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

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...

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Published in:	Annals of surgical oncology Vol. 20; no. Suppl 3; pp. 650 - 660
Main Authors:	Forget, Patrice, Machiels, Jean-Pascal, Coulie, Pierre G., Berliere, Martine, Poncelet, Alain J., Tombal, Bertrand, Stainier, Annabelle, Legrand, Catherine, Canon, Jean-Luc, Kremer, Yann, De Kock, Marc
Format:	Journal Article
Language:	English
Published:	Boston Springer US 01-12-2013 Springer Nature B.V
Subjects:	Adenocarcinoma - mortality Adenocarcinoma - secondary Adenocarcinoma - therapy Anti-Inflammatory Agents, Non-Steroidal - administration & dosage Breast Neoplasms - mortality Breast Neoplasms - pathology Breast Neoplasms - therapy Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - secondary Carcinoma, Non-Small-Cell Lung - therapy Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - secondary Carcinoma, Squamous Cell - therapy Combined Modality Therapy Diclofenac - administration & dosage Female Follow-Up Studies Humans Intraoperative Care Ketorolac - administration & dosage Kidney Neoplasms - mortality Kidney Neoplasms - pathology Kidney Neoplasms - therapy Lung Neoplasms - mortality Lung Neoplasms - pathology Lung Neoplasms - therapy Lymphocytes - pathology Male Medicine Medicine & Public Health Neoplasm Metastasis Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - therapy Neoplasm Staging Neutrophils - pathology Oncology Prognosis Prospective Studies Surgery Surgical Oncology Survival Rate Translational Research and Biomarkers Breast Cancer Patient Locoregional Recurrence Circulate Tumour Cell Kidney Cancer Ketorolac
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1068-9265 1534-4681
DOI:	10.1245/s10434-013-3136-x