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

  • Pediatric Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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).

Results

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).

Conclusions

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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Author notes

    Authors and Affiliations

    1. Faculty of Medicine, University of New South Wales, New South Wales, Australia

      Agnish Nayak

    2. Division of Child and Adolescent Health, Sydney Medical School, The University of Sydney, New South Wales, Australia

      Dermot T. McDowell MRCS, Stewart J. Kellie FRACP, MD & Jonathan Karpelowsky FRACS, PhD

    3. Department of Paediatric Surgery, The Children’s Hospital at Westmead, Westmead, Australia

      Dermot T. McDowell MRCS & Jonathan Karpelowsky FRACS, PhD

    4. Children’s Cancer Centre, The Children’s Hospital at Westmead, Westmead, Australia

      Stewart J. Kellie FRACP, MD

    5. Children’s Cancer Research Unit, Kids Research Institute, Westmead, Australia

      Jonathan Karpelowsky FRACS, PhD

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    1. Agnish Nayak
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    2. Dermot T. McDowell MRCS
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    3. Stewart J. Kellie FRACP, MD
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    Correspondence to Jonathan Karpelowsky FRACS, PhD.

    Additional information

    Agnish Nayak and Dermot Thomas McDowell have equally contributed to this work.

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    Nayak, A., McDowell, D.T., Kellie, S.J. et al. Elevated Preoperative Neutrophil–Lymphocyte Ratio is Predictive of a Poorer Prognosis for Pediatric Patients with Solid Tumors. Ann Surg Oncol 24, 3456–3462 (2017). https://doi.org/10.1245/s10434-017-6006-0

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    • DOI: https://doi.org/10.1245/s10434-017-6006-0

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