Prediction of High-Risk Gastrointestinal Stromal Tumor Recurrence Based on Delta-CT Radiomics Modeling: A 3-Year Follow-up Study After Surgery

Background

Medium- to high-risk classification-gastrointestinal stromal tumors (MH-GIST) have a high recurrence rate and are difficult to treat. This study aims to predict the recurrence of MH-GIST within 3 years after surgery based on clinical data and preoperative Delta-CT Radiomics modeling.

Methods

A retrospective analysis was conducted on clinical imaging data of 242 cases confirmed to have MH-GIST after surgery, including 92 cases of recurrence and 150 cases of normal. The training set and test set were established using a 7:3 ratio and time cutoff point. In the training set, multiple prediction models were established based on clinical data of MH-GIST and the changes in radiomics texture of enhanced computed tomography (CT) at different time periods (Delta-CT radiomics). The area under curve (AUC) values of each model were compared using the Delong test, and the clinical net benefit of the model was tested using decision curve analysis (DCA). Then, the model was externally validated in the test set, and a novel nomogram predicting the recurrence of MH-GIST was finally created.

Results

Univariate analysis confirmed that tumor volume, tumor location, neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), diabetes, spicy hot pot, CT enhancement mode, and Radscore 1/2 were predictive factors for MH-GIST recurrence (P < .05). The combined model based on these above factors had significantly higher predictive performance (AUC = 0.895, 95% confidence interval [CI] = [0.839-0.937]) than the clinical data model (AUC = 0.735, 95% CI = [0.6 62-0.800]) and radiomics model (AUC = 0.842, 95% CI = [0.779-0.894]). Decision curve analysis also confirmed the higher clinical net benefit of the combined model, and the same results were validated in the test set. The novel nomogram developed based on the combined model helps predict the recurrence of MH-GIST.

Conclusions

The nomogram of clinical and Delta-CT radiomics has important clinical value in predicting the recurrence of MH-GIST, providing reliable data reference for its diagnosis, treatment, and clinical decision-making.

Evaluation of the hematological inflammatory parameters in the patients with immune thrombocytopenic purpura: A case-control study

Background and Aims

Inflammation is one of the immune thrombocytopenic purpura (ITP)'s aggravating elements due to inflammatory cells' function. This study aims to identify and evaluate hematological inflammatory parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hemoglobin-to-platelet ratio (HPR), in patients with ITP compared to the control group.

Methods

We retrospectively analyzed the profile of 190 ITP patients from August 2019 to January 2021 at Imam Reza Hospital of Mashhad, Iran, along with 100 healthy individuals who had no ITP-related clinical or laboratory symptoms. Immune cell counts, NLR, PLR, and HPR were calculated using the complete blood count at the time of diagnosis and after the treatment. The results were analyzed through MedCalc, SPSS software, and the receiver operating characteristic curve.

Results

The result showed that white blood cell (WBC) and neutrophil counts were higher in ITP patients (WBC: p: 0.001, neutrophil: p: 0.001), and conversely, platelet and lymphocyte counts were higher in the control group compared to ITP patients (platelets: p: 0.001, lymphocytes: p: 0.001). The indices analysis between the two groups revealed that NLR was significantly increased in ITP patients (p: 0.001), but PLR was significantly reduced in ITP patients (with the mean platelet count of 23.44 ± 35.26 × 109/L) compared to the control group (with the mean platelet count of 234.04 ± 55.88 × 109/L). The HPR index also significantly increased in ITP patients (p: 0.001).

Conclusion

An increase in NLR, PLR, and a decrease in HPR can be considered a valuable diagnostic algorithm in patients with ITP.

Novel biomarkers for the assessment of disease activity in patients with sarcoidosis: a case-control study

BACKGROUND AND AIM

The prognosis of sarcoidosis is challenging and largely depends on the persistence of disease activity and the degree of organ dysfunction. Various biomarkers have been evaluated for diagnosis, disease activity assessment, and prognosis. This study aimed to determine if the ratios of monocytes to high-density lipoprotein cholesterol (MHR), platelets to lymphocytes (PLR), neutrophils to lymphocytes (NLR), and lymphocytes to monocytes ratio (LMR) could be used as novel sarcoidosis activity markers.

METHODS

In a case-control study, 54 patients with biopsy-confirmed sarcoidosis were divided into two groups; group 1: consisted of 27 patients with active sarcoidosis who were newly diagnosed and treatment-naive, and group 2: consisted of 27 patients with inactive sarcoidosis who had been on treatment for at least 6 months. All patients were subjected to a comprehensive history, physical examination, laboratory tests, chest imaging, spirometry, and screening for extrapulmonary organ involvement by means of electrocardiogram and eye examination.

RESULTS

The mean age of the patients was 44 ± 11 years (79.6% were females & 20.4% were males). MHR, NLR, and LMR were significantly higher in patients with active sarcoidosis than in an inactive disease with a cut-off value of 8.6, a sensitivity of 81.5%, and a specificity of 70.4% (P-value < 0.001), a cut-off value of 1.95, sensitivity of 74% and specificity of 66.7% (P-value 0.007) and a cut-off value of < 4, a sensitivity of 81.5%, and a  specificity of 85.2% (P-value < 0.001), respectively. In contrast, PLR was not statistically significant between active and inactive sarcoidosis patients.

CONCLUSIONS

The lymphocytes monocytes ratio is a highly sensitive and specific biomarker that could be used to assess the disease activity in sarcoidosis patients.

Investigation of the value of hematological biomarkers in the clinical differential diagnosis of IgG4-RD

BACKGROUND

IgG4- related disease (IgG4- RD) is a systemic fibroinflammatory disease whose pathogenesis has not been completely elucidated. Due to the novelty and complexity of the diagnostic criteria, it is difficult to distinguish from the diseases included in the differential diagnosis without tissue biopsy. This study aimed to discover new biomarkers that can help for disease diagnosis and its differential diagnosis by reviewing the relationships between neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI).

METHODS

Thirty IgG4- RD, 38 granulomatous polyangiitis (GPA), and 46 sarcoidosis patients presenting to the Rheumatology Clinic meeting the criteria of 2019 American College of Rheumatology, 2012 International Chapel Hill and 1999 American Thoracic Society meeting, respectively, and 27 healthy control subjects were included. We collected data on complete blood count with automated differential values including NLR, PLR, SII, and SIRI.

RESULTS

The SII and PLR values were significantly higher in patients with IgG4-RD compared to healthy controls, (SII median (minmax) 572 (102-5583) vs. 434 (172-897), PLR median (min-max) 130 (56.8-546) vs. 104 (57.5- 253) p < 0.001). SII value was found to have a significant positive correlation with CRP in IgG4-RD disease (r = 0.371; p = 0.043). While SII, SIRI, NLR, PLR parameters were not significant between the IgG4-RD and sarcoidosis groups, SII, SIRI, NLR, PLR were significantly higher in patients with GPA than in IgG4-RD patients (p < 0.001).

DISCUSSION

This is the first study to review the SII, SIRI, NLR, and PLR in IgG4-RD. The obtained results suggest that the SII could beused as a new tool, for differential diagnosis and activity of the IgG4-RD.

Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratio in Preterm Premature Rupture of Membranes

AIM

This study aimed to investigate maternal hematological laboratory parameters of pregnancies complicated with preterm premature rupture of membranes (PPROM) compared to mothers of healthy-term infants (control group).

MATERIALS AND METHODS

This case-control study included 158 mothers who were divided into PPROM (n=67) and control (n=91) groups, respectively. Laboratory parameters of platelet, lymphocyte, and neutrophil counts, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were recorded at the time of diagnosis for the PPROM group and at the time of hospital admission for birth for the control group.

RESULTS

NLR was significantly higher in the PPROM group than in the control group (p=0.001). The cutoff value of NLR to predict PPROM was 6.73 (AUC=0.671, 95% confidence interval=0.58-0.75, p=0.000).

CONCLUSION

A cheap and routine NLR blood test can be used to predict PPROM before labor.

Comparison of NLR (neutrophil/lymphocyte ratio) and PLR (platelet/lymphocyte ratio) as inflammatory markers in 1st episode mania and bipolar mania: A preliminary study

Background

There are various factors including inflammation that have been studied in bipolar disorder. NLR (Neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are one of them. Various psychotropic drugs can affect the inflammatory state.

Aim

This study was planned to find NLR and PLR in bipolar disorder (mania) and psychotropic drug naïve 1^st episode mania.

Materials and Methods

Total of 120 subjects were chosen including, 40 bipolar mania, 40 drugs naïve 1^st episode mania, and 40 healthy controls. The severity of mania was assessed by the Young Mania Rating Scale. Blood samples were collected in the morning hours in order to get blood counts.

Results

A significantly higher values of neutrophil counts and NLR, while the significant lower values of lymphocyte counts in both 1^st episode and bipolar mania compared to healthy control were observed. The first episode mania group had significantly higher neutrophil counts and NLR in comparison to bipolar mania.

Conclusion

Results suggest a possible inflammatory pathophysiology of mania. Psychotropic medicines may have an anti-inflammatory effect, signified by the fact that 1^st episode mania group has a greater level of inflammation in comparison to bipolar mania.

Establishment and validation of a predictive model for bone metastasis in prostate cancer patients based on multiple immune inflammatory parameters

OBJECTIVE

This study aims to establish and validate a predictive model for bone metastasis in prostate cancer patients based on multiple immune inflammatory parameters.

METHODS

In this retrospective study, 162 prostate cancer patients who met the inclusion criteria were selected by Urology Surgery, Shaanxi Provincial People's Hospital. Based on the medical record number of patients and the random number table method, 40 patients were randomly included in a validation group, and the rest were in a modeling group. The patients in the modeling group were divided into a metastatic group (n=67) and a non-metastatic group (n=55) according to the whole-body bone imaging results.

RESULTS

The predictive model was established based on the results of Logistics regression analysis: Logit (P) = -5.341 + 0.930*total Gleason score + 1.426*total prostate specific antigen + 0.836*neutrophil-lymphocyte ratio + 0.896*platelet lymphocyte ratio + 0.641*lymphocyte/monocyte ratio + 0.750*albumin/globulin ratio. ROC analysis showed that the areas under the curve of the predictive model for bone metastasis in the modeling and validation groups were 0.896 and 0.870, respectively. Hosmer-Lemeshow test showed that P=0.253, indicating a high degree of the fitting. External verification results showed that the C-index for predicting prostate cancer bone metastasis in the predictive model established in this study was 0.760 (95% CI: 0.670-0.851).

CONCLUSION

The bone metastasis predictive model based on the multiple immune inflammatory parameters (neutrophil-lymphocyte ratio, platelet lymphocyte ratio, lymphocyte/monocyte ratio and albumin/globulin ratio) in prostate cancer patients can reasonably predict the occurrence of bone metastasis and is well worth clinical application.

Can Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, or Systemic Immune Inflammation Index Be an Indicator of Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy?

AIM

Through this study, we aim to investigate whether biomarkers like the neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII) might predict the postoperative first 24 hours analgesic requirement and pain scores of patients undergoing laparoscopic cholecystectomy.  Material & Method: After receiving the local ethical board approval, records of 67 patients, aged between 18 and 75 years, with ASA classifications I-III who underwent elective laparoscopic cholecystectomy were retrospectively evaluated to record postoperative analgesic requirements and numerical pain scale (NRS) scores. NLR, PLR, and SII scores were calculated from preoperative hemograms and compared with analgesic requirements and NRS scores.

RESULTS

The data of 67 patients were evaluated. There was no correlation between postoperative tramadol use and NRS scores, PLR, or SII values (p>0.05). NRS scores and the cumulative 24-hour postoperative tramadol use were correlated (p=0.0001), as it was observed that patients with high NRS scores used higher amounts of tramadol. Additionally, a poor statistically significant correlation was found between PDW (Platelet distribution width) value and tramadol dose (AUC = 0.611).

CONCLUSION

No significant association between NLR, PLR, SII, pain scores, and tramadol use was detected.

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.

Can neutrophil-lymphocyte ratio predict mortality in acute non-variceal upper gastrointestinal bleeding?

BACKGROUND

Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is one of the common gastrointestinal problems and has a high mortality, especially in patients with poor hemodynamics. Therefore, treatment and follow-up should be managed dy-namically. Neutrophil-lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are fast workable, cheap, and easy to calculate he-matological parameters. We need easily accessible parameters as well as routine classifications such as Rockall score in the treatment and follow-up of NVUGIB patients, whose hemodynamics are unstable and progress with high mortality. In this study, we planned to evaluate NLR and PLR levels in patients with NVUGIB in the treatment follow-up with other scoring systems and their relationship with mortality in these patients.

METHODS

Two hundred and forty-nine patients who were admitted to our clinic between January 2015 and January 2017 diag-nosed with NVUGIB, and who underwent necessary examinations and follow-ups, were included in the study. The patients' Glasgow Blacthford, Rockall Score, NLR, and PLR levels were calculated at the first admission.

RESULTS

One hundred and fifty-six of the patients were male (70.6%) and the mean age of all patients was 64.5±18.0 years. After follow-up and treatment, 28 (11.2%) patients died due to bleeding. High NLR and tachycardia at the time of admission and high patient age were found to be independent risk factors affecting the long of hospital stay. High Rockall score, high NLR at admission, and hy-potension at admission were shown to be independent risk factors affecting mortality.

CONCLUSION

Besides the use of various scoring systems in patients with NVUGIB, we think that the use of simple hematological parameters may be appropriate and the use of these hematological parameters may be useful in the management of patients with unstable hemodynamics.

Relationship of prognostic factors in stomach cancer with Helicobacter pylori: A retrospective study

Background and study aims

The prognostic value of H. pylori, which infects more than half of the human population living in the world and plays a role in gastric cancer pathogenesis, is controversial. Our aim is to investigate the relationship between H. pylori and prognostic factors in gastric cancer.

Patients and methods

The data of 110 patients (38 females and 72 males) that underwent surgeries due to gastric cancer between 2014 and 2017 were retrospectively analyzed. The relationships between survival (disease-free and overall) and factors such as p53, HER2/neu, Ki-67, neutrophil and platelet lymphocyte ratio (NLR / PLR), histopathological and demographic characteristics were examined. In addition, the results of H. pylori positive and negative groups were compared.

Results

Sixty-one (55%) patients were H. pylori negative and 49 (45%) were positive. In multivariate analysis, TNM stage, lymph node capsule invasion and NLR were determined as independent prognostic factors in both disease-free and overall survival. Age>62 and PLR>14.3 were determined as independent predictive factors of poor prognosis in overall survival. In univariate analysis, tumor diameter of >4.3 cm, lymphovascular and perineural invasion, and diffuse p53 expression were determined as predictive factors of poor prognosis in disease-free and overall survival. The effectiveness of these markers in prognosis was not different between H. pylori negative and positive groups.

Conclusion

While age, tumor diameter, TNM stage, lymph node capsule invasion, perineural and lymphovascular invasion, diffuse p53, PLR, and NLR were determined as prognostic factors in gastric cancer, these factors were not affected by the presence of H. pylori.

Predictive values of combined platelet count, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio in preeclampsia

We aimed to determine predictive values of the platelet count (PC), Neutrophil lymphocyte ratio (NLR), and platelet lymphocyte ratio (PLR) in preeclampsia independently and in combination. One hundred and eighty pregnant women (96 normal pregnancies, 84 preeclampsia) were included in this study. ROC evaluated the predictive value of PC, NLR, and PLR. AUC, Youden's index, and optimal cut-off thresholds were calculated independently and in combination. The PC significantly decreased in preeclampsia (p < .0001, 95% CI -60.6437 to -24.5963) with cut-off level ≤250.3, whereas NLR was significantly increased in preeclampsia (5.28 ± 4.77, p = .0001, 95% CI 0.9813-2.9187) with cut-off level >4.47. In preeclampsia, PLR significantly decreased (94.32 ± 30.81, p = .0001, 95% CI 58.2583 to -29.6817) with cut-off level ≤100.48. Combined indices of PC, NLR, and PLR were significantly more predictive of preeclampsia when compared to independent indices (AUC 0.86, p < .001, 95% CI 0.801-0.907, sensitivity 75.0, and specificity 81.2) compared to independent indices.IMPACT STATEMENTWhat is already known on this subject? Many studies have tried to find out a simple screening test that would predict the risk of developing preeclampsia. Platelet count, Neutrophil lymphocyte ratio, and platelet lymphocyte ratio have been investigated independently to predict preeclampsia. These parameters are simple, cheap, and are usually available for all patients. Unfortunately, there are no universal cut-off levels accepted.What do the results of this study add? The use of a combination of platelet count, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio is a simple and effective test to predict preeclampsia. The use of a scoring system involving cut-off levels of platelet count, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio is a highly predictive index for developing preeclampsia.What are the implications of these findings for clinical practice and/or further research? In this study, we aimed to highlight the importance of using a combination of platelet count, neutrophil-lymphocyte ratio, and platelet lymphocyte ratio as a scoring index instead of using these parameters independently. More studies are needed to reach a universal cut-off level for each parameter.

Relationship of prognostic factors in stomach cancer with helicobacter pylori: a retrospective study

BACKGROUND AND STUDY AIMS

The prognostic value of H. pylori, which infects more than half of the human population living in the world and plays a role in gastric cancer pathogenesis, is controversial. Our aim is to investigate the relationship between H. pylori and prognostic factors in gastric cancer.

PATIENTS AND METHODS

The data of 110 patients (38 females and 72 males) that underwent surgeries due to gastric cancer between 2014 and 2017 were retrospectively analyzed. The relationships between survival (disease-free and overall) and factors such as p53, HER2/neu, Ki-67, neutrophil and platelet lymphocyte ratio (NLR / PLR), histopathological and demographic characteristics were examined. In addition, the results of H. pylori positive and negative groups were compared.

RESULTS

Sixty-one (55%) patients were H. pylori negative and 49 (45%) were positive. In multivariate analysis, TNM stage, lymph node capsule invasion and NLR were determined as independent prognostic factors in both disease-free and overall survival. Age>62 and PLR>14.3 were determined as independent predictive factors of poor prognosis in overall survival. In univariate analysis, tumor diameter of >4.3 cm, lymphovascular and perineural invasion, and diffuse p53 expression were determined as predictive factors of poor prognosis in disease-free and overall survival. The effectiveness of these markers in prognosis was not different between H. pylori negative and positive groups.

CONCLUSION

While age, tumor diameter, TNM stage, lymph node capsule invasion, perineural and lymphovascular invasion, diffuse p53, PLR, and NLR were determined as prognostic factors in gastric cancer, these factors were not affected by the presence of H. pylori.

Prognostic significance of platelet lymphocyte ratio in patients with melanoma: A meta-analysis

BACKGROUND

The aim of this study was to systematically evaluate the prognostic role of platelet lymphocyte ratio (PLR) in patients with melanoma through performing a meta-analysis.

METHODS

PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure were searched for potential studies. The basic characteristics and relevant data were extracted. Hazard ratios with 95% confidence intervals (CIs) were pooled to evaluate the prognostic role of PLR in patients with melanoma.

RESULTS

Ten studies enrolling 2422 patients were included. The pooled hazard ratios of higher PLR for overall survival and progression-free survival in melanoma were 1.70 (95% CI, 1.22-2.37) and 1.65 (95% CI, 1.10-2.47), respectively. Sensitivity analysis and subgroup analyses were also performed. No significant publication bias was observed.

CONCLUSION

Our results showed that higher PLR was associated with poorer overall survival and progression-free survival in patients with melanoma. These findings may help to determine the prognosis and explore future novel therapies based on modulating inflammation and immune responses in melanoma.

The Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio Predicts Disease-Free Survival in Resectable Esophageal Squamous Cell Carcinoma

BACKGROUND

Recent studies have revealed that the presence of systemic inflammation is associated with poor survival for esophageal squamous cell carcinoma. We aimed to investigate prognostic values of preoperative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in resectable esophageal squamous cell carcinoma.

METHODS

A cohort of 167 resectable ESCC patients was retrospectively reviewed between January 2017 and September 2020. The best cut-off value of NLR and PLR was selected by plotting the receiver operating characteristic curve. All reviewed patients were divided into high NLR/PLR or low NLR/PLR group to evaluate prognostic factors.

RESULTS

Among the 167 patients, 34 (20.36%) were women and 133 (79.64%) were men. The mean age was 62.64 ±7.91 years, with an age range from 44 to 85 years. All patients were divided into low NLR (<2.20) or high NLR (≥2.20) group (AUC=62.5% with the sensitivity of 61.8% and specificity 60.9%, P=0.025), low PLR (<110) or high PLR (≥110) group (AUC=59.6% with the sensitivity of 82.4% and specificity 35.3%, P=0.083). High NLR and PLR were associated with a larger tumor diameter (P<0.05), while high NLR was also associated with poor tumor classification (P=0.022). There was a positive correlation between NLR and PLR (r = 0.614, P < 0.001). High NLR and PLR were significantly associated with poor disease-free survival. Multivariate analyses identified NLR as a prognostic factor in resectable ESCC.

CONCLUSION

The NLR and PLR predict disease-free survival in resectable esophageal squamous cell carcinoma.

Role of hematological parameters in COVID-19 patients in the emergency room

Aim: In this study, the roles of biomarkers from a peripheral blood sample in the diagnosis of COVID-19 patients who have visited the emergency room have been evaluated. Materials & methods: Peripheral blood parameters, systemic inflammatory index (SII), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio were compared in patients with and without confirmed COVID-19 infection. Results: Comparisons made according to real-time PCR test results revealed that while no statistically significant difference was observed between test groups (negative-positive) regarding lymphocyte and platelet lymphocyte ratio values (p > 0.05), a statistically significant difference (p < 0.05) was found between the test groups regarding platelet, hemoglobin, leukocyte, neutrophil, NLR and SII values. Conclusion: Leukocyte, neutrophil, platelet count, NLR and SII values can be used in the diagnosis of COVID-19.

Can the CRP/albumin Ratio be Used as a New Indicator of Activation in Patients with Uveitis?

Purpose: To evaluate whether the C-reactive protein (CRP)/albumin ratio (CAR) in patients with uveitis during an attack is a marker that can give information about the activity, severity and prognosis of the disease.Methods: This study included 35 patients with an uveitis attack and 35 healthy volunteers. The localization and severity of uveitis were recorded. Patients' complete blood count (CBC) during the attack, CRP, CAR, erythrocyte sedimentation rate(ESR), neutrophil/lymphocyte ratio(NLR), and platelet/lymphocyte ratio(PLR) were recorded.Results: The mean age was 34.1 ± 12.5 years for the 35 uveitis cases and 30.1 ± 4.1 years for the healthy volunteers. CRP and CAR were significantly higher in uveitis patients (p = .015 and 0.011, respectively). While CRP and CAR were significantly higher in severe anterior uveitis than mild anterior uveitis (p = .036 and 0.022, respectively), only CAR was significantly higher in severe posterior and panuveitis than mild ones(p = .017).Conclusion: CAR may be an important parameter in determining the activation of the uveitis.

The Utility of Retinol-Binding Protein 4 in Predicting Liver Fibrosis in Chronic Hepatitis C Patients in Response to Direct-Acting Antivirals

Background

Hepatic fibrosis grading is crucial for chronic hepatitis C (CHC) patients in monitoring liver disease progression and antiviral treatment indication. Retinol-binding protein 4 (RBP4), an adipokine secreted by adipocytes and hepatocytes, has variable levels in health and disease.

Purpose

To comparatively evaluate RBP4 serum levels in predicting liver fibrosis in CHC versus fibroscan, noninvasive fibrosis, and inflammatory indices.

Patients and Methods

Cohort study included 50 naive non-obese CHC patients and 20 age-, sex- and body mass index-matched healthy subjects. Fibroscan, RBP4, and noninvasive fibrosis as APRI, CDS, FIB-4, GUCI, Lok index indices based on serological markers, and inflammatory indices as platelet to lymphocyte ratio (PLR) and liver regeneration markers as; alpha-fetoprotein (AFP) and APRI, were evaluated in response to direct-acting antivirals (DAAs).

Results

RBP4 was significantly lower in patients than in controls (P=0.0001) and progressively decreased with the increase in fibrosis grade (F0-F=41.42±3.08), (F2=39.32±1.43), (F3-F4= 35.31±0.5), (P=0.0001). Liver function, stiffness, and RBP4 significantly improved after treatment (P=0.0001). RBP4 negatively correlated with viral load (r=−0.78, p=0.0001), fibroscan fibrosis grade (r=−0.52, p=0.0001), AFP (r=−0.63, p=0.0001), and positively correlated with platelet (r=0.424, p=0.0001), and white cell count (r=0.298, p=0.002). RBP4 at a cutoff value <40.55 ng/mL might predict significant fibrosis (90.48% sensitivity, 62.5% specificity, AUROC=0.811, 95% CI=67.5–90.0) and at a cutoff value <35.9 ng/mL could predict advanced fibrosis (100% sensitivity, 100% specificity, AUROC =1.0, 95% CI=0.929–1).

Conclusion

RBP4 showed excellent accuracy, sensitivity, specificity, PPV, and NPV. RBP4 has a superior diagnostic performance in predicting advanced fibrosis grads in CHC patients and hence can replace expensive invasive procedures.

Substantial tumor regression in prostate cancer patient with extensive skeletal metastases upon Immunotherapy (APCEDEN): A case report

RATIONALE

Prostate cancer along with colorectal and lung cancers accounts for 42% of cancer cases in men globally. It is the first cancer indication for which the use of active immunotherapy, Sipuleucel-T (Provenge) was granted by the FDA in 2010. This study presents a case of prostate carcinoma and the tumour remission observed after administration of a personalised Dendritic cell vaccine (APCEDEN).

PATIENT CONCERNS

A 58 years old Caucasian male diagnosed with prostate carcinoma with GLEASON score 8. The patient had previously been diagnosed with Renal Cell Carcinoma (RCC) in 1996 and had undergone nephrectomy of the right kidney. PET CT scan revealed multiple intensely PSMA avid lesions noted in both lobes of the prostate gland with SUVmax -28.3 and the prostate gland measuring 3.2 × 3.2 cm displaying maximum dimensions.

DIAGNOSIS

FNAC followed by PETCT confirmed CA Prostate and further supported by increased serum PSA level.

INTERVENTIONS

The patient underwent personalised Dendritic Cell Immunotherapy APCEDEN regimen of six doses biweekly, in a time frame of 3 months were given both via intravenous and intradermal route. Six months post completion of APCEDEN, the patient was administered 6 booster shots for 6 months.

OUTCOMES

Progressive remission of carcinoma was observed along with reduction in PSA and Testosterone levels. PET CT showed decline in PSMA avidity by 50% with SUVmax -14.0 and normal size and shape of prostate gland.

LESSONS

Prostate carcinoma is the second most common cancer in men with majority of them exhibiting locally advanced disease. Apparently 20% to 30% of them are categorized as relapsed cases after various therapeutic interventions. Modulating immune system is an emerging therapy termed as Immunotherapy and potentiates the killing cancer cells via immune activation. Interestingly, prostate cancer is slow growing and it provides the scope and time to mount an anti-tumor response which makes it an attractive target for immunotherapy. This case study demonstrates the efficacy of APCEDEN Immunotherapy regimen resulting in a significant disease remission benefiting the patient.

Substantial remission of prostate adenocarcinoma with dendritic cell therapy APCEDEN® in combination with chemotherapy

Of the most prevalent solid tumors with advanced disease, prostate and ovarian cancer and non-small cell lung carcinoma have the fewest therapeutic options. Herein, we report the case of a 63-year-old male with metastatic prostate adenocarcinoma showing substantial remission post-administration of personalized dendritic cell-based vaccine APCEDEN^® in combination with chemotherapeutic drug Mitoxantrone. Therapeutic response displayed an interesting clinical correlation validated by PET scan images showing decreased fluorodeoxyglucose (FDG) avidity in the prostate gland, reduced skeletal metastases further established by the drop in serum Prostate Specific Antigen (PSA) levels and expression of immune assessment markers (IFN-γ, Tregs, neutrophil lymphocyte ratio and platelet lymphocyte ratio). This case demonstrates the potential efficacy of dendritic cell immunotherapy, showing a potent antitumor activity by enhancing the host immune responses, and improving quality of life.

Prostate adenocarcinoma is the most common cancer and second leading cause of cancer-related death in men. Advanced cancers have very few therapeutic options. Understanding of the immune system has led to the development of novel personalized vaccines as an emerging and efficient treatment modality for cancer. This case study describes the substantial remission of advanced prostate cancer after receiving the personalized dendritic cell therapy APCEDEN in combination with the chemotherapy drug mitoxantrone, even after the patient’s previous failed treatment history of standard hormonal, chemo- and radiotherapy regimens. This case stands as an interesting example of combination therapy for cancer benefiting the patient.

IS THERE A RELATIONSHIP BETWEEN PARATHYROID HORMONE AND NEUTROPHIL LYMPHOCYTE RATIO OR PLATELET LYMPHOCYTE RATIO?

Context

Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are recent prognostic markers associated with inflammation in many diseases such as chronic kidney disease (CKD), malignancies, myocardial infarction.

Objective

In this study, we investigated the relationship between NLR-PLR and parathyroid hormone (PTH) and vitamin D in patients with high PTH levels.

Design

The patients with high PTH levels in Nephrology and Endocrinolgy Outpatient clinics were evaluated retrospectively.

Subjects and methods

The medical records of the patients were examined and clinical data, including demographic details, clinical and laboratory findings, treatment and follow-up data were obtained. NLR and PLR were calculated. Serum creatinine, calcium, phosphorus, magnesium, lipid levels, calcium phosphorus product, PTH and vitamin D values were investigated. The relationship between NLR-PLR and laboratory parameters, GFR (MDRD-GFR), PTH and vitamin D were investigated.

Results

48 male and 253 female patients were enrolled in this study. The mean age was 57.57±13.28. NLR correlated negatively with albumin, hemoglobin, vitamin D, calcium and cholesterol and it positively correlated with creatinine and PTH. Multiple regression analysis showed that main determinants of NLR were PTH, albumin, LDL-cholesterol, hemoglobin and gender.

Conclusions

In this study NLR and PLR correlated negatively with hemoglobin and cholesterol. Positive correlation between NLR and creatinine could be explained by increased degrees of inflammation associated with more pronounced degrees of renal dysfunction. The impact of PTH on NLR was independent of GFR. In multiple regression model this suggests that PTH could be a pro-inflammatory parameter independent of the degree of renal dysfunction.

Predictive Value of Hematological Inflammatory Markers in Endometrial Neoplasia

Objective: To investigate the predictive role of neutrophil lymphocyte ratio (NLR) and the platelet lymphocyte ratio (PLR) as hematological inflammatory markers in cases of endometrial hyperplasia and cancer. Material and Method: This retrospective study was performed between 2005-2015 with 247 cases of 83 endometrial adenocarcinoma (group 1), 64 of endometrial hyperplasia (group 2) and 100 controls (group 3) who underwent a curettage due to abnormal uterine bleeding and had a normal histopathology in our tertiary clinic. The cases were chosen from patients without chronic diseases, that do not have infection or medication that could affect the systemic inflammatory response. Preintervention blood parameters were taken into account. The neutrophil/ lymphocyte and platelet/lymphocyte ratios were and statistical comparisons of the groups were conducted. Results: The age distribution of 247 patients was between 26 and 85 years, and the mean age was 48.8 ± 8.92.The median age was 54 in group 1, 46 in group 2 and 45 in group 3. The age was significant between group 1 and the other groups (p=0.001). Some 71% of the cases were premenopausal and 29% were postmenopausal, the latter being significantly more frequent in group 1 (62.7%; p=0.001). Of the cases with endometrial hyperplasia, 42 (65.6%) had simple and 22 (34.4%) have atypical-complex lesions. The median NLRs in groups 1, 2, and 3 were 2.15, 2.10, and 1.92, respectively, with median PLRs of 135.1, 134.0 and 145.6. There was a statistically significant difference between the NLR measurements of the cases from different groups (p=0.048; p<0.05). The NLR value for the endometrial adenocarcinoma group was significantly higher than for the control group (p=0.033; p<0.05). The optimum cut-off value was calculated to be ≥4, at which sensitivity was 20.5%, specificity 99%, positive predictive value (PPV) 94.4% and negative predictive value (NPV) 60%. Conclusion: The value of NLR ≥4 has predictive significance in distinguishing endometrial pathologies before intervention in patients with abnormal uterine bleeding. Simple, cheap and easy-to-perform, the NLR can be used as a potential hematological marker for endometrial malignancy.

Determinants of lymph node count and positivity in patients undergoing surgery for colon cancer

Prognosis in colon cancer is based on pathological criteria including TNM staging. However, there are deficiencies in this approach, and the lymph node ratio (LNR) has been proposed to improve the prediction of outcomes. LNR is dependent on optimal retrieval of lymph nodes-lymph node count (LNC). Recent studies have suggested that an elevated preoperative systemic inflammatory response (SIR) was associated with a lower LNC and a higher LNR. However, there are a number of potential confounding factors. The aim of the present study was to examine, in detail, these relationships in a large cohort of patients.A prospectively maintained database of all patients undergoing colon cancer resection in our institution was examined. The SIR was measured by a number of inflammatory markers and their scores: modified Glasgow Prognostic Score (mGPS) (C-reactive protein/albumin), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR) using standard thresholds. The relationships between LNC and LNR, and clinicopathological characteristics (including the mGPS, NLR, PLR, and LMR) were examined using chi-square test for trend and binary logistic regression analysis, where appropriate.Of the 896 patients included in the study, 418 (47%) were male, the median LNC was 17 (1-71), and the median LNR in node positive disease was 0.16 (0.03-1). On multivariate analysis, there was a significant independent relationship between an elevated LNC (≥12) and laparoscopic surgery (P < .001), right-sided tumors (P < .001), later date of resection (2007-2016) (P < .001), T stage (P < .001), and venous invasion (P < .001). In those patients with a LNC ≥12 and node-positive disease (n = 272), on multivariate analysis, there was a significant relationship between an elevated LNR (≥0.25), and T stage (P < .01) and differentiation (P < .05). Finally, in patients with node-positive disease who had surgery later (2007-2016), LNR was directly superior to N stage for both cancer-specific survival (LNR: hazard ratio [HR] 2.62, 95% confidence interval [CI] 1.25-5.52, P = .011) and overall survival (LNR: HR 2.02, 95% CI 1.12-3.68, P = .022).Neither LNC nor LNR was associated with markers of the SIR; however, LNC and LNR were directly associated. In high-quality surgical and pathological practice, LNR had superior prognostic value compared with N stage in patients undergoing surgery for colon cancer.

Preoperative Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio Cannot Predict Lymph Node Metastasis and Prognosis in Patients with Early Gastric Cancer: a Single Institution Investigation in China

In the present study, we aimed at exploring the applied value of preoperative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in the prediction of lymph node metastasis (LNM) and prognosis in patients with early gastric cancer (EGC). We retrospectively analyzed a total of248 consecutive patients who underwent curative gastrectomy to be identified T1 stage gastric adenocarcinoma between January 1, 2010 and May 1, 2016 in a single institution. According to median preoperative NLR and PLR value, we divided the patients into four groups: high NLR >1.73 and low NLR <1.73, high PLR >117.78 and low PLR <117.78. Furthermore, to evaluate the relationship between preoperative NLR and PLR values, we categorized patients according to cutoff preoperative NLR-PLR score of 2 [high NLR (>1.73) and high PLR (>117.78)], 1 [either high NLR or high PLR], and 0 [neither high NLR nor high PLR], Statistical analyses were conducted using SPSS 20.0 software. The results showed that the preoperative NLR or PLR values, lower or higher, could not predict the LNM in patients with EGC (both P=0.544>0.05). The invasive depth of tumor was significantly correlated with LNM of EGC (P0.001). Kaplan-Meier plots illustrated that preoperative NLR and PLR values were not associated with overall survival (OS) in patients with EGC. It was concluded that the preoperative NLR and PLR may be the predictors for LNM and prognosis in patients with advanced gastric cancer; nevertheless, they cannot predict LNM and prognosis in patients with EGC.

Evaluation of platelet lymphocyte ratio and 90-day mortality in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have high mortality and health care costs. The platelet to lymphocyte ratio (PLR) is a marker of inflammation and has been reported to be elevated in patients with AECOPD compared to stable state. In this study, we sought to evaluate the association of the PLR in patients with AECOPD with 90-day mortality.

METHODS

We conducted a retrospective cohort study of patients admitted to our institution with a primary diagnosis of AECOPD between January 2014 and July 2014. Blood test results on admission were recorded. The primary outcomes were 90-day mortality.

RESULTS

One hundred and eighty-one AECOPD patients were considered for the study. Death had occurred in 16 (9%) patients within 90 days of hospital discharge. Univariable analysis identified age, haemoglobin, neutrophil count, and urea level, neutrophil lymphocyte ratio (NLR) and PLR as being associated with increased 90-day mortality. Multivariable logistic regression analysis variables demonstrated that only PLR (P=0.03) was significantly associated with death at 90 days. Receiver operator characteristic analysis identified PLR ≥235 had a sensitivity of 63% and specificity of 74% in predicting 90-day mortality. PLR was ≥235 was also associated with worse survival (days) [mean ± standard deviation (SD): PLR ≥235 vs. PLR <235: 512±358 vs. 626±346, P=0.004].

CONCLUSIONS

A PLR ≥235 was significantly associated with 90-day mortality, which may provide prognostic guidance to clinicians.

Preoperative NLR and PLR in the middle or lower ESCC patients with radical operation

Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) had been analysed in many kind of tumours, but its role of predict the oesophageal squamous cell carcinoma (ESCC) patients' prognosis was not reach a consensus. Relationship between NLR, PLR and ESCC located in the middle or lower segment was evaluated. 317 patients with ESCC who underwent attempted curative oesophagectomy were analysed in this study. 157 and 98 patients had elevated NLR and PLR respectively (NLR >3.3 and PLR >150). The median overall survival time (OS) and disease-free survival (DFS) was 34.1 and 19.2 months respectively. Multivariate analysis found PLR >150 (P = 0.018, HR 1.426, 95%CI 1.063-1.912) accompanied by male, lymphatic metastases, tumour size more than 3 cm, tumour located at middle segment and poor differentiation were associated with significantly worse DFS. Meanwhile, gender, lymphatic metastases, tumour location and differentiation along with PLR >150 (P = 0.003, HR 1.595, 95% CI 1.172-2.170) and NLR>3.3 (P = 0.039, HR 1.367, 95% CI 1.015-1.840) were all independent prognostic factors for OS. Preoperative NLR and PLR might be used as predictive factors in patients with ESCC. For DFS, elevated PLR compared to NLR may have an advantage to indicate poor prognosis.

Blood mean platelet volume and platelet lymphocyte ratio as new predictors of hip osteoarthritis severity

Osteoarthritis (OA) is a low grade systemic inflammatory disease in which many inflammatory mediators are known to be elevated in the peripheric blood. Blood platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) are accepted as novel markers in many of the systemic inflammatory disorders, but have not been investigated in synovitis-free radiographic OA yet.The aim of this study was to evaluate the levels of blood PLR and MPV in radiographic hip OA. A total of 880 patients were evaluated retrospectively and after certain exclusion criteria, 237 of them who have primary hip OA were included. Age, sex, height, weight, body mass index, neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR), PLR, and MPV levels were recorded, Kellgren-Lawrence (KL) grading of the hip joints were performed. Patients were then divided into 2 groups as KL grades 1 to 2 (mild-moderate) and KL grades 3 to 4 (severe) hip OA.Mean age, mean neutrophil, lymphocyte and platelet counts, mean MPV, mean PLR, and mean ESR were statistically significantly different between mild/moderate hip OA group and severe hip OA group. In univariate analysis, older age and higher MPV, PLR, and ESR were severely associated with severe hip OA. In multiple logistic regression analysis, MPV, PLR, and ESR emerged as independent predictors of severe hip OA.The results of the present study, for the first time in the literature, suggest blood PLR and MPV as novel inflammatory markers predicting the radiographic severity of hip OA in the daily practice.

Clinical significance of pre-operative neutrophil lymphocyte ratio and platelet lymphocyte ratio as prognostic factors for patients with colorectal cancer

The present study aimed to investigate the independent prognostic values of the pre-operative neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in patients with colorectal cancer (CRC). The present study retrospectively analyzed the data of 216 patients with CRC from a single hospital. The clinicopathological characteristics of the patients were compared and prognostic factors were evaluated. NLR and PLR were associated with tumor differentiation status and the tumor diameter, respectively, and PLR was also associated with the primary tumor classification (T classification). Furthermore, NLR and PLR were positively associated with each other (R2=0.5368; P<0.0001). Univariate analyses indicated that stage II and III patients with a high NLR (≥4.98; P<0.001) or PLR (≥246.36; P<0.001) possessed a significantly poorer 5-year OS rate compared with those with a low NLR or PLR. Post-operative adjuvant chemotherapy improved the 5-year OS rate in patients with a high NLR or PLR. Multivariate analyses indicated that NLR and PLR were independent prognostic factors [NLR, relative risk (RR)=4.074 and P<0.001; PLR, RR=2.029 and P=0.029] in patients with CRC, and were associated with the T classification, lymph node metastasis and post-operative adjuvant chemotherapy response of patients. Additionally, the area under the curve (AUC) was 0.748 for NLR (95% CI, 0.684-0.804; P<0.0001) and 0.690 for PLR (95% CI, 0.623-0.751; P<0.0001). The RR and AUC indicated that NLR was the superior predictive factor in patients with CRC. In conclusion, the pre-operative NLR and PLR were significant independent prognostic factors in patients with CRC, and NLR was more effective as a prognostic marker compared with PLR. Adjuvant chemotherapy appeared to be more effective in CRC patients with a higher NLR or PLR.