Investig Clin Urol.  2019 May;60(3):176-183. 10.4111/icu.2019.60.3.176.

Neutrophil-to-lymphocyte ratio independently predicts advanced pathological staging and poorer survival outcomes in testicular cancer

• Tan YG
• Sia J
• Huang HH
• Lau WK

• KMID: 2444272
• DOI: http://doi.org/10.4111/icu.2019.60.3.176

Abstract

PURPOSE
An elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with adverse outcomes in various malignancies. However, its role in prognosticating testicular cancer (TC) has not been validated. We aim to study the relationship between NLR and TC.
MATERIALS AND METHODS
We retrospectively reviewed 160 patients with histological proven TC from January 2005 to June 2016. Youden's index was used to analyse NLR and a cut-off point of 3.0 was obtained, with statistical receiver operating characteristics of 0.755. Chi-square test, Kaplan-Meier (log rank test) and logistics regression models were used to predict NLR association with survival outcomes.
RESULTS
Median age was 34 years old (range, 17-68 years old). There were 102 pure seminomas and 58 non-seminomatous germ cell tumours. Median follow-up period was 8 years (range, 2.5-17 years). NLR ≥3.0 was independently associated with lymph node involvement (p=0.031; odds ratio [OR], 2.91; 95% confidence interval [CI], 1.67-5.83; p=0.038; OR, 4.12; 95% CI, 1.26-6.51) and metastatic disease (p=0.041; OR, 2.48; 95% CI, 1.22-3.98; p=0.043; OR, 2.21; 95% CI, 1.17-3.65) in both seminomatous and non-seminomatous germ cell tumours, translating to a more advanced disease. Moreover, NLR ≥3.0 also predicts poorer cancer specific survival in these patients.
CONCLUSIONS
NLR can be an inexpensive haematological marker in predicting advanced TC staging and poorer survival outcome. NLR complements the traditional cancer staging by identifying a group of high risk patients who may benefit from multimodal treatment and closer surveillance to achieve long term survival.

Keyword

Lymphocytes; Neutrophils; Testicular neoplasms

MeSH Terms

Combined Modality Therapy
Complement System Proteins
Follow-Up Studies
Germ Cells
Humans
Kaplan-Meier Estimate
Lymph Nodes
Lymphocytes
Neoplasm Staging
Neutrophils
Odds Ratio
Organization and Administration
Retrospective Studies
ROC Curve
Seminoma
Testicular Neoplasms*
Translating
Complement System Proteins

Figure

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  Fig. 1 Receiver operating characteristic (ROC) curve.

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  Fig. 2 (A) American Joint Committee on Cancer (AJCC) staging and cancer specific survival (CSS) in seminoma. (B) AJCC staging and CSS in non-seminomatous germ cell tumour (NSGCT).

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  Fig. 3 (A) Neutrophil-to-lymphocyte ratio (NLR) and cancer specific survival (CSS) in seminoma. (B) NLR and CSS in non-seminomatous germ cell tumour (NSGCT). HR, hazard ratio; CI, confidence interval.

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