Are Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios Associated with Endometrial Precancerous and Cancerous Lesions in Patients with Abnormal Uterine Bleeding?

Acmaz, Gokhan,Aksoy, Huseyin,Unal, Dilek,Ozyurt, Sezin,Cingillioglu, Basak,Aksoy, Ulku,Muderris, Ipek Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.4

Background: An easy, reproducible and simple marker is needed to estimate phase of endometrial pathologic lesions such as hyperplasia and endometrial cancer and distinguish from pathologically normal results. We here aimed to clarify associations among neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), endometrial hyperplasia and cancer in patients with abnormal uterine bleeding. Materials and Methods: Patients (n=161) who were admitted with abnormal uterine bleeding and the presence of endometrial cells on cervical cytology or thick endometrium were investigated. The study constituted of three groups according to pathologic diagnosis. Group 1 included endometrial precancerous lesions like hyperplasia (n=63), group 2 included endometrial cancerous lesions (n=38) and group 3 was a pathologically normal group (n=60). Blood samples were obtained just before the curettage procedure and the NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count; similarly, PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. Results: The white blood cell count was significantly higher in patients with cancer than in those with hyperplasia (p=0.005). The platelet count and neutrophil to lymphocyte ratio were significantly higher in patients with cancer than in control patients, but there was significantly no difference between patients with hyperplasia and other groups (p=0.001 and p=0.025 respectively). PLR was significantly lower in control subjects than in other groups (p<0.001), but there was no significant difference between patients with hyperplasia and those with cancer. Conclusions: PLR was significantly lower in control subjects than in other groups. Thus both hyperplasia and cancer may be differentiated from pathologically normal patients by using PLR. White blood cell count was significantly higher in patients with cancer than in those with hyperplasia and pathologically normal patients. Therefore white blood cell count may be used for discriminate hyperplasia to cancer. By using multiple inflammation parameters, discrimination may be possible among endometrial cancer, endometrial precancerous lesions and pathologically normal patients.

Comparison of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios for Predicting Malignant Potential of Suspicious Ovarian Masses in Gynecology Practice

Topcu, Hasan Onur,Guzel, Ali Irfan,Ozer, Irfan,Kokanali, Mahmut Kuntay,Gokturk, Umut,Muftuoglu, Kamil Hakan,Doganay, Melike Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.15

Purpose: To compare the diagnostic accuracy of the neutrophil/lymphocyte ratio (NLR) with the platelet/lymphocyte ratio (PLR) in predicting malignancy of pelvic masses which are pre-operatively malignant suspicious. Materials and Methods: In this retrospective study we evaluated the clinical features of patients with ovarian masses which had pre-operatively been considered suspicious for malignancy. The patients whose intraoperative frozen sections were malign were classified as the study group, while those who had benign masses were the control group. Data recorded were age of the patient, diameter of the mass, pre-operative serum Ca 125 levels, platelet count, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio. Results: There was statistically significantly difference between the groups in terms of age, diameter of the mass, serum Ca 125 levels, platelet number and platelet/lymphocyte ratio. Mean neutrophil/lymphocyte ratios showed no difference between the groups. ROC curve analysis showed that age, serum Ca 125 levels, platelet number and PLR were discriminative markers in predicting malignancy in adnexal masses. Conclusions: According to the current study, serum Ca 125 levels, pre-operative platelet number and PLR may be good prognostic factors, while NLR is an ineffective marker in predicting the malignant characteristics of a pelvic mass.

The role of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in ulcerative colitis

( Yujin Jeong ),( Seong Ran Jeon ),( Hyun Gun Kim ),( Jung Rock Moon ),( Tae Hee Lee ),( Jae Young Jang ),( Jun-hyung Cho ),( Jun Seok Park ),( Heesu Park ),( Ki-hun Lee ),( Jin-oh Kim ),( Joon Seong 대한장연구학회 2021 Intestinal Research Vol.19 No.1

Background/Aims: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) can serve as biomarkers for diagnosing and assessing disease activity in ulcerative colitis (UC). We investigated their clinical significance in UC. Methods: We analyzed 48 patients with UC who underwent measurement of fecal calprotectin (FC) and endoscopy and 96 age- and sex-matched healthy controls. NLR and PLR were compared between the patients and healthy controls. The endoscopic activity was divided into 2 groups: group 1 (mild to moderate inflammation) and group 2 (severe inflammation) according to the Mayo endoscopic subscore in UC. Results: To diagnose UC, the optimal cutoff of NLR and PLR was 2.26 (sensitivity 54.2%; specificity 90.6%; positive likelihood ratio 5.778, 95% confidence interval [CI] 2.944-11.339; area under the curve [AUC] 0.774, 95% CI, 0.690-0.859) and 179.8 (sensitivity 35.4%; specificity 90.6%; positive likelihood ratio 3.778, 95% CI 1.821-7.838; AUC 0.654, 95% CI 0.556-0.753), respectively. The optimal cutoff to differentiate group 1 and group 2 was 3.44, 175.9, and 453 μg/g for NLR, PLR, and FC, respectively (sensitivity, 63.6% vs. 90.9% vs. 81.8%; specificity, 81.1% vs. 78.4% vs. 73.0%; positive likelihood ratio, 3.364 vs. 4.205 vs. 3.027; AUC, 0.714 vs. 0.897 vs. 0.813). PLR had the highest AUC and positive likelihood ratio. Conclusions: NLR and PLR help differentiate patients with UC from healthy controls. NLR, PLR, and FC indicate endoscopic activity and may reflect intestinal mucosal conditions. (Intest Res 2021;19:62-70)

The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases

Armen Yuri Gasparyan,Lilit Ayvazyan,Ulzhan Mukanova,Marlen Yessirkepov,George D. Kitas 대한진단검사의학회 2019 Annals of Laboratory Medicine Vol.39 No.4

The platelet-to-lymphocyte ratio (PLR) has emerged as an informative marker revealing shifts in platelet and lymphocyte counts due to acute inflammatory and prothrombotic states. PLR has been extensively examined in neoplastic diseases accompanied by immune suppression and thrombosis, which can be predicted by combined blood cell counts and their ratios. Several large observational studies have demonstrated the value of shifts in PLR in evaluating the severity of systemic inflammation and predicting infections and other comorbidities, in inflammatory rheumatic diseases. The value of PLR as an inflammatory marker increases when its fluctuations are interpreted along with other complementary hematologic indices, particularly the neutrophil-to-lymphocyte ratio (NLR), which provides additional information about the disease activity, presence of neutrophilic inflammation, infectious complications, and severe organ damage in systemic lupus erythematosus. PLR and NLR have high predictive value in rheumatic diseases with predominantly neutrophilic inflammation (e.g., Behçet disease and familial Mediterranean fever). High PLR, along with elevated platelet count, is potentially useful in diagnosing some systemic vasculitides, particularly giant-cell arteritis. A few longitudinal studies on rheumatic diseases have demonstrated a decrease in PLR in response to anti-inflammatory therapies. The main limitations of PLR studies are preanalytical faults, inadequate standardization of laboratory measurements, and inappropriate subject selection. Nonetheless, accumulating evidence suggests that PLR can provide valuable information to clinicians who encounter multisystem manifestations of rheumatic diseases, which are reflected in shifts in platelet, lymphocyte, neutrophil, or monocyte counts. Interpretation of PLR combined with complementary hematologic indices is advisable to more accurately diagnose inflammatory rheumatic diseases and predict related comorbidities.

Roles of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios in the Early Diagnosis of Malignant Ovarian Masses

Yildirim, Mem Arjen,Seckin, Kerem Doga,Togrul, Cihan,Baser, Eralp,Karsli, Mehmet Fatih,Gungor, Tayfun,Gulerman, Hacer Cavidan Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.16

Background: The present study aimed to investigate the utility and importance of the various parameters of complete blood count panel for benign-malignant differentiation of adnexal masses. Materials and Methods: This retrospective study involved 316 patients with documented benign and 253 patients with malignant adnexal masses who underwent primary surgical treatment at a tertiary referral center. Prior to the study, all benign and malignant cases were compared within their own groups and then the benign and malignant cases were compared to each other. For all cases, cut-off, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), neutrophil, lymphocyte, platelet and CA-125 parameters, and the results were compared in regards to the groups. Results: NLR, PLR, neutrophil, CA-125, and platelet values were higher in the malignant compared to the benign cases (p<0.01). The lymphocyte value was lower in the malignant cases (p<0.01). No significant differences were found for basophils and eosinophils (p > 0.05). For CA-125, the sensitivity, specificity, PPV and NPV for all cases were 78%, 62%, 62% and 78%, respectively. For NLR, they were 65.6%, 72.1%, 65.3%, and 72.3%, and for PLR, 48%, 81%, 67%, and 66%. Additionally, the sensitivity and specificity were 55% and 77% for CA-125, 66% and 58% for NLR, and 61% and 58% for PLR in early malignant cases. Conclusions: NLR and PLR appear to be useful methods that can be applied together with CA-125 due to the relatively high sensitivity values for the malign-benign differentiation of ovarian masses. Although the specificity of these parameters is lower than CA-125, especially in cases with early malignant ovarian pathology, their sensitivity being higher is promising for the early diagnosis of ovarian cancer. It can be used to detect ovarian malignancies in the early stages, and it will increase the treatment options and improve survival rates.

Incorporating Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Place of Neutrophil Count and Platelet Count Improves Prognostic Accuracy of the International Metastatic Renal Cell Carcinoma Database Consortium Model

Pawel Chrom,Rafal Stec,Lubomir Bodnar,Cezary Szczylik 대한암학회 2018 Cancer Research and Treatment Vol.50 No.1

Purpose The study investigated whether a replacement of neutrophil count and platelet count by neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) within the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model would improve its prognostic accuracy. Materials and Methods This retrospective analysis included consecutive patients with metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitors. The IMDC and modified-IMDC models were compared using: concordance index (CI), bias-corrected concordance index (BCCI), calibration plots, the Grønnesby and Borgan test, Bayesian Information Criterion (BIC), generalized R2, Integrated Discrimination Improvement (IDI), and continuous Net Reclassification Index (cNRI) for individual risk factors and the three risk groups. Results Three hundred and twenty-one patients were eligible for analyses. The modified-IMDC model with NLR value of 3.6 and PLR value of 157 was selected for comparison with the IMDC model. Both models were well calibrated. All other measures favoured the modified-IMDC model over the IMDC model (CI, 0.706 vs. 0.677; BCCI, 0.699 vs. 0.671; BIC, 2,176.2 vs. 2,190.7; generalized R2, 0.238 vs. 0.202; IDI, 0.044; cNRI, 0.279 for individual risk factors; and CI, 0.669 vs. 0.641; BCCI, 0.669 vs. 0.641; BIC, 2,183.2 vs. 2,198.1; generalized R2, 0.163 vs. 0.123; IDI, 0.045; cNRI, 0.165 for the three risk groups). Conclusion Incorporation of NLR and PLR in place of neutrophil count and platelet count improved prognostic accuracy of the IMDC model. These findings require external validation before introducing into clinical practice.

조현병 중증도와 염증 표지자(호중구/림프구 비율, 단핵구/림프구 비율, 혈소판/림프구 비율)의 연관성

허재원,김호찬 대한생물치료정신의학회 2023 생물치료정신의학 Vol.29 No.3

Objectives: Neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR) are inflammatory biomarkers. Potential of these inflammatory biomarkers as state marker of schizophrenia severity is controversial. This study aimed to investigate the relationship between inflammatory biomarkers and schizophrenia severity. Methods: From January 2010 to June 2020, the medical records of schizophrenia patients admitted to Kosin University Gospel Hospital were retrospectively examined and 91 patients who met the inclusion criteria were selected as the subjects of the study. The Korean version of the Positive and Negative Syndrome Scale (PANSS-KV) was used to assess schizophrenia symptom severity and divided into PANSS-KV total score (PANSS-T), PANSS-KV positive syndrome subscale (PANSS-P), PANSS-KV negative syndrome subscale (PANSS-N), PANSS-KV general psychopathology subscale (PANSS-G). Results: In 91 subjects, 40 were male and 51 were female. We found no significant relationship between sex, age, number of hospitalization and NLR, MLR, PLR. Patients with higher NLR, MLR, PLR had higher PANSS-T scores. Positive correlation between NLR, MLR, PLR and PANSS-N, PANSS-G was demonstrated. There was no significant correlation between NLR, MLR, PLR and PANSS-P. Conclusions: We investigate the possibility of inflammatory biomarkers as state markers of schizophrenia symptom severity. A well-designed prospective study involving a larger cohort is needed in the future.

Are Neutrophil/Lymphocyte and Platelet/Lymphocyte Rates in Patients with Non-Small Cell Lung Cancer Associated with Treatment Response and Prognosis?

Unal, Dilek,Eroglu, Celalettin,Kurtul, Neslihan,Oguz, Arzu,Tasdemir, Arzu Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.9

Background: Inflammation is a critical component of tumor progression. Many cancers arise from sites of infection, chronic irritation, and inflammation. It is now becoming clear that the tumour microenvironment, which is largely orchestrated by inflammatory cells, is an essential participant in the neoplastic process, promoting proliferation, survival and migration. Platelets can release some growth factors such as platelet-derived growth factor, platelet factor 4, and thrombospondin. Such factors have been shown to promote hematogenous tumour spread, tumor cell adhesion and invasion, and angiogenesis and to play an important role in tumor progression. In this study, we aimed to investigate effects of the pretreatment neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) on survival and response to chemoradiotherapy in patients with non-small-cell lung cancer (NSCLC). Materials and Methods: Ninety-four patients with non-metastatic NSCLC were included and separated into two groups according to median valuse of NLR and PLR (low:<3.44 or high:${\geq}3.44$ and low:<194 or high${\geq}194$, respectively). Results: Pretreatment high NLR and PLR were associated with significantly shorter disease-free and overall survival rates. Multivariate analysis revealed that the overall survival rates were significantly linked with PLR (OR: 1.87, CI: 1.20-2.91, p: 0.006) and response to chemoradiotherapy (OR: 1.80, CI: 1.14-2.81, p: 0.012) and the disease-free survival rates were significantly associated with NLR (OR: 1.81, CI: 1.16-2.82, p: 0.009) and response to chemoradiotherapy (OR: 2.30, CI: 1.45-3.66, p: 0.001). There was no significant difference between patients with high and low NLR in terms of response to chemoradiotherapy. Similarly, there was no significant influence of the PLR. Conclusions: Pretreatment NLR and PLR measurements can provide important prognostic results in patients with NSCLC and assessment of the two parameters together appears to better predict the prognosis in patients with NSCLC. The effect of inflammation, indicators of NLR and PLR, on survival seems independent of the response to chemoradiotherapy.

Association between the Neutrophil-to-lymphocyte Ratio, and Platelet-to-lymphocyte Ratio and Rheumatoid Arthritis and their Correlations with the Disease Activity: A Meta-analysis

( Young Ho Lee ) 대한류마티스학회 2018 대한류마티스학회지 Vol.25 No.3

Objective. This study examined the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and rheumatoid arthritis (RA), to establish a correlation among the NLR, PLR, and MPV and RA activity. Methods. Medline, Embase, and Cochrane were searched, and a meta-analysis was performed to compare the NLR, PLR, and MPV between RA patients and healthy controls. The correlation coefficients between NLR, PLR, and MPV and the Disease Activity Score 28 (DAS28) in the RA patients were examined. Results. Sixteen studies were included in this meta-analysis. NLR was significantly higher in the RA group (standardized mean difference [SMD], 0.800; 95% confidence interval [CI], 0.542∼1.058; p<0.001). Stratification according to ethnicity revealed a significantly elevated NLR in the RA group in Asian and Turkish populations (SMD, 95% CI: 0.994, 0.418∼1.519, p=0.001 and 0.695, 0.443∼0.948, p<0.001, respectively). Subgroup analysis revealed a significantly high NLR in RA, independent of the data type and adjustment for age and/or sex. PLR was also significantly higher in the RA group (SMD, 0.708; 95% CI, 0.401∼0.995; p<0.001), regardless of ethnicity, data type, and adjustment for age and/or sex. In addition, NLR and PLR were positively associated with the RA activity based on the DAS28 (correlation coefficient, 95% CI: 0.277, 0.190∼0.359, p<0.001 and 0.318, 0.197∼0.430, p<0.001, respectively). However, MPV showed no correlation with the RA activity (correlation coefficient, -0.095; 95% CI, -0.435 to 0.269; p=0.615). Conclusion. Meta-analysis showed that the NLR and PLR were significantly higher in the RA patients and positively but weakly correlated with the RA activity. (J Rheum Dis 2018;25:169-178)

Inflammatory Biomarkers and Bipolar Disorder: Neutrophil/Lymphocyte Ratio, Monocyte/Lymphocyte Ratio and Platelet/Lymphocyte Ratio

Jaewon Heo(허재원),Yunna Lee(이윤나) 대한생물치료정신의학회 2022 생물치료정신의학 Vol.28 No.3

목적:호중구/림프구 비율(NLR), 단핵구/림프구 비율(MLR) 및 혈소판/림프구 비율(PLR)은 염증의 표지자이다. 여러 연구에서 비율들과 양극성 장애의 중증도와의 관계를 평가했지만 상반되는 결과였다. 저자들은 이러한 염증 비율과 양극성 장애의 중증도 및 임상적 특징 사이의 관계를 조사했다. 방법:2010년 1월부터 2021년 8월까지 고신대학교 복음병원에 입원하였고 선정기준을 만족하는 양극성 장애 환자의 의무기록을 후향적으로 조사하였다. NLR, MLR, PLR은 온혈구계산에 따라 측정되었다. 중증도는 경조증/조증 삽화 환자에서 Young Mania Rating Scale (YMRS), 우울 삽화 환자에서 Hamilton Rating Scale for Depression (HAMD)로 평가되었다. 환자는 두 가지 임상적 특징인 현재의 정신병적 증상 및 자살 시도 과거력의 유무에 따라 분류되었다. 결과:선정된 181명의 대상자 중 123명이 여성이고 58명이 남성이었다. 더 높은 NLR 수치를 보인 환자군은 더 높은 HAMD 점수를 보였다(n=36, r=0.337, p=0.045). YMRS와 염증 표지자 사이에는 유의한 상관관계가 없었다. 이전 자살 시도가 있는 환자군은 이전 자살 시도가 없는 환자군보다 더 높은 PLR 수치를 보였다(N[SA+]=52, N[SA-]=129, p=0.035). 정신병적 특징에 따른 염증 비율의 수치에는 유의한 차이가 없었다. 결론:이 연구로 양극성 장애 우울에피소드의 중증도와 염증 표지자 사이의 상관 관계와 함께 양극성 장애에서 이전 자살 시도 과거력과 염증 표지자 사이의 가능한 상관 관계를 밝혀냈다. 앞으로 더 많은 대상자를 포함하는 잘 설계된 전향적 연구의 필요성이 시사된다. Objectives:Neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR) are indicators of inflammation. Several studies have evaluated their relationship with bipolar disorder severity, but the results are controversial. Here, we investigate the relationship between inflammatory ratios and the severity and clinical characteristics of bipolar disorder. Methods:We retrospectively reviewed the medical records of bipolar disorder patients who met the inclusion criteria and admitted to Kosin University Gospel Hospital between January 2010 and August 2021. NLR, MLR and PLR were measured according to the complete blood count. Severity was assessed by the Young Mania Rating Scale (YMRS) in hypo/manic episode patients, the Hamilton Rating Scale for Depression (HAMD) in depressive episode patients. Patients are grouped by presence of two clinical features, current psychotic features and history of suicide attempts. Results:181 subjects, of whom 123 were women and 58 men, were included. Subjects with higher NLR had higher HAMD scores (N=36, r=0.337, p=0.045). We found no significant correlation between YMRS and the inflammatory biomarkers. Patients with previous suicide attempts exhibited a greater PLR than those without previous suicide attempts (N[SA+]=52, N[SA-]=129, p=0.035). There was no significant difference in inflammatory ratios with respect to psychotic features. Conclusions:We found a possible correlation between the severity of bipolar depression and inflammatory indicators in the Korean population, in addition to correlation between previous suicidal attempt of bipolar disorder and inflammatory indicators. A well-designed prospective study involving a larger cohort is needed in the future.