Pretreatment Neutrophil-to-Lymphocyte Ratio Was a Predictor of Lymph Node Metastasis in Endometrial Cancer Patients

Abstract

Objective: The pretreatment neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have been reported to be useful as markers for prognostic factors and metastasis in several cancers. The aim of this study was to identify the predictor of lymph node (LN) metastasis by pretreatment NLR and PLR in patients with endometrial cancer. Methods: Medical charts of the patients with endometrial cancers that received primary surgery at our hospital between 2007 and 2013 were retrospectively analyzed. The cutoff value was calculated from the receiver operating characteristics (ROC) curve. Clinicopathological parameters including inflammatory markers were evaluated for LN metastasis using multiple logistic regression analysis. Results: Among 197 patients enrolled in the study, LN metastasis was observed in 25 patients (13%). ROC curves demonstrated that the best cutoff value of NLR for predicting LN metastasis was 2.18 and that of PLR was 206. In univariate analysis, several pathological factors, NLR, and PLR were identified as predictors of LN metastasis. In multiple logistic regression analysis, lymphovascular invasion and NLR were found to be significantly correlated with LN metastasis (p = 0.002, 0.039). Conclusion: A higher pretreatment NLR was identified as a predictor of LN metastasis in endometrial cancers. Although further study is needed to confirm the results, NLR could be a candidate clinical marker for detection of LN metastasis.

<p>Performance of a Nomogram Based on the Integration of Inflammation Markers with Tumor Staging in Prognosis Prediction of Stage III Colorectal Cancer</p>

“…The worse prognosis associated with higher PLR might also reflect an important role of platelet dominant inflammation response in the process of lymph node metastasis in CRC, except for the neutrophil dominant inflammation effects that were confirmed by NLR in a previous study. 22 Moreover, we also found that T4 stage and N stages were independent prognosis factors in stage III CRC patients, which is consistent with the latest NCCN guideline recommendations 23 and previous reports. 24,25 P-glycoprotein (P-GP), a member of the ATP binding box (ABC) superfamily, extrudes chemotherapeutic drugs out of cells.…”

Incorporation of pretreatment leukocytosis and thrombocytosis into the FIGO staging system for prognosis in surgically treated endometrial cancer

“…Previous studies of endometrial cancer have suggested that the presence of pretreatment leukocytosis or thrombocytosis is associated with an advanced clinical stage and is an independent predictor of decreased survival 10–14,16,17 . The present results showed, however, that women who had only leukocytosis or only thrombocytosis had a favorable prognosis; in other words, they had survival rates equivalent to those of women with normal leukocyte/platelet counts.…”

“…To our knowledge, eight retrospective studies have investigated the significance of elevated leukocyte and platelet counts among women with endometrial cancer (Table ) 10–13 . Of these, four studies used higher leukocyte count and higher platelet count as prognostic variables, 10,11,14,15 whereas the other four used higher neutrophil‐to‐lymphocyte ratio (NLR) and higher platelet‐to‐lymphocyte ratio (PLR) 12,13,16,17 . Seven of the eight studies investigated the prognostic significance of elevated leukocyte count (or increased NLR) and elevated platelet count (or increased PLR) separately, 10–12,14–17 and most found that both leukocytosis (or increased NLR) and thrombocytosis (or increased PLR) are associated with advanced clinical stage or poor prognosis 10–12,14,16,17 .…”

“…Of these, four studies used higher leukocyte count and higher platelet count as prognostic variables, 10,11,14,15 whereas the other four used higher neutrophil‐to‐lymphocyte ratio (NLR) and higher platelet‐to‐lymphocyte ratio (PLR) 12,13,16,17 . Seven of the eight studies investigated the prognostic significance of elevated leukocyte count (or increased NLR) and elevated platelet count (or increased PLR) separately, 10–12,14–17 and most found that both leukocytosis (or increased NLR) and thrombocytosis (or increased PLR) are associated with advanced clinical stage or poor prognosis 10–12,14,16,17 . However, only one of the studies evaluated the prognostic significance of concurrent leukocytosis and thrombocytosis in endometrial cancer, 13 although both leukocytosis and thrombocytosis can be caused by the upregulated expression of tumor‐derived factors 18 …”

Prognostic function of platelet-to-lymphocyte ratio in gynecologic cancers: A systematic review and meta-analysis

“…Among them, one concerning cervical cancer was disposed separately cause of providing HRs and survival outcomes for patients with two different treatments [21]. As a consequence, fifteen, nine, and four publications regarding to cervical [19,[21][22][23][24][25][26][27][28][29][30][31][32][33][34], ovarian [35][36][37][38][39][40][41][42][43], and endometrial cancer [44][45][46][47] were enrolled, respectively.…”