Baseline neutrophil lymphocyte ratio predicts survival in soft-tissue sarcoma: 17-year cohort study

Griffiths, Arango, Smith, Wade JPRAS 2022. PMID: 34955395.
Baseline neutrophil lymphocyte ratio predicts survival in soft-tissue sarcoma: 17-year cohort study

In this Journal Club

5-Point Summary
401 patients, NLR ≥3 predicts poorer survival, not recurrence, aids risk stratification & treatment planning.

4-Key Findings
Elevated NLR reduces survival, links to tumor size and stage, has no link with recurrence, and histological subtype impacts survival.

3-Critiques
Lack of adjustment for co-morbidities, cohort heterogeneity from recurrent tumuors, unclear link between NLR and recurrence

2-Practical Takeaways
Use NLR for identifying high-risk patients and guide closer monitoring for elevated NLR.

1-Recommended Reading
Szkandera J. et al. (Br J Cancer, 2013) found elevated preoperative NLR predicts poor prognosis in STS, reinforcing its prognostic role.

✍️
Note from the Editor

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5 Point Summary

Baseline NLR predicts overall survival in extremity STS, with higher NLR linked to worse survival. Useful for identifying high-risk patients.



1️⃣ Hypothesis
Baseline neutrophil-lymphocyte ratio predicts overall survival in extremity soft-tissue sarcoma (STS).

2️⃣ Method
17-year retrospective study of 401 adults. Preoperative NLR tests analysed with multivariable Cox regression.

3️⃣ Results
NLR ≥3 linked to poorer overall survival but not disease-free survival or recurrence.

4️⃣ Conclusion
NLR predicts survival in STS, aiding risk stratification & treatment planning

5️⃣ Implication
High NLR identifies patients needing aggressive therapy and monitoring.

4 Key Findings

1️⃣
NLR Predicts Survival
Elevated NLR (≥3) independently predicts reduced survival (HR 1.44; 95% CI 1.01–2.03), even after adjusting for age, tumor size, and grade.
2️⃣
Association with Tumor Burden and Stage
Higher NLR correlates with larger tumors and advanced stages, reflecting systemic inflammation and tumor aggressiveness.
3️⃣
No Link to Recurrence
NLR did not significantly predict recurrence or disease-free survival after adjustment, limiting its utility to mortality prediction.
4️⃣
Histological Subtypes Matter
Patients with lipomatous sarcomas had better survival regardless of NLR, emphasising the role of tumour biology.

3 Critiques

1️⃣
Confounding Variables Not Fully Addressed
Key factors like diabetes and performance status were not adjusted for, potentially influencing both NLR and survival. Future studies should address these to confirm NLR's independent role.
2️⃣
Heterogeneity from Recurrent Tumors
Including primary and recurrent STS cases may have diluted outcome associations. Separate analyses could yield clearer insights.
3️⃣
Unclear Link to Recurrence
While NLR predicts overall survival, its lack of association with recurrence raises questions about its relevance to STS progression, warranting further study.

2 Practical Takeaways

Use NLR for identifying high-risk patients and guide closer monitoring for elevated NLR.

1️⃣
Follow-Up Strategies
High NLR can guide closer post-treatment monitoring to detect disease progression early.
2️⃣
Personalized Treatment
Elevated NLR identifies high-risk STS patients who may benefit from tailored neoadjuvant or adjuvant therapies to improve survival.

Szkandera J. et al. (Br J Cancer, 2013) found elevated preoperative NLR predicts poor prognosis in STS, reinforcing its prognostic role.

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