Neutrophil: Lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery

Patrice Forget; Jean-Pascal Machiels; Pierre G. Coulie; Martine Berliere; Alain J. Poncelet; Bertrand Tombal; Annabelle Stainier; Catherine Legrand; Jean-Luc Canon; Y. Kremer; Marc De Kock

doi:10.1245/s10434-013-3136-x

Neutrophil: Lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery

Patrice Forget^* (Corresponding Author), Jean-Pascal Machiels, Pierre G. Coulie, Martine Berliere, Alain J. Poncelet, Bertrand Tombal, Annabelle Stainier, Catherine Legrand, Jean-Luc Canon, Y. Kremer, Marc De Kock

^*Corresponding author for this work

Applied Health Sciences

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136 Citations (Scopus)

Abstract

Background
Inflammation is associated with a worse outcome in cancer and neutrophil:lymphocyte ratio (NLR) is a strong prognostic value. In cancer, nonsteroidal anti-inflammatory drugs (NSAIDs) could be of interest. We investigated the prognostic significance of NLR and the impact of intraoperative NSAIDs in cancer surgeries.

Methods
We performed an observational study in early breast, kidney, and lung cancers (357, 227, and 255 patients) with uni- and multivariate analyses (Cox model).

Results
In breast cancer (Centre 1), NLR ≥ 4 is associated with a higher risk of relapse (hazards ratio (HR) = 2.41; 95 % confidence interval (CI) 1.01–5.76; P = 0.048). In breast cancer (Centre 2), NLR ≥ 3 is associated with a higher risk of relapse (HR = 4.6; 95 % CI 1.09–19.1; P = 0.04) and higher mortality (HR = 4.0; 95 % CI 1.12–14.3; P = 0.03). In kidney cancer, NLR ≥ 5 is associated with a higher risk of relapse (HR = 1.63; 95 % CI 1.00–2.66; P = 0.05) and higher mortality (HR = 1.67; 95 % CI 1.0–2.81; P = 0.05). In lung cancer, NLR ≥ 5 is associated with higher mortality (HR = 1.45; 95 % CI 1.02–2.06; P = 0.04). The intraoperative use of NSAIDs in breast cancer patients (Centre 1) is associated with a reduced recurrence rate (HR = 0.17; 95 % CI 0.04–0.43; P = 0.0002) and a lower mortality (HR = 0.25; 95 % CI 1.08–0.75; P = 0.01). NSAIDs use at the beginning of the surgery is independently associated with a lower metastases risk after lung cancer surgery (HR = 0.16; 95 % CI 0.04–0.63; P = 0.009). Ketorolac use is independently associated with longer survival (HR = 0.55; 95 % CI 0.31–0.95; P = 0.03).

Conclusions
In these cohorts, these analyses show that NLR is a strong perioperative prognosis factor for breast, lung, and kidney cancers. In this context, intraoperative NSAIDs administration could be associated with a better outcome.

Original language	English
Pages (from-to)	650–660
Number of pages	11
Journal	Annals of Surgical Oncology
Volume	20
Issue number	Supplement 3
Early online date	25 Jul 2013
DOIs	https://doi.org/10.1245/s10434-013-3136-x
Publication status	Published - Dec 2013

Bibliographical note

Acknowledgment
The authors thank Sarah Amar, M.D., Nathalie Blondeel, B.Sc., Monique Huang, M.D., Jean-Paul Lechat, M.D., and Julie Vandenhende, M.D., for their help in collecting the data. This work was supported by the Fondation Saint-Luc, the Departments of Anesthesiology, Oncology, Gynecology and Cardio-vascular and Thoracic Surgery, Saint-Luc Hospital, the Commission du Patrimoine of the Université catholique de Louvain and the Belgian Society of Anaesthesia and Resuscitation.

Keywords

Breast Cancer Patient
Circulate Tumour Cell
Ketorolac
Locoregional Recurrence
Kidney Cancer

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Forget, P., Machiels, J.-P., Coulie, P. G., Berliere, M., Poncelet, A. J., Tombal, B., Stainier, A., Legrand, C., Canon, J.-L., Kremer, Y., & De Kock, M. (2013). Neutrophil: Lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery. Annals of Surgical Oncology, 20(Supplement 3), 650–660. https://doi.org/10.1245/s10434-013-3136-x

Neutrophil: Lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery. / Forget, Patrice (Corresponding Author); Machiels, Jean-Pascal; Coulie, Pierre G. et al.
In: Annals of Surgical Oncology, Vol. 20, No. Supplement 3, 12.2013, p. 650–660.

Research output: Contribution to journal › Article › peer-review

Forget, P, Machiels, J-P, Coulie, PG, Berliere, M, Poncelet, AJ, Tombal, B, Stainier, A, Legrand, C, Canon, J-L, Kremer, Y & De Kock, M 2013, 'Neutrophil: Lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery', Annals of Surgical Oncology, vol. 20, no. Supplement 3, pp. 650–660. https://doi.org/10.1245/s10434-013-3136-x

Forget P, Machiels JP, Coulie PG, Berliere M, Poncelet AJ, Tombal B et al. Neutrophil: Lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery. Annals of Surgical Oncology. 2013 Dec;20(Supplement 3):650–660. Epub 2013 Jul 25. doi: 10.1245/s10434-013-3136-x

@article{472f967b079b48479e54bf1d6fb0dad8,

title = "Neutrophil: Lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery",

abstract = "BackgroundInflammation is associated with a worse outcome in cancer and neutrophil:lymphocyte ratio (NLR) is a strong prognostic value. In cancer, nonsteroidal anti-inflammatory drugs (NSAIDs) could be of interest. We investigated the prognostic significance of NLR and the impact of intraoperative NSAIDs in cancer surgeries.MethodsWe performed an observational study in early breast, kidney, and lung cancers (357, 227, and 255 patients) with uni- and multivariate analyses (Cox model).ResultsIn breast cancer (Centre 1), NLR ≥ 4 is associated with a higher risk of relapse (hazards ratio (HR) = 2.41; 95 % confidence interval (CI) 1.01–5.76; P = 0.048). In breast cancer (Centre 2), NLR ≥ 3 is associated with a higher risk of relapse (HR = 4.6; 95 % CI 1.09–19.1; P = 0.04) and higher mortality (HR = 4.0; 95 % CI 1.12–14.3; P = 0.03). In kidney cancer, NLR ≥ 5 is associated with a higher risk of relapse (HR = 1.63; 95 % CI 1.00–2.66; P = 0.05) and higher mortality (HR = 1.67; 95 % CI 1.0–2.81; P = 0.05). In lung cancer, NLR ≥ 5 is associated with higher mortality (HR = 1.45; 95 % CI 1.02–2.06; P = 0.04). The intraoperative use of NSAIDs in breast cancer patients (Centre 1) is associated with a reduced recurrence rate (HR = 0.17; 95 % CI 0.04–0.43; P = 0.0002) and a lower mortality (HR = 0.25; 95 % CI 1.08–0.75; P = 0.01). NSAIDs use at the beginning of the surgery is independently associated with a lower metastases risk after lung cancer surgery (HR = 0.16; 95 % CI 0.04–0.63; P = 0.009). Ketorolac use is independently associated with longer survival (HR = 0.55; 95 % CI 0.31–0.95; P = 0.03).ConclusionsIn these cohorts, these analyses show that NLR is a strong perioperative prognosis factor for breast, lung, and kidney cancers. In this context, intraoperative NSAIDs administration could be associated with a better outcome.",

keywords = "Breast Cancer Patient, Circulate Tumour Cell, Ketorolac, Locoregional Recurrence, Kidney Cancer",

author = "Patrice Forget and Jean-Pascal Machiels and Coulie, {Pierre G.} and Martine Berliere and Poncelet, {Alain J.} and Bertrand Tombal and Annabelle Stainier and Catherine Legrand and Jean-Luc Canon and Y. Kremer and {De Kock}, Marc",

note = "Acknowledgment The authors thank Sarah Amar, M.D., Nathalie Blondeel, B.Sc., Monique Huang, M.D., Jean-Paul Lechat, M.D., and Julie Vandenhende, M.D., for their help in collecting the data. This work was supported by the Fondation Saint-Luc, the Departments of Anesthesiology, Oncology, Gynecology and Cardio-vascular and Thoracic Surgery, Saint-Luc Hospital, the Commission du Patrimoine of the Universit{\'e} catholique de Louvain and the Belgian Society of Anaesthesia and Resuscitation.",

year = "2013",

month = dec,

doi = "10.1245/s10434-013-3136-x",

language = "English",

volume = "20",

pages = "650–660",

journal = "Annals of Surgical Oncology",

issn = "1068-9265",

publisher = "Springer New York",

number = "Supplement 3",

}

TY - JOUR

T1 - Neutrophil

T2 - Lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery

AU - Forget, Patrice

AU - Machiels, Jean-Pascal

AU - Coulie, Pierre G.

AU - Berliere, Martine

AU - Poncelet, Alain J.

AU - Tombal, Bertrand

AU - Stainier, Annabelle

AU - Legrand, Catherine

AU - Canon, Jean-Luc

AU - Kremer, Y.

AU - De Kock, Marc

N1 - Acknowledgment The authors thank Sarah Amar, M.D., Nathalie Blondeel, B.Sc., Monique Huang, M.D., Jean-Paul Lechat, M.D., and Julie Vandenhende, M.D., for their help in collecting the data. This work was supported by the Fondation Saint-Luc, the Departments of Anesthesiology, Oncology, Gynecology and Cardio-vascular and Thoracic Surgery, Saint-Luc Hospital, the Commission du Patrimoine of the Université catholique de Louvain and the Belgian Society of Anaesthesia and Resuscitation.

PY - 2013/12

Y1 - 2013/12

N2 - BackgroundInflammation is associated with a worse outcome in cancer and neutrophil:lymphocyte ratio (NLR) is a strong prognostic value. In cancer, nonsteroidal anti-inflammatory drugs (NSAIDs) could be of interest. We investigated the prognostic significance of NLR and the impact of intraoperative NSAIDs in cancer surgeries.MethodsWe performed an observational study in early breast, kidney, and lung cancers (357, 227, and 255 patients) with uni- and multivariate analyses (Cox model).ResultsIn breast cancer (Centre 1), NLR ≥ 4 is associated with a higher risk of relapse (hazards ratio (HR) = 2.41; 95 % confidence interval (CI) 1.01–5.76; P = 0.048). In breast cancer (Centre 2), NLR ≥ 3 is associated with a higher risk of relapse (HR = 4.6; 95 % CI 1.09–19.1; P = 0.04) and higher mortality (HR = 4.0; 95 % CI 1.12–14.3; P = 0.03). In kidney cancer, NLR ≥ 5 is associated with a higher risk of relapse (HR = 1.63; 95 % CI 1.00–2.66; P = 0.05) and higher mortality (HR = 1.67; 95 % CI 1.0–2.81; P = 0.05). In lung cancer, NLR ≥ 5 is associated with higher mortality (HR = 1.45; 95 % CI 1.02–2.06; P = 0.04). The intraoperative use of NSAIDs in breast cancer patients (Centre 1) is associated with a reduced recurrence rate (HR = 0.17; 95 % CI 0.04–0.43; P = 0.0002) and a lower mortality (HR = 0.25; 95 % CI 1.08–0.75; P = 0.01). NSAIDs use at the beginning of the surgery is independently associated with a lower metastases risk after lung cancer surgery (HR = 0.16; 95 % CI 0.04–0.63; P = 0.009). Ketorolac use is independently associated with longer survival (HR = 0.55; 95 % CI 0.31–0.95; P = 0.03).ConclusionsIn these cohorts, these analyses show that NLR is a strong perioperative prognosis factor for breast, lung, and kidney cancers. In this context, intraoperative NSAIDs administration could be associated with a better outcome.

AB - BackgroundInflammation is associated with a worse outcome in cancer and neutrophil:lymphocyte ratio (NLR) is a strong prognostic value. In cancer, nonsteroidal anti-inflammatory drugs (NSAIDs) could be of interest. We investigated the prognostic significance of NLR and the impact of intraoperative NSAIDs in cancer surgeries.MethodsWe performed an observational study in early breast, kidney, and lung cancers (357, 227, and 255 patients) with uni- and multivariate analyses (Cox model).ResultsIn breast cancer (Centre 1), NLR ≥ 4 is associated with a higher risk of relapse (hazards ratio (HR) = 2.41; 95 % confidence interval (CI) 1.01–5.76; P = 0.048). In breast cancer (Centre 2), NLR ≥ 3 is associated with a higher risk of relapse (HR = 4.6; 95 % CI 1.09–19.1; P = 0.04) and higher mortality (HR = 4.0; 95 % CI 1.12–14.3; P = 0.03). In kidney cancer, NLR ≥ 5 is associated with a higher risk of relapse (HR = 1.63; 95 % CI 1.00–2.66; P = 0.05) and higher mortality (HR = 1.67; 95 % CI 1.0–2.81; P = 0.05). In lung cancer, NLR ≥ 5 is associated with higher mortality (HR = 1.45; 95 % CI 1.02–2.06; P = 0.04). The intraoperative use of NSAIDs in breast cancer patients (Centre 1) is associated with a reduced recurrence rate (HR = 0.17; 95 % CI 0.04–0.43; P = 0.0002) and a lower mortality (HR = 0.25; 95 % CI 1.08–0.75; P = 0.01). NSAIDs use at the beginning of the surgery is independently associated with a lower metastases risk after lung cancer surgery (HR = 0.16; 95 % CI 0.04–0.63; P = 0.009). Ketorolac use is independently associated with longer survival (HR = 0.55; 95 % CI 0.31–0.95; P = 0.03).ConclusionsIn these cohorts, these analyses show that NLR is a strong perioperative prognosis factor for breast, lung, and kidney cancers. In this context, intraoperative NSAIDs administration could be associated with a better outcome.

KW - Breast Cancer Patient

KW - Circulate Tumour Cell

KW - Ketorolac

KW - Locoregional Recurrence

KW - Kidney Cancer

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U2 - 10.1245/s10434-013-3136-x

DO - 10.1245/s10434-013-3136-x

M3 - Article

SN - 1068-9265

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JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

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ER -

Neutrophil: Lymphocyte ratio and intraoperative use of ketorolac or diclofenac are prognostic factors in different cohorts of patients undergoing breast, lung, and kidney cancer surgery

Abstract

Bibliographical note

Keywords

UN SDGs

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