Prognostic Significance of NLR, PLR, LMR and Tumor Infiltrating T Lymphocytes in Patients Undergoing Surgical Resection for Hilar Cholangiocarcinoma

Abstract

ObjectiveThis study evaluated the prognostic significance of preoperative neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and tumor-infiltrating lymphocytes (TILs), and whether these preoperative blood inflammatory indicators were associated with TILs in hilar cholangiocarcinoma (HCCA).MethodsA total of 76 patients with HCCA who underwent radical resection were included. Data on their clinicopathologic characteristics, perioperative features, and survival outcomes were analyzed. The optimal cutoff levels for the NLR, PLR and LMR were defined by using the web application Cut-off Finder. The densities of specific immune cells (CD3+, CD4+, CD8+) within the tumor microenvironment were examined by immunohistochemical. The association of the number of CD3+, CD4+ and CD8+ T cells infiltration in the local tumor microenvironment with preoperative NLR, PLR and LMR level was analyzed. Survival curves were calculated using the Kaplan–Meier estimate. Univariate and multivariate logistic regression models were used to identify factors associated with overall survival.ResultsThe optimal cutoff value of preoperative NLR, PLR and LMR was 2.00, 117.60, and 4.02, respectively. NLR was significantly negatively correlated with CD3+ and CD8+ T cell infiltration, but not with CD4+ T cells. PLR had no correlation with CD3+, CD4+, or CD8+ T cell infiltration, while LMR had a significantly positive correlation with CD3+ T cells infiltration but not with CD4+ or CD8+ T cells. In the multivariate logistic regression model, T stage, lymph node metastasis, CA19-9 and LMR were independent risk factors associated with overall survival (OS). Survival curves indicated that HCCA patients with low CD3+ T cells infiltration and low preoperative LMR live shorter than others.ConclusionsLMR played as an independent factor for predicting the survival in patients with HCCA after R0 radical resection. A high LMR was associated with an accumulation of CD3+ T cells in HCCA.

Preoperative peripheral blood inflammatory markers especially the fibrinogen-to-lymphocyte ratio and novel FLR-N score predict the prognosis of patients with early-stage resectable extrahepatic cholangiocarcinoma

“…Fan’s study showed that a higher FLR was significantly related to poor OS and DFS for ESCC ( 38 ). In ECC, Ji’s study showed that an increased NLR was related to poor prognosis for patients with DCC ( 39 ), and Lin’s study showed that a high LMR could predict poor prognosis in patients with PCC after R0 radical resection ( 11 ). However, these were not studies comparing the prognostic power of inflammatory indicators for ECC.…”

“…High NLR, platelet-to-lymphocyte ratio (PLR), and FAR values and low lymphocyte-to-monocyte ratio (LMR) values could be prognostic factors for short overall survival (OS) in patients with CCA ( 10 – 12 ). There have been some studies on ICC ( 13 – 16 ); however, very few studies have referred to ECC, PCC ( 11 ), and DCC ( 17 , 18 ). Additionally, no study has yet explored whether inflammatory indicators such as fibrinogen, neutrophil, fibrinogen-to-lymphocyte ratio (FLR), and FPR could be prognostic markers for patients with ECC.…”

Prognostic value of preoperative white blood cell to hemoglobin ratio and fibrinogen to albumin ratio in patients with colorectal cancer

“…[7] Many inflammatory mediator-based neogenetic markers, such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR), can be used to evaluate the prognosis of cancer patients and have attracted widespread interest because they are intuitive, readily available, and inexpensive markers. [8,9] Recently it has been shown that preoperative white blood cells to hemoglobin ratio (WHR) are related to poor prognosis in patients with hepatocellular carcinoma after hepatectomy. [10] Meanwhile, preoperative fibrinogen to albumin ratio (FAR) has been shown to be associated with poor prognosis in a variety of cancers.…”

The role of preoperative inflammatory markers in patients with central nervous system tumors, focus on glioma

“…These serum indicators are often economical and readily available as part of normal preoperative testing. Currently, studies have confirmed the predictive role of circulating inflammatory markers and their ratios in solid tumors, including lung cancer ( 20 ), penile cancer ( 21 ), cervical cancer ( 22 ), colorectal cancer ( 23 ), thyroid carcinoma ( 24 ), bladder cancer ( 25 ), esophageal squamous cell carcinoma ( 26 ), Hilar Cholangiocarcinoma ( 27 ), breast cancer ( 28 ), et al. Compared to peripheral solid tumors, only a limited number of studies have reported the diagnostic value of circulating inflammatory markers in gliomas ( 3 , 29 , 30 ).…”

“…These serum indicators are often economical and readily available as part of normal preoperative testing. Currently, studies have confirmed the predictive role of circulating inflammatory markers and their ratios in solid tumors, including lung cancer (20), penile cancer (21), cervical cancer (22), colorectal cancer (23), thyroid carcinoma (24), bladder cancer (25), esophageal squamous cell carcinoma (26), Hilar Cholangiocarcinoma (27), breast cancer (28), et al Compared to peripheral solid tumors, only a limited number of studies have reported the diagnostic value of circulating inflammatory markers in gliomas (3,29,30). Moreover, most relevant studies have focused on survival and recurrence in GBM patients, and there are no in-depth studies on inflammatory markers and their ratios in the diagnosis, grading and molecular typing of glioma, and the reported studies have not reached uniform conclusions.…”