Prognostic and diagnostic impact of fibrinogen, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio on thymic epithelial tumors outcome

Abstract

BackgroundPeripheral blood-derived inflammation-based markers, such as Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Fibrinogen have been identified as prognostic markers in various solid malignancies. Here we aimed to investigate the prognostic and diagnostic impact of NLR, PLR, and Fibrinogen in patients with thymic epithelial tumors (TETs).ResultsPretreatment Fibrinogen serum concentrations, NLRs and PLRs were highest in patients with TCs and advanced tumor stages. High pretreatment Fibrinogen serum concentration (≥452.5 mg/dL) was significantly associated with worse cause specific survival (CSS; p = 0.001) and freedom from recurrence (FFR; p = 0.043), high NLR (≥4.0) with worse FFR (p = 0.008), and high PLR (≥136.5) with worse CSS (p = 0.032). Longitudinal analysis revealed that compared to patients without tumor recurrence, patients with tumor recurrence had significantly higher NLR (11.8 ± 4.0 vs. 4.70 ± 0.5; p = 0.001) and PLR (410.8 ± 149.1 vs. 228.3 ± 23.7; p = 0.031).ConclusionOverall, Fibrinogen serum concentrations, NLRs, and PLRs were associated with higher tumor stage, more aggressive tumor behavior, recurrence, and worse outcome. Prospective multicenter studies of the diagnostic and prognostic potential of Fibrinogen, NLR, and PLR are warranted.MethodsThis retrospective analysis included 122 patients with TETs who underwent surgical resection between 1999-2015. Fibrinogen serum concentrations, NLRs, and PLRs were measured in patients preoperatively, postoperatively, and later during follow-up. These markers were analyzed for association with several clinical variables, including tumor stage, tumor subtype, FFR, and CSS and to evaluate their prognostic and diagnostic impact for detecting tumor recurrence.

Follistatin impacts Tumor Angiogenesis and Outcome in Thymic Epithelial Tumors

“…Additionally to Activin A and Follistatin serum concentrations, Fibrinogen, CRP, heat shock protein 27 and 70, and molecules of the RAGE axis (sRAGE, esRAGE, HMGB1) as previously shown, were correlated with MVD 3,14,46,49 .…”

“…Recurrences can occur even decades after radical tumor resection, and therefore life-long oncologic follow up is recommended 2,12,13 . In our previous works we could demonstrate that different systemic inflammatory proteins, such as CRP or Fibrinogen and indices formed from inflammatory cell counts, such as neutrophil-to-lymphocyte ratio (NLR) were associated with higher tumor stage and worse prognosis 3,14 . However, despite improved insights also into genetic profiles of TETs, there exist no established markers for diagnosis or to predict tumor recurrence during oncologic follow-up of TETs 15–17 .…”

Assessment of the prognostic role of neutrophil-to-lymphocyte ratio following complete resection of thymoma

“…Recently, Janik et al [ 23 ] reported about the prognostic value of NLR and other inflammatory markers in 122 patients affected by thymic epithelial tumors (75% thymoma, 25% thymic carcinoma). Higher preoperative values of NLR resulted predictive of lower freedom from recurrence at survival analysis, but not at multivariate analysis.…”

Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as an alternative to C-reactive protein in diagnostics of inflammatory state in patients with psoriasis

“…Recently, the ratio of neutrophils to lymphocytes (NLR), the ratio of platelets to lymphocytes (PLR), and the ratio of monocytes to lymphocytes (MLR) have been recognized as inflammatory markers [10][11][12]. NLR, PLR, and MLR are assessed as a prognostic of poor neoplastic disease outcome [13][14][15][16][17], whereas mean platelet volume (MPV) has been studied as an inflammatory marker in several diseases [18][19][20]. There are also a few studies which investigate simple markers, viz.…”