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

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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 languageEnglish
Pages (from-to)650–660
Number of pages11
JournalAnnals of Surgical Oncology
Volume20
Issue numberSupplement 3
Early online date25 Jul 2013
DOIs
Publication statusPublished - Dec 2013

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Keywords

  • Breast Cancer Patient
  • Circulate Tumour Cell
  • Ketorolac
  • Locoregional Recurrence
  • Kidney Cancer

Cite this

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