Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as Possible Prognostic Markers for Patients
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ORIGINAL SCIENTIFIC REPORT
Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-toLymphocyte Ratio (PLR) as Possible Prognostic Markers for Patients Undergoing Resection of Adrenocortical Carcinoma Mechteld C. de Jong1 • Radu Mihai1 • Shahab Khan1
Accepted: 7 November 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Aim Adrenocortical cancer (ACC) is a rare disease with a poor outcome, and robust prognostic factors remain unclear. High neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as markers of host inflammation have been found to be associated with decreased long-term outcomes in several tumour types, but have been scarcely analysed in ACC. Methods Patients who underwent resection of their ACC between 2000 and 2020 were identified; therapeutic, operative and outcome data were analysed. Pre-operative NLR and PLR were calculated by division of neutrophils and platelets by lymphocytes measured in peripheral blood. Results Fifty-seven patients (30F:27 M) with an overall median age of 53 years [range: 18–86] presented with tumours of median size 11.5 cm [range: 3.0–22.0], of whom 26 (46%) were hormonally active. Majority of patients underwent an open resection (n = 48; 84%); more than half (n = 30; 53%) underwent multi-organ excision. Median NLR was 4.63 and median PLR was 186.21; these values were used for median split analyses (low vs. high). There were no differences with regard to age, sex or tumour characteristics and peri-operative data between the two groups (all p [ 0.05). Overall, median recurrence-free survival (RFS) was 26 months (3-year: 45%) on Kaplan–Meier analysis. On univariate analyses, a high NLR did not influence RFS [HR = 1.57 (95%-CI: 0.73–2.38); p = 0.25], but patients with a high PLR had an increased risk of developing recurrence [HR = 2.39 (95%-CI: 1.08–5.31); p = 0.03]. The median overall survival (OS) was 33 months (3 years: 79%) on Kaplan–Meier analysis. Both a high NLR [HR = 2.24 (95%-CI: 1.07–4.70); p = 0.03] and a high PLR [HR = 4.02 (95%-CI: 1.80–8.98); p = 0.001] were strongly associated with a shorter OS on unadjusted analyses. Conclusion Elevated pre-operative NLR and PLR are associated with shorter OS, while higher PLR was also associated with a shorter RFS for patients undergoing curative intent resection of ACC.
Introduction
& Mechteld C. de Jong [email protected] 1
Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
Adrenocortical cancer (ACC) is a rare tumour with an incidence of 1–2/million population/year. [1] Complete surgical resection is the backbone of treatment for localised disease, with reported 5-year survival rates after curative intent resection ranging from 40 to 51%. [2–4] Factors currently commonly used for survival estimates are clinical parameters, such as hormonal functionality of the tumour [5, 6] and age of the patient [7], or pathological variables,
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such as stage of the tumour [8], proliferation index of the tumour (
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