Role of Inflammatory Biomarkers (NLR, LMR, PLR) in the Prognostication of Malignancy in Indeterminate Thyroid Nodules

Abstract

Indeterminate follicular thyroid lesions (Thyr 3A and 3B) account for 10% to 30% of all cytopathologic diagnoses, and their unpredictable behavior represents a hard clinical challenge. The possibility to preoperatively predict malignancy is largely advocated to establish a tailored surgery, preventing diagnostic thyroidectomy. We analyzed the role of the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and the lymphocyte-to-monocyte ratio (LMR) as prognostic factors of malignancy for indeterminate thyroid nodules. In patients affected by cytological Thyr 3A/3B nodules, NLR, PLR and LMR were retrospectively compared and correlated with definitive pathology malignancy, utilizing student’s t-test, ROC analysis and logistic regression. One-hundred and thirty-eight patients presented a Thyr 3A and 215 patients presented a Thyr 3B. After the logistic regression, in Thyr 3A, none of the variables were able to predict malignancy. In Thyr 3B, NLR prognosticated thyroid cancer with an AUC value of 0.685 (p < 0.0001) and a cut-off of 2.202. The NLR results were also similar when considering the overall cohort. The use of cytological risk stratification in addressing the management of indeterminate thyroid nodules in patients is not always reliable. NLR is an easy and reproducible inflammatory biomarker capable of improving the accuracy of preoperative prognostication of malignancy.

Neutrophils in the tumor microenvironment: role in tumor progression and potential targeted therapeutic strategy

“…The neutrophil to lymphocyte ratio (NLR) is known to increase in many types of tumors including sarcoma, and is closely related to a shorter OS, disease-free survival, or progression-free survival [64][65][66][67][68] . The high NLR has been considered a biomarker of poor clinical outcomes in gastric, triple-negative breast, colorectal, pancreatic, thyroid, and ovarian cancers and soft tissue sarcoma [69][70][71][72][73][74][75][76] . Moreover, the results of a recent study about sarcomas indicate that high NLR may be associated with chemoresistance [77] .…”

Eosinophil-Count-Derived Inflammatory Markers and Psoriasis Severity: Exploring the Link

“…Recently, various components of complete blood cell count have emerged as reliable indicators of inflammation in various diseases, such as malignant tumors, rheumatic disorders, or heart conditions [6][7][8][9][10]. Moreover, they are accessible, cost-effective, and widely available indices for evaluating systemic inflammation.…”

Predictive Performances of Blood-Count-Derived Inflammatory Markers for Liver Fibrosis Severity in Psoriasis Vulgaris

“…Blood-count-derived inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), or systemic immune inflammation index (SII) have gained increased interest in recent years. They were proven to be associated with and predicted outcomes in patients with cardiovascular disease [11][12][13], tumors [14][15][16][17][18], and kidney disease [19,20]. For skin disorders, the usefulness of these markers has been assessed in erythema nodosum [21], Behcet disease [22], and sarcoidosis [23].…”