Abstract 506P
Background
CUP is a heterogeneous disease entity, as a result prognostication in this cohort of patients (pts) can be difficult. High NLR (hNLR) and PLR (hPLR) have been shown to be associated with poorer prognosis in solid tumours, however, their utility in CUP is poorly described. We aimed to examine the role of NLR/PLR as prognostic markers in pts with CUP at our centre.
Methods
All pts referred to our institute between January 2016-June 2020 with pre-treatment bloods available were included. Demographics, treatment history and outcomes were collected. HNLR was defined as a ratio >5 and hPLR as a ratio > 180. Parametric tests were used to compare variables between groups. Overall survival (OS) was calculated using Kaplan Meier methodology and Cox regression analysis. Log rank analysis was used to assess survival differences between groups.
Results
161 pts were included, 76 men (47%) and 85 women (53%). Median age at diagnosis was 67(range 25-93). The median NLR of the group was 4.15(range 1.03-22.0) with 68(42%) pts having a hNLR. The median PLR was 229.1(range 16.7-1073.3) with 110 (68%) pts having a hPLNR. Compared to pts with a normal NLR (nNLR) or PLR (nPLR) those with a high NLR or PLR were less likely to receive systemic anticancer therapy (72% vs 56% p=0.02) and (60% vs 76% p=0.05). 73.5% of pts with a nNLR were ECOG-PS 0-1 compared to 51.5% with a hNLR (p=0.005). 78% of pts with ECOG-PS 0-1 had a nPLR compared to 57.8% who had a hPLR (p=0.015). At a median follow up time of 48.8 months, 139(86%) pts had died. The median OS for nNLR and hNLR was 12.6 months and 5.9 months respectively (p<0.001). On Cox regression analysis, those with a hNLR had 2-fold increased risk of death compared to those with a nNLR (HR 2.0 95% CI 1.4-2.8 P<0.001). The median OS for nPLR and hPLR was 15.2 months and 7.3 months respectively (p<0.001). High PLNR was associated with a 2.3-fold increased risk of death (HR 2.3 95% CI 1.6-3.5 p<0.001).
Conclusions
Similarly, to other solid tumours, high NLR and PLR are highly prognostic in pts with CUP. Both offer the potential of providing a bedside prognostic tool in this heterogenous group of pts aiding discussions surrounding treatment and prognosis.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
N. Cook: Financial Interests, Institutional, Invited Speaker: Roche, Taiho, AstraZeneca, RedX, Orion, Avacta, Bayer, Eisai, UCB, Starpharma, Boehringer Ingelheim, Stemline, Ergomed; Non-Financial Interests, Advisory Role: Roche. All other authors have declared no conflicts of interest.