Neutrophil-to-Lymphocyte Ratio May Guide the Choice of Treatment in Metastatic Cancer Patients: Chemotherapy or Best Supportive Care

Year 2020, , 111 - 115, 15.12.2020

Serdar Arıcı , Ruhper Çekin

https://doi.org/10.25000/acem.803359

Abstract

Aim: We set out in this study to investigate whether the neutrophil-to-lymphocyte ratio (NLR) is a predictor in deciding whether to either continue palliative chemotherapy or choose the best supportive care (BSC) for advanced cancer patients.
Methods: Those with advanced solid tumors who had died after palliative chemotherapy were included the study. The patients were divided into two groups based on the time between the beginning of their last chemotherapy regimen and death (DCD), at ≤ 60 or > 60 days. Neutrophil-to-lymphocyte ratio was calculated using the laboratory values taken before the beginning of the last chemotherapy line. The determinant factors of ≤ 60-days DCD were examined by logistic regression analysis, and a statistical significance level of alpha was accepted as p < 0.05.
Results: The study included 404 patients, with the mean age at diagnosis of 61.7±12.0 years. The mean NLR was calculated as 11.3±27.1. In the univariate analysis for determining ≤ 60-days DCD, breast and colorectal cancers, ECOG status, single agent chemotherapy usage, neutrophil count, lymphocyte count and NLR were all found to be significant factors. The cutoff value determining the ≤ 60-days DCD, was determined as NLR ≥ 3.59. In logistic regression analysis, NLR ≥ 3.59, as well as ECOG status, were found to be significant factors.
Conclusion: The neutrophil-lymphocyte ratio, combined with ECOG, can predict survival in patients with solid advanced tumors and can therefore help clinicians in choosing to either administer chemotherapy to their patients or direct them to the best supportive care.

Keywords

neutrophil-to-lymphocyte ratio, solid tumors, palliative chemotherapy, best supportive care

References

• 1. Allard P, Dionne A, Potvin D. Factors associated with length of survival among 1081 terminally ill cancer patients. Journal of palliative care. 1995 Autumn;11(3):20-4.
• 2. Aggarwal BB, Vijayalekshmi RV, Sung B. Targeting inflammatory pathways for prevention and therapy of cancer: short-term friend, long-term foe. Clin Cancer Res. 2009 Jan 15;15(2):425-30.
• 3. Duman TT, Aktas G, Atak BM, Kocak MZ, Erkus E, Savli H. Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus. African health sciences. 2019 Mar;19(1):1602-6.
• 4. Aktas G, Sit M, Dikbas O, Erkol H, Altinordu R, Erkus E, et al. Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto's thyroiditis. Revista da Associacao Medica Brasileira. 2017 Dec;63(12):1065-8.
• 5. Fang Q, Tong YW, Wang G, Zhang N, Chen WG, Li YF, et al. Neutrophil-to-lymphocyte ratio, obesity, and breast cancer risk in Chinese population. Medicine. 2018 Jul;97(30):e11692.
• 6. Posul E, Yilmaz B, Aktas G, Kurt M. Does neutrophil-to-lymphocyte ratio predict active ulcerative colitis? Wiener klinische Wochenschrift. 2015 Apr;127(7-8):262-5.
• 7. Bilgin S, Aktas G, Zahid Kocak M, Atak BM, Kurtkulagi O, Duman TT, et al. Association between novel inflammatory markers derived from hemogram indices and metabolic parameters in type 2 diabetic men. The aging male : the official journal of the International Society for the Study of the Aging Male. 2019 Jun 28:1-5.
• 8. Sit M, Aktas G, Erkol H, Yaman S, Keyif F, Savli H. Neutrophil to Lymphocyte Ratio is Useful in Differentiation of Malign and Benign Thyroid Nodules. Puerto Rico health sciences journal. 2019 Mar;38(1):60-3.
• 9. Sakin A, Sahin S, Yasar N, Demir C, Arici S, Geredeli C, et al. The Relation between Hemogram Parameters and Survival in Extensive-Stage Small Cell Lung Cancer. Oncol Res Treat. 2019;42(10):506-15.
• 10. Yodying H, Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Yamada M, et al. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Oncologic Outcomes of Esophageal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol. 2016 Feb;23(2):646-54.
• 11. Pedrazzani C, Mantovani G, Fernandes E, Bagante F, Luca Salvagno G, Surci N, et al. Assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and platelet count as predictors of long-term outcome after R0 resection for colorectal cancer. Sci Rep. 2017 May 4;7(1):1494.
• 12. Prodromidou A, Andreakos P, Kazakos C, Vlachos DE, Perrea D, Pergialiotis V. The diagnostic efficacy of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in ovarian cancer. Inflamm Res. 2017 Jun;66(6):467-75.
• 13. Turri-Zanoni M, Salzano G, Lambertoni A, Giovannardi M, Karligkiotis A, Battaglia P, et al. Prognostic value of pretreatment peripheral blood markers in paranasal sinus cancer: Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio. Head Neck. 2017 Apr;39(4):730-6.
• 14. Christakis NA, Lamont EB. Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study. BMJ. 2000 Feb 19;320(7233):469-72.
• 15. Barbot AC, Mussault P, Ingrand P, Tourani JM. Assessing 2-month clinical prognosis in hospitalized patients with advanced solid tumors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2008 May 20;26(15):2538-43.
• 16. Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. 2004 Jan 15;22(2):315-21.
• 17. Gripp S, Moeller S, Bolke E, Schmitt G, Matuschek C, Asgari S, et al. Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol. 2007 Aug 1;25(22):3313-20.
• 18. Amano K, Maeda I, Shimoyama S, Shinjo T, Shirayama H, Yamada T, et al. The Accuracy of Physicians' Clinical Predictions of Survival in Patients With Advanced Cancer. J Pain Symptom Manage. 2015 Aug;50(2):139-46 e1.
• 19. Deng M, Ma X, Liang X, Zhu C, Wang M. Are pretreatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio useful in predicting the outcomes of patients with small-cell lung cancer? Oncotarget. 2017 Jun 6;8(23):37200-7.
• 20. Kasmann L, Bolm L, Schild SE, Janssen S, Rades D. Neutrophil-to-Lymphocyte Ratio Predicts Outcome in Limited Disease Small-cell Lung Cancer. Lung. 2017 Apr;195(2):217-24.
• 21. Kang MH, Go SI, Song HN, Lee A, Kim SH, Kang JH, et al. The prognostic impact of the neutrophil-to-lymphocyte ratio in patients with small-cell lung cancer. Br J Cancer. 2014 Jul 29;111(3):452-60.
• 22. Caliskan S, Sungur M, Kaba S, Ozsoy E, Koca O, Ozturk MI. Neutrophil-to-Lymphocyte Ratio in Renal Cell Carcinoma Patients. Folia Med (Plovdiv). 2018 Dec 1;60(4):553-7.
• 23. Zhan H, Ma JY, Jian QC. Prognostic significance of pretreatment neutrophil-to-lymphocyte ratio in melanoma patients: A meta-analysis. Clin Chim Acta. 2018 Sep;484:136-40.
• 24. Szor DJ, Dias AR, Pereira MA, Ramos M, Zilberstein B, Cecconello I, et al. Prognostic Role of Neutrophil/Lymphocyte Ratio in Resected Gastric Cancer: A Systematic Review and Meta-analysis. Clinics (Sao Paulo). 2018;73:e360.
• 25. Zhou Y, Wei Q, Fan J, Cheng S, Ding W, Hua Z. Prognostic role of the neutrophil-to-lymphocyte ratio in pancreatic cancer: A meta-analysis containing 8252 patients. Clin Chim Acta. 2018 Apr;479:181-9.
• 26. Ethier JL, Desautels D, Templeton A, Shah PS, Amir E. Prognostic role of neutrophil-to-lymphocyte ratio in breast cancer: a systematic review and meta-analysis. Breast Cancer Res. 2017 Jan 5;19(1):2.
• 27. Bowen RC, Little NAB, Harmer JR, Ma J, Mirabelli LG, Roller KD, et al. Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis. Oncotarget. 2017 May 9;8(19):32171-89.
• 28. Kiriu T, Yamamoto M, Nagano T, Hazama D, Sekiya R, Katsurada M, et al. The time-series behavior of neutrophil-to-lymphocyte ratio is useful as a predictive marker in non-small cell lung cancer. PLoS One. 2018;13(2):e0193018.
• 29. Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. Use of Palliative Performance Scale in end-of-life prognostication. J Palliat Med. 2006 Oct;9(5):1066-75.
• 30. Chow E, Abdolell M, Panzarella T, Harris K, Bezjak A, Warde P, et al. Predictive model for survival in patients with advanced cancer. J Clin Oncol. 2008 Dec 20;26(36):5863-9.
• 31. Tredan O, Ray-Coquard I, Chvetzoff G, Rebattu P, Bajard A, Chabaud S, et al. Validation of prognostic scores for survival in cancer patients beyond first-line therapy. BMC Cancer. 2011 Mar 15;11:95.