Prognostic Clue in Papillary Thyroid Carcinoma: Neutrophil Lymphocyte Ratio

Year 2023, , 137 - 141, 31.08.2023

Zeynel Abidin Sayiner , Osman Hakan Demir , Mesut Özkaya

https://doi.org/10.29058/mjwbs.1231084

Abstract

Aim: Inflammation plays a critical role in many cancer features such as tumor development and
progression. Recently, the neutrophil-lymphocyte ratio (NLR) has been evaluated as a simple and valid
systematic marker of inflammatory response. The aim of this study was to investigate the prognostic
value of the preoperative neutrophil / lymphocyte ratio.
Material and Methods: In this study, archive files of 259 adult cases were evaluated retrospectively.
Kolmogorov Smirnov test, Mann Whitney U Test, Kruskal Wallis and Dunn multiple comparison tests
were used in the statistical analysis.
Results: A statistical correlation was found between the neutrophil/lymphocyte ratio and T staging,
lymph node and distant metastases (p<0.001). As the TNM stage increased, the neutrophil/lymphocyte
ratio also increased (p=0.001). As a separate subgroup, a statistically significant correlation was found
between papillary microcarcinomas and neutrophil/lymphocyte ratio (p=<0.001). When the neutrophil/
lymphocyte cut-off values were taken as >1,644 >2.0906>1,644, the sensitivity to predict papillary
thyroid cancers larger than 1 cm, lymph node metastasis and distant metastasis was found to be 85.4%,
73.8%, and 96% respectively.
Conclusion: Neutrophil/lymphocyte ratio is associated with tumor size and presence of metastasis.
The neutrophil/lymphocyte ratio may help us predict the size of the tumor, lymph node involvement, and
distant metastasis when the right cut-off points are established.

Keywords

Thyroid cancer, neutrophil lymphocyte ratio, carcinogenesis

Papiller Tiroid Karsinomada Tümör Büyüklüğü ve Metastazın Belirticisi Olarak Nötrofil Lenfosit Oranı

Abstract

Amaç: Enflamasyon, tümör gelişimi ve ilerlemesi gibi birçok kanser özelliğinde kritik bir rol oynar. Son
zamanlarda, nötrofil lenfosit oranı (NLR), inflamatuar yanıtın basit ve geçerli bir sistematik belirteci
olarak değerlendirilmiştir. Bu çalışmanın amacı ameliyat öncesi nötrofil/lenfosit oranının prognostik
değerini araştırmaktır.
Gereç ve Yöntemler: Bu çalışmada 259 erişkin olgunun arşiv dosyaları retrospektif olarak değerlendirildi.
İstatistiksel analizde Kolmogorov Smirnov testi, Mann Whitney U Testi, Kruskal Wallis ve Dunn çoklu
karşılaştırma testleri kullanıldı.
Bulgular: Nötrofil/lenfosit oranı ile TNM evrelemesi, lenf nodu ve uzak metastazlar arasında istatistiksel
korelasyon bulundu (p<0.001). TNM evresi arttıkça nötrofil/lenfosit oranı da artışı saptandı (p=0,001).
Ayrı bir alt grup olarak papiller mikrokarsinomlar ile nötrofil/lenfosit oranı arasında istatistiksel olarak
anlamlı bir korelasyon bulundu (p=<0,001). Nötrofil/lenfosit kesim değerleri >1.644 >2.0906>1.644
olarak alındığında 1 cm'den büyük papiller tiroid kanserlerini, lenf nodu metastazı ve uzak metastazı
öngörme duyarlılığı %85,4, %73,8 ve %96 olarak bulundu.
Sonuç: Nötrofil/lenfosit oranı tümör boyutu ve metastaz varlığı ile ilişkilidir. Nötrofil/lenfosit oranı, doğru
kesme noktaları belirlendiğinde tümörün boyutunu, lenf nodu tutulumunu ve uzak metastazı tahmin
edilmesine yardımcı olabilir.

Keywords

Tiroid kanseri, nötrofil lenfosit oranı, karsinogenez

References

• 1. Deniz MS. A novel proportional index to differentiate between demographically and clinically matched cases with papillary thyroid carcinoma or non-cancerous nodule: PLR-to-PDW ratio. Am J Transl Res. 2023 Apr 15;15(4):2820-2827. PMID: 37193193; PMCID: PMC10182524.
• 2. Martin S, Mustata T, Enache O, Ion O, Chifulescu A, Sirbu A, Barbu C, Miron A, Giulea C, Andrei F, Fica S. Platelet Activation and Inflammation in Patients with Papillary Thyroid Cancer. Diagnostics (Basel). 2021 Oct 22;11(11):1959.
• 3. Zhang X, Li S, Wang J, Liu F, Zhao Y. Relationship Between Serum Inflammatory Factor Levels and Differentiated Thyroid Carcinoma. Technol Cancer Res Treat. 2021 Jan- Dec;20:1533033821990055.
• 4. Ozmen S, Timur O, Calik I, Altinkaynak K, Simsek E, Gozcu H, Arslan A, Carlioglu A. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be superior to C-reactive protein (CRP) for predicting the occurrence of differentiated thyroid cancer. Endocr Regul 2017;51(3):131-136.
• 5. Chen W, Wei T, Li Z, Gong R, Lei J, Zhu J, Huang T. Association of the preoperative inflammation-based scores with tnm stage and recurrence in patients with papillary thyroid carcinoma: a retrospective, multicenter analysis. Cancer Manag Res 2020;12:1809-1818.
• 6. Tuttle RM, Haugen B, Perrier ND. 2017. Updated American Joint Committee on Cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid 27:751-756
• 7. Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol 2010;6(1):149-163.
• 8. Liu JF, Ba L, Lv H, Lv D, Du JT, Jing XM, Yang NJ, Wang SX, Li C, Li XX. Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: a meta-analysis. Sci Rep 2016;6:38551.
• 9. Gondo T, Nakashima J, Ohno Y, Choichiro O, Horiguchi Y, Namiki K, Yoshioka K, Ohori M, Hatano T, Tachibana M. Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology 2012;79(5):1085-1091.
• 10. Aizawa M, Gotohda N, Takahashi S, Konishi M, Kinoshita T. Predictive value of baseline neutrophil/lymphocyte ratio for T4 disease in Wall-penetrating gastric cancer. World J Surg 2011;35:2717-2722.
• 11. Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, Park KJ, Roh MS, Kim SG, Kim HJ, Lee JH. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012;17(3):216-222.
• 12. He JR, Shen GP, Ren ZF, Qin H, Cui C, Zhang Y, Zeng YX, Jia WH. Pretreatment levels of peripheral neutrophils and lymphocytes as independent prognostic factors in patients with nasopharyngeal carcinoma. Head Neck 2012;34(12):1769- 1776.
• 13. Seretis C, Gourgiotis S, Gemenetzis G, Seretis F, Lagoudianakis E, Dimitrakopoulos G. The significance of neutrophil/lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters: a pilot study. Am J Surg 2013;205(6):691-696.
• 14. Liu CL, Lee JJ, Liu TP, Chang YC, Hsu YC, Cheng SP. Blood neutrophil to lymphocyte ratio correlates with tumor size in patients with differentiated thyroid cancer. J Surg Oncol 2013;107(5):493-497.
• 15. Cho JS, Park MH, Ryu YJ, Yoon JH. The neutrophil to lymphocyte ratio can discriminate anaplastic thyroid cancer against poorly or well differentiated cancer. Ann Surg Treat Res 2015;88(4):187-92.
• 16. Çetinkaya Altuntaş S, Topaloğlu Ö. Comparison of mean platelet volume, platelet distribution width, neutrophil/ lymphocyte ratio, platelet/lymphocyte ratio and lymphocyte/ monocyte ratio in patients with differentiated thyroid cancer according to tsh levels. Batı Karadeniz Tıp Dergisi 2022;6(3): 302-310.
• 17. Beştepe N, Başer H, Aksoy Altınboğa A, Yalçın A, Topaloğlu O, Ersoy R, Çakır B. Comparison of clinicopathological features in differentiated thyroid carcinomas at 55 age cut-off point: a single center experience. Batı Karadeniz Tıp Dergisi 2022;6(3):274-282.
• 18. Topaloğlu Ö, Açıkgöz G, Tekin S, Malkoç B, Kaymaz E, Karadeniz Çakmak G, Bayraktaroğlu T. Difficulty in Follow-Up of Papillary Thyroid Cancer Co-Existent with Hypopituitarism: Case Report and Review of the Literature. Batı Karadeniz Tıp Dergisi 2022;6(3):410-416.
• 19. An X, Ding PR, Wang FH, Jiang WQ, Li YH. Elevated neutrophil to lymphocyte ratio predicts poor prognosis in nasopharyngeal carcinoma. Tumor Biol 2011;32:317-324.