The use of preoperative neutrophil–lymphocyte ratio and lymphocyte–monocyte ratio in predicting survival and groin node involvement of patients with squamous cell carcinoma of penis

Abstract

Introduction: The association between inflammation and malignancies is being recognized. In this study, we assessed the use of preoperative neutrophil–lymphocyte ratio (NLR) and lymphocyte–monocyte ratio (LMR) in predicting cancer-specific survival (CSS) and inguinal node involvement in patients with carcinoma penis. Methods: Sixty-nine patients operated for squamous cell carcinoma penis with inguinal node dissection between 2012 and 2020 were identified. We recorded the type of surgery (partial/total penectomy), T stage, grade, lymphovascular invasion (LVI), perineural invasion (PNI), pathological status of inguinal nodes and nodal stage (pN1–3), extranodal extension (ENE), and CSS. The hemogram performed within 2 weeks of surgery was used for calculating NLR and LMR. Results: Partial penectomy was the most common surgery (65.22%) and pT2 was the most common stage (53.62%). Grade 2 was seen in 66.67%, LVI in 34.78%, PNI in 37.68%, 52.17% had inguinal node involvement with pN3 being the most common (36.23%), and 36.23% had ENE. Kaplan–Meier analysis revealed that NLR of >3 and the LMR ≤3 indicated an inferior CSS ( P = 0.05 and 0.04, respectively). T stage, inguinal node involvement, LVI, pN stage, and ENE were also associated with inferior CSS ( P < 0.05). On multivariate analysis, T stage was significantly associated with CSS ( P = 0.02). The NLR >3 and LMR ≤3 were also significantly associated with the presence of pathological inguinal node involvement ( P = 0.001 and 0.026). Conclusion: NLR and LMR may help in predicting CSS and inguinal node involvement in patients of carcinoma penis.

Prognostic value of neutrophil-to-lymphocyte ratio (NLR) in penile cancer: A systematic review and meta-analysis

“…After the primary screening process, fourteen studies were further evaluated in full text. The final analysis included seven articles [ 7 , [9] , [10] , [11] , [12] , 16 , 17 ] for the systematic review, six of which [ 7 , [9] , [10] , [11] , [12] , 16 ] were eligible to be included in the meta-analysis.

Fig.

…”

“…In addition, the median CSS was also not described in the results of most of the studies. However, Chen Hu et al [ 12 ] and Jindal et al [ 7 ] reported that the penile cancer patients in their cohort had a median CSS of 33 months and 18 months, respectively. The value of NLR was obtained from a complete blood count examination taken from peripheral blood samples prior to the surgical procedure which the course varied from 1 month to 3 days before inguinal lymph node dissection surgery.…”

“…The meta-analysis included five studies [ 7 , [9] , [10] , [11] , [12] ], totalling 482 patients with penile cancer who underwent inguinal node dissection. Based on the forest plot analysis, patients with high NLR values had a higher incidence of lymph node invasion compared to patients with low NLR (OR 3.56, 95% CI 2.38, 5.32, p < 0.01) ( Fig.…”

“…Recent literature highlights that the association between systemic inflammation and tumor development is confirmed in various solid organ cancers [ 7 ]. Since complete blood count can signify underlying systemic inflammation, the Neutrophil to Lymphocyte Ratio (NLR) invariably serves as an indicator of tissue inflammation in cancer [ 8 ].…”

Prognostic Significance of Systemic Inflammation Markers in Testicular and Penile Cancer: A Narrative Review of Current Literature

“…Elevated NLR was significantly correlated with worse OS and PFS, but only by conducting a univariate analysis [ 68 ]. Jindal et al reported concordant results regarding the association between NLR and pN+ disease and survival outcomes [ 69 ]. Li et al investigated the prognostic significance of NLR in 228 patients treated with bilateral ILND for PSCC.…”