Neutrophil-lymphocyte ratio (NLR) is a predictive factor of survival in cancer, probably as a biomarker of systemic inflammation, but with limited evidence in neuroendocrine neoplasms (NENs). NENs are a very heterogeneous disease with a large range of survival from few months to many years. Stage, grade and primary tumor location are known prognostic factors, but still limited. New prognostic biomarkers are needed. The aim of this study is to evaluate the association between NRL and survival (OS) in neuroendocrine neoplasms.
Data from patients diagnosed with extra-pulmonary neuroendocrine neoplasms (Grade 1 to 3) from a Portuguese tertiary cancer center were reviewed retrospectively (January 00 - March 19). NLR was calculated at diagnosis as the ratio between neutrophils and lymphocytes.
In our cohort, 116 patients were identified (52% male; median age 62yo (IQR 33-80) with neuroendocrine neoplasms: 76 gastroenteropancreatic (GEP), 32 unknown primary (UP) and 8 from other primary tumor location. 54 patients were G1/G2 and 51 patients were G3/NEC. 5year OS was different according to grade [79% (IC95% 68-91%) for G1/G2 tumors and 16% (IC95% 7-35%) for G3/NEC (p < 0.001)] and to primary tumor location [62% (95%CI 51-76%) for GEP and 15% (95%CI 6-34%) for UP (p < 0.001)]. NLR analysis started by determination of NLR median in this cohort: 2.526 (IQR 1.690-3.681). Patients were then divided in two groups: low NLR (< 2.526) and high NLR (≥2.526). 5year OS according to NLR was significantly different: 58% (IC95% 46-73%) for low NLR and 33% (ICD95% 22-49%) for high NLR (p = 0.038). After stratification by grade and primary tumor location, influence of NLR categories remains, patients with high NLR had a poor OS comparing to patients with low NLR (HR = 1.87, 95%CI 1.00-3.49, p = 0.05). A non-categorical analysis of NLR, stratified by grade and primary tumor location, showed that the risk of death increases 17% by each 1 unit rise in NLR (HR = 1.17, 95%CI 1.08-1.27, p = 0.0002).
Our study showed that NRL is an independent prognostic factor in survival in neuroendocrine neoplasms. Further studies are needed to evaluate the prognostic value of NLR as well as to evaluate its ability to predict response to different therapies.
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All authors have declared no conflicts of interest.