Prognostic Significance of the Post-Treatment Neutrophil-to-Lymphocyte Ratio in Pharyngeal Cancers Treated with Concurrent Chemoradiotherapy

Prognostic significance of HALP score and combination of peripheral blood multiple indicators in patients with early breast cancer

Background

To assess the prognostic significance of preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score combined with multiple peripheral blood indicators in patients with early breast cancer (EBC).

Methods

A total of 411 patients with early invasive breast cancer underwent breast-conserving surgery or radical surgery at Changzhou No.2 People's Hospital from January 2015 to December 2020. The cut-off values of HALP, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and prognostic nutritional index (PNI) were calculated using the software X-tile. The primary outcomes were recurrence-free survival (RFS), which was analyzed using the Kaplan Meier (K-M) method, while log-rank was used to test the differences between high and low curves. Cox regression analysis was used to analyze the prognostic significance of HALP. Furthermore, the prognostic predictive value of independent prognostic factors was determined using the receiver operating characteristic (ROC) curve.

Results

Low HALP score (P<0.0001), high PLR (P<0.0001), and low LMR (P = 0.0345) were significantly associated with worse RFS. Body mass index (BMI)<24 (P = 0.0036), no diabetes (P = 0.0205), earlier TNM stage (P = 0.0005), and no lymph node metastasis (P = 0.0022) were positively correlated with longer survival HALP scores (hazard ratio [HR] 95% confidence interval [CI]: 0.08 (0.024-0.265), P<0.0001), BMI (HR 95%CI: 0.254 (0.109-0.589), P = 0.001), TNM stage (HR 95%CI: 0.153 (0.041-0.571), P = 0.005), and diabetes (HR 95%CI: 0.259 (0.085-0.785), P = 0.017) were demonstrated as independent prognostic factors by Cox regression analysis. The ROC curves depicted that the two most valuable factors were TNM stage and HALP, and combined independent factors were more accurate in prognostic prediction than any single factor. This further indicated that the TNM stage combined HALP or BMI were more valuable combinations.

Conclusion

The HALP score was an independent prognostic factor for EBC and was significantly associated with worse RFS. This score may predict the probability of postoperative tumor recurrence or metastasis before surgery.

A nomogram based on platelet-to-lymphocyte ratio for predicting lymph node metastasis in patients with early gastric cancer

Background

Preoperative assessment of the presence of lymph node metastasis (LNM) in patients with early gastric cancer (EGC) remains difficult. We aimed to develop a practical prediction model based on preoperative pathological data and inflammatory or nutrition-related indicators.

Methods

This study retrospectively analyzed the clinicopathological characteristics of 1,061 patients with EGC who were randomly divided into the training set and validation set at a ratio of 7:3. In the training set, we introduced the least absolute selection and shrinkage operator (LASSO) algorithm and multivariate logistic regression to identify independent risk factors and construct the nomogram. Both internal validation and external validation were performed by the area under the receiver operating characteristic curve (AUC), C-index, calibration curve, and decision curve analysis (DCA).

Results

LNM occurred in 162 of 1,061 patients, and the rate of LNM was 15.27%. In the training set, four variables proved to be independent risk factors (p < 0.05) and were incorporated into the final model, including depth of invasion, tumor size, degree of differentiation, and platelet-to-lymphocyte ratio (PLR). The AUC values were 0.775 and 0.792 for the training and validation groups, respectively. Both calibration curves showed great consistency in the predictive and actual values. The Hosmer-Lemeshow (H-L) test was carried out in two cohorts, showing excellent performance with p-value >0.05 (0.684422, 0.7403046). Decision curve analysis demonstrated a good clinical benefit in the respective set.

Conclusion

We established a preoperative nomogram including depth of invasion, tumor size, degree of differentiation, and PLR to predict LNM in EGC patients and achieved a good performance.