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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

  • Translational Research and Biomarkers
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Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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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.

Conflict of interest

The authors attest no conflict of interest.

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Authors and Affiliations

  1. Department of Anesthesiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

    Patrice Forget MD, Yann Kremer MD & Marc De Kock MD, PhD

  2. Department of Medical Oncology, Institut de Recherche Clinique et Expérimentale (pôle MIRO), Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

    Jean-Pascal Machiels MD, PhD

  3. de Duve Institute, Université catholique de Louvain, Brussels, Belgium

    Pierre G. Coulie MD, PhD

  4. Department of Gynecology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

    Martine Berliere MD, PhD

  5. Department of Cardiovascular and Thoracic Surgery, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

    Alain J. Poncelet MD, PhD

  6. Department of Urology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium

    Bertrand Tombal MD, PhD & Annabelle Stainier MD

  7. Institute of Statistics, Biostatistics and Actuarial Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium

    Catherine Legrand PhD

  8. Department of Oncology–Hematology, Grand Hôpital de Charleroi, Charleroi, Belgium

    Jean-Luc Canon MD

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  1. Patrice Forget MD
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Correspondence to Patrice Forget MD.

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Forget, P., Machiels, JP., Coulie, P.G. 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. Ann Surg Oncol 20 (Suppl 3), 650–660 (2013). https://doi.org/10.1245/s10434-013-3136-x

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