Diagnostic role of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in patients with enchondroma and low-grade chondrosarcoma

Abstract

Cartilaginous tumors of the skeleton are amongst the most common; however, differential diagnosis remains to be a challenge. [1,2] These neoplasms range from enchondromas to chondrosarcomas with diagnostic margin being rather vague, particularly between enchondromas and low-grade chondrosarcomas where misdiagnosis may bring burdensome consequences. Currently, clinical discrimination mainly relies on location, radiologic, and pathologic properties of the tumor which yield little agreement between different clinicians for each patient. The need for a reliable and easily generalizable criteria is evident; however, there are no specific biomarkers available in the clinical setting despite ongoing studies. [3,4] Recent decade has seen many reports delivering evidence on the role of inflammation in the development and carcinogenic advancement of neoplasms, although pathways remain mainly unknown up to this date. [5,6] Therefore, blood-based markers of inflammation such as inflammatory cell counts and rates which are derived from those, Objectives: This study aims to evaluate the role of elevated neutrophil-to-lymphocyte ratio (NLR) and monocyte-tolymphocyte ratio (MLR) in differential diagnosis of enchondroma and low-grade chondrosarcoma. Patients and methods: One-hundred-and-one patients (44 males, 57 females; mean age 53.6±11.5 years; range, 21 to 85 years) diagnosed with enchondroma and low-grade chondrosarcoma in Ankara Oncology Training and Research Hospital between January 2010 and December 2019 were included in this retrospective study. Patients' age, gender, location and type of tumor, and pre-treatment complete blood count results were acquired. One-hundred patients (48 males, 52 females; mean age 50.9±13.6 years; range, 19 to 76 years) with complete blood count results admitted to the same center for reasons other than fracture, infection or tumors with similar age and gender to the aforementioned study group were included as healthy controls. Results: Neutrophil-to-lymphocyte ratio and MLR of the study group were found to be significantly higher than the control group (p<0.001). Neutrophil-to-lymphocyte ratio and MLR held diagnostic importance with statistically significant cutoff values. Statistically significant cutoffs for NLR and MLR were ≥2.0 (sensitivity=73.3%, specificity=67%) and ≥0.2 (sensitivity=76.2%, specificity=63%), respectively. Multivariate logistic regression analysis was performed adjusting for age and gender and NLR ≥2 [odds ratio (OR)=3.1] or MLR ≥0.2 (OR=2.9) were found to be associated with approximately threefold risk for diagnosis of enchondroma or low-grade chondrosarcoma. Conclusion: The NLR and MLR have diagnostic value in cartilaginous tumors such as enchondroma and low-grade chondrosarcoma. However, our results do not support utilization of NLR and MLR as diagnostic value for differentiation of enchondroma and low-grade chondrosarcoma.

Preoperative Blood Inflammatory Markers for the Differentiation of Uterine Leiomyosarcoma from Leiomyoma

“…11 However, few studies have investigated the diagnostic values of markers of systemic inflammation in different cancers (Table 5). In non-gynecologic cancers, NLR has been suggested to predict the presence of Hodgkin lymphoma, glioma, prostate cancer, or cartilaginous tumors (enchondroma and low-grade chondrosarcoma), 10,[37][38][39][40] whereas in gynecologic cancers, we have reported on the usefulness of NLR as a diagnostic marker for the presence of EOC. 8 Kim et al described the efficacy of NLR for the preoperative diagnosis of uterine sarcomas and suggested that NLR (≥2.12) might provide a more useful and costeffective means than serum CA-125 for their preoperative differentiation.…”

“…[5][6][7][8][9] Other researchers have also reported that systemic inflammatory markers have prognostic and diagnostic values in various malignancies. 10,11 However, the values of preoperative hematological parameters for the differentiation of LMS and LM have not been fully determined.…”

Are preoperative complete blood count parameters in peripheral nerve sheath tumors useful diagnostic tools?

“…Systemic inflammatory biomarkers such as NLR, PLR, and LMR have recently started to be used as alternatives to conventional methods in the diagnosis and management of different types of tumors. [5,[9][10][11][12][13][14][15][16][17] The use of CBC parameters in the clinical setting as screening tools in diagnosis and prognosis of musculoskeletal tumors has been gaining popularity due to the inexpensive, non-invasive, and being easy to access nature of this method. [17] There are reports showing that the number of neutrophils that produce reactive oxygen species, which induce tumor growth, angiogenesis and metastasis, is increased more around malignant tumor cells.…”

Diagnostic and prognostic role of mean platelet volume and mean platelet volume/platelet ratio in the most common soft tissue sarcomas

“…Studies on blood values for diagnostic and prognostic purposes have been increasing in recent years for sarcomas. [ 5 - 7 ]…”