Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance.
Predicting survival of patients with malignant pleural effusions (MPEs) is notoriously difficult. A robust prognostic marker can guide clinical decision making. The neutrophil-to-lymphocyte ratio (NLR) in blood has been shown to predict survival in many cancers. Pleural fluid bathes the malignant pl...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2021-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0250628 |
| _version_ | 1818899714604531712 |
|---|---|
| author | Natalia Popowicz Hui Min Cheah Cynthia Gregory Alina Miranda Ian M Dick Y C Gary Lee Jenette Creaney |
| author_facet | Natalia Popowicz Hui Min Cheah Cynthia Gregory Alina Miranda Ian M Dick Y C Gary Lee Jenette Creaney |
| author_sort | Natalia Popowicz |
| collection | DOAJ |
| description | Predicting survival of patients with malignant pleural effusions (MPEs) is notoriously difficult. A robust prognostic marker can guide clinical decision making. The neutrophil-to-lymphocyte ratio (NLR) in blood has been shown to predict survival in many cancers. Pleural fluid bathes the malignant pleural tissues, thus the NLR of the pleural fluid may reflect more closely the local tumour environment. The objective of this study was to explore the prognostic significance of pleural effusion NLR for MPE. We analysed matched effusion and blood from 117 patients with malignant and 24 with benign pleural effusions. Those who had received recent chemotherapy or had a pleurodesis were excluded. Neutrophil and lymphocyte counts in effusions were performed by manual review of cytospin cell preparations by trained observers. Clinical data were extracted from a state-wide hospital database. We found significantly fewer neutrophils (expressed as percentage of total leukocyte count) in pleural fluid than in corresponding blood (9% vs 73%; p<0.001). The NLR was an order of magnitude lower in pleural fluid than in corresponding blood: median [IQR] = 0.20 [0.04-1.18] vs 4.9 [3.0-8.3], p<0.001. Correlation between blood and pleural fluid NLR in MPE patients was moderate (rs = 0.321, p<0.001). In univariate analysis, NLR (>0.745)) in malignant pleural fluid was predictive of poorer survival (HR = 1.698 [1.0054-2.736]; p = 0.030), and remained significant after adjustment for age, sex, presence of a chest drain, cancer type, concurrent infection and subsequent treatment with chemotherapy (HR = 1.786 [1.089-2.928]; p = 0.022). Patients with pleural fluid NLR > 0.745 had a significantly shorter median survival of 130 (95% CI 0-282) days compared to 312 (95% CI 195-428) days for pleural NLR < 0.745, p = 0.026. The NLR in blood was also predictive of poorer survival in MPE patients (HR = 1.959 [1.019-3.096]; p<0.001). The proportion of neutrophils in pleural fluid was predictive of prognosis more strongly than lymphocytes. This study provides evidence that NLR in malignant effusions can predict survival, and therefore may provide prognostic information for this cohort. This prognostic association in the fluid is driven by the presence of neutrophils. |
| first_indexed | 2024-12-19T19:52:21Z |
| format | Article |
| id | doaj.art-586dc014c22f4beb84773390e1133975 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-19T19:52:21Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-586dc014c22f4beb84773390e11339752022-12-21T20:07:56ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01164e025062810.1371/journal.pone.0250628Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance.Natalia PopowiczHui Min CheahCynthia GregoryAlina MirandaIan M DickY C Gary LeeJenette CreaneyPredicting survival of patients with malignant pleural effusions (MPEs) is notoriously difficult. A robust prognostic marker can guide clinical decision making. The neutrophil-to-lymphocyte ratio (NLR) in blood has been shown to predict survival in many cancers. Pleural fluid bathes the malignant pleural tissues, thus the NLR of the pleural fluid may reflect more closely the local tumour environment. The objective of this study was to explore the prognostic significance of pleural effusion NLR for MPE. We analysed matched effusion and blood from 117 patients with malignant and 24 with benign pleural effusions. Those who had received recent chemotherapy or had a pleurodesis were excluded. Neutrophil and lymphocyte counts in effusions were performed by manual review of cytospin cell preparations by trained observers. Clinical data were extracted from a state-wide hospital database. We found significantly fewer neutrophils (expressed as percentage of total leukocyte count) in pleural fluid than in corresponding blood (9% vs 73%; p<0.001). The NLR was an order of magnitude lower in pleural fluid than in corresponding blood: median [IQR] = 0.20 [0.04-1.18] vs 4.9 [3.0-8.3], p<0.001. Correlation between blood and pleural fluid NLR in MPE patients was moderate (rs = 0.321, p<0.001). In univariate analysis, NLR (>0.745)) in malignant pleural fluid was predictive of poorer survival (HR = 1.698 [1.0054-2.736]; p = 0.030), and remained significant after adjustment for age, sex, presence of a chest drain, cancer type, concurrent infection and subsequent treatment with chemotherapy (HR = 1.786 [1.089-2.928]; p = 0.022). Patients with pleural fluid NLR > 0.745 had a significantly shorter median survival of 130 (95% CI 0-282) days compared to 312 (95% CI 195-428) days for pleural NLR < 0.745, p = 0.026. The NLR in blood was also predictive of poorer survival in MPE patients (HR = 1.959 [1.019-3.096]; p<0.001). The proportion of neutrophils in pleural fluid was predictive of prognosis more strongly than lymphocytes. This study provides evidence that NLR in malignant effusions can predict survival, and therefore may provide prognostic information for this cohort. This prognostic association in the fluid is driven by the presence of neutrophils.https://doi.org/10.1371/journal.pone.0250628 |
| spellingShingle | Natalia Popowicz Hui Min Cheah Cynthia Gregory Alina Miranda Ian M Dick Y C Gary Lee Jenette Creaney Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance. PLoS ONE |
| title | Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance. |
| title_full | Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance. |
| title_fullStr | Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance. |
| title_full_unstemmed | Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance. |
| title_short | Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance. |
| title_sort | neutrophil to lymphocyte ratio in malignant pleural fluid prognostic significance |
| url | https://doi.org/10.1371/journal.pone.0250628 |
| work_keys_str_mv | AT nataliapopowicz neutrophiltolymphocyteratioinmalignantpleuralfluidprognosticsignificance AT huimincheah neutrophiltolymphocyteratioinmalignantpleuralfluidprognosticsignificance AT cynthiagregory neutrophiltolymphocyteratioinmalignantpleuralfluidprognosticsignificance AT alinamiranda neutrophiltolymphocyteratioinmalignantpleuralfluidprognosticsignificance AT ianmdick neutrophiltolymphocyteratioinmalignantpleuralfluidprognosticsignificance AT ycgarylee neutrophiltolymphocyteratioinmalignantpleuralfluidprognosticsignificance AT jenettecreaney neutrophiltolymphocyteratioinmalignantpleuralfluidprognosticsignificance |