505PD - Elevated blood neutrophil-to-lymphocyte ratio is associated with poor clinical outcome in patients with synovial sarcoma

Date 17 December 2016
Event ESMO Asia 2016 Congress
Session Sarcoma
Topics Soft Tissue Sarcomas
Presenter Lingyue Zhou
Citation Annals of Oncology (2016) 27 (suppl_9): ix163-ix168. 10.1093/annonc/mdw597
Authors L. Zhou1, J.Y. Chan2, G.F.M. Tan1, C.L.W. Lim1, W.L. Goh2, S. Sathiyamoorthy3, K. Sittampalam3, J. Teh4, F. Chin4, M.H. Tan5, K.C. Soo5, M. Teo5, M. Farid2, R. Quek2
  • 1Yong Loo Lin School Of Medicine, National University of Singapore, 119228 - Singapore/SG
  • 2Division Of Medical Oncology, National Cancer Center, 169610 - Singapore/SG
  • 3Department Of Anatomical Pathology, Singapore General Hospital, 169856 - Singapore/SG
  • 4Division Of Radiation Oncology, National Cancer Center, 169610 - Singapore/SG
  • 5Division Of Surgical Oncology, National Cancer Center, 169610 - Singapore/SG



Systemic inflammation plays a fundamental role in cancer development and progression. Recent studies have demonstrated that blood neutrophil-to-lymphocyte ratio (NLR) may be prognostic for various malignancies, and this study aims to investigate its clinical relevance in human synovial sarcoma.


Fifty patients with synovial sarcoma who had available neutrophil and lymphocyte blood counts at the time of diagnosis and/or metastatic relapse were retrospectively examined. An optimal cutoff value for high NLR (> 4.25) in predicting overall survival (OS) and event-free survival (EFS) in our cohort was determined using receiver operating curve analysis. Survival analysis was performed using the Kaplan-Meier method and multivariate Cox proportional models.


Seventeen patients (34%) demonstrated high NLR at diagnosis, which was significantly associated with distant metastasis at diagnosis (p = 0.033), but not with sex, age at diagnosis, ethnicity, tumor size or site. Median NLR for patients without metastasis at diagnosis was significantly lower compared to those with metastasis (2.46 vs 4.36 respectively, Mann-Whitney p = 0.024). Interestingly, median NLR increased from the time of diagnosis of localized disease to the time of metastatic relapse within the same patients (n = 15) (2.55 vs 3.64 respectively, Wilcoxon p = 0.030). High NLR was significantly correlated with worse OS (HR 2.98; 95% CI 1.08-8.20; logrank p = 0.0121). In a multivariate model adjusted for other clinicopathological predictors of survival, high NLR remained correlated with worse OS (HR 3.43; 95% CI 1.21-9.68; p = 0.020), as did the presence of distant metastasis at diagnosis (HR 9.93; 95% CI 2.56-38.55; p = 0.0009) and tumor size ≥ 10 cm (HR 3.42; 95% CI 1.06-11.06; p = 0.040). Sex, age at diagnosis and tumor site were not correlated with any survival outcome in the multivariate model.


High NLR is an independent marker of poor overall survival among patients with synovial sarcoma.

Clinical trial indentification

Legal entity responsible for the study

National Cancer Centre, Singapore General Hospital, Singapore


National Cancer Centre, Singapore General Hospital, Singapore


R. Quek: Grants/research support: Novartis, Pfizer, Janssen Pharmaceuticals, Bayer, Eisai Honoraria/consultation fees: Novartis, Bayer, BMS, Merck, Roche, Eisai Participation in company sponsored speaker's bureau: Novartis, Bayer, Merck, Eisai. All other authors have declared no conflicts of interest.