An Increased Neutrophil-to-Lymphocyte Ratio Predicts Incomplete Response to Therapy in Differentiated Thyroid Cancer

Fang Lee, Po-Sheng Yang, Ming-Nan Chien, Jie-Jen Lee, Ching-Hsiang Leung, Shih-Ping Cheng, Fang Lee, Po-Sheng Yang, Ming-Nan Chien, Jie-Jen Lee, Ching-Hsiang Leung, Shih-Ping Cheng

Abstract

Background: Previously we have shown that an elevated baseline neutrophil-to-lymphocyte ratio (NLR) was associated with a high risk of recurrence in patients with differentiated thyroid cancer. The clinical significance of the longitudinal changes in NLR following treatment remained unestablished. Methods: Adults patients with differentiated thyroid cancer were included in the study if the follow-up NLR data at 6 to 18 months after initial treatment were available. The response to treatment was categorized as excellent, indeterminate, biochemical incomplete, and structural incomplete as per guidelines of the American Thyroid Association. Results: Among 151 patients with thyroid cancer, a significant decrease in NLR following treatment was observed in those with stage I disease, those with low risk of recurrence, and those with an excellent response to therapy. Patients with a structural incomplete response had a significant increase in NLR at follow-up (p = 0.012). On multivariate analysis, incomplete response to therapy was associated with male sex (odds ratio [OR] = 3.35), tumor size (OR = 1.63), lymph node metastasis (OR = 4.80), distant metastasis (OR = 12.95), and increased NLR (OR = 13.68). Conclusions: An increase in systemic inflammation following treatment as measured by NLR is independently associated with an incomplete response to therapy in differentiated thyroid cancer.

Keywords: Differentiated thyroid cancer; Dynamic risk stratification; Inflammation; Neutrophil-to-lymphocyte ratio.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Scatter plots of preoperative (left dot groups) and post-treatment (right dot groups) values of the neutrophil-to-lymphocyte ratio (NLR) in patients with benign thyroid lesions (n = 87) and differentiated thyroid cancer categorized by the response to therapy (excellent, n = 92; indeterminate, n = 25; biochemical incomplete, n = 22; structural incomplete, n = 12). *, Wilcoxon signed rank test p < 0.05; ***, p < 0.001.
Figure 2
Figure 2
Scatter plots of the difference in the post-treatment and preoperative neutrophil-to-lymphocyte ratio (ΔNLR) in patients with differentiated thyroid cancer categorized by the risk of recurrence (upper panel) or response to therapy (lower panel). *, p for trend < 0.05; ***, p < 0.001.
Figure 3
Figure 3
Percentages of the relative changes in the neutrophil-to-lymphocyte ratio (NLR) after treatment of differentiated thyroid cancer, categorized by the risk of recurrence (upper panel) or response to therapy (lower panel).

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