Neutrophil–lymphocyte ratio predicts survival in patients with advanced cholangiocarcinoma on chemotherapy

Abstract

The blood neutrophil-to-lymphocyte ratio (NLR) is reported to be a prognostic marker in several cancers. However, the prognostic role of NLR in patients with advanced cholangiocarcinoma on chemotherapy is unknown. A total of 221 patients with pathologically confirmed locally advanced or metastatic cholangiocarcinoma receiving first-line palliative chemotherapy were enrolled. Associations between baseline clinical and laboratory variables including NLR and survival were investigated. Patients were classified into two groups according to the NLR level (≤ 5 vs. >5). Median overall survival (OS) and time to progression (TTP) in patients with NLR ≤ 5 were 10.9 and 6.7 months, respectively, and 6.8 and 4.1 months in patients with NLR > 5 (P < 0.001, P = 0.002, respectively). In multivariate analysis, number of cycles of chemotherapy was a significant predictor of longer OS (HR 0.86, P < 0.001), whereas adverse prognostic factors for OS were CA 19-9 > 300 (HR 1.43, P = 0.025), CEA > 5 (HR 1.44, P = 0.029), higher stage (HR 1.69, P = 0.004), and NLR > 5 (HR 1.87, P < 0.001). NLR > 5 was also associated with reduced TTP (HR 1.66, P = 0.007). Among 50 patients with initial NLR > 5, 33 patients had NLR ≤ 5 after two cycles of chemotherapy and they had significantly better survival than the others (HR 0.48, P = 0.015). NLR independently predicts survival in patients with advanced cholangiocarcinoma undergoing chemotherapy. Considering cost-effectiveness and easy availability, NLR may be a useful biomarker for prognosis prediction.

Activation or suppression of the immune response mediators in biliary tract cancer (BTC) patients: a systematic review and meta-analysis

“…The elevated Neutrophils cells and reduced CD8+ lymphocyte demonstrated an exhausted state of the effector T cells, thus contributing to a progression of tumors 10, 13, 14, 29. In comparison, intraepithelial tumor-infiltrating CD4+, CD8+, and Foxp3+ T lymphocytes, MHC I and NKG2D were referred as positive factors to prolong the overall survival of patients with BTC.…”

“…Immune microenvironment determines the proliferative activity of the tumor cells, invasion and metastasis. In BTC, several immune mediators have so far been investigated 8-14. Studies identified immune cell types or ratio including CD4+, CD8+, and Foxp3+ Tumor-infiltrating T lymphocytes (TILs), IL17+, neutrophil recruitment (CD66b+), PD-1/CD8 TILs and neutrophil/lymphocyte (NLR), and analyzed the distribution and clinical relevance of these mediators 8, 10, 12-14.…”

“…In BTC, several immune mediators have so far been investigated 8-14. Studies identified immune cell types or ratio including CD4+, CD8+, and Foxp3+ Tumor-infiltrating T lymphocytes (TILs), IL17+, neutrophil recruitment (CD66b+), PD-1/CD8 TILs and neutrophil/lymphocyte (NLR), and analyzed the distribution and clinical relevance of these mediators 8, 10, 12-14. Others observed the impact of the expression of major histocompatibility complex class I (MHC I) and natural killer group 2 member D (NKG2D) 9, 11.…”

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

“…[20] The authors hypothesized that elevated neutrophil cells and reduced CD8+ lymphocytes may indicate exhaustion of effector T cells, contributing to tumor progression. [20, 34–37] Post-operative complications have been demonstrated to be immunosuppressive and mediate immunological changes. [20] In the current study, we noted an association between post-operative SSI and RFS, as patients with SSI had a worse long-term RFS (Figure 1&2).…”

Circulating Biomarkers for Cholangiocarcinoma

“…Of note, this association could be confirmed in a multivariate analysis. Moreover, patients with a decrease of the NLR during chemotherapy had a significantly better survival than other patients, suggesting that the NLR might be a new and easily available biomarker for prognosis prediction in CCA patients [68]. …”