title: Blood preoperative neutrophil-to-lymphocyte ratio is correlated with TNM stage in patients with papillary thyroid cancer.
abstract: OBJECTIVE
  To predict the American Joint Cancer Committee tumor-node-metastasis stage in patients with papillary thyroid carcinoma by evaluating the relationship between the preoperative neutrophil-to-lymphocyte ratio and the tumor-node-metastasis stage.
  
  
  METHODS
  We retrospectively examined 161 patients with a diagnosis of papillary thyroid carcinoma. The Neutrophil-to-Lymphocyte Ratio was calculated according to the absolute neutrophil counts and absolute lymphocyte counts on routine blood tests obtained prior to surgery and patients with a Neutrophil-to-Lymphocyte Ratio of 2.0 or more were classified as the high NLR group, while those with a Neutrophil-to-Lymphocyte Ratio less than 2.0 were classified as the low Neutrophil-to-Lymphocyte Ratio group. Clinicopathological variables, which were stratified by the Neutrophil-to-Lymphocyte Ratio, were analyzed. A multivariate analysis was performed to determine factors that affect the Neutrophil-to-Lymphocyte Ratio. The association between the Neutrophil-to-Lymphocyte Ratio and the TNM stage in patients ≥45 years of age was analyzed using the Spearman rank correlation.
  
  
  RESULTS
  Various blood indices, including hemoglobin, platelet and thyroid-stimulating hormone levels in the two groups showed no significant differences. Lymph node metastasis, multifocality and tumor size exhibited significant differences in the two groups (p=0.000, p=0.000 and p=0.035, respectively). Correlation analysis indicated that a higher preoperative Neutrophil-to-Lymphocyte Ratio was observed in patients with lymph node metastasis, larger tumor size and multifocality (r=0.341, p=0.000; r=0.271, p=0.000; and r=0.182, p=0.010, respectively). For patients ≥45 years of age, the number of patients with an advanced TNM stage in the high NLR group was higher than that in the low Neutrophil-to-Lymphocyte Ratio group (p=0.013). A linear regression analysis showed that the preoperative Neutrophil-to-Lymphocyte Ratio was positively correlated with the American Joint Cancer Committee tumor-node-metastasis stage (rho=0.403, p=0.000).
  
  
  CONCLUSIONS
  The preoperative Neutrophil-to-Lymphocyte Ratio was closely related to the stage of papillary thyroid carcinoma. The increase in the preoperative Neutrophil-to-Lymphocyte Ratio contributed to the advanced tumor-node-metastasis stage of papillary thyroid carcinoma patients ≥45 years of age.
authors.affiliation: Zhongshan Hospital Affiliated to Fudan University, Department of Hematology, Shanghai, China.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Gong
authors.affiliation: Zhangqiu People's Hospital, Jinan Sixth Municipal Hospital, Department of Pathology, Jinan, China.
authors.forename: Shenjiu
authors.initials: S
authors.lastname: Yang
authors.affiliation: Qian'an Maternal and Child Care Service Center, Department of Anesthesia, Tangshan, China.
authors.forename: Xiumin
authors.initials: X
authors.lastname: Yang
authors.affiliation: Zhangqiu People's Hospital, Jinan Sixth Municipal Hospital, Department of Pathology, Jinan, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002291:Carcinoma, Papillary / Q000097:blood / Q000473:pathology / Q000556:secondary*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor