Surgical Oncology. Skin, Soft Tissue & Bone Tumors Department, National Cancer Institute, Mexico City, Mexico.
Surgical Oncology Fellow, Surgical Department, National Cancer Institute, Mexico City, Mexico.
Surg Oncol. 2022 Jun;42:101746. doi: 10.1016/j.suronc.2022.101746. Epub 2022 Mar 29.
Neutrophil-to-lymphocyte ratio (NLR) in peripheral blood reflects the balance between systemic inflammation and immunity and has been reported as a prognostic biomarker in many neoplastic diseases, but its role in sarcomas has been poorly investigated. In this paper we analyzed the prognostic role of the neutrophil to lymphocyte ratio (NLR) in extremity undifferentiated pleomorphic sarcoma (eUPS).
We performed an observational, retrospective study including all eUPS cases treated at the National Institute of Cancer in Mexico City from January 2000 to December 2018. We used a ROC analysis to find the cut-off point where the NLR had the best value in predicting death (area under the curve: 0.73, P = 0.001). When the cut-off point was set at 3.09, the sensitivity of the test was 79% and the specificity was 59%. Demographic and clinical variables using log-rank test were also analyzed. Univariate Cox regression analyses and multivariate proportional hazards regression model were carried out to identify independent prognostic factors for Overall survival (OS), Disease-free survival (DFS), Metastasis free survival (MFS) and their association with the NLR.
We included 112 cases, 53.6% were women. Most cases were stage IIIA (33.9%) or IIIB (30.4%) and Grade 3 (91.1%). High NLR correlated with metastatic disease at presentation (p = 0.001), locally advanced stage (p = 0.05), worse OS (HR = 1.33, 95% CI:1.01-1.75 p = 0.041) and higher risk of specific death (HR = 4.89, 95% CI: 1.88-12.72 p = 0.001). Non-use of chemotherapy (HR: 1.33, 95% CI:1.01-1.75 p = 0.041) was also associated with worse OS.
The NLR is a simple yet useful prognostic factor in patients with eUPS when using a cut-off value of 3.09. Soft tissue sarcomas lack routine biomarkers that are applied widely, therefore we propose to consider and include the NLR in prospective trials or prognostic nomograms.
外周血中性粒细胞与淋巴细胞比值（NLR）反映了全身炎症与免疫之间的平衡，已被报道为许多肿瘤疾病的预后生物标志物，但在肉瘤中的作用尚未得到充分研究。本文分析了 NLR 在四肢未分化多形性肉瘤（eUPS）中的预后作用。
我们进行了一项观察性、回顾性研究，纳入了 2000 年 1 月至 2018 年 12 月在墨西哥城国家癌症研究所治疗的所有 eUPS 病例。我们使用 ROC 分析来确定 NLR 预测死亡的最佳截断值（曲线下面积：0.73，P=0.001）。当截断值设定为 3.09 时，该检测的灵敏度为 79%，特异性为 59%。还使用对数秩检验分析了人口统计学和临床变量。进行单因素 Cox 回归分析和多因素比例风险回归模型，以确定总生存（OS）、无病生存（DFS）、无转移生存（MFS）的独立预后因素及其与 NLR 的关系。
我们纳入了 112 例患者，其中 53.6%为女性。大多数病例为 IIIA 期（33.9%）或 IIIB 期（30.4%）和 3 级（91.1%）。高 NLR 与初诊时转移性疾病（p=0.001）、局部晚期（p=0.05）、较差的 OS（HR=1.33，95%CI：1.01-1.75，p=0.041）和更高的特异性死亡风险（HR=4.89，95%CI：1.88-12.72，p=0.001）相关。未使用化疗（HR：1.33，95%CI：1.01-1.75，p=0.041）也与 OS 较差相关。
当 NLR 截断值为 3.09 时，NLR 是 eUPS 患者的一种简单而有用的预后因素。软组织肉瘤缺乏广泛应用的常规生物标志物，因此我们建议在前瞻性试验或预后列线图中考虑并纳入 NLR。
