Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival

BACKGROUND

Variations in systemic inflammatory response biomarker levels have been associated with adverse clinical outcome in various malignancies. This study determined the prognostic significance of preoperative neutrophil:lymphocyte (NLR), platelet:lymphocyte (PLR) and monocyte:lymphocyte (MLR) ratios in endometrial cancer.

METHODS

Clinicopathological and 5-year follow-up data were obtained for a retrospective series of surgically treated endometrial cancer patients (n=605). Prognostic significance was determined for overall (OS) and cancer-specific survival (CSS) using Cox proportional hazards models and Kaplan-Meier analysis. Receiver-operator characteristic and log-rank functions were used to optimise cut-offs. NLR, PLR and MLR associations with clinicopathological variables were determined using non-parametric tests.

RESULTS

Applying cut-offs of ⩾2.4 (NLR), ⩾240 (PLR) and ⩾0.19 (MLR), NLR and PLR (but not MLR) had independent prognostic significance. Combining NLR and PLR scores stratified patients into low (NLR-low and PLR-low), intermediate (NLR-high or PLR-high) and high risk (NLR-high and PLR-high) groups: multivariable hazard ratio (HR) 2.51; P<0.001 (OS); HR 2.26; P<0.01 (CSS) for high vs low risk patients. Increased NLR and PLR were most strongly associated with advanced stage (P<0.001), whereas increased MLR was strongly associated with older age (P<0.001).

CONCLUSION

Both NLR and PLR are independent prognostic indicators for endometrial cancer, which can be combined to provide additional patient stratification.

Agreement between objective and subjective assessment of image quality in ultrasound abdominal aortic aneurism screening

OBJECTIVE

To investigate agreement between objective and subjective assessment of image quality of ultrasound scanners used for abdominal aortic aneurysm (AAA) screening.

METHODS

Nine ultrasound scanners were used to acquire longitudinal and transverse images of the abdominal aorta. 100 images were acquired per scanner from which 5 longitudinal and 5 transverse images were randomly selected. 33 practitioners scored 90 images blinded to the scanner type and subject characteristics and were required to state whether or not the images were of adequate diagnostic quality. Odds ratios were used to rank the subjective image quality of the scanners. For objective testing, three standard test objects were used to assess penetration and resolution and used to rank the scanners.

RESULTS

The subjective diagnostic image quality was ten times greater for the highest ranked scanner than for the lowest ranked scanner. It was greater at depths of <5.0 cm (odds ratio, 6.69; 95% confidence interval, 3.56, 12.57) than at depths of 15.1-20.0 cm. There was a larger range of odds ratios for transverse images than for longitudinal images. No relationship was seen between subjective scanner rankings and test object scores.

CONCLUSION

Large variation was seen in the image quality when evaluated both subjectively and objectively. OBJECTIVE scores did not predict subjective scanner rankings. Further work is needed to investigate the utility of both subjective and objective image quality measurements.

ADVANCES IN KNOWLEDGE

Ratings of clinical image quality and image quality measured using test objects did not agree, even in the limited scenario of AAA screening.