Abstract
Background
Soft tissue sarcomas are a heterogenous group of neoplasms without well-validated
biomarkers. Cancer-related inflammation is a known driver of tumor growth and progression.
Recent studies have implicated a high circulating neutrophil-lymphocyte ratio as a
surrogate marker for the inflammatory tumor microenvironment and a poor prognosticator
in multiple solid tumors, including colorectal and pancreatic cancers. The impact
of circulating neutrophil-lymphocyte ratio in soft tissue sarcomas has yet to be elucidated.
Methods
We performed a retrospective analysis of patients undergoing curative resection for
primary or recurrent extremity soft tissue sarcomas at academic centers within the
US Sarcoma Collaborative. Neutrophil-lymphocyte ratio was calculated retrospectively
in treatment-naïve patients using blood counts at or near diagnosis.
Results
A high neutrophil-lymphocyte ratio (≥4.5) was associated with worse survival on univariable
analysis in patients with extremity soft tissue sarcomas (hazard ratio 2.07; 95% confidence
interval, 1.54–2.8; P < .001). On multivariable analysis, increasing age (hazard ratio 1.03; 95% confidence
interval, 1.02–1.04; P < .001), American Joint Committee on Cancer T3 (hazard ratio 1.89; 95% confidence
interval, 1.16–3.09; P = .011), American Joint Committee on Cancer T4 (hazard ratio 2.36; 95% confidence
interval, 1.42–3.92; P = .001), high tumor grade (hazard ratio 4.56; 95% confidence interval, 2.2–9.45;
P < .001), and radiotherapy (hazard ratio 0.58; 95% confidence interval, 0.41–0.82;
P = .002) were independently predictive of overall survival, but a high neutrophil-lymphocyte
ratio was not predictive of survival (hazard ratio 1.26; 95% confidence interval,
0.87–1.82; P = .22).
Conclusion
Tumor inflammation as measured by high pretreatment neutrophil-lymphocyte ratio was
not independently associated with overall survival in patients undergoing resection
for extremity soft tissue sarcomas.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2015.CA Cancer J Clin. 2015; 65: 5-29
- Sarcomas in the United States: recent trends and a call for improved staging.Oncotarget. 2019; 10: 2462-2474
- The evolving classification of soft tissue tumours - an update based on the new 2013 WHO classification.Histopathology. 2014; 64: 2-11
- Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons.Ann Surg. 1987; 205: 349-359
- Lessons learned from the study of 10,000 patients with soft tissue sarcoma.Ann Surg. 2014; 260 (discussion 21–22): 416-421
- Sarcomas associated with genetic cancer predisposition syndromes: a review.Oncologist. 2016; 21: 1002-1013
- The clinical and functional outcome for patients with radiation-induced soft tissue sarcoma.Cancer. 2012; 118: 2682-2692
- Secondary sarcomas in childhood cancer survivors: a report from the Childhood Cancer Survivor Study.J Natl Cancer Inst. 2007; 99: 300-308
- Ulcerative colitis and colorectal cancer. A population-based study.N Engl J Med. 1990; 323: 1228-1233
- DNA damage induced by chronic inflammation contributes to colon carcinogenesis in mice.J Clin Invest. 2008; 118: 2516-2525
- Molecular analysis of genetic instability caused by chronic inflammation.Methods Mol Biol. 2009; 512: 15-28
- Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability.Carcinogenesis. 2009; 30: 1073-1081
- Cancer-related inflammation.Nature. 2008; 454: 436-444
- Preoperative neutrophil-to-lymphocyte ratio predicts clinical outcome in patients with stage II and III colon cancer.Anticancer Res. 2013; 33: 4591-4594
- Cytokine profile and prognostic significance of high neutrophil-lymphocyte ratio in colorectal cancer.Br J Cancer. 2015; 112: 1088-1097
- Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer.Br J Cancer. 2013; 109: 416-421
- A systematic review and meta-analysis on the impact of pre-operative neutrophil lymphocyte ratio on long term outcomes after curative intent resection of solid tumours.Surg Oncol. 2014; 23: 31-39
- Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy.Ann Surg Oncol. 2009; 16: 614-622
- The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer.Crit Rev Oncol Hematol. 2013; 88: 218-230
- Prognostic value of pretreatment neutrophil-to-lymphocyte ratio in patients with soft tissue sarcoma: A meta-analysis.Medicine (Baltimore). 2018; 97e12176
- Localized extremity soft tissue sarcoma: improved knowledge with unchanged survival over time.J Clin Oncol. 2003; 21: 2719-2725
- Serum macrophage-colony stimulating factor levels in colorectal cancer patients correlate with lymph node metastasis and poor prognosis.Clin Chim Acta. 2007; 380: 208-212
- The biological significance of soluble interleukin-2 receptors in solid tumors.Eur J Cancer. 1990; 26: 33-36
- Inflammation and cancer.Nature. 2002; 420: 860-867
- II. Contribution to the knowledge of sarcoma.Ann Surg. 1891; 14: 199-220
Article info
Publication history
Published online: July 28, 2020
Accepted:
June 10,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
