REKÜRRENTVE/VEYA METASTATIK JINEKOLOJIK TÜMÖRLERDE TEDAVİ ÖNCESİ NÖTROFİL-LENFOSİT ORANI VE TROMBOSİT-LENFOSİT ORANI TERAPÖTİK ETKİYE SAHİP MİDİR?

Year 2021, , 125 - 131, 12.04.2021

Ozlem Yetmen Dogan , Makbule Eren

https://doi.org/10.18229/kocatepetip.700298

Abstract

AMAÇ: Bu çalışmada radyoterapive/veya radyokemoterapi uygulanan jinekolojik malignitelerde tedavi öncesi nötrofil-lenfosit (NLR) ve trombosit-lenfosit (PLR) oranlarının sağkalım üzerine etkisi incelenmiştir.dıkları ve yan etkilerini incelemek amacıyla planlanmıştır.
GEREÇ VE YÖNTEM: 2009 - 2014 yılları arasında kliniğimize tüm tedavileri yapılmış ve rutin takipleri sırasında nüks ve/veya metastaz gelişmiş 82 hasta retrospektif olarak incelenmiştir. Tüm hastaların tedavi öncesi tam kan parametreleri incelenip, sağkalım üzerindeki etkileri Kaplan Meier ve ROC eğrisi ile analiz edildi.
BULGULAR: Hastaların ortanca yaşı 57,5 (30-82) ve ortanca takip süresi 26 aydı. Kan değerlerine göre medyan WBC: 7.34, RBC: 4.33, hb: 11.7, hct: 36.4, MCV: 85.8, MCH: 27.6, MCHC: 32.1, plt: 270050, lenfosit: 1,66, nötrofil: 4.79, monosit: 0.56, eozinofiller: 0.11, bazofiller: 0.1. idi. ROC analizine göre, istatistiksel olarak PLR değeri 174 ve NLR değeri 2.06 idi. Genel sağkalım oranları 2 ve 3 yılda % 78 ve % 57 idi. Tek değişkenli analizde tedavi öncesi kan tablosunda WBC > 7.34 (p = 0.01), trombosit sayısı> 270050 (p = 0.021) ve mutlak nötrofil sayısı> 4.79 (p = 0.04) olması sağkalım üzerine olumsuz etkisi görüldü. ROC analizinin sonucunda bulunan, NLR oranının>2.06 sağkalımı olumsuz etkilediği (p = 0.005) ancak PLR oranı sağkalımı etkilemediği tespit edildi.
SONUÇ: Gelecekte, jinekolojik kanser teşhisi alan hastaların çok basit ve ucuz bir kan testi ile tedavi şekli belirlenebilir. Yüksek NLR, hastalara daha agresif bir tedavi yapılması gerektiğini gösteren bir parametre olarak kullanılabilir.

Keywords

Radyoterapi, Jinekolojik kanserler, Nötrojil lenfosit oranı

DOES PRETREATMENT NEUTROPHIL‑LYMPHOCYTE RATIO AND PLATELET-LYMPHOCYTE RATIO HAVE A THERAPEUTIC EFFECTS IN RECURRENT AND/OR METASTATIC GYNECOLOGICAL MALIGNANCIES?

Abstract

OBJECTIVE: In this study, the effect of pre-treatment neutrophil-to lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) on gynecological malignancies that applied radiotherapy and /or radiochemotherapy was investigated.
MATERIAL AND METHODS: The data obtained from 82 patients who applied to our clinic between 2009- 2014 and developed recurrence and/or metastasis during their routine follow-up were retrospectively evaluated. Pre-treatment whole blood parameters of all patients were examined, and their effects on survival were analyzed by Kaplan Meier and the ROC curve.
RESULTS: The median age was 57.5 (30-82), follow-up was 26 months. According to the blood values median WBC: 7.34, RBC: 4.33, hb: 11.7, hct: 36.4, MCV: 85.8, MCH: 27.6, MCHC: 32.1, plt: 270050, lymphocyte: 1,66, neutrophils: 4.79, monocytes: 0.56, eosinophils: 0.11, basophils: 0.1.Statistically; according to the ROC analysis, the boundary PLR value was 174 and the NLR value was 2.06. Overall survival rates were 2 and 3 years 78% , 57% . In univariate analysis the pre-treatment blood values; WBC > 7.34 (p = 0.01), the platelet value > 270050 (p = 0.021) and the absolute neutrophil value > 4.79 (p = 0.04) found to have a negative effect on survival. At the end of the ROC analysis, the NLR ratio was found to be above 2.06, adversely affecting survival (p = 0.005), but the PLR rate did not affect survival.
CONCLUSIONS: In the future, the treatment method of patients diagnosed with gynecological cancer can be determined with a very simple and inexpensive blood test. High NLR before treatment can be used as a parameter indicating a more aggressive treatment approach may be required in patients.

Keywords

radiotherapy, gynecological cancer, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio

References

• Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin 2013; 63(1):11–30.
• Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in the critically ill. BratislLekListy 200; 102(1):5–14.
• Walsh SR, Cook EJ, Goulder F ,Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer J Surg Oncol 2005; 91(3):181–184.
• Halazun KJ, Hardy MA, Rana AA, et al. Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Ann Surg 2009;250(1):141–151.
• Bhatti I, Peacock O, Lloyd G,Larvin M, Hall RI. Preoperative hematologic markers as independent predictors of Prognosis in resected pancreatic ductal adenocarcinoma: neutrophil-lymphocyte versus platelet-lymphocyte ratio. Am J Surg 2010; 200(2):197–203.
• Sarraf KM, Belcher E, Raevsky E , Nicholson AG, Goldstraw P, Lim E. Neutrophil/lympocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J ThoracCardiovasc Surg 2009;137(2):425–28.
• Wei Y, Jiang YZ, Qian WH . Prognostic role of NLR in urinary cancers: a meta-analysis. PLoS One 2014;9(3):e92079.
• Cho HB, Hur HW, Kim SW, et al .Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer ImmunolImmunother 2009;58(1):15–23.
• Lee Y-Y, Choi CH, Kim HJ, et al. Pretreatment Neutrophil: lymphocyte ratio as a prognostic factor in cervical carcinoma. Anticancer Res 2012; 32(4):1555–1562.
• Zhang Y, Wang L, Liu Y, et al. Preoperative neutrophillymphocyte ratio before platelet-lymphocyte ratio predicts clinical outcome in patients with cervical cancer treated with initial radical surgery. Int J Gynecol Cancer 2014;24(7):1319–25.
• Jackson JR, Seed MP, Kircher CH, Willoughby DA, Winkler JD. The codependence of angiogenesis and chronic inflammation. FASEB J 1997; 11: 457- 65.
• Balkwill F and Mantovani A. Inflammation, cancer: back to Virchow?. Lancet 2001; 357: 539-45.
• Grivennikov SI, Greten FR, Karin M. Immunity, inflammation and cancer. Cell 2010;140: 883-99.
• Assoian RK, Sporn MB. Type beta transforming growth factor in human platelets: release during platelet degranulation and action on vascular smooth muscle cells. J Cell Biol 1986;102: 1217-1223.
• Dubernard V, Arbeille BB, Lemesle MB, Legrand C. Evidence for an alpha granular pool of the cytoskeletal protein alpha actinin in human platelets that redistributes with the adhesive glycoprotein thrombospondin 1 during the exocytotic process. Arterioscler Thromb Vasc Biol 1997;17: 2293-22305.
• Allensworth SK, Langstraat CL, Martin JR, Lemens MA, McGree ME, Weaver AL, et al. Evaluating the prognostic significance of preoperative thrombocytosis in epithelial ovarian cancer. Gynecol Oncol 2013;130: 499-504.
• Unal D, Eroglu C, Kurtul N, OguzA,Tasdemir A. Are neutrophil/lymphocyte and platelet/lymphocyte rates in patients with non small cell lung cancer associated with treatment response and prognosis? . Asian Pac J Cancer Prev 2013; 14: 5237-5242.
• Feng JF, Huang Y, Zhao Q , Chen QX. Clinical significance of preoperative neutrophil lymphocyte ratio versus platelet lymphocyte ratio in patients with small cell carcinoma of the esophagus. Scientific World Journal 2013;50:43-65.
• Wang D, Yang JX, Cao DY, et al. Preoperative neutrophil lymphocyte and platelet lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther 2013;6: 211-16.
• Absenger G, Szkandera J, PichlerM, et al. A derived neutrophil to lymphocyte ratio predicts clinical outcome in stage II and III colon cancer patients. Br J Cancer 2013; 109: 395-400.
• Cedrés S, Torrejon D, MartínezA, et al. Neutrophil to lymphocyte ratio (NLR) as an indicator of poor prognosis in stage IV non small cell lung cancer. ClinTranslOncol 2012; 14: 864-69.
• Absenger G, Szkandera J, Stotz M, et al. Preoperative neutrophil to lymphocyte ratio predicts clinical outcome in patients with stage II and III colon cancer. Anticancer Res 2013; 33: 4591-94.
• Ulu S, Bucak A, Ulu MS, Ahsen A, Duran A, Yucedag F, et al. Neutrophil-lymphocyte ratio as a new predictive and prognostic factor at the hearing loss of diabetic patients. Eur Arch Otorhinolaryngol 2013;271:2681-6.
• Acmaz G, Aksoy H, Unal D, et al. Are neutrophil/ lymphocyte and platelet/lymphocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding?. Asian Pac J Cancer Prev 2014;15: 1689-92.
• Mishalian I, Bayuh R, Levy L, Zolotarov L, Michaeli J, Fridlender ZG. Tumor-associated neutrophils (TAN) develop pro-tumorigenic properties during tumor progression. Cancer Immunol Immunother 2013; 62:1745–56.
• Markl B, Wieberneit J, Kretsinger H, Mayr P, et al. Number of Intratumoral T Lymphocytes Is Associated With Lymph Node Size, Lymph Node Harvest, and Outcome in Node-Negative Colon Cancer. Am J Clin Pathol 2016; 145:826–36.
• Noble F, Mellows T, McCormick ML, et al.Tumour infiltrating lymphocytes correlate with improved survival in patients with oesophageal adenocarcinoma. Cancer Immunol Immunother 2016; 65:651-62. Sprague BL, Trentham-Dietz A, Klein BE, et al. Physical activity, white blood cell count, and lung cancer risk in a prospective cohort study. Cancer Epidemiol Biomarkers Prev 2008;17:2714-22.
• Tavares-Murta BM, Mendonca MA, Duarte NL, et al. Systemic leukocyte alterations are associated with invasive uterine cervical cancer. Int J Gynecol Cancer 2010;20: 1154-9.
• Alexandrakis MG, PassamFH, Moschandrea IA, et al. Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol 2003;26:135-40.
• Smith RA, Bosonnet L, Ghaneh P, et al. The platelet-lymphocyte ratio improves the the predictive value of serum CA 19.9 levels in determining patient selection for staging laparascopy in suspected periampullary cancer. Surgery 2008;143: 658-66.
• Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol 2013; 88: 218-30.
• Gwak MS, Choi SJ, Kim JA, et al. Effects of gender on white blood cell populations and neutrophil- lymphocyte ratio following gastrectomy in patients with stomach cancer. J Korean Med Sci 2007; 22:104-8.
• Jeerakornpassawat D, Suprasert P. Potential predictors for chemotherapeutic response and prognosis in epithelial ovarian, fallopian tube and primary peritoneal cancer patients treated with platinum-based chemotherapy. Obstet Gynecol Sci 2020;63(1):55-63.
• Hyun Jung Lee, Jong Mi Kim, Yoo Jeong Chin, et al. Prognostic Value of Hematological Parameters in Locally Advanced Cervical Cancer Patients Treated With Concurrent Chemoradiotherapy. Anticancer Research 2020; 40: 451-458.