Abstract
Background
Preoperative neutrophil to lymphocyte ratio (NLR) might be prognostic in papillary thyroid carcinoma (PTC). Given the controversy of prophylactic central neck dissection (pCND) in clinically nodal-negative (cN0) PTC, our study evaluated whether preoperative NLR predicted disease-free survival (DFS) and occult central nodal metastasis (CNM) in cN0 PTC.
Methods
A total of 191 patients who underwent pCND were analyzed. Complete blood counts with differential counts were taken before operation. NLR was calculated by dividing preoperative neutrophil count with lymphocyte count. Patients were categorized into NLR tertiles: first (NLR < 1.93; n = 63), second (NLR = 1.93–2.79; n = 64), and third tertile (NLR > 2.79; n = 64). Four other patient types, namely, benign nodular goiter, clinically nodal-positive (cN1) PTC, poorly differentiated thyroid carcinoma, and anaplastic thyroid carcinoma (ATC), were used as references.
Results
Age at operation (p < 0.001) and tumor size (p = 0.037) significantly increased with higher NLR. First tertile had significantly more TNM stage I tumors (p = 0.01) and lowest MACIS score (p = 0.002). Tumor size [hazard ratio (HR) 1.422, 95% confidence interval (CI) 1.119–1.809, p = 0.004] and multicentricity (HR = 2.545, 95% CI 1.073–6.024, p = 0.034) independently predicted DFS, whereas old age [odds ratio (OR) 1.026, 95% CI 1.006–1.046, p = 0.009), male (OR 2.882, 95% CI 1.348–6.172, p = 0.006), and large tumor (OR 1.567, 95% CI 1.209–2.032, p = 0.001) independently predicted occult CNM. NLR was not significantly associated with DFS or occult CNM. ATC had significantly higher NLR than cN1 PTC (7.28 vs. 2.74, p < 0.001).
Conclusions
Although a higher NLR may imply a poorer tumor profile, it was not significantly associated with a worse DFS or higher risk of occult CNM in cN0 PTC. Perhaps, future research should focus on the prognostic value in other thyroid cancer types with a poorer prognosis.
Similar content being viewed by others
References
Cancer incidence and mortality in Hong Kong 1983–2009. Hong Kong Cancer Registry, Hong Kong. Available: http://www3.ha.org.hk/cancereg/e_stat.asp. Accessed 15 Feb 2013
Lang B, Lo CY, Chan WF, Lam KY, Wan KY (2007) Restaging of differentiated thyroid carcinoma by the sixth edition AJCC/UICC TNM staging system: stage migration and predictability. Ann Surg Oncol 14(5):1551–1559
Machens A, Hauptmann S, Dralle H (2009) Lymph node dissection in the lateral neck for completion in central node-positive papillary thyroid cancer. Surgery 145:176–181
Hwang HS, Orloff LA (2011) Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope 121(3):487–491
Roh JL, Park JY, Kim JM, Song CJ (2009) Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma. J Surg Oncol 99(1):28–31
Lang BH, Ng SH, Lau L, Cowling B, Wong KP, Wan KY (2013) A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid 23:1087–1098
Zhang L, Wei WJ, Ji QH, Zhu YX, Wang ZY, Wang Y, Huang CP, Shen Q, Li DS, Wu Y (2012) Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma: a study of 1066 patients. J Clin Endocrinol Metab 97(4):1250–1257
Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, Widmann WD (2012) Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 19(1):217–224
Kishi Y, Kopetz S, Chun YS, Palavecino M, Abdalla EK, Vauthey JN (2009) Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol 16(3):614–622
Wang S, Zhang Z, Fang F, Gao X, Sun W, Liu H (2011) The neutrophil/lymphocyte ratio is an independent prognostic indicator in patients with bone metastasis. Oncol Lett 2(4):735–740
Perez DR, Baser RE, Cavnar MJ, Balachandran VP, Antonescu CR, Tap WD, Strong VE, Brennan MF, Coit DG, Singer S, Dematteo RP (2013) Blood neutrophil-to-lymphocyte ratio is prognostic in gastrointestinal stromal tumor. Ann Surg Oncol 20(2):593–599
Seretis C, Gourgiotis S, Gemenetzis G, Seretis F, Lagoudianakis E, Dimitrakopoulos G (2013) The significance of neutrophil/lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters: a pilot study. Am J Surg 205(6):691–696
Liu CL, Lee JJ, Liu TP, Chang YC, Hsu YC, Cheng SP (2013) Blood neutrophil-to-lymphocyte ratio correlates with tumor size in patients with differentiated thyroid cancer. J Surg Oncol 107(5):493–497
Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, Brokhin M, Omry G, Fagin JA, Shaha A (2010) Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 20(12):1341–1349
Lang BH, Wong KP, Wan KY, Lo CY (2012) Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol 19(1):60–67
Lang BH, Chow SM, Lo CY, Law SC, Lam KY (2007) Staging systems for papillary thyroid carcinoma: a study of 2 tertiary referral centers. Ann Surg 246(1):114–121
Chan WF, Lang BH, Lo CY (2006) The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery 140:866–873
Fridlender ZG, Albelda SM (2012) Tumor-associated neutrophils: friend or foe? Carcinogenesis 33(5):949–955
Lang BH, Tang AH, Wong KP, Shek TW, Wan KY, Lo CY (2012) Significance of size of lymph node metastasis on postsurgical stimulated thyroglobulin levels after prophylactic unilateral central neck dissection in papillary thyroid carcinoma. Ann Surg Oncol 19(11):3472–3478
Barczyński M, Konturek A, Stopa M, Nowak W (2013) Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg 100(3):410–418
Roh JL, Kim JM, Park CI (2011) Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence. Ann Surg Oncol 18(8):2245–2250
Paulson L, Shindo M, Schuff K, Corless C (2012) The role of molecular markers and tumor histological type in central lymph node metastasis of papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 138(1):44–49
Zhao Q, Ming J, Liu C, Shi L, Xu X, Nie X, Huang T (2013) Multifocality and total tumor diameter predict central neck lymph node metastases in papillary thyroid microcarcinoma. Ann Surg Oncol 20(3):746–752
So YK, Son YI, Hong SD, Seo MY, Baek CH, Jeong HS, Chung MK (2010) Subclinical lymph node metastasis in papillary thyroid microcarcinoma: a study of 551 resections. Surgery 148(3):526–531
Hartl DM, Leboulleux S, Al Ghuzlan A, Baudin E, Chami L, Schlumberger M, Travagli JP (2012) Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg 255(4):777–783
Lang BH, Chai YJ, Cowling BJ, Min HS, Lee KE, Youn YK (2014) Is BRAFV600E mutation a marker for central nodal metastasis in small papillary thyroid carcinoma? Endocr Relat Cancer 21(2):285–295
Kim KE, Kim EK, Yoon JH, Han KH, Moon HJ, Kwak JY (2013) Preoperative prediction of central lymph node metastasis in thyroid papillary microcarcinoma using clinicopathologic and sonographic features. World J Surg 37(2):385–391. doi:10.1007/s00268-012-1826-3
Joo JY, Park JY, Yoon YH, Choi B, Kim JM, Jo YS, Shong M, Koo BS (2012) Prediction of occult central lymph node metastasis in papillary thyroid carcinoma by preoperative BRAF analysis using fine-needle aspiration biopsy: a prospective study. J Clin Endocrinol Metab 97(11):3996–4003
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lang, B.HH., Ng, C.PC., Au, K.B. et al. Does Preoperative Neutrophil Lymphocyte Ratio Predict Risk of Recurrence and Occult Central Nodal Metastasis in Papillary Thyroid Carcinoma?. World J Surg 38, 2605–2612 (2014). https://doi.org/10.1007/s00268-014-2630-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2630-z