Annals of Surgical Oncology

, Volume 24, Issue 11, pp 3456–3462 | Cite as

Elevated Preoperative Neutrophil–Lymphocyte Ratio is Predictive of a Poorer Prognosis for Pediatric Patients with Solid Tumors

  • Agnish Nayak
  • Dermot T. McDowell
  • Stewart J. Kellie
  • Jonathan Karpelowsky
Pediatric Oncology



An elevated neutrophil–lymphocyte ratio (NLR) has been shown to indicate poorer prognosis for adults with solid tumors and potentially represents an independent, universal adjunct prognostic factor. The value of NLR in a pediatric setting has not been evaluated. This study sought to determine the prognostic value of NLR for pediatric patients with solid tumors.


Pediatric patients with solid tumors undergoing neoadjuvant chemotherapy followed by surgery with curative intent between 2000 and 2014 were eligible for this study. A preoperative peripheral blood count within 1 month of surgery taken after recovery from recent chemotherapy was analyzed in relation to overall survival (OS) and event-free survival (EFS).


This retrospective study enrolled 293 patients. The median age at diagnosis was 46.5 months (range 0.1–206.1 months). Males accounted for 58% of the patients. The median OS was 49 months. An NLR cutoff of 2.5 was used in the analysis. In the univariate analysis, a high NLR was associated with low OS (p = 0.001) and low EFS (p = 0.020). Other factors identified in the univariate analysis that affected survival included metastatic disease at diagnosis (p < 0.001) and tumor type (p = 0.012). The multivariate analyses showed that a high NLR was associated with low OS (p = 0.014) but not with EFS (p = 0.270). The multivariate analysis of neuroblastoma patients found that a high NLR was associated with low OS (p = 0.013).


An elevated NLR is prognostic of a poorer outcome for pediatric patients with solid tumors and potentially represents an independent, universal adjunct prognosticator in such cases.


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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Agnish Nayak
    • 1
  • Dermot T. McDowell
    • 2
    • 3
  • Stewart J. Kellie
    • 2
    • 4
  • Jonathan Karpelowsky
    • 2
    • 3
    • 5
  1. 1.Faculty of MedicineUniversity of New South WalesNew South WalesAustralia
  2. 2.Division of Child and Adolescent Health, Sydney Medical SchoolThe University of SydneyNew South WalesAustralia
  3. 3.Department of Paediatric SurgeryThe Children’s Hospital at WestmeadWestmeadAustralia
  4. 4.Children’s Cancer Centre, The Children’s Hospital at WestmeadWestmeadAustralia
  5. 5.Children’s Cancer Research UnitKids Research InstituteWestmeadAustralia

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