ESMO 2017: The prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic germ cell tumors
This study utilized a single institution database of 475 patients diagnosed with metastatic GCTs between January 1990 and December 2013 who were treated with chemotherapy. 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 IGCCCG risk classification. Discriminatory accuracy was evaluated by determining the area under the receiver operating characteristic (ROC) curve for survival at 5 years. The optimal cut-off for NLR selection was chosen based on a highest ROC curve.
Among the 475 patients identified, there were 354 (75%) patients of which NLR data were available. Of these patients, 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 a ROC curve of 0.70 (95% CI 0.59-0.75, p < 0.001). On univariable analysis, NLR >2.5 was associated with a hazard ratio (HR) of 3.91 (95%CI 2.01-7.60), which persisted after adjustment for IGCCCG risk group (HR 2.33, 95%CI 1.14-4.76). Among patients with IGCCCG high risk disease, 5-year survival was 87.5% if NLR ≤ 2.5 whereas if NLR > 2.5, 5-year survival was only 51.3%.
The authors concluded that a high NLR is associated with worse 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.
Speaker: Domen Ribnikar, University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada
Co-Authors: P. L. Bedard (Toronto, Canada) R. J. Hamilton (Toronto, Canada) M. A. Jewett (Toronto, Canada) P. Warde (Toronto, Canada) P. Chung (Toronto, Canada) L. Anson Cartwright (Toronto, Canada) A. Templeton (Basel, Switzerland) E. Amir (Toronto, Canada)
A. R. Hansen (Toronto, Canada) J. Lewin (Toronto, Canada)
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md at the European Society for Medical Oncology Annual Congress - September 8 - 12, 2017 - Madrid, Spain