title: Neutrophil-lymphocyte and platelet-lymphocyte ratio as predictors of disease specific survival after resection of adrenocortical carcinoma.
abstract: BACKGROUND
  The systemic inflammatory response may be associated with tumor progression. We sought to analyze the impact of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) on recurrence-free survival (RFS) and disease-specific survival (DSS) among patients who underwent surgery for adrenocortical carcinoma (ACC).
  
  
  METHODS
  Patients undergoing surgery for ACC were identified from a multi-center database. Cut-off values of 5 and 190 were defined as elevated NLR and PLR, respectively, and long-term outcome was assessed.
  
  
  RESULTS
  Among 84 patients with ACC, 29 (34.%) had NLR > 5 while 32 (40.5%) had PLR > 190. NLR and PLR were associated with larger tumors (NLR > 5: ≤ 5 cm, 0% vs. >5 cm, 39.7%; PLR > 190: ≤ 5cm, 0% vs. >5 cm, 45.7%), as well as need to resect of other organs (NLR > 5: other organ resected 48.8% vs. not resected 20.9%; PLR > 190: other organ resected 25.0% vs. not resected 56.4%)(all P < 0.05). Five-year RFS was associated with an elevated NLR (NLR ≤ 5, 14.2% vs. NLR> 5, 10.5%) and PLR (PLR ≤ 190: 19.4% vs. PLR > 190: 5.2%) (both P < 0.05). On multivariate survival analyses, PLR remained a predictor of RFS (HR 1.72), while NLR was associated with both DSS (HR 2.21) and RFS (HR 1.99) (both P < 0.05).
  
  
  CONCLUSIONS
  Immune markers such as NLR and PLR may be useful to stratify patients with regards to prognosis following surgery for ACC.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bagante
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: Thuy B
authors.initials: TB
authors.lastname: Tran
authors.affiliation: Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Postlewait
authors.affiliation: Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Wang
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Hatzaras
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Rivfka
authors.initials: R
authors.lastname: Shenoy
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: John E
authors.initials: JE
authors.lastname: Phay
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Kara
authors.initials: K
authors.lastname: Keplinger
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Linda X
authors.initials: LX
authors.lastname: Jin
authors.affiliation: Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.affiliation: Department of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Salem
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, California.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Sicklick
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, California.
authors.forename: Shady
authors.initials: S
authors.lastname: Gad
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Yopp
authors.affiliation: Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: John C
authors.initials: JC
authors.lastname: Mansour
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Natalie
authors.initials: N
authors.lastname: Seiser
authors.affiliation: Department of Surgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Solorzano
authors.affiliation: Department of Surgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Kiernan
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Votanopoulos
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, California.
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000097:blood / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D001792:Blood Platelets; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis
keywords: adrenocortical carcinoma; neutrophil-lymphocyte ratio; platelet-lymphocyte ratio; prognosis