. El análisis de las características operativas del receptor (receiver‐operator‐characteristic, ROC) de NLR antes de la NAC predijo una pobre TRG (área bajo la curva ROC, AUC 0,71, i.c. del 95% 0,58‐0,83, P = 0,002). En el análisis univariable, el estadio pT (P < 0,001), ...

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“…Furthermore, ovarian cancer patients with high level of NLR had poor response to chemotherapy [ 18 , 19 ]. Kim et al [ 20 ] suggested that dynamic changes in NLR during chemotherapy might help estimate a more accurate progression-free survival than pretreatment NLR. The positive correlation of pretreatment NLR with platinum resistance was demonstrated in our study as well.…”

Section: Discussionmentioning

confidence: 99%

Serum lactate dehydrogenase is a possible predictor of platinum resistance in ovarian cancer

Ikeda¹,

Yamaguchi²,

Abiko³

et al. 2020

Obstet Gynecol Sci

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The need for tailoring ovarian cancer treatments to individual patients is increasing. This study aimed to evaluate the prognostic value of pretreatment laboratory test data for predicting the response and survival outcomes of platinumbased chemotherapy in ovarian cancer. Methods We enrolled 270 patients with ovarian cancer diagnosed at the Kyoto Medical Center (n=120; group A) and Kyoto University (n=150; group B). Data on 9 blood parameters (neutrophil to lymphocyte ratio [NLR], platelet to lymphocyte rate [PLR], C-reactive protein, lactate dehydrogenase [LDH], glucose, total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein, and triglyceride levels), cancer pathology, cancer stage, cytoreduction outcomes, serum cancer antigen 125 levels, platinum-free interval (PFI), disease-free survival (DFS), and overall survival were assessed retrospectively. Results NLR, PLR, LDH, and HDL were significantly different in advanced stage patients (P<0.001, <0.001, 0.029, and <0.001, respectively). The Kaplan-Meier curves revealed that high LDH level (≥250 U/L) was associated with reduced PFI (P=0.037 and 0.012) and DFS (P=0.007 and 0.002) in groups A and B, respectively. High NLR (≥4) was associated with reduced DFS in both groups (P=0.036 and 0.005, respectively). LDH showed higher area under the curve (AUC) values in predicting platinum resistance with a PFI of less than 6 months and 12 months (AUC=0.606 and 0.646, respectively) than NLR. In the multivariate analysis, LDH remained significant (P=0.019) after adjusting for the 9 blood parameters. Conclusion Serum LDH level may possibly predict platinum resistance and prognosis in ovarian cancer and may be useful when developing precision medicine for individual patients.

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Pretreatment neutrophil-to-lymphocyte ratio and its dynamic change during neoadjuvant chemotherapy as poor prognostic factors in advanced ovarian cancer

Cited by 25 publications

References 28 publications

Extreme skeletal muscle loss during induction chemotherapy is an independent predictor of poor survival in advanced epithelial ovarian cancer patients

Extreme skeletal muscle loss during induction chemotherapy is an independent predictor of poor survival in advanced epithelial ovarian cancer patients

Neutrophil to lymphocyte ratio as a predictor of response to neoadjuvant chemotherapy and survival in oesophageal adenocarcinoma

Serum lactate dehydrogenase is a possible predictor of platinum resistance in ovarian cancer

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