NEW YORK (Reuters Health) - A high neutrophil-lymphocyte ratio (NLR) predicts a poor response to anticoagulation and other adverse outcomes in lung cancer patients with venous thromboembolism (VTE), researchers from Korea report.
In other studies of lung cancer patients, NLR has been associated with response to treatment and survival, but there have been few studies of the relationship between NLR and cancer-related thrombosis.
Dr. Gyeong-Won Lee from Gyeongsang National University School of Medicine in Jinju, Republic of Korea, and colleagues evaluated the NLR at the time of VTE diagnosis as a prognostic factor for response to anticoagulation, survival, and the clinical characteristics of 114 lung cancer patients treated with anticoagulation for VTE.
Prothrombin time was significantly prolonged in patients with high NLR (3 or higher), and hematocrit and C-reactive protein (CRP) were significantly higher, but other coagulation markers did not differ between patients with high and low NLR.
More patients in the high NLR group had stage IV non-small cell lung cancer (NSCLC), CNS metastasis, and cancer progression at the time of VTE onset compared with patients in the low NLR group, whereas risk factors for VTE did not differ between the groups.
Resolution of VTE was less likely among patients with high NLR (42.4% vs. 76.2% of patients with low NLR) and among patients with NSCLC (55.7% vs. 86.7% of patients with SCLC) or low albumin (45.2% vs. 72.7% of patients with high albumin), according to the January 28 Lung Cancer online report.
High NLR was associated with poor overall survival, but NLR status did not independently affect survival in multivariate analysis. Cancer stage did independently predict overall survival, with stage IV doubling the likelihood of mortality.
"We found that NLR at the time of VTE diagnosis could be a useful biomarker for predicting response and prognosis following anticoagulation in patients with lung cancer and VTE," the researchers conclude, "and it significantly correlated with well evaluated clinical and laboratory markers, including serum albumin, and CRP. However, further large prospective studies are warranted to validate our findings."
Dr. Patrizia Ferroni from IRCCS San Raffaele Pisana in Rome, Italy has also studied NLR. She told Reuters Health in an email, "I am not really surprised, as there is a great deal of data in the recent literature that indicates a complex interplay between cancer, inflammation, and impaired hemostasis. Moreover, we must not forget that cancer-associated inflammation (and thrombosis) is responsible for neoangiogenesis, with all that this implies for tumor progression."
"Although the data shown are of a great interest in the context of a widely debated issue, I think that, at the state of the art, they do not entail any change on clinical decision making by the medical oncologist," Dr. Ferroni said.
"I would like to put emphasis on the need to increase efforts for early identification of at-risk patients in order to establish appropriate thromboprophylaxis to improve the clinical outcome of specific subsets of cancer patients," Dr. Ferroni concluded.
Dr. Lee did not respond to a request for comments.
SOURCE: http://bit.ly/1c26ZiI
Lung Cancer 2014.
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