Significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in lung cancer
Abstract
Background: An underlying inflammatory state is an important contributor to carcinogenesis and progression of tumors. Many of the etiological factors in development of lung cancer are linked to persistent inflammation. Neutrophil lymphocyte ratio (NLR) and Platelet lymphocyte ratio (PLR) are markers of systemic inflammatory response that have shown clinical significance in cancer, according to recent research.
Objective: To evaluate NLR and PLR in lung cancer and compare these parameters in healthy controls.
Materials and Methods: Clinicopathological details and hematological parameters of complete blood counts were recorded for 106 patients of lung cancer and 106 healthy controls retrospectively. NLR and PLR values were evaluated and compared in the two groups.
Results: NLR and PLR were significantly elevated in lung cancer patients (NLR 4.44±2.98; PLR 162.72±96.15) as compared to control group (NLR 1.90±0.67, PLR 115.15±29.15) with p value <0.05. NLR showed a sensitivity of 74.5% and specificity 85.8% at optimal cut off value (2.5), as per Receiver operating characteristics (ROC) curve analysis. ROC curve analysis for PLR showed sensitivity 48.1% and specificity 87.8% at optimal cut off value (148.7).
Conclusion: NLR and PLR are significantly raised in lung cancer. This reflects an underlying inflammatory state that may contribute to development and progression of neoplastic disease in lung. NLR a more sensitive than PLR and may provide useful diagnostic and prognostic information in a country like India that bears a high load of lung cancer cases.
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Fitzmaurice C, Akinyemiju TF, Al Lami FH, Alam T, Alizadeh-Navaei R, Allen C, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: a systematic analysis for the global burden of disease study. JAMA Oncol. 2018;4(11):1553-1568. doi:10.1001/jamaoncol.2018.2706.
The Global Cancer Observatory. International Agency for research in cancer. World Health Organization. Globocan 2019: India fact sheet. May 2019.
Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860-867. doi: 10.1038/nature01322.
Morriello F. Neutrophils and inflammation: unraveling a new connection. Biol Med. 2016;8(6):1-3. doi:10.4172/0974-8369.1000325.
O'Callaghan DS, O'Donnell D, O'Connell F, O'Byrne KJ. The role of inflammation in the pathogenesis of non-small cell lung cancer. J Thorac Oncol. 2010;5(12):2024-2036. doi: https://doi.org/10.1097/JTO.0b013e3181f387e4
Franco AT, Corken A, Ware J. Platelets at the interface of thrombosis, inflammation, and cancer. Blood. 2015;126(5):582-588. doi: 10.1182/blood-2014-08-531582. Epub 2015 Jun 24.
Olsson AK1, Cedervall J. The pro-inflammatory role of platelets in cancer. The pro-inflammatory role of platelets in cancer. Platelets. 2018;29(6):569-573. doi: 10.1080/09537104.2018.1453059. Epub 2018 Mar 27.
Song Y, Yang Y, Gao P, Chen X, Yu D, Xu Y, et al. The preoperative neutrophil to lymphocyte ratio is a superior indicator of prognosis compared with other inflammatory biomarkers in resectable colorectal cancer. BMC Cancer. 2017;17(1):744. doi: 10.1186/s12885-017-3752-0.
Zhang Y, Lu JJ, Du YP, Feng CX, Wang LQ, Chen MB. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in gastric cancer. Medicine (Baltimore). 2018;97(12):e0144. doi: 10.1097/MD.0000000000010144.
Park YM, Oh KH, Cho JG, Baek SK, Kwon SY, Jung KY, et al. A prognostic scoring system using inflammatory response biomarkers in oral cavity squamous cell carcinoma patients who underwent surgery-based treatment. Acta Otolaryngol. 2018;138(4):422-427. doi: 10.1080/00016489.2017.1404640. Epub 2017 Nov 23.
Graziano V, Grassadonia A, Iezzi L, Vici P, Pizzuti L, Barba M, et al. Combination of peripheral neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio is predictive of pathological complete response after neoadjuvant chemotherapy in breast cancer patients. Breast. 2019;44:33-38. doi: 10.1016/j.breast.2018.12.014. Epub 2019 Jan 2.
Shankar A, Dubey A, Saini D, Singh M, Prasad CP, Roy S et al. Environmental and occupational determinants of lung cancer. TransLung Cancer. 2019;8(1):S31-S49. doi: 10.21037/tlcr.2019.03.05.
Şahin F, Aslan AF. Relationship between Inflammatory and Biological Markers and Lung Cancer. J Clin Med. 2018;7(7). pii: E160. doi: https://doi.org/10.3390/jcm7070160.
Yu Y, Qian L, Cui J. Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: A meta-analysis of 7,219 patients. Mol Clin Oncol. 2017;7(3):498-506. doi: https://doi.org/10.3892/mco.2017.1342. Epub 2017 Jul 24.
Unal D, Eroglu C, Kurtul N, Oguz A, Tasdemir A. Are neutrophil/lymphocyte and platelet/lymphocyte rates in patients with non-small cell lung cancer associated with treatment response and prognosis? Asian Pac J Cancer Prev. 2013;14(9):5237-5242. doi: https://doi.org/10.7314/APJCP.2013.14.9.5237.
Caielli S, Banchereau J, Pascual V. Neutrophils come of age in chronic inflammation. Curr Opin Immunol. 2012;24(6):671-677. doi: https://doi.org/10.1016/j.coi.2012.09.008. Epub 2012 Nov 3.
Multhoff G, Molls M, Radons J. Chronic inflammation in cancer development. Front Immunol. 2012;2:98. doi: https://doi.org/10.3389/fimmu.2011.00098.
Aggarwal BB, Gehlot P. Inflammation and cancer: how friendly is the relationship for cancer patients? Curr Opin Pharmacol. 2009;9(4):351-369. doi: https://doi.org/10.1016/j.coph.2009.06.020. Epub 2009 Aug 6.
Pantschenko AG, Pushkar I, Anderson KH, Wang Y, Miller LJ, Kurtzman SH, et al. The interleukin-1 family of cytokines and receptors in human breast cancer: implications for tumor progression. Int J Oncol. 2003;23(2):269-284. doi: https://doi.org/10.3892/ijo.23.2.269.
Lam WK, White NW, Chan-Yeung MM. Lung cancer epidemiology and risk factors in Asia and Africa. Int J Tuberc Lung Dis. 2004;8(9):1045-1057.
Husebø GR, Nielsen R, Hardie J, Bakke PS, Lerner L, D'Alessandro-Gabazza C, et al. Risk factors for lung cancer in COPD - results from the Bergen COPD cohort study. Respir Med. 2019;152:81-88. doi: https://doi.org/10.1016/j.rmed.2019.04.019. Epub 2019 Apr 30.
Kuwano K, Kunitake R, Kawasaki M, Nomoto Y, Hagimoto N, Nakanishi Y, et al. P21Waf1/Cip1/Sdi1 and p53 expression in association with DNA strand breaks in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1996;154(2 Pt 1):477-483. doi: https://doi.org/10.1164/ajrccm.154.2.8756825.
Ocana A, Nieto-Jiménez C, Pandiella A, Templeton AJ. Neutrophils in cancer: prognostic role and therapeutic strategies. Mol Cancer. 2017;16(1):137. doi: https://doi.org/10.1186/s12943-017-0707-7.
Liu H, Wu Y, Wang Z, Yao Y, Chen F, Zhang H, et al. Pretreatment platelet-to-lymphocyte ratio (PLR) as a predictor of response to first-line platinum-based chemotherapy and prognosis for patients with non-small cell lung cancer. J Thorac Dis. 2013;5(6):783-789. doi: https://doi.org/10.3978/j.issn.2072-1439.2013.12.34.
Mitrugno A, Sylman JL, Ngo AT, Pang J, Sears RC, Williams CD, et al. Aspirin therapy reduces the ability of platelets to promote colon and pancreatic cancer cell proliferation: Implications for the oncoprotein c-MYC. Am J Physiol Cell Physiol. 2017;312(2):C176-C189. https://doi.org/10.1152/ajpcell.00196.2016. Epub 2016 Nov 30.
Peterson JE, Zurakowski D, Italiano JE Jr, Michel LV, Connors S, Oenick M, et al. VEGF, PF4 and PDGF are elevated in platelets of colorectal cancer patients. Angiogenesis. 2012;15(2):265-273. https://doi.org/10.1007/s10456-012-9259-z. Epub 2012 Mar 9.
Nieswandt B, Hafner M, Echtenacher B, Männel DN. Lysis of tumor cells by natural killer cells in mice is impeded by platelets. Cancer Res. 1999;59(6):1295-300.