Neutrophil-to-Lymphocyte Ratio: A Systemic Inflammatory Index for Primary Diagnosis and Prognosis of Cholangiocarcinoma
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 13, Issue 2
Abstract
Cholangiocarcinoma (CCA) is a major cause of cancer death in the northeastern Thailand. A primary diagnosis for CCA is essential to reduce the mortality of CCA patients. In this study, the Neutrophil-to-Lymphocyte ratio (NLR) was demonstrated for the first time to be a potential primary diagnostic index for CCA. NLR was determined in parallel with serum CA19-9, in histologically proven CCA patients (n=103) and non-CCA subjects (n = 217). CCA patients exhibited significantly higher NLRs (mean ± SD, 4.88 ± 3.95) than the non-CCA subjects (2.34 ± 1.63) (P <0.001). NLR had diagnostic power for CCA with an area under curve (AUC) of 0.773, comparable with that of CA19-9. A cut-off NLR at 2.3 provided diagnostic values for CCA with 70.9% sensitivity, 69.1% specificity, and 69.7% accuracy. Furthermore, a high NLR (> 2.3) was associated with larger tumor sizes, shorter survival of CCA patients (P = 0.001) and was suggested to be an independent poor prognostic indicator for CCA. In conclusion, besides being an indicator of poor prognosis, NLR is as good as serum CA19-9 in discriminating CCA from non-CCA conditions. This suggested the potential of using NLR as a primary diagnostic indicator of CCA, especially in the peripheral clinics where advanced biomarkers cannot be offered. A complete blood count (CBC) is one of the most common and basic laboratory tests for medical investigation in every hospital. Although the CBC is a simple blood analysis, it provides a lot of meaningful information of possible clinical conditions of the patients. The neutrophil-to-lymphocyte ratio (NLR), calculated from the ratio of absolute numbers of peripheral blood neutrophils and lymphocytes, is a useful index reflecting systemic inflammation in several pathological conditions [1,2]. NLR is recently reported to be a potential prognostic marker predicting the shorter survival of patients in many types of cancer, including cholangiocarcinoma (CCA) [3-5]. CCA is a tumor of bile duct epithelium where the highest incidence has been recorded in northeastern Thailand [6,7]. One of the major problems of CCA is lacking a sensitive and specific diagnostic aide at an early stage. Tumor markers used in the clinical practice, such as carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9, are less sensitive and able to detect CCA only when tumor is in the advanced stage. High quality imaging techniques.
Authors and Affiliations
Chalongchai Chalermwat, Atit Silsirivanit, Waraporn Saentaweesuk, Vajarapong Bhudisawasdi, Chawalit Pairojkul, Samrit Khahmahpahte, Tayata Thanong, Yotsombat Changtrakul, Katsarin Pintaraks, Chaisiri Wongkham, Sopit Wongkham
Keywords
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- EP ID EP585838
- DOI 10.26717/BJSTR.2019.13.002375
- Views 156
- Downloads 0
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