Preoperative Neutrophil-to-Lymphocyte Ratio and a New Inflammatory Biomarkers Prognostic Index for Primary Retroperitoneal Sarcomas: Retrospective Monocentric Study

Abstract

Purpose: Inflammatory biomarkers and neutrophil-to-lymphocyte ratio (NLR) are associated with prognosis in several tumors. Data on sarcomas are limited, and insufficient on retroperitoneal sarcoma (RPS). Experimental Design: Patients with primary RPS operated between 2002 and 2016 were included. Hemoglobin, monocytes, NLR, platelet-to-lymphocyte ratio (PLR) were retrieved and analyzed both individually and combined into a prognostic index (IBPI). Correlation with clinicopathologic variables was studied, as well as postoperative morbidity according to NLR and IBPI risk categories. The association between overall survival (OS) and biomarkers and, in addition, the 7-year Sarculator-predicted OS probability (pOS) was analyzed using univariable and multivariable Cox models. Results: 423/463 patients had complete data. The median follow-up was 84 months. The median NLR was 3.3 (IQR, 2.4-4.7), with significant variation across histologies. NLR was the only biomarker that independently predicted OS (HR 1.2, 95% CI 1.03 – 1.40; p=0.02). The IBPI showed good discrimination for subgroups at different OS (log-rank test p <0.0001). The Cox model for pOS alone showed a 7-year Index of Prediction Accuracy of 26.9, which increased to 29.5 when IBPI was added to pOS as a complementary prognostic tool. IBPI was also associated with the risk of serious infectious postoperative complications (p=0.0094; non-infectious complications, p=0.6463). Conclusions: NLR was an independent prognostic factor for OS in RPS. When combined into a prognostic index with hemoglobin, monocytes, and PLR, it serves as a readily available prognostic tool addressing tumor-related inflammation and helps in classifying RPS risk in addition to the Sarculator nomogram.

Sarculator: how to improve further prognostication of all sarcomas

“…In a study by Fiore et al [36 ▪▪ ], a significant correlation between NLR and survival was found within a large mono-institutional series of primary RPS (Table 2). Preoperative low hemoglobin, high percentage of monocytes, a high NLR, and a high platelet-to-lymphocyte ratio were associated with shorter OS in univariable Cox models.…”

Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma

“…NLR is an indicator of tumor-related inflammation and helps predict tumor prognosis[ 28 , 29 ]. In nivolumab-treated patients with HCC, dynamic changes in the NLR (at week 4) are effective prognostic indicators and may facilitate patient selection and subsequent clinical strategies for immunotherapies[ 30 ].…”

Next questions in the management of retroperitoneal sarcoma

“…The neutrophil-to-lymphocyte ratio (NLR) is an example of a serum inflammatory biomarker that has gained popularity as a prognostic measure in many cancers, including RPS [8,9 ▪ ]. An analysis of over 420 patients who underwent primary surgery for RPS demonstrated that NLR was an independent predictor of OS and improved the prognostic accuracy of Sarculator (a prognostic nomogram) [9 ▪ ]. Additional work on identifying a genomic signature that improves the performance of the Sarculator nomogram for patients with primary RPS was presented at the 2022 Connective Tissue Oncology Society meeting by Callegaro et al [10].…”

“…Recently, efforts to further enhance the accuracy of these nomograms by integration of novel biomarkers and/or genomic signatures have been underway. The neutrophil-to-lymphocyte ratio (NLR) is an example of a serum inflammatory biomarker that has gained popularity as a prognostic measure in many cancers, including RPS [8,9 of the Sarculator nomogram for patients with primary RPS was presented at the 2022 Connective Tissue Oncology Society meeting by Callegaro et al [10]. As the discovery of novel biomarkers and genomic signatures continue to evolve, the possibility of incorporating these variables into existing prognostic nomograms for RPS holds promise to refine our ability to prognosticate and provide tailored treatment to patients undergoing surgery for primary RPS.…”

“…Recently, efforts to further enhance the accuracy of these nomograms by integration of novel biomarkers and/or genomic signatures have been underway. The neutrophil-to-lymphocyte ratio (NLR) is an example of a serum inflammatory biomarker that has gained popularity as a prognostic measure in many cancers, including RPS [8,9 ▪ ]. An analysis of over 420 patients who underwent primary surgery for RPS demonstrated that NLR was an independent predictor of OS and improved the prognostic accuracy of Sarculator (a prognostic nomogram) [9 ▪ ].…”