NLR is a robust prognostic factor in many solid tumors. Limited data exist about its role in patients with metastatic germ cell tumors (GCTs).
We utilized a single institution database of patients diagnosed with metastatic GCTs between January 1990 and December 2013 who were treated with chemotherapy at Princess Margaret Cancer Centre. The peripheral blood count prior to first line chemotherapy was used to calculate the derived NLR (absolute neutrophil count divided by the total white blood cell count minus the absolute neutrophil count). Predictive accuracy was assessed as the association between NLR and overall survival and was evaluated using a 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) for survival at 5 years. The optimal cut-off for NLR selection was chosen based on a highest AUROC.
In total, 475 patients were identified of which NLR data were available from 354 (75%) patients. Among these, 63% were good risk, 23% intermediate risk and 15% poor risk. The 5-year survival for good, intermediate and poor risk groups was 96.3%, 92.4% and 62.9%, while 10-year survival was 94.8%, 92.4% and 62.9%, respectively. Over the whole cohort, a NLR cut-off of 2.5 provided the best discriminatory accuracy with an AUROC of 0.70 (95% CI 0.59-0.75, p 2.5 was associated with a hazard ratio (HR) of 3.91 (95% CI 2.01-7.60, p 2.5, 5-year survival was only 51.3%.
A high NLR is associated with an adverse survival in patients with metastatic GCTs undergoing first line chemotherapy and provides moderate discriminatory accuracy in this setting. The utility of NLR appears particularly marked in patients with IGCCCG high risk disease.
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Senior authors, Dr. Jeremy Lewin and Dr. Eitan Amir
All authors have declared no conflicts of interest.