More on the platelets-to-lymphocyte ratio (PLR).

[pjoshea13]

Following up on my post of yesterday:

"Neutrophil, Platelets, and Eosinophil to Lymphocyte Ratios Predict Gleason Score Upgrading in Low-Risk Prostate Cancer Patients."

here is another Italian study from 2016 [1] - but from a different team (un laboratorio diverso).

"Systemic Immune-Inflammation Index Predicts the Clinical Outcome in Patients with mCRPC Treated with Abiraterone"

In my series of posts on inflammation 2 years ago, there is nothing on the platelets-to-lymphocyte ratio (PLR). Perhaps it's considered more important in Italy, but I don't recall seeing references to the PLR before yesterday.

Anyway, for those who are tracking their PLR:

"A total of 230 mCRPC patients treated abiraterone were included. SII {systemic immune-inflammation index} ≥ 535, NLR {neutrophil-to-lymphocyte ratio} ≥ 3 and PLR {platelets-to-lymphocyte ratio} ≥ 210 were considered as elevated levels (high risk groups)."

"A systemic immune-inflammation index (SII) based on neutrophil (N), lymphocyte (L), and platelet (P) counts has shown a prognostic impact in several solid tumors."

"Discussion

"Our results confirmed the activity of abiraterone in post-docetaxel setting in routinely clinical practice with a PSA response rate of 44.5% and a median OS of 17.3 months comparable to results of the pivotal phase III clinical trial (de Bono et al., 2011). The prognostic significance of NLR, PLR, and percentage of lymphocytes evaluate before systemic treatment was shown in several tumors (De Giorgi et al., 2012; Templeton et al., 2014; Cannon et al., 2015; Rossi et al., 2015), while SII to date has been evaluated before antiangiogenic agents only in CRC and RCC (Lolli et al., 2016; Passardi et al., 2016). Herein, we reported for the first time SII to be an independent predictor of OS for patients with mCRPC treated with abiraterone, a recently approved hormonal therapy in mCRPC. Its ability to predict OS was higher than conventional parameters such as Gleason score (Table ​Table22). We also confirmed previous data on the OS prediction ability of NLR in these patients (Leibowitz-Amit et al., 2014), whereas PLR showed a borderline significance in the multivariate analysis (HR = 1.41, p = 0.068). Our results suggest a possible prominent prognostic role for neutrophil levels, included in SII and NLR, but not in PLR."

Inflammation due to chronic NF-kB activation in cancer cells can be curbed by inhibiting NF-kB. Common otc polyphenols have been found to inhibit NF-kB in the lab. It is an easy experiment on one's self to take a generous mix of polyphenols for a month, say, & retest.

-Patrick

[1] ncbi.nlm.nih.gov/pmc/articl...

[kmack57]

Patrick, I am looking at the results of my bloodwork:

Value Range

Neutrophil %88.7 % 40.0 - 70.0 %

Lymphocytes %6.4 % 24.0 - 44.0 %

ANC-Neutrophil Absolute7.75 K/cu mm 1.50 - 7.80 K/cu mm

Lymphcytes Absolute0.56 K/cu mm 1.10 - 4.80 K/cu mm

How do I interpret this information?

Thanks

Kevin

[pjoshea13 in reply to kmack57]

Kevin,

At 7.75, your Neutrophils [N] are at the high end of normal.

At 0.56, your Lymphcytes [L] are below normal.

So, unfortunately, the NLR (N divided by L) is going to be high ... 13.8.

You should recheck your numbers & my math. You really want that number to be less than 3.

Do you have a test result for Albumin? 4.5 is a decent number - you don't want to be below 4.0.

-Patrick

[curt504a in reply to pjoshea13]

Patrick, there was posted here (or I heard at a conference) Albumin vs (???) ratio is hugely predictive (mainly bad). You mentioned absolute Albumin, what is the other metric that one divides into albumin? Tnx

[pjoshea13 in reply to curt504a]

Curt,

You may be thinking of globulin.

Here is a paper from last month:

ncbi.nlm.nih.gov/pubmed/304...

Cancer Manag Res. 2018 Oct 17;10:4695-4708. doi: 10.2147/CMAR.S178271. eCollection 2018.

Preoperative albumin-to-globulin ratio as a significant prognostic indicator in urologic cancers: a meta-analysis.

Zhang Y1, Wang L2, Lin S3, Wang R1.

Author information

Abstract

BACKGROUND:

Emerging studies reported that preoperative albumin-to-globulin ratio (AGR) correlated with tumor progression and prognosis in several types of cancer. The aim of this study was to systematically explore the association between preoperative AGR and clinical outcomes in cancers of the urinary system.

METHODS:

Relevant articles were searched in PubMed, Embase and Web of Science by two independent investigators from inception to June 1, 2018. Eligible studies were selected based on predetermined selection criteria. Summarized HRs or ORs and 95% CIs were calculated for prognosis and clinicopathologic features with the fixed-effects or random-effects models.

RESULTS:

Eight cohort studies comprising 2,668 patients were included for analysis. The pooled results showed that a low AGR significantly correlated with poor OS (HR: 0.38, 95% CI: 0.27-0.48, P<0.001), worse cancer-specific survival (CSS) (HR: 0.36, 95% CI: 0.22-0.50, P<0.001) and inferior event-free survival (EFS) (HR: 0.36, 95% CI: 0.25-0.48, P<0.001) in urologic cancers. In addition, patients in low and high AGR groups showed significant differences in lymphovascular invasion (P<0.001), pT status (P<0.001) and pN status (P<0.001).

CONCLUSION:

Preoperative AGR might be a valuable, cheap and reproducible prognostic bio-marker in urologic cancers following surgical resection.

KEYWORDS:

albumin-to-globulin ratio; clinical features; prognosis; urologic cancer

PMID: 30410403 PMCID: PMC6199965 DOI: 10.2147/CMAR.S178271

***

& one from July:

ncbi.nlm.nih.gov/pubmed/300...

Asian J Androl. 2018 Jul 17. doi: 10.4103/aja.aja_50_18. [Epub ahead of print]

Pretreatment serum albumin/globulin ratio as a prognostic biomarker in metastatic prostate cancer patients treated with maximal androgen blockade.

Wang N1,2, Liu JY1,2, Li X2,3,4, Deng MH1,2, Long Z1,2, Tang J1,2, Yao K1,2, Zhang YC1,2, He LY1,2.

Author information

Abstract

The pretreatment serum albumin/globulin ratio (AGR) has been used as a prognostic biomarker for various cancer types. However, the prognostic value of the AGR for prostate cancer, especially for metastatic prostate cancer (mPCa) after maximal androgen blockade (MAB), remains unclear. The aim of this study was to evaluate the prognostic value of the pretreatment serum AGR for mPCa treated with MAB. This retrospective study included 214 mPCa patients receiving MAB from October 2007 to March 2017. The correlation of the AGR with survival was estimated using Kaplan-Meier analysis and Cox proportional hazards models. The cutoff value of the AGR was 1.45 according to the receiver operating characteristic curve. Kaplan-Meier analysis demonstrated that patients with a low AGR (<1.45) had poor outcomes in terms of progression-free survival (PFS) and cancer-specific survival (CSS). Multivariate Cox analyses showed that the AGR was an independent predictor of PFS (hazard ratio [HR] = 0.642; 95% confidence interval [CI]: 0.430-0.957; P = 0.030) and CSS (HR = 0.412; 95% CI: 0.259-0.654; P < 0.001). Furthermore, in a subset of 79 patients with normal serum albumin levels (≥40.0 g l-1), the serum AGR remained an independent predictor of CSS (P = 0.009). The pretreatment AGR was an independent prognostic biomarker for PFS and CSS in patients with mPCa receiving MAB. In addition, the AGR remained effective for the prediction of CSS in patients with normal albumin levels (≥40 g l-1). However, further prospective studies are needed to confirm our conclusions.

KEYWORDS:

albumin/globulin ratio; maximal androgen blockade; metastatic prostate cancer; prognosis; survival

PMID: 30027930 DOI: 10.4103/aja.aja_50_18

***

-Patrick

[kmack57 in reply to pjoshea13]

Albumin was 4.6