Pretreatment serum neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios: Two tumor-related systemic inflammatory markers in patients with thymic epithelial tumors

• DOI: 10.1016/j.cyto.2020.155149
• Publication Date: 2020-06-05T23:50:14Z
• Authors: Lihua Wang; Maomei Ruan; Hui Yan; Bei Lei; Xiaoyan Sun; Cheng Chang; Liu Liu; Wenhui Xie
• Keywords: Adult; Blood Platelets; Inflammation; Male; Neutrophils; Middle Aged; Monocytes; 3. Good health; Leukocyte Count; 03 medical and health sciences; C-Reactive Protein; 0302 clinical medicine; ROC Curve; Case-Control Studies; Positron Emission Tomography Computed Tomography; Biomarkers, Tumor; Humans; Female; Lymphocyte Count; Lymphocytes; Neoplasms, Glandular and Epithelial; Aged; Retrospective Studies

To understand underlying changes in pretreatment serum inflammatory markers associated with thymic epithelial tumors (TETs) development.A retrospective analysis of 113 TETs patients who underwent 18-fluorine fluorodeoxyglucose (18F-FDG) positron emission tomography combined computed tomography (PET/CT) one to two weeks before tumor resection or biopsy was performed. Pretreatment serum neutrophil, monocyte, platelet, and lymphocyte counts, and fibrinogen and C-reaction protein (CRP) concentrations were measured one day before surgery or biopsy. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were calculated by dividing corresponding cells counts by lymphocyte counts, respectively. The maximum standard uptake value (SUVmax) of 18F-FDG of primary TETs was applied to reflect tumor glycolytic activity. The student's t-test, one-way ANOVA analysis, Chi-square test, receiver operating characteristic curve analysis, and Logistic regression analysis were used for statistical analysis.The serum NLR and MLR were significantly higher in TETs patients than in healthy volunteers (P both ≤ 0.001). High serum NLR and MLR were related to the thymic carcinomas (TCs) subtype, elevated Masaoka-Koga (M-K) tumor stage, and metastasis of TETs (P all < 0.005). High serum NLR and MLR were also associated with high SUVmax values of TETs (P all < 0.005), with increasingly differences between groups as the cut-off values defining low-SUVmax and high-SUVmax groups increased. With the medium cutoff of NLR, MLR, and SUVmax of 3.07, 0.25, and 8.00 respectively, the high NLR and MLR levels were significantly associated with high SUVmax level of TETs (P both < 0.005). Moreover, the incidences of co-high SUVmax/NLR and co-high SUVmax/MLR were higher in TETs patients older than 55 years, with TCs, in M-K stage IV, and with metastasis (P all < 0.05). Both the co-high SUVmax/NLR and co-high SUVmax/MLR increased the risk of TETs metastasis (P both < 0.001), while the co-high SUVmax/MLR was also an independent risk factor for TETs metastasis (odds ratio: 3.92, 95% confidence interval: 1.02-15.12, P = 0.047).Pretreatment serum NLR and MLR of TETs patients are two tumor-progression- and tumor-glycolysis-related inflammatory markers. Enhanced tumor glycolytic activity and associated systemic inflammatory reaction may play a synergistic role in TETs metastasis.