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

Prolonged skeletal muscle ischemia has been reported in acute arterial occlusion and crush syndrome. It often induces progressive edema and necrosis and occasionally life-threatening systemic complications, such as hypotension, hyperkalemia, acidosis, pulmonary edema, and acute renal failure. As in other organs, ischemic injury in skeletal muscle is initiated during hypoxia and is aggravated by reoxygenation during blood reperfusion. This study aimed at examining the protective effect of antioxidative enzymes, superoxide dismutase and catalase, on ischemia-reperfusion injury in skeletal muscle. Skeletal muscles in rat hindlimb were subjected to in vivo ischemia by clamping both the infrarenal aorta and the bilateral femoral arteries for 4h and to the subsequent blood reperfusion for 1h under profound anesthesia with pentobarbitone. An attempt was made to suppress the muscle injury by infusing superoxide dismutase and catalase 5min before starting reperfusion. Tissue water content was significantly increased by reperfusion. The increase in the water content was suppressed by the addition of those scavengers. Plasma levels of creatine phosphokinase and lactate dehy-drogenase were increased by ischemia and reperfusion. Addition of the scavengers did not suppress these increases, indicating that scavengers were not effective in suppressing the cellular injury, which might have begun during the ischemia and which might have been exacerbated by the reperfusion. Mitochondrial oxidative phosphorylation was significantly suppressed by ischemia and reperfusion. Such scavengers restored the inhibited mitochondrial function. These results indicate that the radical scavengers tested were effective to protect mitochondrial functions against ischemia-reperfusion insults. Although the present study was carried out on an animal model, administration of these radical scavengers may be effective to reduce injury due to acute arterial occlusion and crush syndrome.

Suppression of Reperfusion Injury in Rat Skeletal Muscle by Antioxidative Enzymes.

稀な非定型抗酸菌症を伴った肺分画症の1切除例を報告する.症例は43歳男性で, 近医にて右肺下葉に嚢胞を伴う非定型抗酸菌症の診断にて治療されていたが, 症状が反復再燃し, 嚢胞内の鏡面像も存在したため, 嚢胞の持続感染を疑い, 当科紹介になった.紹介時点で, 胸部X線写真および胸部CT上, 右肺全体に小葉中心性の結節および細気管支の拡張を認め, Mycobacterium intracellulareの喀痰排菌を認めたため, RFP, EB, clarithromycin (CAM) の3剤併用療法を行った.胸部CTにより肺分画症が疑われたため血管造影を行ったところ, 下行胸部大動脈より右肺下葉嚢胞部に走行する1本の動脈を認め, 肺分画症の診断を得た.右肺浸潤影の軽快を確認し, 手術を施行した.右下葉の嚢胞性病変内は, 隔壁を伴う多嚢胞性で, 黄白色の膿を認めた.分画症病変を含めた右中下葉切除を施行した.

https://www.jstage.jst.go.jp/article/jacsurg1992/15/7/15_7_779/_pdf

Intralobar sequestration associated with nontuberculous mycobacterial infection

A case of transverse colonic actinomycosis with difficulty in differential diagnosis

The amount of a 97-kDa protein in the sarcoplasmic reticulum-enriched microsomal fraction from rabbit heart changed in a manner dependent on the oxygenated condition after global hypothermic ischemia and subsequent normothermic reperfusion. Isolated hearts were immersed in physiologic saline for 0h (control group) or 1, 2 and 3h at 4°C (ischemia group) and were subjected to 40-min reperfusion at 37°C after 1h of hypothermic ischemia (reperfused group). The amount of the 97-kDa protein in the microsomal fraction apparently increased after ischemia, but decreased after reperfusion. The N-terminal amino acid of the protein was blocked and two internal sequences were determined, demonstrating the 97-kDa protein to be glycogen phosphorylase. A polyclonal antibody against rabbit skeletal muscular glycogen phosphor-ylase (GP) stained only the 97-kDa protein in the microsomal fraction in Western blot analysis. Microsomal fractions isolated from rabbit brain, liver, spleen, and white skeletal muscle were also examined by Western blot analysis using anti-GP. Liver and skeletal muscle contained a 97-kDa protein that reacted with anti-GP in control preparations. Ischemia induced a modest increase in the amount of the 97-kDa protein skeletal muscle microsomes, whereas no change in the amount of the protein occurred in liver microsomes. The results indicate that alteration in the energy metabolism from ischemia to the subsequent reperfusion is associated with the amount of GP.

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Increase in Content of Glycogen Phosphorylase during Ischemia in Isolated Rabbit Heart.

We investigated whether the combined use of computed tomography, thallium-201 single photon emission computed tomography and serum carcinoembryonic antigen level improves preoperative non-invasive mediastinal. 128 consecutive non-small cell lung cancer patients (85 adenocarcinomas, 31 squamous cell carcinomas and 12 others) who underwent a surgical resection were enrolled in this study. The results of the combined procedures were compared with the pathologic findings. Our results showed that the combined evaluation of mediastinal nodal involvement with the three procedures might increase underestimation, but decrease overestimation as compared to computed tomography alone. Thallium-201 single photon emission computed tomography for patients with enlarged nodes at computed tomography showed 81.3% and 100% of positive predictive value in overall and squamous cell carcinoma patients, respectively. The negative predictive value of thallium-201 single photon emission computed tomography for patients without en...

Toshio Onitsuka

Papers

Suppression of Reperfusion Injury in Rat Skeletal Muscle by Antioxidative Enzymes.

Intralobar sequestration associated with nontuberculous mycobacterial infection

A case of transverse colonic actinomycosis with difficulty in differential diagnosis

Increase in Content of Glycogen Phosphorylase during Ischemia in Isolated Rabbit Heart.

Combined procedures for mediastinal staging in non-small cell lung cancer.