Derived neutrophil by lymphocytes ratio is a misnomer, implication of derived leucocytes ratio in diagnosing gastric cancers
DOI:
https://doi.org/10.18203/2349-2902.isj20185187Keywords:
Derived leucocytes ratio, Derived neutrophil/lymphocyte ratio, Gastric cancer, Leucocyte parameters, Misnomer, Screening markersAbstract
Background: Gastric malignant neoplasms are well-known common malignant disease seen in routine clinical practice. In India incidence are comparatively low but accounts for significant mortality and morbidity. Gastric malignancy incidence adds significant numbers every year to cancer related deaths worldwide. And prognosis is not satisfactory in spite of medical innovations and technological advancements. Early diagnosis helps for successful surgical removal of gastric cancer and to achieve a curative resections. Present study objectives are to solve the paradox of misnomer derived neutrophil by lymphocyte ratio and to evaluate statistical differences of blood leucocyte parameters in patients with gastric malignancies as compared to control cases and its application as screening markers in diagnosing gastric cancers.
Methods: Hundred cases of gastric malignancy and hundred controls-age, gender matched to cases without malignancy or infection were included. Both groups evaluated with routine complete blood count and upper GI endoscopy reports, Data regarding WBC counts, neutrophil counts, lymphocyte counts, monocytes, eosinophils and basophils were noted and Derived Leucocytes Ratio (DLR) were calculated and compared to look for statistical differences.
Results: Hematological leucocyte parameters revealed statistical differences in gastric cancer patients in comparison to controls. Neutrophils were increased and lymphocytes decreased with elevated DLR levels.
Conclusions: Leucocyte parameters like neutrophils and lymphocytes shows varying trends in gastric cancer and elevated derived leucocytes ratio can be utilized as a screening marker in Gastric cancers.
References
GLOBOCAN. Estimated cancer incidence, mortality and prevalence worldwide in 2012, stomach cancer, 2012. Available at: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.
Deng Q, He B, Liu X, Yue J, Ying H, Pan Y, et al. Prognostic value of pre-operative inflammatory response biomarkers in gastric cancer patients and the construction of a predictive model. J Transl Med. 2015;13:66.
Kanda M, Kobayashi D, Tanaka C, Iwata N, Yamada S, Fujii T, et al. Adverse prognostic impact of perioperative allogeneic transfusion on patients with stage II/III gastric cancer. Gastric cancer. 2016 Jan 1;19(1):255-63.
Cho JY. Molecular diagnosis for personalized target therapy in gastric cancer. J Gastric Cancer 2013;13:129-35.
Lee K, Hwang H, Nam KT. Immune response and the tumor microenvironment: how they communicate to regulate gastric cancer. Gut Liver. 2014;8:131-9.
Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539-45.
De Larco JE, Wuertz BR, Furcht LT. The potential role of neutrophils in promoting the metastatic phenotype of tumors releasing interleukin-8. Clin Can Res. 2004 Aug 1;10(15):4895-900.
Stoppacciaro A, Melani C, Parenza M, Mastracchio A, Bassi C, Baroni C, et al. Regression of an established tumor genetically modified to release granulocyte colony-stimulating factor requires granulocyte-T cell cooperation and T cell-produced interferon gamma. J Exp Med. 1993 Jul 1;178(1):151-61.
Sylman JL, Mitrugno A, Atallah M, Tormoen GW, Shatzel JJ, Tassi Yunga S, et al. The predictive value of inflammation-related peripheral blood measurements in cancer staging and prognosis. Frontiers in oncology. 2018 Mar 21;8:78.
Wood G, Grenader T, Nash S, Adams R, Kaplan R, Fisher D, et al. Derived neutrophil to lymphocyte ratio as a prognostic factor in patients with advanced colorectal cancer according to RAS and BRAF status: a post-hoc analysis of the MRC COIN study. Anti-cancer drugs. 2017 Jun;28(5):546-50.
Grenader T, Nash S, Adams R, Kaplan R, Fisher D, Maughan T, et al. Derived neutrophil lymphocyte ratio is predictive of survival from intermittent therapy in advanced colorectal cancer: a post hoc analysis of the MRC COIN study. Br J Cancer. 2016;114(6):612-5.
Ferrucci PF, Ascierto PA, Pigozzo J, Del Vecchio M, Maio M, Antonini Cappellini GC, et al. Baseline neutrophils and derived neutrophil-to-lymphocyte ratio: prognostic relevance in metastatic melanoma patients receiving ipilimumab. Annals Oncol. 2016 Jan 22;27(4):732-8.
Ren K, Yin Y, He F, Shao Y, Wang S. Prognostic role of derived neutrophil-to-lymphocyte ratio in surgical triple-negative breast cancer. Cancer Manag Res. 2018;10:4891-8.
Li Y, Shao Y, Bai L, Zhou X. Increased derived neutrophil-to-lymphocyte ratio and Breast Imaging-Reporting and Data System classification predict poor survival in patients with non-distant metastatic HER2+ breast cancer treated with neoadjuvant chemotherapy. Cancer Manag Res. 2018;10:3841-7.
Krenn-Pilko S, Langsenlehner U, Stojakovic T, Pichler M, Gerger A, Kapp KS, Langsenlehner T. The elevated preoperative derived neutrophil-to-lymphocyte ratio predicts poor clinical outcome in breast cancer patients. Tumour Biol. 2016;37(1):361-8.
Dirican A, Kucukzeybek BB, Alacacioglu A, Kucukzeybek Y, Erten C, Varol U,et al. Do the derived neutrophil to lymphocyte ratio and the neutrophil to lymphocyte ratio predict prognosis in breast cancer?. Inter J Clin Oncol. 2015 Feb 1;20(1):70-81.
Du JH, Lu J. Circulating CEA-dNLR score predicts clinical outcome of metastatic gallbladder cancer patient. J Clin Lab Anal. 2018 Nov 21:e22684.
Proctor MJ, McMillan DC, Morrison DS, Fletcher CD, Horgan PG, Clarke SJ. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012;107(4):695-9.
Suzuki R, Takagi T, Hikichi T, Konno N, Sugimoto M, Watanabe KO, et al. Derived neutrophil/lymphocyte ratio predicts gemcitabine therapy outcome in unresectable pancreatic cancer. Oncol Lett. 2016 May;11(5):3441-5.
Zhou D, Liang J, Xu LI, He F, Zhou Z, Zhang Y, Chen M. Derived neutrophil to lymphocyte ratio predicts prognosis for patients with HBV-associated hepatocellular carcinoma following transarterial chemoembolization. Oncol Lett. 2016;11(5):2987-94.
Szkandera J, Gerger A, Liegl-Atzwanger B, Stotz M, Samonigg H, Friesenbichler J, et al. The derived neutrophil/lymphocyte ratio predicts poor clinical outcome in soft tissue sarcoma patients. Am J Surg. 2015 Jul;210(1):111-6.
Absenger G, Szkandera J, Pichler M, Stotz M, Arminger F, Weissmueller M, et al. A derived neutrophil to lymphocyte ratio predicts clinical outcome in stage II and III colon cancer patients. Br J Cancer. 2013 Jul 23;109(2):395-400.
Leitch EF, Chakrabarti M, Crozier JEM, McKee RF, Anderson JH, Horgan PG, et al. Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer. 2007;97:1266-70.
Feng F, Zheng G, Wang Q, Liu S, Liu Z, Xu G, et al. Low lymphocyte count and high monocyte count predicts poor prognosis of gastric cancer. BMC Gastroenterol. 2018 Dec;18(1):148.
Hsueh C, Tao L, Zhang M, Cao W, Gong H, Zhou J. The prognostic value of preoperative neutrophils, platelets, lymphocytes, monocytes and calculated ratios in patients with laryngeal squamous cell cancer. Oncotarget. 2017;8:60514-27.
Kim HS, Choi HY, Lee M, Suh DH, Kim K, No JH, et al. Systemic inflammatory response markers and CA-125 levels in ovarian clear cell carcinoma: a two center cohort study. Cancer Res Treat. 2016;48:250-8.
Wang Y, Xu F, Pan J, Zhu Y, Shao X, Sha J, et al. Platelet to lymphocyte ratio as an independent prognostic indicator for prostate cancer patients receiving androgen deprivation therapy. BMC Cancer. 2016;16:329.