The Correlation of Preoperative Neutrophil-to-Lymphocyte Ratio with Neck Ultrasonography and Pathological Findings in Patients with Differentiated Thyroid Cancer
Abstract
Aim: Neutrophil-lymphocyte ratio (NLR) is a strong biomarker of oxidative stress and systemic inflammation. The aim of this study is to compare NLR with lymph node features detected in USG and pathology results of patients operated with diagnosis of differentiated thyroid cancer. Methods: Demographic characteristics, preoperative neck USG and pathology results of patients who were operated with the diagnosis of differentiated thyroid cancer between 2012-2020 in the General Surgery Clinic of Hatay State Hospital were recorded. NLR was calculated by dividing the neutrophil count by the lymphocyte count in preoperative routine blood tests. The cut-off value for the NLO was calculated with Receiver Operating Curve (ROC) analysis and compared with other parameters.
Results: 105 patients were included in our study. 71.4% are women. The average age is 47.9 ± 14.1. No lymph node was found in 63.8% of the preoperatively performed neck USG. Postoperative 94.3% were diagnosed with papillary carcinoma. Tumor diameter was 2-4 cm (T2) in 30.5%. No metastatic lymph node was found in 74.3% (N0). There was no capsule invasion in 63.8%. Surgical margins were free in 90.5%. 38.6% were multifocal and 23.8% were bilaterally located. The cut-off for NLR was calculated as 2.16. NLR was significantly higher in thyroid carcinomas with male gender (p=0,027), suspected lymph node metastasis on USG (p=0,001) and lymph node metastasis detected in pathology (p<0,001). There was no significant difference in other parameters. Conclusions: We recommend that the use of NLR as a prognostic indicator should be kept in mind in patients with thyroid cancer, due to the increase in neck lymph node metastasis development at high NLR values
References
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- 8. Pacini F., Schlumberger M., Dralle H., et al. "European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium." Europeanjournal of endocrinology 154.6 (2006): 787-803.
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- 10. Vassilatou E., Fisfis M., Morphopoulos G., et al. "Papillary thyroid carcinoma producing granulocyte-macrophage colony-stimulating factor is associated with neutrophilia and eosinophilia." Hormones-Athens- 5.4 (2006): 303.
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- 15. Liu J., Du J., Fan J., et al. "The neutrophil-to-lymphocyte ratio correlates with age in patients with papillary thyroid carcinoma." Orl 77.2 (2015): 109-116.
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- 18. Ceylan Y., Kumanlıoğlu K., Oral A., et al. "The correlation of clinico pathological findings and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in papillary thyroid carcinoma." Molecular Imaging and Radionuclide Therapy 28.1 (2019): 15.
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- 20. Haugen B.R., Alexander E.K., Bible K.C., et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26 (1):1-133. doi:10.1089/thy.2015.0020
- 21. Özçelik S., Çelik M., Özçelik M. "Evaluation of preoperative neutrophil-lymphocyte ratio in differentiated thyroid carcinoma with lymph node metastasis." Journal of Surgery and Medicine 3.5 (2019): 377-380.
- 22. Zeren S., Özbay İ., Bayhan Z., et al. "The neutrophil-to-lymphocyte ratio as a diagnostic marker for malignant thyroid diseases." Turkish Journal of Biochemistry 42.5 (2017): 559-563.
- 23. Kocer D., Karakukuçu C., Karaman H., et al. "May the neutrophil / lymphocyte ratio be a predictor in the differentiation of different thyroid disorders." AsianPac J CancerPrev 16.9 (2015): 3875-3879.
- 24. Gong W., Yang S., Yang X., et al. "Blood preoperative neutrophil-to-lymphocyte ratio is correlated with TNM stage in patients with papillary thyroid cancer." Clinics 71.6 (2016): 311-314.
- 25. Kim Y.J., Park T., Jeong S.H., et al. "Prognostic importance of baseline neutrophil to lymphocyte ratio in patients with advanced papillary thyroid carcinomas." Endocrine 46.3 (2014): 526-531.
- 26. Azab B., Bhatt V.R., Phookan J., et al. "Usefulness of the neutrophil-to-lymphocyte ratio in predicting short-and long-term mortality in breast cancer patients." Annals of surgical oncology 19.1 (2012): 217-224.
Diferansiye Tiroid Kanserli Hastalarda Preoperatif Nötrofil / Lenfosit Oranının Boyun Ultrasonografisi ve Patolojik Bulgularla İlişkisi
Abstract
Amaç: Nötrofil lenfosit oranı (NLO) da oksidatif stresin ve sistemik enflamasyonun güçlü bir belirtecidir. Bu çalışma ile; diferansiye tiroid kanseri tanısı ile opere olan hastaların patolojik bulgularının ve ultrasonda (USG) saptanan lenf nodu özelliklerinin preoperatif dönemde bakılan NLO ile karşılaştırılması amaçlanmıştır. Materyal–Metot: 2012-2020 yılları arasında Hatay Devlet Hastanesi Genel Cerrahi Kliniği’nde diferansiye tiroid kanseri tanısı ile opere olan hastaların demogrofik özellikleri, preoperatif boyun USG’si ve patoloji sonuçları kayıt edildi. NLO; preoperatif rutin kan testlerindeki nötrofil sayısının lenfosit sayısına bölünmesiyle hesaplandı. Receiver Operating Curve (ROC) analizi ile NLO için cut-off değeri hesaplanarak diğer parametreler ile karşılaştırıldı. Bulgular: Çalışmamıza 105 hasta dahil edilmiştir. %71,4’ü kadındır. Yaş ortalaması 47,9 ± 14,1’dur. %63,8’ inin preoperatif yapılan boyun USG’ de lenf nodu tespit edilmedi. Ameliyat sonrası %94,3’ ü papiller karsinom tanısı aldı. %30,5’inde tümör çapı 2-4 cm (T2)’ di. %74,3’ünde metastatik lenf nodu saptanmadı (N0). %63,8’ inde kapsül invazyonu yoktu. %90,5’ inde cerrahi sınırlar negatifdi. %38,6’ sı multifokal ve %23,8’ i ise bilateral yerleşimliydi. NLO için cut-off 2,16 olarak hesaplandı. Tiroid kanserlerinde NLO; erkek cinsiyette (p=0,027), USG’de lenf nodu metastazı şüphesi olanlarda (p=0,001) ve patolojide lenf nodu metastazı saptananlarda (p<0,001) anlamlı olarak daha yüksekti. Diğer parametrelerde anlamlı fark izlenmedi. Sonuç: Tiroid kanserli hastalarda yüksek NLO değerlerinde boyun lenf nodu metastazı gelişiminin artması nedeni ile NLO’ nun prognostik gösterge olarak kullanımının akılda tutulmasını öneriyoruz.
Keywords
References
- 1. Cancer Fact Sheet. Cervical Cancer Incidence and Mortality World wide in 2020. Erisim adresi https://gco.iarc.fr/factsehhets/canscers32/thyroid (access date: 24.12.2020)
- 2. Mantovani A., Allavena P., Sica A. et al. "Cancer-related inflammation." nature 454.7203 (2008): 436-444.
- 3. Moore, M. M., Chua, W., Charles, K. A., et al. ‘‘Inflammation and cancer: causes and consequences. Clinical Pharmacology & Therapeutics’’, 87(4), (2010): 504-508.
- 4. Proctor, M. J., Mc Millan D.C., Morrison D.C., et al. "A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer." British journal of cancer 107.4 (2012): 695-699.
- 5. Larson S.D., Jackson L.N., Riall T.S., et al. "Increased incidence of well-differentiated thyroid cancer associated with Hashimoto thyroiditis and the role of the PI3k / Akt pathway." Journal of the American College of Surgeons 204.5 (2007): 764-773.
- 6. Trigo J.M., Capdevilla J., Grande E., et al. "Thyroid cancer: SEOM clinical guidelines." Clinical and Translational Oncology 16.12 (2014): 1035-1042.
- 7. Perwez H., S., and Harris C.C. "Inflammation and cancer: an ancient link with novel potentials." International journal of cancer 121.11 (2007): 2373-2380.
- 8. Pacini F., Schlumberger M., Dralle H., et al. "European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium." Europeanjournal of endocrinology 154.6 (2006): 787-803.
- 9. Dailey M.E., Lindsay S., Skahen R. "Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland." AMA archives of surgery 70.2 (1955): 291-297.
- 10. Vassilatou E., Fisfis M., Morphopoulos G., et al. "Papillary thyroid carcinoma producing granulocyte-macrophage colony-stimulating factor is associated with neutrophilia and eosinophilia." Hormones-Athens- 5.4 (2006): 303.
- 11. Ray-Coquard L., Cropet C., Van Glabbeke M., et al. "Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas." Cancer research 69.13 (2009): 5383-5391.
- 12. Liu C.L., Lee J.J., Chang Y.C., et al. "Blood neutrophil‐to‐lymphocyte ratio correlates with tumor size in patients with differentiated thyroid cancer." Journal of surgical oncology 107.5 (2013): 493-497.
- 13. Manatakis D.K., Tseleni Balafouta S., Balalis D., et al. "Association of baseline neutrophil-to-lymphocyte ratio with clinico pathological characteristics of papillary thyroid carcinoma." International journal of endocrinology 2017 (2017).
- 14. Templeton A. J., McNamara M.G., Seruga B., et al. "Prognostic role of neutrophil-to-lymphocyte ratio in solidtumors: a systematic review and meta-analysis." JNCI: Journal of the National CancerInstitute 106.6 (2014).
- 15. Liu J., Du J., Fan J., et al. "The neutrophil-to-lymphocyte ratio correlates with age in patients with papillary thyroid carcinoma." Orl 77.2 (2015): 109-116.
- 16.Kim, S.M., Kim E.H., Kim B.H.,, et al. "Association of the preoperative neutrophil-to-lymphocyte count ratio and platelet-to-lymphocyte count ratio with clinico pathological characteristics in patients with papillary thyroid cancer." Endocrinology and metabolism 30.4 (2015): 494-501.
- 17. Cho J.S., Park M.H., Ryu Y.J., et al. "The neutrophil to lymphocyte ratio can discriminate anaplastic thyroid cancer against poorly or well differentiated cancer." Annals of surgical treatment and research 88.4 (2015): 187-192.
- 18. Ceylan Y., Kumanlıoğlu K., Oral A., et al. "The correlation of clinico pathological findings and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in papillary thyroid carcinoma." Molecular Imaging and Radionuclide Therapy 28.1 (2019): 15.
- 19. Stulak J.M., Grant C.S., Farley D.Y., et al. "Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer." Archives of Surgery 141.5 (2006): 489-496.
- 20. Haugen B.R., Alexander E.K., Bible K.C., et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26 (1):1-133. doi:10.1089/thy.2015.0020
- 21. Özçelik S., Çelik M., Özçelik M. "Evaluation of preoperative neutrophil-lymphocyte ratio in differentiated thyroid carcinoma with lymph node metastasis." Journal of Surgery and Medicine 3.5 (2019): 377-380.
- 22. Zeren S., Özbay İ., Bayhan Z., et al. "The neutrophil-to-lymphocyte ratio as a diagnostic marker for malignant thyroid diseases." Turkish Journal of Biochemistry 42.5 (2017): 559-563.
- 23. Kocer D., Karakukuçu C., Karaman H., et al. "May the neutrophil / lymphocyte ratio be a predictor in the differentiation of different thyroid disorders." AsianPac J CancerPrev 16.9 (2015): 3875-3879.
- 24. Gong W., Yang S., Yang X., et al. "Blood preoperative neutrophil-to-lymphocyte ratio is correlated with TNM stage in patients with papillary thyroid cancer." Clinics 71.6 (2016): 311-314.
- 25. Kim Y.J., Park T., Jeong S.H., et al. "Prognostic importance of baseline neutrophil to lymphocyte ratio in patients with advanced papillary thyroid carcinomas." Endocrine 46.3 (2014): 526-531.
- 26. Azab B., Bhatt V.R., Phookan J., et al. "Usefulness of the neutrophil-to-lymphocyte ratio in predicting short-and long-term mortality in breast cancer patients." Annals of surgical oncology 19.1 (2012): 217-224.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original research article |
| Authors | |
| Publication Date | August 31, 2021 |
| Submission Date | January 5, 2021 |
| Published in Issue | Year 2021 Volume: 54 Issue: 2 |
