Fabio Bagante1, Thuy B Tran2, Lauren M Postlewait3, Shishir K Maithel3, Tracy S Wang4, Douglas B Evans4, Ioannis Hatzaras5, Rivfka Shenoy5, John E Phay6, Kara Keplinger6, Ryan C Fields7, Linda X Jin7, Sharon M Weber8, Ahmed Salem8, Jason K Sicklick9, Shady Gad9, Adam C Yopp10, John C Mansour10, Quan-Yang Duh11, Natalie Seiser11, Carmen C Solorzano12, Colleen M Kiernan12, Konstantinos I Votanopoulos13, Edward A Levine13, George A Poultsides2, Timothy M Pawlik1. 1. Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Department of Surgery, Stanford University School of Medicine, Stanford, California. 3. Department of Surgery, Emory University, Atlanta, Georgia. 4. Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. 5. Department of Surgery, New York University School of Medicine, New York, New York. 6. Department of Surgery, The Ohio State University, Columbus, Ohio. 7. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. 8. Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 9. Department of Surgery, University of California San Diego, San Diego, California. 10. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. 11. Department of Surgery, University of California San Francisco, San Francisco, California. 12. Department of Surgery, Vanderbilt University, Nashville, Tennessee. 13. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Abstract
BACKGROUND: The systemic inflammatory response may be associated with tumor progression. We sought to analyze the impact of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) on recurrence-free survival (RFS) and disease-specific survival (DSS) among patients who underwent surgery for adrenocortical carcinoma (ACC). METHODS: Patients undergoing surgery for ACC were identified from a multi-center database. Cut-off values of 5 and 190 were defined as elevated NLR and PLR, respectively, and long-term outcome was assessed. RESULTS: Among 84 patients with ACC, 29 (34.%) had NLR > 5 while 32 (40.5%) had PLR > 190. NLR and PLR were associated with larger tumors (NLR > 5: ≤ 5 cm, 0% vs. >5 cm, 39.7%; PLR > 190: ≤ 5cm, 0% vs. >5 cm, 45.7%), as well as need to resect of other organs (NLR > 5: other organ resected 48.8% vs. not resected 20.9%; PLR > 190: other organ resected 25.0% vs. not resected 56.4%)(all P < 0.05). Five-year RFS was associated with an elevated NLR (NLR ≤ 5, 14.2% vs. NLR> 5, 10.5%) and PLR (PLR ≤ 190: 19.4% vs. PLR > 190: 5.2%) (both P < 0.05). On multivariate survival analyses, PLR remained a predictor of RFS (HR 1.72), while NLR was associated with both DSS (HR 2.21) and RFS (HR 1.99) (both P < 0.05). CONCLUSIONS: Immune markers such as NLR and PLR may be useful to stratify patients with regards to prognosis following surgery for ACC.
BACKGROUND: The systemic inflammatory response may be associated with tumor progression. We sought to analyze the impact of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) on recurrence-free survival (RFS) and disease-specific survival (DSS) among patients who underwent surgery for adrenocortical carcinoma (ACC). METHODS:Patients undergoing surgery for ACC were identified from a multi-center database. Cut-off values of 5 and 190 were defined as elevated NLR and PLR, respectively, and long-term outcome was assessed. RESULTS: Among 84 patients with ACC, 29 (34.%) had NLR > 5 while 32 (40.5%) had PLR > 190. NLR and PLR were associated with larger tumors (NLR > 5: ≤ 5 cm, 0% vs. >5 cm, 39.7%; PLR > 190: ≤ 5cm, 0% vs. >5 cm, 45.7%), as well as need to resect of other organs (NLR > 5: other organ resected 48.8% vs. not resected 20.9%; PLR > 190: other organ resected 25.0% vs. not resected 56.4%)(all P < 0.05). Five-year RFS was associated with an elevated NLR (NLR ≤ 5, 14.2% vs. NLR> 5, 10.5%) and PLR (PLR ≤ 190: 19.4% vs. PLR > 190: 5.2%) (both P < 0.05). On multivariate survival analyses, PLR remained a predictor of RFS (HR 1.72), while NLR was associated with both DSS (HR 2.21) and RFS (HR 1.99) (both P < 0.05). CONCLUSIONS: Immune markers such as NLR and PLR may be useful to stratify patients with regards to prognosis following surgery for ACC.
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Authors: Eliza W Beal; Lai Wei; Cecilia G Ethun; Sylvester M Black; Mary Dillhoff; Ahmed Salem; Sharon M Weber; Thuy Tran; George Poultsides; Andre Y Son; Ioannis Hatzaras; Linda Jin; Ryan C Fields; Stefan Buettner; Timothy M Pawlik; Charles Scoggins; Robert C G Martin; Chelsea A Isom; Kamron Idrees; Harveshp D Mogal; Perry Shen; Shishir K Maithel; Carl R Schmidt Journal: HPB (Oxford) Date: 2016-09-24 Impact factor: 3.647