Preoperative platelet lymphocyte ratio is superior to neutrophil lymphocyte ratio to be used as predictive marker for lymph node metastasis in oral squamous cell carcinoma

The prognostic role of pre-treatment neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in esophageal squamous cell carcinoma treated with concurrent chemoradiotherapy

PURPOSE

In this study, we retrospectively investigated the prognostic role of pre-treatment neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in esophageal squamous cell carcinoma patients (ESCC) treated with concurrent chemo-radiotherapy (CCRT).

METHODS

We retrospectively analyzed the records of 338 patients with pathologically diagnosed esophageal squamous cell carcinoma that underwent concurrent chemo-radiotherapy from January 2013 to December 2017. Univariate and multivariate analyses were used to identify prognostic factors for progression free survival (PFS) and overall survival (OS).

RESULTS

The result showed that the thresholds for NLR and PLR were 2.47 and 136.0 by receiver operating characteristic curve. High NLR and PLR were both associated with tumor length (P < 0.05). High NLR and PLR were significantly associated with poor PFS and OS. Multivariate analyses identified NLR, PLR and TNM stage were independent risk factors for PFS and OS.

CONCLUSIONS

We show that the pre-treatment NLR and PLR may serve as prognostic indicators for esophageal squamous cell carcinoma treated with concurrent chemo-radiotherapy.

Prognostic Significance of Pre-Treatment Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Head and Neck Malignancies

Introduction

Carcinoma is the second most common cause of death worldwide. The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are essential markers of inflammation and tumorigenesis in various cancers including head and neck cancers. Pretreatment platelet- lymphocytic ratio can be used as an independent predictor of mortality whereas neutrophil- lymphocytic ratio is an independent predictor of recurrence. The main aim of this study is to compare the pre-treatment neutrophil lymphocyte ratio and platelet-lymphocyte ratio in the patients of head and neck malignancies with those of the control group.

Material and Method

100 patients with histologically diagnosed cases of head and neck malignancies. Age and sex matched healthy subjects attending Otorhinolaryngology out-patient department for any other complaints (100 control subjects). Complete blood count had been done to calculate absolute neutrophil count and absolute lymphocyte count.

Results

The mean age of the subjects in the study group was 55.73 ± 11.56 years. In control group, the mean age group was 54.11 ± 10.46 years. NLR and PLR significantly increased in cases than controls. NLR associated with T stage, histological type and histological grade but not with site and nodal involvement. PLR associated with T stage, metastasis but not with the histological grade, histological type, site and nodal involvement.

Conclusion

From this study, we conclude that pre-treatment NLR and PLR were closely associated both with the size of primary tumor and also with the stage of malignant disease in patients of head and neck malignancies.

Prognostic relevance of pre-treatment inflammatory biomarkers along with other clinicopathological and treatment factors in oral cavity cancers

Background

Inflammation has traditionally been considered to be one of the hallmarks of cancer, and systemic inflammatory responses have a prognostic value in many solid cancers. The use of inflammation-based prognostic markers along with traditional clinicopathological prognostic markers in oral cavity cancers has not been studied well.

Materials and Methods

This is a retrospective study from a prospectively maintained database of patients with oral cancers who were managed in a regional cancer center in south India. The study included patients with squamous cell carcinoma of the oral cavity who were treated with curative intent from January to December 2016.

Results and Discussion

Three hundred sixty-one patients met the eligibility criteria and were included in the study. The median age of our patient cohort was 45 years; the male-to-female ratio was 3.7:1. All of the patients underwent curative treatments after a multi-disciplinary board concurrence. Advanced T stage, patients with buccal mucosal cancers and patients who received upfront non-surgical treatments have poorer survival outcomes. The clinicopathological variables that predicted a poorer overall survival in the cohort of patients treated with upfront surgery were advanced T Stage, higher grade, presence of perineural invasion, a higher inflammatory maker, and combination of platelet and neutrophil lymphocyte ratio (COP-NLR).

Conclusion

Our unique study of oral cavity cancer patients with a primary aim of exploring the prognostic significance of the pre-treatment inflammatory markers gave very interesting results. The prognostic significance of COP-NLR and other inflammatory markers in oral cancers need to be further explored. More importantly, our study has clearly reiterated that meaningful long-term survival outcomes in oral cavity cancers can only be achieved with the incorporation of upfront surgery.

Prognostic and clinicopathological significance of prognostic nutritional index (PNI) in patients with oral cancer: a meta-analysis

Accumulating literature has explored how prognostically significant the prognostic nutritional index (PNI) was for the oral carcinoma population, but with inconsistent findings. Therefore, we retrieved the most recent data and carried out this meta-analysis to comprehensively analyze the prognostic performance of pretreatment PNI in oral cancer. The electronic databases of PubMed, Embase, China National Knowledge Infrastructure (CNKI), Cochrane Library and Web of Science were fully retrieved. PNI's prognostic value for survival outcomes in oral carcinoma was assessed by estimating pooled hazard ratios (HRs) plus 95% confidence intervals (CIs). We examined the correlation of PNI with clinicopathological traits of oral carcinoma by utilizing the pooled odds ratios (ORs) plus 95% CIs. According to the pooled results of the present meta-analysis, which enrolled 10 studies involving 3,130 patients, for oral carcinoma suffers whose PNI was low, their disease-free survival (DFS) (HR=1.92, 95%CI=1.53-2.42, p<0.001) and overall survival (OS) (HR=2.44, 95%CI=1.45-4.12, p=0.001) would be inferior. Nonetheless, cancer-specific survival (CSS) was not linked significantly to PNI for the oral carcinoma population (HR=1.89, 95%CI=0.61-5.84, p=0.267). Significant associations of low PNI with TNM stages III-IV (OR=2.16, 95%CI=1.60-2.91, p<0.001) and age ≥ 65 years (OR=2.29, 95%CI=1.76-2.98, p<0.001) were found. As suggested by the present meta-analysis, a low PNI was linked to inferior DFS and OS among oral carcinoma patients. Oral cancer patients with low PNI may have high-risk of tumor progression. PNI could be served as a promising and effective index to predict prognosis in patients with oral cancer.

Pretherapy platelet-to-lymphocyte ratio as a prognostic parameter for locally advanced hypopharyngeal cancer patients treated with radiotherapy combined with chemotherapy

PURPOSE

This study aimed to identify whether the platelet-to-lymphocyte ratio (PLR) correlated with the prognosis of patients with locally advanced hypopharyngeal squamous cell carcinoma (LA-HPSCC) undergoing radiotherapy combined with chemotherapy.

METHODS

This study enrolled 103 patients diagnosed with LA-HPSCC and treated with radiotherapy combined with chemotherapy between 2008 and 2021. The optimal PLR cut-off value was chosen from the receiver operating characteristic (ROC) curve analysis. According to the cut-off value of PLR, patients were divided into two groups: a low PLR group (< 133.06) and a high PLR group (≥ 133.06). Propensity score matching (PSM) was used to balance the confounding factors between the two PLR groups. Univariate and multivariate Cox proportional hazard regression models, the Kaplan-Meier curve by the log-rank test, and univariate and multivariate Fine-Gray competing risk models were all used for assessment.

RESULTS

After PSM, 27 pairs were left, and the high PLR group correlated with higher local failure (sHR 6.91, 95% CI 2.14-22.35, p = 0.001) in the multivariate Fine-Gray competing risk model. Moreover, the low PLR group had a significantly longer 3-year progression-free survival (43.7% vs. 29.2%, p = 0.038) and overall survival (55.1% vs. 32.1%, p = 0.034) than the high PLR group had. Multivariate Cox analysis showed that a low PLR was an independent protective factor for PFS (HR 0.43, 95% CI 0.21-0.92, p = 0.019) and OS (HR 0.46, 95% CI 0.22-0.96, p = 0.039) in patients with LA-HPSCC.

CONCLUSION

Pretherapy PLR might be a factor in predicting the risk of local failure and survival in LA-HPSCC patients undergoing radiotherapy combined with chemotherapy.

Prognostic value of inflammatory biomarkers in aged patients with oral squamous cell carcinoma

Background: Better prognostic biomarkers for oral squamous cell carcinoma (OSCC) must be developed, particularly within the realm of clinically and frequently administered tests, to advise appropriate clinical therapy and follow-up. In this study, we retrospectively investigated which of the several inflammation-nutrition indicators might predict the prognosis of patients with OSCC. Methods:  The preoperative neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), CRP-albumin ratio (CAR), Glasgow prognostic score (GPS), modified GPS (mGPS), prognostic nutritional index (PNI), controlling nutrition status (CONUT), and modified CONUT (mCONUT) were retrospectively evaluated using blood samples collected 1-5 days before surgery. To estimate the effect on the prognosis of tumor progression, the mean values of the markers between stages I/II and III/IV were used for subgroup analysis. The multivariate Cox proportional hazards model included all independent variables significantly associated with survival in the univariate analysis to determine the independent variables. Results: A total of 112 patients (69 males and 43 females) with primary OSCC who underwent surgical treatment at our hospital were included. There were statistically significant differences in the mean values of monocytes, platelets, and albumin between stages I/II and III/IV. According to the multivariate Cox proportional hazards regression, a low PNI was associated with shorter overall survival (OS) and disease-free survival (DFS); women were associated with shorter DFS. Conclusion: The pretreatment PNI had excellent predictive value for the 5-year OS and DFS of patients with OSCC. Future large-scale prospective studies with a high sample size are needed to verify our findings in OSCC patients.

Preoperative platelet-lymphocyte ratio and neutrophil-lymphocyte ratio as predictors of occult lymph node metastasis detected using Desmoglein 3 and Cytokeratin in Indian population

Aim

This study aims to assess whether preoperative platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) can predict occult metastasis in oral squamous cell carcinoma (OSCC).

Materials and Methods

Thirty-five OSCC cases were analyzed for clinicopathological and hematological data. Cases without metastasis (pN0) were checked for micrometastasis immunohistochemically using Desmoglein 3 (DSG3) and Cytokeratin (CK). Mean PLR and NLR were compared and analyzed between the study groups.

Results

Metastatic deposits were detected in 9 out of 26 pN0 cases (34.6%) accounting for 11 out of 62 (17%) lymph nodes subjected to immunohistochemistry. The mean PLR was higher in OSCC cases with or without occult metastasis in comparison to controls (P < 0.001). No significant difference was found in the mean PLR and NLR between OSCC cases with and without occult metastasis. Furthermore, we found DSG3+ sinus histiocytes within the lymph nodes in majority of cases which is least reported in literature.

Conclusion

A significant percentage of cases showed occult metastasis in this study which led to upstaging of tumor. Although PLR was elevated in OSCC cases, it did not have a positive correlation with the presence of occult metastasis but was able to successfully distinguish OSCC patients from healthy individuals.

Prognostic Value of Lymph Node Density Compared to Pre-operative Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio in Patients with Tongue Squamous Cell Carcinoma

Background

We aimed to investigate the prognostic significance of lymph node density (LND), and pre-operative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for outcome measuring in tongue squamous cell carcinoma (TSCC)' patients.

Methods

A total of 129 patients who underwent surgery for TSCC were enrolled in this retrospective study. LND and pre-operative NLR and PLR were used as outcome measures and their correlations with different clinicopathological features were examined.

Results

The cutoff values for NLR, PLR, and LND were obtained 1.21, 97.81, and 0.02, respectively, by receiver operating characteristic (ROC) curve approach. Only LND was found to be significantly associated with decreased overall survival (HR = 4.24; 95% CI 1.49-12.10; P = 0.007) and disease-free survival (HR = 3.48; 95% CI 1.43-8.45; P = 0.006) both in univariate and multivariate analyzes.

Conclusion

Based on the findings, the LND has superiority over pre-operative NLR and PLR in predicting outcomes for the patients with TSCC.

Different inflammatory blood markers correlate with specific outcomes in incident HPV-negative head and neck squamous cell carcinoma: a retrospective cohort study

Background

Inflammatory blood markers have been associated with oncological outcomes in several cancers, but evidence for head and neck squamous cell carcinoma (HNSCC) is scanty. Therefore, this study aims at investigating the association between five different inflammatory blood markers and several oncological outcomes.

Methods

This multi-centre retrospective analysis included 925 consecutive patients with primary HPV-negative HNSCC (median age: 68 years) diagnosed between April 2004 and June 2018, whose pre-treatment blood parameters were available. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), systemic inflammatory marker (SIM), and systemic immune-inflammation index (SII) were calculated; their associations with local, regional, and distant failure, disease-free survival (DFS), and overall survival (OS) was calculated.

Results

The median follow-up was 53 months. All five indexes were significantly associated with OS; the highest accuracy in predicting patients’ survival was found for SIM (10-year OS = 53.2% for SIM < 1.40 and 40.9% for SIM ≥ 2.46; c-index = 0.569) and LMR (10-year OS = 60.4% for LMR ≥ 3.76 and 40.5% for LMR < 2.92; c-index = 0.568). While LMR showed the strongest association with local failure (HR = 2.16; 95% CI:1.22–3.84), PLR showed the strongest association with regional (HR = 1.98; 95% CI:1.24–3.15) and distant failure (HR = 1.67; 95% CI:1.08–2.58).

Conclusion

Different inflammatory blood markers may be useful to identify patients at risk of local, regional, or distant recurrences who may benefit from treatment intensification or intensive surveillance programs.

Inflammation Status and Body Composition Predict Two-Year Mortality of Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma under Provision of Recommended Energy Intake during Concurrent Chemoradiotherapy

Only few prospective cohort trials have evaluated the risk factors for the 2-year mortality rate between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC): oral cavity cancer with adjuvant concurrent chemoradiotherapy (CCRT) (OCC) and non-oral cavity cancer with primary CCRT (NOCC), under the recommended calorie intake and investigated the interplay among calorie supply, nutrition–inflammation biomarkers (NIBs), and total body composition change (TBC), as assessed using dual-energy X-ray absorptiometry (DXA). Patients with LAHNSCC who consumed at least 25 kcal/kg/day during CCRT were prospectively recruited. Clinicopathological variables, blood NIBs, CCRT-related factors, and TBC data before and after treatment were collected. Factor analysis was performed to reduce the number of anthropometric and DXA-derived measurements. Cox proportional hazards models were used for analysis. We enrolled 123 patients with LAHNSCC (69 with OCC and 54 with NOCC). The mean daily calorie intake correlated with the treatment interval changes in total body muscle and fat. Patients consuming ≥30 kcal/kg/day had lower pretreatment levels but exhibited fewer treatment interval changes in anthropometric and DXA measurements than patients consuming <30 kcal/kg/day. In the multivariate analysis of the 2-year mortality rate, the prognostic influence of the recommended calorie intake could not be confirmed, but different risk factors (performance status, pretreatment platelet-to-lymphocyte ratio, and treatment interval body muscle changes in patients with OCC; age, pretreatment neutrophil-to-lymphocyte ratio, and body fat storage in patients with NOCC) showed independent effects. Therefore, the inflammation status and body composition, but not the recommended calorie supply, contribute to the 2-year mortality rate for patients with LAHNSCC receiving CCRT.

A preoperative prognostic nutritional index is a prognostic indicator in oral squamous cell carcinoma patients undergoing radical surgery

The purpose of this study was to investigate the prognostic value of prognostic nutritional index (PNI) in oral squamous cell carcinoma (OSCC) patients and to undertake a comparative evaluation of the prognostic value of comparing PNI, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in terms of prognostic utility. A retrospective study was conducted involving 203 consecutive patients with OSCC who were treated with radical surgery with curative intent. The PNI and systemic inflammatory response were developed, and their prognostic utility was evaluated. Kaplan-Meier curve analysis and log-rank testing showed that PNI (P< 0.001), NLR (P=0.011), PLR (P=0.013), and LMR (P=0.014) were significantly associated with overall survival. Multivariate analysis identified PNI as an independent prognostic factor for OSCC patients (P=0.029). In time-dependent receiver operating characteristic curve analysis, PNI was continuously superior to that of NLR, PLR, and LMR. In conclusion, this study suggested that PNI offered an independent prognostic biomarker in OSCC patients undergoing radical surgery. However, this study was small and retrospective, thus further investigations are needed to clarify the utility of PNI for tailor-made treatments in clinical settings.

Knockdown of Nav1.5 inhibits cell proliferation, migration and invasion via Wnt/β-catenin signaling pathway in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is a common type of malignant oral cancer that has a high recurrence rate. Voltage-gated sodium channel Nav1.5 was reported to be highly up-regulated in various types of cancers. However, the regulatory mechanism of Nav1.5 in cancers including OSCC still remains elusive. In this study, Nav1.5 was found to be highly expressed in OSCC tissues and cells. Through the analysis of clinical characteristics of patients, we found that the expression level of Nav1.5 was closely related to neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, tumor-node-metastasis stage, and lymph node metastasis. Moreover, we found that Nav1.5 mainly located on the cell membrane as well as cytoplasm and knockdown of Nav1.5 promoted cell apoptosis and decreased proliferation in OSCC. Transwell assay results showed that knockdown of Nav1.5 effectively suppressed the migration and invasion in OSCC. In addition, knockdown of Nav1.5 was found to inhibit the protein and mRNA expression levels of β-catenin, cyclin D1, and c-Myc in the Wnt/β-catenin signaling pathway. In summary, these results indicated that Nav1.5 may be involved in the progression of OSCC through the Wnt/β-catenin signaling pathway.

Assessment of Pretreatment Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Prognosis of Oral Squamous Cell Carcinoma

PURPOSE

Recent data have provided evidence of systemic inflammatory markers playing an important role in determining the disease-free survival (DFS) and overall survival (OS) of patients with oral squamous cell carcinoma (OSCC). The aim of the present study was to determine the prognosis of OSCC using the preoperative neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR).

PATIENTS AND METHODS

We enrolled 130 patients with OSCC who received treatment in the present retrospective study. Both PLR and NLR correlated with the demographic data, tumor characteristics, and prognosis. The optimal cutoff for PLR and NLR was determined by receiver operating characteristic curve analysis and was 142 and 3.1 for PLR and NLR, respectively. The prognostic significance of both markers was determined by univariate and multivariate analysis. Survival curves were plotted using the Kaplan-Meier method.

RESULTS

The clinicopathologic variables correlated with cumulative survival on univariate analysis. Advanced clinical lymph node stage (P = .001), pathologic lymph node stage (P = .001), pathologic tumor stage (P = .049), pathologic TNM stage (P = .006), receipt of multimodality treatment (P = .013), and high PLRs (P = .001) and NLRs (P = .002) showed a statistically significant association with shorter DFS. A multivariate Cox proportional hazard regression model demonstrated that a high PLR (hazard ratio [HR], 2.998; 95% confidence interval [CI], 1.128 to 7.968; P = .028) and patient age (HR, 1.100; 95% CI, 0.750 to 1.613; P = .025) were independent factors for determining DFS and OS.

CONCLUSIONS

We observed that high PLRs and NLRs were significant in determining the prognosis. The PLR was superior to the NLR in determining DFS and OS and can be used as an independent prognostic indicator in patients with OSCC.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in chronic periodontitis before and after nonsurgical therapy

Background:

Various biomarkers have been evaluated for understanding the systemic inflammatory response (SIR) to periodontitis. Hematological markers have been reported to be useful biomarkers in a variety of diseases, including periodontal diseases. The role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in periodontitis and their possible role in the SIR are not extensively documented. Therefore, this study assessed NLR and PLR in chronic periodontitis (CP) patients before and after periodontal treatment, which to the best of knowledge has not been reported in the literature.

Materials and Methods:

Sixty participants were grouped as systemically and periodontally healthy (H) (n = 30) and with CP (n = 30). Plaque index, gingival index, probing pocket depth, clinical attachment loss, leukocyte counts, platelet (PLT) counts, NLR, and PLR were estimated at baseline and also after treatment in the CP group. NLR was calculated as total neutrophil count/absolute lymphocyte count, and PLR was calculated as total PLT count/absolute lymphocyte count. The data were statistically analyzed.

Results:

Periodontal parameters differed significantly between groups H and CP at baseline and posttreatment. A pair-wise comparison of NLR and PLR between CP patients at baseline and posttreatment was significant. Correlation analyses were not remarkable. Receiver operating characteristics analyses provided significant NLR and PLR predictive cutoff values to differentiate between CP patients at baseline and posttreatment.

Conclusion:

NLR and PLR may serve as potential biomarkers of the SIR to CP to bridge the association between periodontal and systemic conditions.

Platelet-Lymphocyte Ratio as a Predictor of Prognosis in Head and Neck Cancer: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to investigate the prognostic utility of the platelet-to-lymphocyte ratio (PLR) in head and neck cancer. Medline (via PubMed), EMBASE, Scopus, and the Cochrane Library databases were searched from their inception to May 2017 for relevant literature. A systematic review and meta-analysis were performed to generate the pooled hazard ratios (HR) for overall survival (OS) and disease-specific survival (DSS). The study was conducted in accordance with the Cochrane Handbook and PRISMA guidelines. Risk of bias was assessed using the QUIPS tool. The logarithm of the HR with standard error was used as the primary summary statistic. Heterogeneity was assessed using Cochran's Q and Higgins' I2. A total of 13 studies were included in the final analysis, combining data from 4,541 patients. The results demonstrated that an elevated PLR was significantly associated with poorer OS [HR 1.85, 95% CI 1.35-2.52, p < 0.00001] and DSS [HR 1.57, 95% CI 1.25-1.97, p < 0.0001]. Significant heterogeneity was detected for the pooled end points. Subgroup analysis demonstrated reduction of heterogeneity by controlling for sample size and cutoff value. 95% prediction intervals showed wide ranges crossing the null threshold.

Prognostic role of platelet-to-lymphocyte ratio in oral cancer: A meta-analysis

BACKGROUND AND OBJECTIVE

Platelet-to-lymphocyte ratio (PLR) has been suggested to be associated with the progression of oral cancer with inconclusive results. The objective of the current study was to assess the prognostic role of oral cancer by meta-analysis.

METHOD

PubMed, EMbase(Ovid), CNKI, WanFang Data, VIP, and CBM databases were searched up to August 24, 2018. Studies investigating the association between PLR and progression of oral cancer were included. Meta-analysis was performed by using Revman 5.3 software. The protocol of the study was registered on PROSPERO (CRD42018106836).

RESULTS

A total of five studies were included in the meta-analysis. The results of the meta-analysis showed that higher PLR was associated with the poor progress of oral cancer (overall survival: OR = 2.06, 95 CI: 1.49-2.86, P < 0.0001; disease-specific survival: OR = 2.12, 95 CI: 1.59-2.82, P < 0.00001).

CONCLUSION

The current meta-analysis showed that higher PLR is a poor progression factor for oral cancer. However, larger sample, multi-center studies should be carried out in the future to validate the above conclusion.

Prognostic and clinicopathological significance of neutrophil-to-lymphocyte ratio in patients with oral cancer

Objectives: Many studies have examined the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in oral cancer; however, the results are contradictory. We, therefore, conducted a meta-analysis aiming to clarify the prognostic value of the NLR in oral cancer patients. Methods: A literature search was conducted in the PubMed, Web of Science, and Embase databases. Stata version 12.0 was used for statistical analysis. Results: A total of 14 studies with 3216 patients were finally included. The results indicated that a high NLR was significantly associated with worse DFS (n=10, HR = 1.73, 95% confidence interval [CI] = 1.44–2.07, P<0.001). Similar results were observed for overall survival (OS) (n=9, HR = 1.61, 95% CI = 1.39–1.86, P<0.001). Moreover, a high NLR was also correlated with lymph node metastasis (n=7, odds ratio [OR] = 1.62, 95% CI = 1.32–1.98, P<0.001), advanced tumor stage (n=7, OR = 2.63, 95% CI = 2.12–3.25, P<0.001), T stage (n=6, OR = 3.22, 95% CI = 2.59–4.01, P<0.001), tumor differentiation (n=5, OR = 1.48, 95% CI = 1.03–2.11, P=0.033), and perineural invasion (n=4, OR = 1.83, 95% CI = 1.4–2.39, P<0.001). However, an elevated NLR was not correlated with gender. Conclusion: This meta-analysis showed that the NLR might be a potential independent prognostic factor in patients with oral cancer.

Elevated red blood cell distribution width predicts poor prognosis in patients with oral squamous cell carcinoma

Introduction

Although red blood cell distribution width (RDW) has been reported to reflect inflammation and nutritional status and to predict prognosis in several different types of cancer, little is known about how RDW might be related to oral squamous cell carcinoma (OSCC). The present study aimed to investigate the prognostic value of preoperative RDW in OSCC patients.

Materials and methods

We included 236 OSCC patients from Jinan Stomatological Hospital (Shandong, People’s Republic of China) in this retrospective study. All enrolled patients were divided into 2 groups: high RDW (≥15%) and low RDW (<15%) according to the detected RDW values. The correlation of RDW and clinical characteristics was explored, and the prognostic significance of RDW evaluated using Kaplan–Meier curves, log-rank analysis, and the Cox proportional hazards model.

Results

The pretreatment median RDW among all OSCC patients was 14.4%, with a range from 11.6% to 24.5%. The RDW was found to be significantly correlated with node metastasis, tumor length, and TNM stage (P<0.05 for all). As for biochemical parameters, the results showed that higher RDW values were significantly associated with hemoglobin, mean corpuscular volume, white blood cell count, albumin, and C-reactive protein (P<0.01 for all). A significant association of RDW with the tumor marker cytokeratin 19 fragments (CYFRA21-1) and squamous cell carcinoma antigen (SCC-Ag) was also observed (P=0.02, and P=0.03; respectively). Moreover, patients with higher RDW were more likely to receive postoperative therapy (P=0.02). Kaplan–Meier survival curves showed that a high RDW was significantly associated with poor overall survival (OS) (P<0.01), especially in the early stages (I–II). Multivariate analysis revealed that an elevated RDW at diagnosis was an independent prognostic factor for shorter OS (HR =1.46, 95% CI: 1.13–2.86) after adjustment for other cancer-related prognostic factors.

Conclusion

These data suggest that an elevated preoperative RDW (≥15%) at diagnosis may independently predict poorer OS in patients with OSCC, but better-designed studies in the future should be performed to further confirm the value of monitoring RDW.

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis

BACKGROUND

Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) predict severity in various diseases. In this study, we evaluated the value of NLR and PLR as prognostic factors in acute pancreatitis (AP).

METHODS

Patients with AP were prospectively enrolled from March 2014 to September 2016 at Yonsei University Wonju College of Medicine. NLR and PLR were obtained at admission and were compared with other known prognostic scoring systems.

RESULTS

A total of 243 patients were enrolled with an etiology of gallstone (n = 134) or alcohol (n = 109). NLR (17.7 ± 18.3 vs. 8.8 ± 8.4, P <  0.001) and PLR (344.1 ± 282.6 vs. 177.8 ± 150.1, P <  0.001) were significantly higher in the gallstone AP group than in the alcoholic AP group. For gallstone AP, NLR and PLR were significantly higher in severe AP, whereas high NLR and PLR were not related to severe AP in alcoholic AP. For the gallstone AP group, NLR and PLR demonstrated a predictive value significantly superior to C-reactive protein (CRP), whereas NLR, PLR, and CRP were not significant predictors for alcoholic AP.

CONCLUSION

Our study demonstrated that NLR and PLR can predict the severity of AP, but only in gallstone AP.

Platelet to lymphocyte ratio and red cell distribution width as prognostic factors for survival and recurrence in patients with oral cancer

Although platelet to lymphocyte ratio (PLR) and red cell distribution width (RDW) have been reported as good predictors for survival outcomes in various cancers, there is limited data supporting these as reliable predictors in oral cancer. This study thus aimed to assess the prognostic value of PLR and RDW markers in predicting survival and recurrence rates in patients with oral cancer. The records of 374 oral cancer patients treated with curative intent over a 7-year period (2009-2015) were reviewed. Survival and recurrence outcomes were compared between those with low and high PLR (≤135 vs. >135) and those with low and high RDW (≤14.05 vs. >14.05) using hazard ratios (HR). The 5-year disease-specific survival was significantly higher and recurrence rate significantly lower among the low PLR group compared to the high PLR group (65.7 vs. 37.6%; p < 0.001 and 34.4 and 57.5%; p < 0.001), respectively. There were no significant differences between the low and high RDW groups for disease-specific survival (53.6 vs. 54.7%, p = 0.408) and recurrence (40.0% vs. 53.8%, p = 0.079). Multivariate analysis showed that PLR was associated with disease-specific survival (HR = 2.05, p < 0.001) and recurrence (HR = 1.69, p < 0.005) after adjusting for other factors, but not RDW. High PLR shows promise as a prognostic predictor for poor survival and recurrence in patients with oral cancer, but further studies are required. RDW has no prognostic value on any outcome.