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...
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| 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 |
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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0250628</identifier><identifier>PMID: 33901252</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Biology and Life Sciences ; Cancer ; Chemotherapy ; Complications and side effects ; Lymphocytes ; Medicine and Health Sciences ; Methods ; Neutrophils</subject><ispartof>PloS one, 2021-04, Vol.16 (4), p.e0250628-e0250628</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Popowicz et al 2021 Popowicz et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c533t-abab0cf9011fc076f99391105f964b5c119c21359923a6c54ab9e7f961d0414a3</citedby><cites>FETCH-LOGICAL-c533t-abab0cf9011fc076f99391105f964b5c119c21359923a6c54ab9e7f961d0414a3</cites><orcidid>0000-0001-8872-588X ; 0000-0003-0200-1819 ; 0000-0002-9391-9395</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075197/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075197/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33901252$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Popowicz, Natalia</creatorcontrib><creatorcontrib>Cheah, Hui Min</creatorcontrib><creatorcontrib>Gregory, Cynthia</creatorcontrib><creatorcontrib>Miranda, Alina</creatorcontrib><creatorcontrib>Dick, Ian M</creatorcontrib><creatorcontrib>Lee, Y C Gary</creatorcontrib><creatorcontrib>Creaney, Jenette</creatorcontrib><title>Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance</title><title>PloS one</title><addtitle>PLoS One</addtitle><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.</description><subject>Analysis</subject><subject>Biology and Life Sciences</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Complications and side effects</subject><subject>Lymphocytes</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Neutrophils</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpVkl2L3CAUhkPp0v1o_0EpgULZm8z6EU3sRWFZ-rGwbEtpr8UYTRyMpmoK8-_XdKbLzJXiec_je_QtircQbCBu4M3WL8EJu5m9UxuACKCofVFcQIZRRRHAL4_258VljFsACG4pfVWcY8wARARdFD8f1ZKCn0djq-Qru5vm0ctdUmUQyfjSuHIS1gxOuFTOVi1B2FLbxfQfyx_BD87HZGQZs8JoI4WT6nVxpoWN6s1hvSp-f_n86-5b9fD96_3d7UMlCcapEp3ogNTZCNQSNFQzhhmEgGhG645ICJlEEBPGEBZUklp0TDW5CHtQw1rgq-J-z-292PI5mEmEHffC8H8HPgxchGzOKk5a2ksAa4mQrjvVtXXTrG-gIMxLQzLr0541L92keqlcyoOeQE8rzox88H95CxoCWZMB1wdA8H8WFROfTJTKWuGUXyJHBLaMshqtd73fSweRrRmnfSbKVc5vKWENypZW1Ycj1aiETWP0dsmf4uKpsN4LZfAxBqWfXUPA16TwQ1L4mhR-SEpue3c88XPT_2jgJ5c3vFw</recordid><startdate>20210426</startdate><enddate>20210426</enddate><creator>Popowicz, Natalia</creator><creator>Cheah, Hui Min</creator><creator>Gregory, Cynthia</creator><creator>Miranda, Alina</creator><creator>Dick, Ian M</creator><creator>Lee, Y C Gary</creator><creator>Creaney, Jenette</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-8872-588X</orcidid><orcidid>https://orcid.org/0000-0003-0200-1819</orcidid><orcidid>https://orcid.org/0000-0002-9391-9395</orcidid></search><sort><creationdate>20210426</creationdate><title>Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance</title><author>Popowicz, Natalia ; Cheah, Hui Min ; Gregory, Cynthia ; Miranda, Alina ; Dick, Ian M ; Lee, Y C Gary ; Creaney, Jenette</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c533t-abab0cf9011fc076f99391105f964b5c119c21359923a6c54ab9e7f961d0414a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Analysis</topic><topic>Biology and Life Sciences</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Complications and side effects</topic><topic>Lymphocytes</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Neutrophils</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Popowicz, Natalia</creatorcontrib><creatorcontrib>Cheah, Hui Min</creatorcontrib><creatorcontrib>Gregory, Cynthia</creatorcontrib><creatorcontrib>Miranda, Alina</creatorcontrib><creatorcontrib>Dick, Ian M</creatorcontrib><creatorcontrib>Lee, Y C Gary</creatorcontrib><creatorcontrib>Creaney, Jenette</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Popowicz, Natalia</au><au>Cheah, Hui Min</au><au>Gregory, Cynthia</au><au>Miranda, Alina</au><au>Dick, Ian M</au><au>Lee, Y C Gary</au><au>Creaney, Jenette</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-04-26</date><risdate>2021</risdate><volume>16</volume><issue>4</issue><spage>e0250628</spage><epage>e0250628</epage><pages>e0250628-e0250628</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33901252</pmid><doi>10.1371/journal.pone.0250628</doi><orcidid>https://orcid.org/0000-0001-8872-588X</orcidid><orcidid>https://orcid.org/0000-0003-0200-1819</orcidid><orcidid>https://orcid.org/0000-0002-9391-9395</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Analysis Biology and Life Sciences Cancer Chemotherapy Complications and side effects Lymphocytes Medicine and Health Sciences Methods Neutrophils |
| title | Neutrophil-to-lymphocyte ratio in malignant pleural fluid: Prognostic significance |
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