title: The neutrophil to lymphocyte ratio can discriminate anaplastic thyroid cancer against poorly or well differentiated cancer.
abstract: OBJECTIVE
  We evaluated the capability of the neutrophil to lymphocyte ratio (NLR) as a diagnostic tool to discriminate between poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC) from well differentiated thyroid cancer (WDTC).
  
  
  METHODS
  The NLR of 3,870 patients with benign and malignant thyroid tumors were analyzed. There were 436 benign, 3,364 papillary, 15 medullary, 34 follicular or hurthle type, 14 PDTC, and 7 ATC type neoplasms. Patients were divided into two groups: a high NLR group and a low NLR group.
  
  
  RESULTS
  The NLR of all 3,870 patients was a normal distribution, and the median value was 1.57. Advanced stage cancer, such as T3 or T4 was high (30.4% vs. 26.5%, P = 0.027), and cancer-specific deaths were also high (1.2% vs. 0.4%, P = 0.018) in the high NLR group. The proportion of PDTC (0.6% vs. 0.1%) and ATC (0.3% vs. 0.1%) was higher in the high NLR group. The NLR can discriminate between PTC, PDTC, and ATC (P = 0.035, P = 0.002, and P = 0.025, respectively), and the cutoff value was 3.8 between PDTC versus ATC. None of the NLR of PDTC exceeded the cutoff value of 3.8.
  
  
  CONCLUSIONS
  NLR can play a relevant role as a discriminating tool and may be considered as a new diagnostic criterion in discriminating as well as in selecting therapeutic approaches to these aggressive forms of thyroid cancer.
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Jin-Seong
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Min-Ho
authors.initials: MH
authors.lastname: Park
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Young-Jae
authors.initials: YJ
authors.lastname: Ryu
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Jung-Han
authors.initials: JH
authors.lastname: Yoon
keywords: Inflammation; Lymphocytes; Neutrophils; Thyroid neoplasms
references.citation: Thyroid. 2007 May;17(5):389-93
references.pmid: 17542668
references.citation: Cancer. 2004 Mar 1;100(5):950-7
references.pmid: 14983490
references.citation: Oncogene. 1999 Jan 14;18(2):477-85
references.pmid: 9927204
references.citation: J Surg Oncol. 2013 Apr;107(5):493-7
references.pmid: 22996403
references.citation: Cancer Res. 2005 Oct 1;65(19):8896-904
references.pmid: 16204061
references.citation: Breast. 2007 Dec;16 Suppl 2:S27-33
references.pmid: 17764938
references.citation: Endocr Pathol. 2004 Winter;15(4):293-6
references.pmid: 15681852
references.citation: Endocr Pathol. 2011 Dec;22(4):190-4
references.pmid: 21969055
references.citation: Ann Oncol. 2000 Sep;11(9):1083-9
references.pmid: 11061600
references.citation: Endocr Pathol. 1997 Spring;8(1):21-28
references.pmid: 12114668
references.citation: J Am Coll Surg. 2007 May;204(5):764-73; discussion 773-5
references.pmid: 17481480
references.citation: Nature. 2002 Dec 19-26;420(6917):860-7
references.pmid: 12490959
references.citation: Acta Oncol. 1995;34(1):69-73
references.pmid: 7532422
references.citation: J Surg Oncol. 2005 Sep 1;91(3):181-4
references.pmid: 16118772
references.citation: Curr Oncol Rep. 2007 Mar;9(2):152-8
references.pmid: 17288883
references.citation: Am J Surg Pathol. 2007 Aug;31(8):1256-64
references.pmid: 17667551
references.citation: Int J Surg Pathol. 2002 Apr;10(2):123-31
references.pmid: 12075405
references.citation: Cancer. 1983 Nov 15;52(10):1849-55
references.pmid: 6313176
references.citation: Lancet. 2001 Feb 17;357(9255):539-45
references.pmid: 11229684
references.citation: J Clin Oncol. 2009 Jul 20;27(21):3437-44
references.pmid: 19470939
references.citation: Cancer Res. 2000 Jan 1;60(1):184-90
references.pmid: 10646872
references.citation: Surgery. 2009 Dec;146(6):1099-104
references.pmid: 19958937
references.citation: JAMA. 1982 Feb 19;247(7):1004-6
references.pmid: 7035703
references.citation: FASEB J. 1997 May;11(6):457-65
references.pmid: 9194526
references.citation: Proc Nutr Soc. 2008 Aug;67(3):257-62
references.pmid: 18452641
references.citation: Am J Surg Pathol. 1984 Sep;8(9):655-68
references.pmid: 6476195
references.citation: Br J Cancer. 2003 Sep 15;89(6):1028-30
references.pmid: 12966420