Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients with Acute Decompensated Heart Failure: A Meta-Analysis.

Background: Inflammation plays a pivotal role in the pathogenesis of both acute and chronic heart failure. Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) could be related to adverse outcomes in patients with cardiovascular diseases. We sought to evaluate whether NLR could predict mortality in patients with acute heart failure by means of a meta-analysis. Methods: A comprehensive literature search was performed in PubMed, Embase, and Cochrane databases through January 2023 for studies evaluating the association of NLR with mortality in patients with acute heart failure. Primary outcomes were in-hospital mortality and long-term all-cause mortality. Endpoints were pooled using a random-effects DerSimonian-and-Laird model and were expressed as a hazard ratio (HR) or mean difference (MD) with their corresponding 95% confidence intervals. Results: A total of 15 studies with 15,995 patients with acute heart failure were included in the final study. Stratifying patients based on a cut-off NLR, we found that high NLR was associated with a significantly higher in-hospital mortality [HR 1.54, 95% CI (1.18-2.00), p < 0.001] and long-term all-cause mortality [HR 1.61, 95% CI (1.40-1.86), p < 0.001] compared to the low-NLR group. Comparing the highest against the lowest NLR quartile, it was shown that patients in the highest NLR quartile has a significantly heightened risk of long-term all-cause mortality [HR 1.77, 95% CI (1.38-2.26), p < 0.001] compared to that of lowest NLR quartile. However, the risks of in-hospital mortality were compared between both quartiles of patients [HR 1.78, 95% CI (0.91-3.47), p = 0.09]. Lastly, NLR values were significantly elevated among non-survivors compared to survivors during index hospitalization [MD 5.07, 95% CI (3.34-6.80), p < 0.001] and during the follow-up period [MD 1.06, 95% CI (0.54-1.57), p < 0.001]. Conclusions: Elevated NLR was associated with an increased risk of short- and long-term mortality and could be a useful tool or incorporated in the risk stratification in patients with acute heart failure.

Predictive role of systemic immune-inflammation index and neutrophil/lymphocyte ratio values in infants with retinopathy of prematurity.

PURPOSE: To search the relationship between serum neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) values with the development of retinopathy of prematurity (ROP) and the requirement for laser treatment. METHODS: This retrospective cohort study was carried out with 195 preterm infants between 2012 and 2023. The NLR, PLR, LMR, and SII values were calculated on both the first day and at the end of the first month after birth. The association between development of ROP and other risk factors were analyzed using univariate analysis and multivariate logistic regression analysis. RESULTS: Of patients, 92 infants were diagnosed with ROP. Laser treatment was administered to 36 infants. The postnatal first-day NLR and SII values were higher in infants with ROP than in infants without ROP (p < 0.001 for both). Postnatal first-month NLR, LMR, and SII values were higher in infants with ROP (p < 0.001, p = 0.007, and p < 0.001, respectively). In multivariate analyses, postnatal first-day NLR and first-month LMR values were regarded as independent risk factors for the development of ROP (OR:8.867 and 1.286, p = 0.002 and p = 0.009, respectively). In multivariate analyses performed for laser treatment requirement, postnatal first-month PLR and SII values were determined as independent risk factors (OR:0.951 and 1.011, respectively, p = 0.004 for both). CONCLUSIONS: Postnatal first-day NLR and first-month LMR values were determined as independent risk factors for the development of ROP. For the requirement of laser treatment, the postnatal first-month PLR and SII values were determined as independent risk factors.

White blood cells and patients with psychiatric disorders needing seclusion: A retrospective non-interventional study.

OBJECTIVE: The objective of this retrospective study was to investigate the peripheral immunological markers using leucocyte count, the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio (PLR), and the monocyte to lymphocyte ratio (MLR) in patients with aggressive behavior, during and after seclusion. METHODS: Ninety-nine inpatients were included in this retrospective study. Leucocyte count was measured, and NLR, PLR and MLR were calculated and compared between a group of patients who required seclusion and a group who did not. A multivariate analysis was performed using binary logistic regression, including confounding factors such as age, gender, medication, BMI, smoking status and diagnosis. RESULTS: We found the lowest levels of lymphocytes (P=0.01) and basophils (P<0.01) and the highest NLR (P=0.02) and MLR (P=0.04) in the seclusion group. We also found a restoration of these parameters after the end of the seclusion period. Furthermore, we found a positive correlation between the PANSS negative subscore, and PLR (P=0.05), or MLR (P=0.03) after seclusion, and between the MLR variation across the seclusion period and the PANSS general subscore after the end of seclusion (P=0.04). CONCLUSION: This study shows that NLR and MPR are higher in patients with aggressive symptoms and/or agitation who require seclusion. These immunological markers could be considered as state markers.

High preoperative neutrophile-lymphocyte ratio predicts poor prognosis of patients undergoing radical cystectomy for nonurothelial carcinoma of the bladder / 现代泌尿外科杂志

【Objective】 To investigate the predictive value of high preoperative neutrophile-lymphocyte ratio (NLR) for the prognosis of nonurothelial carcinoma of the bladder (NUBC) after radical cystectomy (RC). 【Methods】 Clinical and follow-up data of NUBC patients undergoing RC during Jan.2005 and Dec.2020 were collected. The optimal cut-off value of NLR was determined with the receiver operating characteristic (ROC) curve. The survival curve was drawn with Kaplan-Meier method to compare the differences in cancer specific survival (CSS) and overall survival (OS) between the high-NLR and low-NLR groups. The independent risk factors of CSS and OS were screened with Cox proportional hazard regression model. 【Results】 Of the 62 eligible cases,34 (54.8%) were diagnosed with adenocarcinoma,17 (27.4%) with squamous cell carcinoma, 6 (9.7%) with small cell carcinoma and 5 (8.1%) with sarcoma. Kaplan-Meier analysis results showed high NLR was associated with poor CSS (P=0.001) and OS (P<0.001). Cox regression results indicated that high NLR (HR=2.42, 95%CI: 1.12-5.23, P=0.025) and advanced pathologic tumor stage (HR=3.21, 95%CI:1.53-6.74,P=0.002) were independent risk factors of unfavorable CSS. Similarly, high NLR (HR=2.75, 95%CI: 1.35-5.56, P=0.005) and advanced pathologic tumor stage (HR=2.81, 95%CI:1.43-5.57, P=0.003) were independent risk factors of unfavorable OS. 【Conclusion】 As an independent risk factor of unfavorable CSS and OS in NUBC patients undergoing RC, high preoperative NLR is of great value in the prediction of long-term prognosis and may help to optimize individualized treatment.

Utilizing peripheral blood inflammatory biomarker (PBIB) to predict response to systemic therapy in patients with breast cancer.

Background: Inflammation is a recognized factor in cancer progression and resistance to treatments. Several studies correlated inflammation-related peripheral blood inflammatory biomarkers (PBIB) to disease progression and poor survival in various cancer types and different populations. Nonetheless, inflammation is affected by the distinctive characteristics and environmental exposure of each population. There is no prior study addressing the association of pre-treatment inflammatory markers with outcomes in patients with breast cancer (BC) from Saudi Arabia. In this study, we evaluated the prognosis of locally advanced breast cancer (LABC) in relation to several PBIB. Materials and Methods: We retrospectively analyzed the data of female patients with LABC undergoing neoadjuvant chemotherapy (NACT). Demographics, body mass index (BMI), clinicopathologic characteristics and stage of the tumor, follow-up status, and response to treatment were collected. Outcomes were evaluated in relation to pre-treatment peripheral blood indices that were grouped based on the local laboratory cutoff values. Objective response rate (ORR) was predefined and assessed according to the post-NACT magnetic resonance imaging (MRI) breast and subcategorized into complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Results: A total of 172 female patients with BC met the eligibility criteria from January 2014 to December 2019. The mean age at diagnosis was 53.4 ± 11, and BMI was 31.2 ± 6. Left BC accounted for 54.7%, and the majority was invasive ductal carcinoma (85.5%), moderately differentiated (51%), stage III (AJCC 8th edition) (73%), and estrogen receptor (ER)-positive tumor (79.1%). Human epidermal growth factor receptor 2 (HER2)-positive BC was reported in 32% and triple-negative breast cancer (TNBC) in 10%. Radiologic CR accounted for the majority of ORR (71.5%). Higher percentage of patients with normal red cell distribution width (RDW) of red blood cell (RBC) and low neutrophil-lymphocyte ratio (NLR) had CR with a significant P value of 0.003 and 0.014, respectively. Conclusion: Among several peripheral blood indices, RDW and NLR significantly influenced ORR. They can be explored further to potentially predict response after systemic therapy in patients with LABC. The great advantage of these biomarkers stems from their availability and affordability in routine clinical practice.

Neutrophile-Lymphocyte Ratio and Outcome in Takotsubo Syndrome.

Background: Takotsubo syndrome (TTS) is an important type of acute heart failure with significant risk of acute complications and death. In this analysis we sought to identify predictors for in-hospital clinical outcome in TTS patients and present long-term outcomes. Methods: In this analysis from the Austrian national TTS registry, univariable and multivariable analyses were performed to identify significant predictors for severe in-hospital complications requiring immediate invasive treatment or leading to irreversible damage, such as cardiogenic shock, intubation, stroke, arrhythmias and death. Furthermore, the influence of independent predictors on long-term survival was evaluated. Results: A total of 338 patients (median age 72 years, 86.9% female) from six centers were included. Severe in-hospital complications occurred in 14.5% of patients. In multivariable analysis, high neutrophile-lymphocyte-ratio (NLR; OR 1.04 [95% CI 1.02−1.07], p = 0.009) and low LVEF (OR 0.92 [0.90−0.95] per %, p < 0.001) were significant predictors of severe in-hospital complications. Both the highest NLR tercile and the lowest LVEF tercile were significantly associated with reduced 5-year survival. Conclusions: Low LVEF and high NLR at admission were independently associated with increased in-hospital complications and reduced long-term survival in TTS patients. NLR is a new easy-to-measure tool to predict worse short- and long-term outcome after TTS.

The Predictive Value of Systemic Immune-Inflammation Index on Bladder Recurrence on Upper Tract Urothelial Carcinoma Outcomes after Radical Nephroureterectomy.

BACKGROUND: This study aimed to assess the prognostic significance of pre-treatment lymphocyte-related systemic inflammatory biomarkers in upper tract urothelial carcinoma (UTUC) patients. METHODS: This study included non-metastatic UTUC patients treated at our hospital between 2001 and 2013. The receiver operating characteristic curve was used to obtain the optimal neutrophile-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Multivariate logistic regression was performed to investigate the relationship between NLR, PLR, and SII and clinical pathologic characteristics. The Kaplan-Meier method was used to calculate the metastasis-free survival (MFS), cancer-specific survival (CSS), and bladder recurrence-free survival (BRFS), and the log-rank test was used to compare the survival rate. RESULTS: Overall, 376 patients were included in the current study. An elevated SII was associated with symptomatic hydronephrosis, bladder cancer history, advanced pathologic tumor stage, lymph node invasion, adjuvant chemotherapy and concomitant carcinoma in situ (CIS); high NLR was associated with older age, symptomatic hydronephrosis, hemodialysis status, anemia, multifocal tumor, advanced pathologic tumor stage, and adjuvant chemotherapy; and high PLR was associated with older age, anemia, advanced pathologic tumor stage, and adjuvant chemotherapy. The Kaplan-Meier analysis indicated that patients exhibiting higher NLR, PLR, and SII showed significantly poor MFS and CSS rates. Only high SII showed significantly worse BRFS rates. CONCLUSIONS: The NLR, PLR, and SII were independent predictive factors for both MFS and CSS in UTUC patients. Among the factors, only elevated SII can predict bladder recurrence. Therefore, the patients might need close bladder monitoring during the follow-up.

[Can a single value of a perypheric inflammatory response marker predict the response to BCG?] / Ratios neutrófilo/linfocito y plaqueta/linfocito: ¿Se asocian con la respuesta al tratamiento con BCG en tumores vesicales no músculoinvasivos de alto grado?

OBJECTIVES: To evaluate the association of neuthophyl/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) with BCG intravesical responses in patients with initial diagnosis of non/muscle invasive bladder tumor high-risk (NMIBC). MATERIAL AND METHODS: Retrospective multicenter study on patients with initial diagnosis of high-grade NMIBC treated with BCG between January 2016 and December 2017. Initially a total of 74 patients were collected. Those patients with mixt pathology, cis, chronic corticoid usage and lost to follow-up, were excluded. Induction BCG (x6) and BCG maintenance schedules were administered (x9) over 1 year. Demographic variables (sex, age, BMI) and blood variables (NLR, PLR) before BCG instillation were collected. Response to treatment was defined as absence of recurrence and/ or progression. A statistical analysis with T-student, Chi square, ANOVA and ROC curves was performed. RESULTS: Final study cohort included a total of 50 patients. 10 females and 40 males. Median age was 70 year old. All patients had pure urothelial carcinoma, 12 with pTa and 38 with pT1. Median follow-up was 24 months. A total of 28% had a recurrence. No correlation between NLR or PLR and BCG response was observed (p=0.738; p= 0.768). Neither a cut off was established through ROC curves. At multivariate analysis, there was no significative relationship between recurrence and the clinical and blood samples analyzed (sec, age, BMI, NLR, PLR)CONCLUSION: No correlation between NLR and PLR has been reported with BCG response on high-grade NMIBC.

OBJETIVOS: Evaluar la asociación de la ratio neutrófilo/linfocito (RNL) y ratio plaqueta/linfocito (RPL) con la respuesta al tratamiento mediante instilaciones de Bacilo Calmette Guerin (BCG) intravesical, en pacientes con diagnóstico inicial de tumor vesical no músculo-invasivos (TVNMI) de alto riesgo.MATERIAL Y MÉTODOS: Estudio retrospectivo multicéntrico con pacientes diagnosticados de tumor vesical inicial de alto riesgo y sometidos a instilaciones endovesicales con BCG entre enero 2016 y diciembre 2017. Inicialmente se recogieron 74 pacientes con tumor vesical inicial. Se excluyeron aquellos sin estirpe urotelial pura, con carcinoma in situ (Cis) asociado, con tratamientos corticoideos crónicos y perdidos durante el seguimiento. Instilamos dosis completa de BCG (81mg) con pauta de inducción (6 dosis) y mantenimiento (9 dosis) durante un año. Se recogieron variables demográficas (sexo, edad e índice de masa corporal) y analíticas (RNL y RPL) previas al inicio del tratamiento con BCG. Definimos respuesta al tratamiento como ausencia de recidiva y/o progresión. Se realizó análisis estadístico mediante t de student, Chi cuadrado, ANOVA y curvas ROC. RESULTADOS: La cohorte del estudio incluyó finalmente 50 pacientes: 10 mujeres y 40 varones, con una edad media de 70 años. Todos estos pacientes tenían tumor urotelial puro alto grado, 12 de ellos estadio Ta y 38 estadio T1. El seguimiento mínimo fue de 24 meses, presentando recidiva tumoral un 28% de los pacientes. No se encontró relación entre RNL y éxito de la BCG (p=0,738) ni entre RPL y éxito de BCG (p=0,768). Tampoco pudimos establecer un punto de corte mediante curvas ROC. En el análisis multivariante, no encontramos significación estadística entre la recidiva tumoral y los datos analizados (Variables demográficas: Edad, sexo, índice de masa corporal y variables analíticas: RNL/RPL).CONCLUSIÓN: Pese a lo descrito en la literatura, no hemos encontrado asociación entre la RNL ni la RPL con la respuesta al tratamiento con BCG en TVNMI de alto riesgo.

Ratios neutrófilo/linfocito y plaqueta/linfocito: ¿se asocian con la respuesta al tratamiento con bcg en tumores vesicales no músculoinvasivos de alto grado? / Neutrophil/lymphocyte and platelet/lymphocyte ratios: are they associated with response to bcg treatment in high-grade non-muscle-invasive bladder tumors?

Objetivos: Evaluar la asociación de laratio neutrófilo/linfocito (RNL) y ratio plaqueta/linfocito(RPL) con la respuesta al tratamiento mediante instilaciones de Bacilo Calmette Guerin (BCG) intravesical, enpacientes con diagnóstico inicial de tumor vesical nomúsculo-invasivos (TVNMI) de alto riesgo.Material y métodos: Estudio retrospectivo multicéntrico con pacientes diagnosticados de tumor vesicalinicial de alto riesgo y sometidos a instilaciones endovesicales con BCG entre enero 2016 y diciembre2017. Inicialmente se recogieron 74 pacientes contumor vesical inicial. Se excluyeron aquellos sin estirpeurotelial pura, con carcinoma in situ (Cis) asociado, con tratamientos corticoideos crónicos y perdidos durante elseguimiento. Instilamos dosis completa de BCG (81mg)con pauta de inducción (6 dosis) y mantenimiento (9 dosis) durante un año. Se recogieron variables demográficas (sexo, edad e índice de masa corporal) y analíticas(RNL y RPL) previas al inicio del tratamiento con BCG.Definimos respuesta al tratamiento como ausencia derecidiva y/o progresión. Se realizó análisis estadísticomediante t de student, Chi cuadrado, ANOVA y curvasROC.Resultados: La cohorte del estudio incluyó finalmente50 pacientes: 10 mujeres y 40 varones, con una edadmedia de 70 años. Todos estos pacientes tenían tumorurotelial puro alto grado, 12 de ellos estadio Ta y 38estadio T1. El seguimiento mínimo fue de 24 meses,presentando recidiva tumoral un 28% de los pacientes.No se encontró relación entre RNL y éxito de la BCG(p=0,738) ni entre RPL y éxito de BCG (p=0,768). Tampoco pudimos establecer un punto de corte mediantecurvas ROC.En el análisis multivariante, no encontramos significación estadística entre la recidiva tumoral y los datos analizados (Variables demográficas: Edad, sexo, índice demasa corporal y variables analíticas: RNL/RPL).Conclusion: Pese a lo descrito en la literatura, nohemos encontrado asociación entre la RNL ni la RPL con...(AU)

Objetives: To evaluate the associationof neuthophyl/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) with BCG intravesical responses inpatients with initial diagnosis of non/muscle invasivebladder tumor high-risk (NMIBC).Materials and methods: Retrospective multicenterstudy on patients with initial diagnosis of high-gradeNMIBC treated with BCG between January 2016 andDecember 2017. Initially a total of 74 patients werecollected. Those patients with mixt pathology, cis, chronic corticoid usage and lost to follow-up, were excluded.Induction BCG (x6) and BCG maintenance scheduleswere administered (x9) over 1 year. Demographic variables (sex, age, BMI) and blood variables (NLR, PLR)before BCG instillation were collected. Response totreatment was defined as absence of recurrence and/or progression. A statistical analysis with T-student, Chisquare, ANOVA and ROC curves was performed.Results: Final study cohort included a total of 50 patients. 10 females and 40 males. Median age was 70year old. All patients had pure urothelial carcinoma, 12with pTa and 38 with pT1. Median follow-up was 24months. A total of 28% had a recurrence. No correlationbetween NLR or PLR and BCG response was observed(p=0.738; p= 0.768). Neither a cut off was established through ROC curves.At multivariate analysis, there was no significative relationship between recurrence and the clinical and bloodsamples analyzed (sec, age, BMI, NLR, PLR)Conclusion: No correlation between NLR and PLRhas been reported with BCG response on high-gradeNMIBC.(AU)

Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery.

PURPOSE: In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT). METHODS: Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors. RESULTS: The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145-0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061-4.985). CONCLUSION: Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

Clinical Value of Neutrophil/Lymphocyte Ratio in StageⅡand Ⅲ Middle and Low Rectal Cancer / 中国医科大学学报

Objective To explore the clinical value of neutrophil/lymphocyte ratio (NLR) in staging of stage Ⅱ/Ⅲ middle and low rectal cancer. Methods The clinical and pathological data of 111 patients with middle and low rectal cancer who underwent surgical treatment were retrospectively analyzed. The NLR values along with various clinical factors and pathological parameters were also statistically analyzed, and then the relationship between preoperative NLR and various clinical factors was determined. All patients were divided into high and low groups based on NLR, with the cut-off value of 1.99. Then, the clinical, pathological parameters and disease-free survival of the two groups were analyzed. Results The maximum diameter of the tumor and the NLR value were positively correlated (P ＜ 0.05). The patients with high and low NLR had significant differences in age, stage Ⅱ and Ⅲ, N stage, pathological type, maximum diameter of the tumor, and disease-free survival (P ＜ 0.05). Conclusion Preoperative NLR values may be used as predictive values for the pathological parameters of stage Ⅱ and Ⅲ middle and low rectal cancer, and NLR may be an indicator of its prognostic assessment.

Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery

PURPOSE: In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT). METHODS: Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors. RESULTS: The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145–0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061–4.985). CONCLUSION: Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

C-reactive protein is an independent prognostic marker in patients with tongue carcinoma - A retrospective study.

OBJECTIVES: Reliable prognostic markers are lacking for tongue carcinoma. C-reactive protein (CRP) and a ratio from neutrophils/lymphocytes (NLR) are biomarkers, associated with prognosis in solid cancers. Aim of this work was to investigate the role of CRP and NLR in prognosis of patients with tongue carcinoma. DESIGN: Retrospective cohort study. SETTING: We retrospectively analysed data of patients treated for tongue carcinoma at our institution. Levels of CRP, Neutrophils and Lymphocytes were measured pretherapeutic. PARTICIPANTS: 197 patients treated for squamous cell carcinoma of the tongue between 2002 and 2015. MAIN OUTCOME MEASURES: Overall survival, disease-free survival. RESULTS: Elevated CRP was significantly associated with shorter overall survival in our cohort in uni- and multivariate analysis. NLR was not associated with prognosis. CONCLUSION: In the present study we could confirm the role of CRP as an independent prognostic marker in patients with tongue carcinoma. Incorporating this marker in prognostication could represent a valuable and moreover inexpensive tool for improved decisions making concerning therapy in the future.