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The Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Metastatic Testicular Cancer
Open accessAbstract
We investigated the prognostic utility of pre-chemotherapy neutrophil-to-lymphocyte ratio (NLR) in patients with metastatic germ cell tumors (GCTs) undergoing first-line chemotherapy. We utilized two institutional databases to analyze the pretreatment-derived NLR (dNLR). Predictive accuracy was evaluated using the Cox proportional hazard model adjusted for the international germ cell cancer collaborative group (IGCCCG) risk classification. Discriminatory accuracy was evaluated by determining the area under the receiver operating characteristic curve (AUROC). In total, 569 of 690 patients had available dNLR (IGCCCG: good, 64%; intermediate, 21%; poor, 16%). The 5-year and 10-year overall survivals (OSs) for good, intermediate, and poor risk groups were 96.2%, 92.8%, and 62.7% and 93.9%, 90.3%, and 62.7%, respectively. A dNLR of 2 provided the best discriminatory accuracy with an AUROC of 0.58 (95% CI: 0.52–0.65, p = 0.01) for progression-free survival (PFS), whereas for OS, a dNLR of 3 provided the best discriminatory accuracy with an AUROC of 0.62 (95% CI: 0.53–0.70, p < 0.01). A dNLR > 2 was associated with a hazard ratio (HR) of 1.99 (95% CI: 1.27–3.12, p < 0.01) for PFS, which lost its effect after adjustment for IGCCCG (HR: 1.44, 95% CI: 0.90–2.30, p = 0.13). For OS, a dNLR >3 was associated with an HR of 3.00 (95% CI: 1.79–5.01, p < 0.01), but lost its effect after adjustment for IGCCCG. Systemic inflammation plays a role in metastatic GCT, but its prognostic utility beyond established algorithms is limited. The general prognostic value of NLR can be seen across a number of tumors, although the consistency and magnitude of the effect differ according to cancer type, disease stage, and treatment received. We identified that an elevated NLR was associated with an adverse PFS and OS, but not independent of the IGCCCG risk classification. dNLRs >2 and >3 were associated with an adverse PFS and OS, respectively, in patients with metastatic GCT receiving first-line chemotherapy, but not independent of the IGCCCG risk classification.
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Various studies reported significant differences between NLR, LMR, and SII in early and advanced stage GCTs.
“Various studies reported that there were significant differences between neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and systemic inflammation index (SII), in early and advanced stage GCTs [31,32,33,34,35].”
From The Immune Landscape and Immunotherapeutic Strategies in Platinum-Refractory Testicular Germ Cell Tumors (2024) · cites this paper as [34]
The Discussion reports that higher NLR may be associated with advanced GCT staging and describes a study finding that NLR and the systemic immune-inflammation index were prognostic across risk groups. It does not report findings for LMR or establish significant differences in all three measures between early- and advanced-stage GCTs. Page numbers were not provided in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOther studies question the independent prognostic value of elevated NLR, demonstrating a lack of significant association with shorter PFS and OS independently of IGCCCG risk groups.
“However, other studies question the independent prognostic value of elevated NLR demonstrating a lack of significant association with shorter PFS and OS independently of the IGCCCG risk groups [34].”
From The Immune Landscape and Immunotherapeutic Strategies in Platinum-Refractory Testicular Germ Cell Tumors (2024) · cites this paper as [34]
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Evmorfopoulos, K., Marsitopoulos, K., Karachalios, R., Karathanasis, A., Dimitropoulos, K., Tzortzis, V., Zachos, I., & Vlachostergios, P. J. (2024) · Cancers · doi:10.3390/cancers16020428 · Cited by 11
“However, other studies question the independent prognostic value of elevated NLR demonstrating a lack of significant association with shorter PFS and OS independently of the IGCCCG risk groups [34].”
Background
Metadata
- Authors
- Ribnikar, D., Stukalin, I., Bedard, P. L., Hamilton, R. J., Jewett, M., Warde, P., Chung, P., Anson-Cartwright, L., Templeton, A. J., Amir, E., Hansen, A. R., Heng, D. Y. C., & Lewin, J.
- Affiliations
- Princess Margaret Cancer Centre (CA)
- University of Calgary (CA)
- University Health Network (CA)
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
- University of Basel (CH)
- Corresponding author
- Lewin, Jeremy
- ORCID
- Venue
- Current Oncology
- Publisher
- MDPI AG
- Published
- 2020-12-21
- Volume
- 28
- Issue
- 1
- Pages
- 107-114
- ISSN
- 1198-0052 (ISSN-L)
- 1718-7729
- PMC
- PMC7816171
- OpenAlex
- W3113892970
- Cited by
- 15
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 7
- FWCI
- 0.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Current Oncology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Health Sciences › Medicine › Surgery › Testicular diseases and treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- neutrophil-to-lymphocyte ratio, metastatic testicular cancer, germ cell tumors, prognostic factors, systemic inflammation, first-line chemotherapy, overall survival, progression-free survival, IGCCCG risk classification, neutrophil dysfunction, prediction accuracy, discriminatory accuracy, prognostic cutoff values
- MeSH terms
- Humans, Lymphocytes, Male, Neoplasms, Germ Cell and Embryonal, Neutrophils, Prognosis, Testicular Neoplasms
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