The Role of Inflammatory Markers and the Modified Systemic Inflammatory Score in Bethesda Category 3 And 4 Patients for Prediction of Malignancy

Year 2022, Volume: 5 Issue: 3, 471 - 475, 01.09.2022

Sönmez Ocak , Ömer Faruk Bük , Ahmet Can Sarı , Ahmet Burak Çiftci

https://doi.org/10.19127/bshealthscience.1122731

Abstract

Management of Bethesda Category 3 and 4 patients remains a challenge. The modified systemic inflammatory score (mSIS) and other inflammatory parameters are used for prognosis assessment in various cancers. This retrospective study aims to explore prediction strength of the inflammatory parameters in Category 3 and 4 patients. One hundred and twenty three patients had undergone thyroidectomy for Category 3 and 4 fine needle aspiration biopsy (FNAB). The data of inflammatory markers including Neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), albumin to globulin ratio (AGR) and mSIS were evaluated retrospectively. There were no statistically significant difference in inflammatory parameters between benign and malignant patients and none of the inflammatory parameters had predictivity for thyroid cancer. Also in mSIS groups, thyroid cancer incidence were similar (P=0.684). Inflammatory parameters and mSIS were failed to predict thyroid cancer in patients who had category 3 and 4 FNAB.

Keywords

Thyroid cancer, Systemic inflammatory score, Albumin, Inflammation, Neutrophil to lymphocyte ratio, Fine needle aspiration biopsy

References

• Anand B, Ramdas A, Ambroise MM, Kumar NP. 2020. The bethesda system for reporting thyroid cytopathology: A cytohistological study. J Thyroid Res, 16: 8095378.
• Ataş H, Korukluoğlu B, Özdemir BA, Yakşi N, Saylam B, Tez M. 2021. Diagnostic value of modified systemic inflammation score for prediction of malignancy in patients with indeterminate thyroid nodules. Am J Surg, 221(1): 117-121.
• Atsumi Y, Kawahara S, Kakuta S, Onodera A, Hara K, Kazama K, Numata M, Aoyama T, Tamagawa A, Tamagawa H, Oshima T, Yukawa N, Rino Y. 2021. Low preoperative albumin-to-globulin ratio is a marker of poor prognosis in patients with esophageal cancer. In Vivo, 35(6): 3555-3561.
• Chang Y, An H, Xu L, Zhu Y, Yang Y, Lin Z, Xu J. 2015. Systemic inflammation score predicts postoperative prognosis of patients with clear-cell renal cell carcinoma. Br J Cancer, 113(4): 626-633.
• Chechlinska M, Kowalewska M, Nowak R. 2010. Systemic inflammation as a confounding factor in cancer biomarker discovery and validation. Nat Rev Cancer, 10(1): 2-3.
• Cibas ES, Alexander EK, Benson CB, de Agustín PP, Doherty GM, Faquin WC, Middleton WD, Miller T, Raab SS, White ML, Mandel SJ. 2008. Indications for thyroid FNA and pre-FNA requirements: a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference. Diagn Cytopathol, 36(6): 390-399.
• Cibas ES, Ali SZ. 2017. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid, 27(11): 1341-1346.
• Castineiras CA, Gallardo Martin E, Fernandez Montes A, Carmona Campos M, Covela Rua M, Salgado Fernandez M, Pellon Augusto ML, Martínez Lago N, Vidal Insua Y, Brozos Vazquez E, De La Camara J, Alonso Herrero A, Mendez Mendez JC. 2021. Dynamic perspective of the neutrophil-to-lymphocyte ratio in metastatic gastric cancer. J Buon, 26(5): 2131-2140.
• Deng Y, Pang Q, Miao RC, Chen W, Zhou YY, Bi JB, Liu SS, Zhang JY, Qu K, Liu C. 2016. Prognostic significance of pretreatment albumin/globulin ratio in patients with hepatocellular carcinoma. Onco Targets Ther, 9: 5317-5328.
• Ferrari SM, Fallahi P, Galdiero MR, Ruffilli I, Elia G, Ragusa F, Paparo SR, Patrizio A, Mazzi V, Varricchi G, Marone G, Antonelli A. 2019. Immune and inflammatory cells in thyroid cancer microenvironment. Int J Mol Sci, 20(18): 4413.
• Galdiero MR, Varricchi G, Loffredo S, Bellevicine C, Lansione T, Ferrara AL, Iannone R, di Somma S, Borriello F, Clery E, Triassi M, Troncone G, Marone G. 2018. Potential involvement of neutrophils in human thyroid cancer. PLoS One, 13(6): e0199740.
• Gu L, Li H, Chen L, Ma X, Li X, Gao Y, Zhang Y, Xie Y, Zhang X. 2016. Prognostic role of lymphocyte to monocyte ratio for patients with cancer: evidence from a systematic review and meta-analysis. Oncotarget, 7(22): 31926-31942.
• Hara K, Aoyama T, Yamada T, Nakazono M, Nagasawa S, Shimoda Y, Kumazu Y, Numata M, Hayashi T, Tamagawa H, Shiozawa M, Morinaga S, Yukawa N, Rino Y, Masuda M, Ogata T, Oshima T. 2020. The Prognostic value of the perioperative systemic inflammation score for patients with advanced gastric cancer. Anticancer Res, 40(3): 1503-1512.
• Hsueh C, Tao L, Zhang M, Cao W, Gong H, Zhou J, Zhou L. 2017. The prognostic value of preoperative neutrophils, platelets, lymphocytes, monocytes and calculated ratios in patients with laryngeal squamous cell cancer. Oncotarget, 8(36): 60514-60527.
• Huang ZZ, Hua X, Song CG, Xia W, Bi XW, Yuan ZY, He ZY, Huang JJ. 2020. The prognostic prediction value of systemic inflammation score and the development of a nomogram for patients with surgically treated breast cancer. Front Oncol, 10: 563731.
• Jia W, Wu J, Jia H, Yang Y, Zhang X, Chen K, Su F. 2015. The peripheral blood neutrophil-to-lymphocyte ratio is superior to the lymphocyte-to-monocyte ratio for predicting the long-term survival of triple-negative breast cancer patients. PLoS One, 10(11): e0143061.
• Kanda M, Koike M, Tanaka C, Kobayashi D, Hattori N, Hayashi M, Yamada S, Omae K, Fujiwara M, Kodera Y. 2019. Modified systemic inflammation score is useful for risk stratification after radical resection of squamous cell carcinoma of the esophagus. Ann Surg Oncol, 26(13): 4773-4781.
• Kocer D, Karakukcu C, Karaman H, Gokay F, Bayram F. 2015. May the neutrophil/lymphocyte ratio be a predictor in the differentiation of different thyroid disorders? Asian Pac J Cancer Prev, 16(9): 3875-3879.
• Li N, Fu S, Cui MM, Niu Y, Li B, Liu ZP, Liu T, Wang RT. 2017. Platelet distribution width and serum albumin levels for discrimination of thyroid cancer from benign thyroid nodules. Asian Pac J Cancer Prev, 18(7): 1773-1777.
• Lin JX, Lin JP, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu R, Zheng CH, Huang CM, Li P. 2019. Prognostic importance of the preoperative modified systemic inflammation score for patients with gastric cancer. Gastric Cancer, 22(2): 403-412.
• Liotti F, Visciano C, Melillo RM. 2012. Inflammation in thyroid oncogenesis. Am J Cancer Res, 2(3): 286-297.
• Liu JF, Ba L, Lv H, Lv D, Du JT, Jing XM, Yang NJ, Wang SX, Li C, Li XX. 2016. Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: a meta-analysis. Sci Rep, 12(6): 38551.
• Luo J, McManus C, Chen H, Sippel RS. 2012. Are there predictors of malignancy in patients with multinodular goiter? J Surg Res, 174(2): 207-210.
• Mariani P, Russo D, Maisto M, Troiano G, Caponio VCA, Annunziata M, Laino L. 2022. Pre-treatment neutrophil-to-lymphocyte ratio is an independent prognostic factor in head and neck squamous cell carcinoma: Meta-analysis and trial sequential analysis. J Oral Pathol Med, 51(1): 39-51.
• McMillan DC. 2009. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care, 12(3): 223-226.
• Önder H. 2018. Nonparametric statistical methods used in biological experiments. BSJ Eng Sci, 1(1): 1-6.
• Park JH, Watt DG, Roxburgh CS, Horgan PG, McMillan DC. 2016. Colorectal cancer, systemic inflammation, and outcome: staging the tumor and staging the host. Ann Surg, 263(2): 326-336.
• Schwartz PB, Poultsides G, Roggin K, Howard JH, Fields RC, Clarke CN, Votanopoulos K, Cardona K, Winslow ER. 2020. PLR and NLR are poor predictors of survival outcomes in sarcomas: A new perspective from the USSC. J Surg Res, 251: 228-238.
• Song H, Jeong MJ, Cha J, Lee JS, Yoo JG, Song MJ, Kim JH, Lee SJ, Lee HN, Yoon JH, Park DC, Kim SI. 2021. Preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte and monocyte-to-lymphocyte ratio as a prognostic factor in non-endometrioid endometrial cancer. Int J Med Sci, 18(16): 3712-3717.
• Stotz M, Pichler M, Absenger G, Szkandera J, Arminger F, Schaberl-Moser R, Samonigg H, Stojakovic T, Gerger A. 2014. The preoperative lymphocyte to monocyte ratio predicts clinical outcome in patients with stage III colon cancer. Br J Cancer, 110(2): 435-440.
• Suh B, Park S, Shin DW, Yun JM, Keam B, Yang HK, Ahn E, Lee H, Park JH, Cho B. 2014. Low albumin-to-globulin ratio associated with cancer incidence and mortality in generally healthy adults. Ann Oncol, 25(11): 2260-2266.
• Tan D, Fu Y, Tong W, Li F. 2018. Prognostic significance of lymphocyte to monocyte ratio in colorectal cancer: A meta-analysis. Int J Surg, 55: 128-138.
• Tezuka K, Okamura Y, Sugiura T, Ito T, Yamamoto Y, Ashida R, Ohgi K, Otsuka S, Todaka A, Fukutomi A, Uesaka K. 2021. Predictive factors of survival in patients with borderline resectable pancreatic cancer who received neoadjuvant therapy. Pancreatology, 21(8): 1451-1459.
• Watt DG, McSorley ST, Park JH, Horgan PG, McMillan DC. 2017. A postoperative systemic inflammation score predicts short- and long-term outcomes in patients undergoing surgery for colorectal cancer. Ann Surg Oncol, 24(4): 1100-1109.
• Xia LJ, Li W, Zhai JC, Yan CW, Chen JB, Yang H. 2020. Significance of neutrophilto-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and prognostic nutritional index for predicting clinical outcomes in T1-2 rectal cancer. BMC Cancer, 20: 208.
• Yaylaci S, Tosun O, Sahin O, Genc AB, Aydin E, Demiral G, Karahalil F, Olt S, Ergenc H, Varim C. 2016. Lack of variation in inflammatory hematological parameters between benign nodular goiter and papillary thyroid cancer. Asian Pac J Cancer Prev, 17(4): 2321-2323.
• Zhou W, Kuang T, Han X, Chen W, Xu X, Lou W, Wang D. 2020. Prognostic role of lymphocyte-to-monocyte ratio in pancreatic neuroendocrine neoplasms. Endocr Connect, 9(4): 289-298.