The diagnostic predictive value of neutrophil-to-lymphocyte ratio in thyroid cancer adjusted for tumor size

Abstract

The role of systemic inflammation has not been clearly defined in thyroid cancers. There have been conflicting reports on whether systemic inflammatory markers have predictive value for thyroid cancers. We aimed to evaluate the association between systemic inflammatory markers and clinicopathological factors in thyroid cancers and to assess their predictive value for thyroid cancers in detail. Five hundred thirty-one patients who underwent surgery for thyroid nodules were included. The patient population consisted of 99 individuals (18.6%) with benign thyroid nodules and 432 individuals (81.4%) with thyroid cancers. In 432 patients with thyroid cancers, neutrophil-to-lymphocyte ratio (NLR) was significantly higher in the cases with tumors greater than 2 cm than in those with tumors less than 2 cm. (p = 0.027). NLR and platelet-to-lymphocyte ratio (PLR) were significantly higher in cases with lateral lymph node metastasis (LNM) than in those without LNM (p = 0.007 and 0.090, respectively). The nodule size was significantly higher in benign thyroid nodules than in thyroid cancers (p < 0.001). When the cases were stratified by tumor size, NLR was a significant predictor of thyroid cancers in cases with nodules greater than 2 cm (Exp(B) = 1.85, 95% CI = 1.15–2.97, p = 0.011), but not in those with nodules less than 2 cm. In thyroid cancers, preoperative NLR was associated with pathological prognosticators such as tumor size and lateral lymph node metastasis. When the size difference between thyroid cancers and benign thyroid nodules was adjusted, NLR could be a significant predictor of thyroid cancers.

Platelet Activation and Inflammation in Patients with Papillary Thyroid Cancer

“…Overall, preoperative values for platelet indices (platelets count, MPV, PCT, PDW) ESR, neutrophil count, lymphocyte count, NLR and PLR were similar to the postoperative determinations in PTC patients (Table 7). However, when analyzing the PTC patients based on the pathological report findings (multifocality, capsular invasion, vascular invasion, extracapsular extension, lymph nodes metastasis, autoimmune thyroiditis, pT stage; data not shown) our data exhibit lower median ESR levels before thyroidectomy in patients with no capsular invasion (12 (10) vs. 14 (14) mm/h, p = 0.043), and no extracapsular extension, respectively (12 (13) vs. 14 (14) mm/h, p = 0.030). When it comes to platelet indices, we found lower mean PLT before surgery in PTC patients with vascular invasion (233.63 ± 62.06 vs. 262.13 ± 55.97 × 10 3 /mm 3 , p = 0.013).…”

“…Seretis et al were the first to show that NLR may predict the presence of PTC [11]. Subsequent studies showed higher NLR in PTC patients [22,32] and association with tumor size [14,33], extrathyroidal extension [33], lymph node metastases [34] or cancer recurrence [13]. Furthermore, a recent meta-analysis published by Feng et al…”

“…Gong et al also reported that the preoperative NLR was closely related to the stage of papillary thyroid carcinoma [12]. NLR was also shown to be a prognostic factor for recurrence in low-risk DTC patients [13], and a correlation between NLR and tumor size in thyroid cancers has been shown by Cheong et al [14]. Additionally, recent studies suggest that platelet indices may be possible markers in the differential diagnosis of benign and malignant thyroid disorders.…”

Preoperative platelet distribution width‐to‐platelet ratio combined with serum thyroglobulin may be objective and popularizable indicators in predicting papillary thyroid carcinoma

“…This view has received support from others in the field. 51 , 52 Multivariate analyses in this study identified NLR and PPR as independent risk factors for PTC, implicating PPR and NLR in the pathogenesis and progression of PTC. ROC curve analysis revealed that PDW had a certain degree of diagnostic value for PTC (AUC, 0.61; 95% CI, 0.575 ~ 0.645) but low specificity, in accordance with the findings of Yu et al 39 These findings indicate the limitations of single platelet indicators in the diagnosis of PTC.…”

Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte Ratios, and Systemic Immune-Inflammation Index as Potential Biomarkers of Chronic Inflammation in Patients with Newly Diagnosed Acromegaly: A Single-Centre Study

“…On the other hand, significant positive correlations between NLR, PLR, SII and GH, and IGF-1 were noted in the NFPA group during our investigation. Taking into consideration conflicting data about the link between tumor size and inflammatory markers, we performed the analysis of the correlation between CBC-derived indices and adenoma MD in GH-secreting tumors and NFPAs, but no correlations were observed [57][58][59]. Moreover, we did not observe any significant differences in the calculated ratios in acromegaly patients concerning glucose metabolism disturbances, hypertension, coronary artery disease, obstructive sleep apnea, carpal tunnel syndrome, degenerative changes in bones and joints, and benign neoplasms.…”