Pretreatment neutrophil to lymphocyte and platelet to lymphocyte ratios as predictive factors for the survival of cervical adenocarcinoma patients

Joanna Jonska-Gmyrek,1 Leszek Gmyrek,2 Agnieszka Zolciak-Siwinska,3 Maria Kowalska,4 Malgorzata Fuksiewicz,4 Beata Kotowicz4 1Department of Uro-oncology, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw 02-781, Poland; 2Department of Gynecological Oncology, The Holy Family Hospital, Warsaw 02-544, Poland; 3Department of Brachytherapy, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw 02-781, Poland; 4Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw 02-781, Poland Objective: Our study assessed the clinical utility and prognostic value of pretreatment hematological parameters and calculated coefficients including the platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and monocyte to lymphocyte ratio (MLR) in patients with cervical adenocarcinoma (CA).Materials and methods: Among 738 cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) stages IA–IV treated at our institution, 96 (13%) presented with CA histology. The blood samples, collected within 10 days before treatment, were analyzed using a Sysmex XN-2000 system. The statistical tests included Mann–Whitney U-tests, log-rank tests, and Cox regression models. The cutoff points for the calculated hematological coefficients (NLR, PLR, and MLR) were determined using the MedCalc statistical program.Results: The prognostic factor for overall survival (OS) and recurrence-free survival (RFS) in CA was clinical stage according to FIGO classification (FIGO IIB–IV vs I–IIA) (P=0.0001; P=0.002). Among patients with FIGO stage IIB–IV treated with radiotherapy/chemoradiotherapy, an elevated PLR was a negative prognostic factor for OS (P=0.017; HR: 2.96; 95% CI: 2.069–3.853). Among all patients, an elevated pretreatment NLR was a poor prognostic factor for OS (P=0.014; HR: 2.85; 95% CI: 2.011–3.685) and RFS (P=0.049; HR: 4.0; 95% CI: 2.612–5.392). The white blood cell count (WBC) before treatment was significantly higher in patients who died during follow-up (P=0.009).Conclusion: Elevated NLR values before treatment may be associated with a shorter time of RFS and OS, while PLR index may have prognostic significance for OS in patients with advanced disease (FIGO IIB–IV). Both indexes and WBC may be a cost-effective biomarker that can be used conveniently for stratification of recurrence risk and death. Keywords: platelet to lymphocyte ratio, cervical cancer, neutrophil to lymphocyte ratio, prognostic factor

Radiotherapy in testicular germ cell tumours – a literature review

Testicular germ cell tumours (GCT) represent about 1–2% of malignant in men. The essential therapeutic option for early-stage GCT is radical orchiectomy (RO), except in situ ations that require immediate chemotherapy in patients with a massive dissemination and unequivocally elevated levels of tumour markers. Postoperative radiotherapy (PORT) in patients with testicular seminoma in Clinical Stage I (CS I) is one of the treatment options next to active surveillance (AS) and chemotherapy (CHTH). Regardless of the procedure, five-year survival in this group of patients ranges between 97% and 100%. In the article, we present the literature review pertinent to therapeutic options, with a focus on radiotherapy. We have searched MEDLINE (PubMed) for all studies on patients with GCT treated with radiation therapy during the last 20 years, and the current therapeutic recommendations. We used the following keywords: germ cell tumours, testis, seminoma, non-seminoma, radiotherapy, outcome

Medians and VEGF concentrations in dependence on regional lymph nodes status.

<p>Medians and VEGF concentrations in dependence on regional lymph nodes status.</p

Clinical significance of pretreatment serum levels of VEGF and its receptors, IL- 8, and their prognostic value in type I and II endometrial cancer patients

<div><p>Objectives</p><p>The study aimed to assess the usefulness of the determination of cytokines: IL-8, VEGF and its soluble receptors: VEGF-R1, VEGF-R2 in patients with endometrial cancer (EC).</p><p>Material/Methods</p><p>The study group consisted of 118 patients with EC subjected to surgical treatment. Before the treatment we determined the serum levels of cytokines IL-8, and VEGF as well as VEGFR1 and VEGFR2 receptors. For comparison, the concentration of CA 125 was also measured. VEGFR1 and CA 125 were determined in the COBAS e601 system using Roche Diagnostics kits, while IL-8, VEGF and VEGFR2 were measured by ELISA assay using R&D Systems kits.</p><p>Results</p><p>The concentrations of IL-8, VEGF, VEGFR1 and CA 125 allowed to distinguish patients for the control group. The highest diagnostic sensitivity has been shown for the concentrations of VEGF (AUC = 0.904) and IL-8 (AUC = 0.818). Among all studied parameters only CA125 concentrations increased with the clinical stage; being significantly higher in patients in FIGO III-IV, than FIGO I-IB. In patients at the FIGO stage I-IB, complementary determinations of CA 125 and VEGF resulted in the largest increase of diagnostic sensitivity. Patients with metastases to the para-aortic lymph nodes had significantly higher levels of VEGF compared to subjects without such lesions. The concentrations of IL-8 were an independent prognostic factor in the assessment of overall survival in patients with type I endometrial cancer, while the concentrations of VEGFR2 in those with type II.</p><p>Conclusions</p><p>In patients with endometrial cancer, the clinical usefulness of IL-8 and VEGFR2 measurements as the potential prognostic factors has been demonstrated. In type I, the concentrations of IL-8 determined before treatment can be helpful in predicting overall survival. In patients qualified to type II EC, the concentrations of VEGFR2 have the value of an independent prognostic factor for overall survival, this requires research on larger groups of patients. The increased levels of VEGF may be useful in the preoperative assessment of the status of para-aortic lymph nodes.</p></div

The concentration of serum levels and cut-off points of cytokine and soluble cytokine receptor in healthy subjects.

<p>The concentration of serum levels and cut-off points of cytokine and soluble cytokine receptor in healthy subjects.</p

The value of medians, statistical differences and the percentage of patients with elevated levels of CA 125 and cytokines, in dependence on the clinical stage.

<p>The value of medians, statistical differences and the percentage of patients with elevated levels of CA 125 and cytokines, in dependence on the clinical stage.</p

The probability of overall survival according to the IL-8 and VEGFR2 levels in endometrial cancer patients, type I/II.

<p>The probability of overall survival according to the IL-8 and VEGFR2 levels in endometrial cancer patients, type I/II.</p

Potential of IL-8, VEGF, VEGFR1, VEGFR2, and CA 125 serum concentrations to discriminate between endometrial cancer patients and control group based on the area under the curve (AUC).

<p>Potential of IL-8, VEGF, VEGFR1, VEGFR2, and CA 125 serum concentrations to discriminate between endometrial cancer patients and control group based on the area under the curve (AUC).</p

Clinicopathological characteristics of ^aEC patients.

<p>Clinicopathological characteristics of <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0184576#t001fn002" target="_blank">^a</a>EC patients.</p