Predictive and prognostic impact of preoperative complete blood count based systemic inflammatory markers in testicular cancer

Systemic Immune-Inflammation Index and Mortality in Testicular Cancer: A Systematic Review and Meta-Analysis

The systemic immune-inflammation index (SIII) is a marker studied in multiple types of urologic cancer. This systematic review evaluates the association between SIII values with overall survival (OS) and progression-free survival (PFS) in testicular cancer. We searched observational studies in five databases. The quantitative synthesis was performed using a random-effects model. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The only measure of the effect was the hazard ratio (HR). A sensitivity analysis was performed according to the risk of bias in the studies. There were 833 participants in a total of 6 cohorts. We found that high SIII values were associated with worse OS (HR = 3.28; 95% CI 1.3-8.9; p < 0.001; I² = 78) and PFS (HR = 3.9; 95% CI 2.53-6.02; p < 0.001; I² = 0). No indication of small study effects was found in the association between SIII values and OS (p = 0.5301). High SIII values were associated with worse OS and PFS. However, further primary studies are suggested to enhance the effect of this marker in different outcomes of testicular cancer patients.

Diagnosis by Volatile Organic Compounds in Exhaled Breath in Exhaled Breath from Patients with Gastric and Colorectal Cancers

One in three cancer deaths worldwide are caused by gastric and colorectal cancer malignancies. Although the incidence and fatality rates differ significantly from country to country, the rates of these cancers in East Asian nations such as South Korea and Japan have been increasing each year. Above all, the biggest danger of this disease is how challenging it is to recognize in its early stages. Moreover, most patients with these cancers do not present with any disease symptoms before receiving a definitive diagnosis. Currently, volatile organic compounds (VOCs) are being used for the early prediction of several other diseases, and research has been carried out on these applications. Exhaled VOCs from patients possess remarkable potential as novel biomarkers, and their analysis could be transformative in the prevention and early diagnosis of colon and stomach cancers. VOCs have been spotlighted in recent studies due to their ease of use. Diagnosis on the basis of patient VOC analysis takes less time than methods using gas chromatography, and results in the literature demonstrate that it is possible to determine whether a patient has certain diseases by using organic compounds in their breath as indicators. This study describes how VOCs can be used to precisely detect cancers; as more data are accumulated, the accuracy of this method will increase, and it can be applied in more fields.

The values of systemic immune-inflammation index and neutrophil-lymphocyte ratio in predicting testicular germ cell tumors: A retrospective clinical study

Purpose

To determine whether complete blood count (CBC) based inflammatory parameters can be used as markers predicting testicular germ cell tumors (TGCT).

Material and methods

Between 2013 to 2018 the data of 58 patients with testicular TGCT undergoing radical orchiectomy and 54 malignancy-free healthy men were retrospectively analyzed as tumor group and control group. Patient baseline characteristics including age, pathological stage and pre-surgery CBC based inflammatory parameters including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), systemic immune-inflammation index (SII), lymphocyte ratio (LR), neutrophil ratio (NR), mean platelet volume (MPV) and red cell distribution width (RDW) were analyzed and compared between tumor group and control group. Receiver operating characteristic (ROC) curve were used analyzing data with significantly difference to assess the discriminative ability of the markers for TGCT, area under the curve (AUC), cut-off value, sensitivity and specificity were calculated. The binary logistic regression model was used to evaluate the association between significant inflammatory markers and risk of TGCT.

Results

Mean age of the tumor and control group was 41.1 ± 15.36 and 44.89 ± 9.2 years, respectively. Mean NLR, SII and RDW were significantly higher in tumor group compared with control group with P=0.005, P=0.001 and P=0.016, respectively; there were no significantly differences of age, PLR, LMR, LR, NR, MPV and RDW between groups. The ROC curve for NLR, SII and RDW was plotted in the diagnosis of TGCT and tumor progression, the cut-off value for NLR, SII and RDW were found as 3.38 (AUC: 0.704, sensitivity=51.4%, specificity=88.6%, P=0.003), 881.24 (AUC: 0.725, sensitivity=45.7%, specificity=91.4%, P=0.001) and 0.14 (AUC: 0.63, sensitivity=28.6%, specificity=97%, P=0.063), respectively. Patients were divided into two groups according to the threshold values, respectively. By using the multivariable logistic regression models, NLR ≥ 3.38 (OR, 5.86; 95% CI, 1.67-20.65, P=0.006) and SII ≥ 881.24 (OR, 4.89; 95% CI, 1.48-15.32, P=0.009) were independent risk factors predicting TGCT. Significantly statistical difference of pathological stage was also found between groups with respect to NLR cut-off values (P=0.034) and SII cut-off values (P=0.049). Combined the data together, NLR and SII both exhibited good differential diagnosis potential which could be used as markers predicting the TGCT.

Conclusion

As the CBC based inflammation parameters, both NLR and SII could be used as effective tumor markers predicting the TGCT, and higher NLR and SII are associated with higher pathological stage. In addition, SII is a more powerful tool among these two inflammatory markers.

Determining the relationship between serum acute phase reactants and cervical premalignant lesions: a cohort study

BACKGROUND

Acute phase reactants play a role in the progression and prognosis of many malignant and premalignant tumors. This study investigated the diagnostic value of certain reactants as markers for cervical premalignant lesions.

OBJECTIVE

Despite advanced screening and vaccination programs, cervical cancer remains a serious health problem worldwide. We aimed to determine the possible relationship between premalignant cervical disease and serum acute phase reactant levels.

DESIGN AND SETTING

This study included 124 volunteers who underwent cervical cancer screening. We divided the patients into three groups according to cervical cytology and histopathological findings as follows: no cervical lesion, low-grade neoplasia, or high-grade neoplasia.

METHODS

We included women aged 25-65 years with benign smear or colposcopy results, low- and high-grade squamous intraepithelial lesions. The benign group was based only on cytology findings, whereas the other groups were based on histopathology findings. Demographic data and serum albumin, fibrinogen, ferritin, and procalcitonin levels were evaluated in the three groups.

RESULTS

We found significant differences among the three groups in terms of age, albumin level, albumin/fibrinogen ratio, and procalcitonin level. The regression analysis revealed lower serum albumin levels in the low- and high-grade squamous intraepithelial lesion groups compared with the benign group.

CONCLUSION

This is the first study to evaluate the importance of serum inflammatory markers in cervical intraepithelial lesions. Our results indicate that serum albumin level, albumin/fibrinogen ratio, procalcitonin level, and neutrophil values differ among cervical intraepithelial lesions.

Preoperatif tam kan sayımı belirteçleri ve De-Ritis oranının testis tümörünün tanısındaki prediktif yeri

Aim: To determine the value of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), systemic immune-inflammation (SII) index and De-Ritis ratio, which are among preoperative whole blood and biochemical parameters, in the diagnosis of testicular tumor. Materials and Methods: The data of patients who underwent inguinal orchiectomy for testicular tumor in our clinic between October 2010 and December 2019 and patients who underwent varicocelectomy, as a control group, were retrospectively analyzed. Patients with missing data, under 18 years of age or with additional morbidity were excluded from the present study. Prediction values for NLR, PLR, LMR, SII index and De-Ritis ratio were determined and the value of these parameters in the diagnosis of testicular tumor was examined. Results: Thirty-four (14.1%) patients underwent inguinal orchiectomy while 207 (85.9%) patients underwent varicocelectomy in the present study. The median age of the patients during surgery was 27 (23-32) years. The number of patients with seminoma, mixt germ cell tumor, yolk sac tumor and embryonal carcinoma was 18 (52.9%), 12 (35.3%), 3 (8.8%) and 1 (2.9%), respectively. It was determined that 61.8% of the patients with testicular tumors were in the T2 stage and 35.3% had metastasis. The cut-off values for NLR, PLR, LMR and SII index were determined as 1.76, 133.43, 7.81 and 571.63, respectively. There was no statistically significant cut-off value for De-Ritis ratio (p = 0.183). The only significant factor for predicting testicular tumor was SII index in multivariate analysis (p

Comprehensive Assessment of Selected Immune Cell Subpopulations Changes in Chemotherapy-Naïve Germ Cell Tumor Patients

The pattern of immune cell distribution in testicular germ cell tumors (GCT) significantly differs from the immune environment in normal testicular tissues. The present study aimed to evaluate the role of different leukocyte subpopulation in GCTs. A cohort of 84 chemotherapy-naïve GCT patients was analyzed. Immunophenotyping of peripheral blood leukocyte subpopulations was carried out by flow cytometry. In addition, the data assessing the immunophenotypes and the baseline clinicopathological characteristics of the included subjects were statistically evaluated. Their prognostic value for the assessment of progression-free survival (PFS) and overall survival (OS) was estimated. The percentage of different innate/adaptive immune cell subpopulations was significantly associated with poor risk-related clinical features, including the number of metastatic sites, presence of retroperitoneal, mediastinal, lung, brain and non-pulmonary visceral metastases as well as with the S-stage and International Germ Cell Consensus Classification Group (IGCCCG) risk groups. In univariate analysis, the percentages of neutrophils, eosinophils, dendritic cells type 2, lymphocytes and T cytotoxic cells were significantly associated with PFS, while the neutrophil, non-classical monocyte and lymphocyte percentage were associated with OS. However, all these outcome correlations were not independent of IGCCCG in multivariate analysis. The data indicated a link among different innate/adaptive peripheral immune cell subpopulations in GCT patients. In addition, the association between these subpopulations and tumor characteristics was also investigated. The findings of the present study may contribute to a deeper understanding of the interactions between cancer and innate/adaptive immune response in GCT patients.

Should haematological inflammatory markers be included as an adjuvant in the differential diagnosis of acute scrotal pathologies?

The aim of this study was to determine discriminative role of haematological inflammatories between acute scrotal pathologies and malignancies. In addition, it was aimed to search for a predictive marker of testicular survival in the TT group. Medical data of 141 patients with acute scrotal pathology and 63 TTm patients who presented to our clinic between January 2015 and July 2019 were retrospectively reviewed and compared in terms of haematological values and demographic parameters following the inclusion of 92 healthy controls. In the TTm group, NLR was the discriminative parameter with a median of 2.42 (0.25-8.42), whereas discriminative median values of MCV for TT and CRP for EO were 83.65 (56.9-98.16) and 59.5 (2.9-337) respectively. NLR, PLR, MER and RDW values were statistically lower in the control group compared to the patients groups. In TT subgroup analysis, monocyte count, MER and CRP were found to be statistically higher in the orchiectomy group, while multivariate logistic regression analysis performed for testicular viability revealed monocyte count to be the only significant variable (Odds Ratio [95% Confidence Interval] = 0.046 (0.006-0.366), p<0.004). While our study demonstrated both diagnostic and discriminative values of haematological parameters, it also showed that monocyte count could predict testicular salvage in TT patients. However, further prospective studies are required.

The value of hematological inflammatory parameters in the differential diagnosis of testicular torsion and epididymorchitis

OBJECTIVE

Aim of this study is to investigate the effectiveness of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) values, that can easily be obtained with complete blood count (CBC), in the diagnostic differentiation of testicular torsion and epididymorchitis.

METHOD

Data of patients, who admitted to the urology or emergency departments, diagnosed with acute scrotum, between 2008-2017, were reviewed and retrospectively extracted. Basic characteristics (age, etc.) of patients and blood test results were retrieved. Inflammatory markers such as MPV, NLR and PLR were compared between groups.

RESULT

After determining inclusion/exclusion criteria, a total of 111 patients were divided as testicular torsion, epididymorchitis and control group, including 37 patients each. Mean age of groups were 19.27±6.93, 26.27±6.23 and 23.24±8.49 years, respectively. Statistical significance was found in epididymorchitis and testicular torsion groups compared to the control group according to NLR (P<0.01). PLR showed a statistically significant relationship only with the epididymorchitis group and control group (P=0.46). However, according to MPV values, no statistically significance was found between the groups. Additionally, ROC analyse was performed to evaluate predictive cut-off values of NLR and PLR for the diagnostic differentiation of both groups.

CONCLUSION

Inflammatory markers, obtained from routinely performed low-cost CBC, might be used as adjuvant parameters to differentiate acute scrotal pathologies like testicular torsion and epididymorchitis.

Mean platelet volume combined red cell distribution width as biomarker of chronic obstructive pulmonary disease with pulmonary heart disease

BACKGROUND AND OBJECTIVE

Platelet activation, inflammatory reactions and oxidative stress are common pathogenesis of chronic obstructive pulmonary disease (COPD) with pulmonary heart disease (PHD). Mean platelet volume (MPV) and red blood cell distribution width (RDW) form part of the pathomechanisms of these conditions. Here, we investigated whether MPV and RDW can be biomarkers of PHD occurring secondary to COPD.

MATERIALS AND METHODS

This was a retrospective study on 229 participants with COPD. Among them, 69 had PHD. Complete blood count (CBC), blood gas analysis, pulmonary function tests and echocardiography were analyzed.

RESULTS

MPV and RDW-standard deviation (RDW-SD) were significantly higher in patients with PHD than in patients without PHD (P ≤ 0.001). MPV and RDW-SD were positively correlated with pulmonary artery pressure (PAP) and the size of the right ventricle (P ≤ 0.05). Multivariate regression analysis showed that the risk of PHD increased 3-fold per unit rise in MPV (OR = 2.901, P ≤ 0.001). We observed that the risk of PHD increased 1.5 times per unit rise in RDW-SD (OR = 1.371, P ≤ 0.001).The AUC of ROC curve for the combined MPV and RDW-SD in predicting PHD among COPD patients was 0.900 (95％CI: 0.846-0．954, P ≤ 0.001), with a sensitivity of 76.8% and a specificity of 99.4%.

CONCLUSIONS

Both MPV and RDW-SD were significantly elevated and correlated with disease severity in COPD patients with PHD. A combination of these two parameters presents an effective biomarker of PHD.