BACKGROUND: Inflammation may play an important role in cancer progression, and a high neutrophil-to-lymphocyte ratio (NLR) has been reported to be a poor prognostic indicator in several malignancies. Here we quantify the prognostic impact of this biomarker and assess its consistency in solid tumors. METHODS: A systematic review of electronic databases was conducted to identify publications exploring the association of blood NLR and clinical outcome in solid tumors. Overall survival (OS) was the primary outcome, and cancer-specific survival (CSS), progression-free survival (PFS), and disease-free survival (DFS) were secondary outcomes. Data from studies reporting a hazard ratio and 95% confidence interval (CI) or a P value were pooled in a meta-analysis. Pooled hazard ratios were computed and weighted using generic inverse-variance and random-effect modeling. All statistical tests were two-sided. RESULTS: One hundred studies comprising 40559 patients were included in the analysis, 57 of them published in 2012 or later. Median cutoff for NLR was 4. Overall, NLR greater than the cutoff was associated with a hazard ratio for OS of 1.81 (95% CI = 1.67 to 1.97; P < .001), an effect observed in all disease subgroups, sites, and stages. Hazard ratios for NLR greater than the cutoff for CSS, PFS, and DFS were 1.61, 1.63, and 2.27, respectively (all P < .001). CONCLUSIONS: A high NLR is associated with an adverse OS in many solid tumors. The NLR is a readily available and inexpensive biomarker, and its addition to established prognostic scores for clinical decision making warrants further investigation.

Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Solid Tumors: A Systematic Review and Meta-Analysis

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Pathology and genetics of tumours of the lung , pleura, thymus and heart

There is increasing and consistent evidence that cancer-associated inflammation is a key determinant of outcome in patients with cancer. Various markers of inflammation have been examined over the past decade in an attempt to refine stratification of patients to treatment and predict survival. One routinely available marker of the systemic inflammatory response is the neutrophil-lymphocyte ratio (NLR), which is derived from the absolute neutrophil and absolute lymphocyte counts of a full blood count. To date, over 60 studies (>37,000 patients) have examined the clinical utility of the NLR to predict patient outcomes in a variety of cancers. The present systematic review examines and comments on the clinical utility of the NLR. The NLR had independent prognostic value in (a) unselected cohorts (1 study of >12,000 patients), (b) operable disease (20 studies, >4000 patients), (c) patients receiving neoadjuvant treatment and resection (5 studies, >1000 patients), (d) patients receiving chemo/radiotherapy (12 studies, >2000 patients) and (e) patients with inoperable disease (6 studies, >1200 patients). These studies originated from ten different countries, in particular UK, Japan, and China. Further, correlative studies (15 studies, >8500 patients) have shown that NLR is elevated in patients with more advanced or aggressive disease evidenced by increased tumour stage, nodal stage, number of metastatic lesions and as such these patients may represent a particularly high-risk patient population. Further studies investigating the tumour and host-derived factors regulating the systemic inflammatory response, in particular the NLR, may identify novel treatment strategies for patients with cancer.

The systemic inflammation-based neutrophil–lymphocyte ratio: Experience in patients with cancer

In the past 25 years, a majority of cancer studies have focused on examining functional consequences of activating and/or inactivating mutations in critical genes implicated in cell cycle control. These studies have taught us a great deal about the functions of oncogenes and tumor suppressor genes and the signaling pathways regulating cell proliferation and/or cell death. However, such studies have largely ignored the fact that cancers are heterogeneous cellular entities whose growth is dependent upon reciprocal interactions between genetically altered “initiated” cells and the dynamic microenvironment in which they live. This review highlights the aspects of cancer development that, like organogenesis during embryonic development and tissue repair in adult mammals, are regulated by interactions between epithelial cells, activated stromal cells, and soluble and insoluble components of the extracellular matrix.

Tumor stroma and regulation of cancer development.

Disease progression in cancer is dependent on the complex interaction between the tumor and the host inflammatory response. There is substantial evidence in advanced cancer that host factors, such as weight loss, poor performance status and the host systemic inflammatory response, are linked, and the latter is an important tumor-stage-independent predictor of outcome. Indeed, the systemic inflammatory response, as evidenced by an elevated level of C-reactive protein, is now included in the definition of cancer cachexia. This review examines the role of the systemic inflammatory response in predicting survival in patients with primary operable cancer. Approximately 80 studies have evaluated the role of the systemic inflammatory response using biochemical or hematological markers, such as elevated C-reactive protein levels, hypoalbuminemia or increased white cell, neutrophil and platelet counts. Combinations of such factors have been used to derive simple inflammation-based prognostic scores, such as the Gl...

Role of systemic inflammatory response in predicting survival in patients with primary operable cancer

Tuberculous Abdominal Aortic Aneurysm. A Case Report.

A 73-year-old woman with a history of hypertension and hyperlipidemia presented with a sharp pain ranging from the right shoulder to the upper limb. She had suffered a sharp pain at rest accompanied by general fatigue and nausea for about ten months prior to admission. Her white blood cell count was 12,800/microl, and her serum C-reactive protein was 17.5 mg/dl. A chest computed tomography scan revealed an aneurysmal change of the origin of the brachiocephalic artery. Pseudoaneurysm due to infection and aortic dissection was considered as a preoperative diagnosis. A total arch replacement was performed under cardiopulmonary bypass, deep hypothermia, and selective cerebral perfusion. Postoperatively, a bacteriologic culture of the contents of the aneurysm revealed Staphylococcus aureus. Perioperative administration of antibiotics was effective and the postoperative course was uneventful.

Mycotic pseudoaneurysm of the brachiocephalic artery.

The validity and indications of limited resection for lung cancer were studied based on the results of 34 patients with lung cancer who underwent surgery. This method appeared to be an effective technique for the preservation of the cardiopulmonary function after surgery, particularly in elderly patients. The prognosis of those who underwent limited resection for selected cases was not significantly different from that of those treated by lobectomy. Recurrences were seen exclusively in Stage II patients, most of whom had a poorly differentiated type of cell pathology and developed blood vessel involvement. It was concluded from this study that this technique can be feasibly applied to patients with a tumor of less than 3 cm located at the periphery of the lung and with the histologic picture of highly differentiated type.

Evaluation of limited resection of the lung for treatment of lung cancer

The aim of this study was to investigate the change of hepatic metabolic activity presented by the ketone body ratio (AKBR) during and after cardiopulmonary bypass (CPB) and to evaluate the prognostic value AKBR were measured in 20 cases of coronary aortic bypass grafting using moderate hypothermic CPB (group M), ten cases of aortic arch surgery using deep hypothermia with selective cerebral perfusion (DHSCP) with an open technique (group D) and 15 cases of descending thoracic aortic replacement using partial CPB (group N) AKBR decreased significantly in all groups 5 min after CPB compared with the value before CPB There was a significant difference in AKBR 1 h after CPB among the three groups and AKBR returned to the prebypass value in group N (group M, 032 +/- 016; group D, 014 +/- 004; group N, 048 +/- 014; P < 00001) AKBR rose significantly after the discontinuation of CPB compared with the value during CPB and returned to the prebypass value in groups M and D The patients who underwent DHSCP with an open technique had a value of AKBR below 02, but liver function still recovered normally The value of AKBR correlated with temperature significantly and a very low level of AKBR below 02 was observed during core cooling to 20 degrees C without negative prognostic implications AKBR decreased 5 min after CPB in group N which suggested decreased hepatic perfusion at an early stage of partial CPB The prognostic implication of AKBR during CPB is whether low level AKBR recovers or not

/pdf/study-in-three-different-types-of-cardiopulmonary-bypass-on-wp1is0wakn.pdf

Study in three different types of cardiopulmonary bypass on arterial ketone body ratio: its prognostic implication and participation of body temperature.

胸腹部大動脈瘤手術後の脊髄障害予防における術中脊髄誘発電位(ESP)測定の意義と限界について検討した. 9例の胸腹部大動脈瘤に対して腰部刺激, 頸部導出にてESPをモニターし, シャント法(1例), F-Fバイパス法(8例)を用いて人工血管置換術を施行した. 4例において術中ESPが消失し, 肋間動脈の灌流と再建, 下肢灌流圧を上げる, 軽度低体温などの処置を施行した. その結果2例ではESPは回復し術後麻痺は認めなかった. しかし, 2例でESPは回復せず, 1例に対麻痺を認めた. またESPが変化しなかった症例では対麻痺は認められなかった. ESPは脊髄前索の虚血モニターとしては不十分であり信頼性には限界があるが, 術中変化による対策にて対麻痺を免れる症例もあり, 現在のところは最も有用な指標である.

https://www.jstage.jst.go.jp/article/jjcvs1975/24/3/24_3_170/_pdf

Toshio Onitsuka

Papers

Tuberculous Abdominal Aortic Aneurysm. A Case Report.

Mycotic pseudoaneurysm of the brachiocephalic artery.

Evaluation of limited resection of the lung for treatment of lung cancer

Study in three different types of cardiopulmonary bypass on arterial ketone body ratio: its prognostic implication and participation of body temperature.

Efficacy of ESP Monitoring during Thoraco-Abdominal Aortic Replacement for Prevention of Intraoperative Spinal Ischemia.