Neutrophil-lymphocyte and platelet-lymphocyte ratio as predictors of disease specific survival after resection of adrenocortical carcinoma

• Authors: Fabio Bagante, Johns Hopkins University; Thuy B. Tran, Stanford University; Lauren M Postlewait, Emory University; Shishir Maithel, Emory University; Tracy S. Wang, Medical College of Wisconsin; Douglas B. Evans, Medical College of Wisconsin; Ioannis Hatzaras, New York University; Rivfka Shenoy, New York University; John E. Phay, Ohio State University; Kara Keplinger, Ohio State University; Ryan C. Fields, Washington University; Linda X. Jin, Washington University; Sharon M. Weber, University of Wisconsin; Ahmed Salem, University of Wisconsin; Jason K. Sicklick, University of California San Diego; Shady Gad, University of California San Diego; Adam C. Yopp, University of Texas Southwestern Medical Center; John C. Mansour, University of Texas Southwestern Medical Center; Quan-Yang Duh, University of California San Francisco; Natalie Seiser, University of California San Francisco; Carmen C. Solorzano, Vanderbilt University; Colleen M. Kiernan, Vanderbilt University; Konstantinos I. Votanopoulos, Wake Forest School of Medicine; Edward A. Levine, Wake Forest School of Medicine; George A. Poultsides, Stanford University; Timothy M. Pawlik, Johns Hopkins University
• Journal Title: Journal of Surgical Oncology
• Volume: Volume 112, Number 2
• Publisher: Wiley: 12 months | 2015-07-31, Pages 164-172
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/jso.23982
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Surgery; adrenocortical carcinoma; prognosis; neutrophil-lymphocyte ratio; platelet-lymphocyte ratio; ADRENAL-CORTICAL CARCINOMA; TUMOR-NECROSIS-FACTOR; C-REACTIVE PROTEIN; COLORECTAL-CANCER; PROGNOSTIC ROLE; SOLID TUMORS; INFLAMMATION; SURGERY; RECURRENCE; MICROENVIRONMENT

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: ≤5cm, 0% vs. >5cm, 39.7%; PLR>190: ≤5cm, 0% vs. >5cm, 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. J. Surg. Oncol. 2015 111:164-172.