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Neutrophil-to-lymphocyte ratio as an independent factor for worse prognosis in radioiodine refractory thyroid cancer patients

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Abstract

Purpose

This study aimed to evaluate neutrophil to lymphocyte ratio (NLR) as a laboratory biomarker in radioactive iodine-refractory (RAIR) locally advanced and/or metastatic differentiated thyroid cancer (DTC) and determine its correlation with overall survival (OS).

Methods

We retrospectively included 172 patients with locally advanced and/or metastatic RAIR DTC admitted between 1993 and 2021 at INCA. Age at diagnosis, histology, presence of distant metastasis (DM), DM site, neutrophil-to- lymphocyte ratio (NLR), imaging studies such as PET/CT results, progression free survival (PFS) and overall survival (OS) data were analyzed. NLR was calculated at the time of locally advanced and/or metastatic disease diagnosis and the cutoff value was 3. Survival curves were established using the Kaplan–Meier method. The confidence interval is 95%, and a p-value of less than 0.05 was considered statistically significant

Results

Out of 172 patients, 106 were locally advanced, and 150 presented DM at some point during follow-up. Regarding NLR data, 35 had NLR over 3 and 137 had NLR under 3. Higher NLR at was associated with shorter OS (6 vs. 10; p = 0.05) and with highest SUV on FDG PET-CT (15.9 vs. 7.7, p = 0.013). We found no association between higher NLR and age at diagnosis, DM or final status.

Conclusion

NLR higher than 3 at the time of locally advanced and/or metastatic disease diagnosis is an independent fator for shorter OS in RAIR DTC patients. Noteworthy higher NLR was also associated with highest SUV on FDG PET-CT in this population.

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Authors and Affiliations

  1. Department of Medicine, Endocrinology Service, Faculdade de medicina, Hospital Universitário Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil

    Natália Treistman, Lara Bessa Campelo Pinheiro Cavalcante & Fernanda Vaisman

  2. Department of Medicine, Endocrinology Service, Instituto Nacional do Cancer (INCA), Rio de Janeiro, RJ, Brazil

    Fabiola Gonzalez, Pollyanna Iemini Weyll Fernandes, Fernanda Accioly de Andrade, Paulo Alonso Garcis Alves-Junior, Rossana Corbo, Daniel Alves Bulzico & Fernanda Vaisman

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  1. Natália Treistman
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Correspondence to Fernanda Vaisman.

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Conflict of interest

F.V. is a speaker for Bayer, Exelixis, Ipsen, AstraZeneca, Lilly and principal investigator for clinical trials for the same companies. Other authors have nothing to declare.

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Treistman, N., Cavalcante, L.B.C.P., Gonzalez, F. et al. Neutrophil-to-lymphocyte ratio as an independent factor for worse prognosis in radioiodine refractory thyroid cancer patients. Endocrine 81, 141–148 (2023). https://doi.org/10.1007/s12020-023-03340-8

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