Clinical Meaning of Neutrophil-to-Lymphocyte Ratio (NLR)in Papillary Thyroid Carcinoma

Yung-il Shin; Ja Young Cho; Yu-mi Lee; Tae-Yon Sung; Jong Ho Yoon; Ki-Wook Chung; Suck Joon Hong

doi:10.16956/kjes.2016.16.2.31

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Shin, Cho, Lee, Sung, Yoon, Chung, and Hong: Clinical Meaning of Neutrophil-to-Lymphocyte Ratio (NLR)in Papillary Thyroid Carcinoma

Original Article

Korean Journal of Endocrine Surgery 2016; 16(2): 31-35.

Published online: 22 June 2016

DOI: https://doi.org/10.16956/kjes.2016.16.2.31

Clinical Meaning of Neutrophil-to-Lymphocyte Ratio (NLR)in Papillary Thyroid Carcinoma

Yung-il Shin, Ja Young Cho, Yu-mi Lee, Tae-Yon Sung, Jong Ho Yoon, Ki-Wook Chung, Suck Joon Hong

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence: Ki-Wook Chung. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3962, Fax: +82-2-474-9027, surgeonckw@amc.seoul.kr, surgeonckw@gmail.com

Received 11 May 2016 Revised 22 May 2016 Accepted 24 May 2016

(open-access):

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammatory response, which is inexpensive, easily calculated, and known to show correlation with prognosis of cancer. The aim of this study was to evaluate the relationship between NLR and prognosis of papillary thyroid carcinoma.

Methods

A total of 1,142 patients who underwent total thyroidectomy for papillary thyroid carcinoma between 1995~2005 at Asan Medical Center were enrolled in this study. Patients were categorized according to two groups based on NLR and clinico-pathological variables and disease survival were compared between the two groups.

Results

Median age of patients was 45.4 years, and the median follow-up period was 48 months. The cut-off value of NLR for prediction of disease-free survival (DFS) was 2. Comparison of DFS between two groups stratified by NLR (NLR ≤2, NLR>2) showed little statistical difference (P=0.48). After adjusting for risk (N stage), there was no significant difference according to N stage (N0: P=0.86, N1a: P=0.4, N1b: P=0.12).

Conclusion

NLR did not show correlation with disease free survival of papillary thyroid carcinoma.

Keywords: Neutrophil-to-lymphocyte ratio, Papillary thyroid carcinoma, Disease-free survival

Figures and Tables

Fig. 1

Disease free survival according to the NLR.

Fig. 2

(A) Overall disease free survival (DFS) of pN10/Nx, pN1a and pN1b. (B) DFS according to the Neutrophil-to-lymphocyte ratio (NLR) in pN0 group. (C) DFS according to the NLR in pN1a group. (D) DFS according to the NLR in pN1b group.

Table 1

Characteristics of the patients

Characteristics
Mean age	45.4±12.5 (14~87)
Sex
Male	157 (13.7%)
Female	985 (86.2%)
Extrathyroidal invasion
Absent	506 (44.3%)
Present	636 (55.6%)
Thyroiditis
Absent	946 (82.8%)
Present	196 (17.1%)
TN stage
T
T1	339 (29.6%)
T2	140 (12.3%)
T3	649 (56.8%)
T4a	14 (1.2%)
N
N0	417 (36.5%)
N1a	568 (49.7%)
N1b	157 (13.7%)
Stage
I	638 (55.9%)
II	40 (3.5%)
III	389 (34%)
IVa	64 (5.6%)
IVb	0 (0%)
IVc	11 (0.9%)
RIA
Not done	59 (5.1%)
Done	1,083 (94.8%)
Total no. of recurrence	170 (14.8%)

RIA = radioactive iodine ablation.

Table 2

Clinico-pathologic variables according to the NLR (percent)

	NLR≤2	NLR>2	P value
Mean age	48.1±12.9	44.3±12.1	0.03
Sex
Male	70 (6.1%)	87 (7.6%)	0.93
Female	430 (37.7%)	555 (48.6%)
Extra-invasion
Absent	217 (19.0%)	289 (25.3%)	0.94
Present	283 (24.8%)	353 (30.9%)
Thyroiditis
Absent	410 (35.9%)	536 (46.9%)	0.48
Present	90 (7.9%)	106 (9.3%)
TN stage
T
T1	150 (13.1%)	189 (16.5%)	0.67
T2	58 (5.1%)	82 (7.2%)
T3	284 (24.9%)	365 (32.0%)
T4a	8 (0.7%)	6 (0.5%)
N
N0	183 (16.0%)	234 (20.5%)	0.18
N1a	237 (20.8%)	331 (29.0%)
N1b	80 (7.0%)	77 (6.7%)
Stage
I	252 (22.1%)	386 (33.8%)	0.06
II	27 (2.4%)	13 (1.1%)
III	178 (15.6%)	210 (18.4%)
IVa	36 (3.2%)	28 (2.5%)
IVb	0 (0%)	0 (0%)
IVc	6 (0.5%)	5 (0.4%)
RIA
Not done	26 (2.3%)	33 (2.9%)
Done	474 (41.5%)	609 (53.3%)
Total no. of recurrence	90 (7.8%)	80 (7.0%)

NLR = neutrophil-to lymphocyte ratio; RIA = radioactive iodine ablation.

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