Thromb Haemost 2018; 118(11): 1875-1884
DOI: 10.1055/s-0038-1673401
Cellular Haemostasis and Platelets
Georg Thieme Verlag KG Stuttgart · New York

Association of Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio with the Risk of Thromboembolism and Mortality in Patients with Cancer

Ella Grilz
1  Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
,
Florian Posch
2  Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
,
Oliver Königsbrügge
1  Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
,
Ilse Schwarzinger
3  Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
,
Irene Marthe Lang
4  Clinical Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
,
Christine Marosi
5  Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
,
Ingrid Pabinger
1  Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
,
Cihan Ay
1  Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
› Author Affiliations
Further Information

Publication History

23 March 2018

23 August 2018

Publication Date:
08 October 2018 (eFirst)

Abstract

Patients with cancer are at risk of developing venous and arterial thromboembolism (VTE and ATE). Elevated platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte ratios (NLR) have been suggested as potential biomarkers for cancer-associated chronic inflammation, VTE and mortality. We investigated the association between PLR and NLR with VTE, ATE and mortality in patients with cancer. Within a prospective cohort study, we followed-up patients with newly diagnosed or progressing cancer for objectively confirmed, symptomatic VTE, ATE and death. Fine and Gray competing-risk regression was used to model the risk of VTE and ATE. Overall survival was analysed with Kaplan–Meier estimators. From 2003 to 2013, 1,469 patients with solid cancer (median age: 61 years; 47.3% female) were recruited and followed for 2 years. Overall, 128 (8.7%) patients developed VTE, 41 (2.8%) ATE and 643 (43.8%) patients died. The sub-distribution hazard ratios (SHRs) for VTE per doubling of PLR and NLR were 1.0 (95% confidence interval [CI]: 0.8–1.3, p = 0.899) and 1.2 (1.0–1.4, p = 0.059), respectively. For ATE, the SHR per doubling of PLR and NLR were 1.0 (0.7–1.5, p = 0.940) and 1.2 (0.9–1.6, p = 0.191), respectively. A higher PLR (hazard ratio [HR] per doubling = 1.5, 1.4–1.7, p < 0.001) and a higher NLR (HR per doubling = 1.5, 1.4–1.7, p < 0.001) were associated with an increased risk of mortality after adjusting for age, sex and cancer stage. There was no statistically significant association between NLR and VTE occurrence in patients with cancer. Neither PLR nor NLR were associated with the risk of ATE. Both elevated PLR and NLR were independently associated with a twofold increased risk of mortality.

Note

Cihan Ay and Ella Grilz had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.


Authors' Contributions

E.G. acquired, analysed and interpreted data, performed statistical analyses, co-ordinated the study and drafted the manuscript. O.K. acquired and interpreted data, and recruited patients. F.P. performed statistical analyses and critically revised the manuscript. I.S. critically revised the manuscript for important intellectual content and contributed to the study design. I.M.L. critically revised the manuscript for important intellectual content, was member of the adjudication committee and contributed to the study design. C.M. critically revised the manuscript for important intellectual content and contributed to the study design. I.P. designed and conceived the study, obtained funding, critically revised the manuscript for important intellectual content and provided administrative support. C.A. acquired the data, designed and supervised the study, obtained funding, critically revised the manuscript for important intellectual content and provided administrative support. All authors reviewed and edited the manuscript and finally approved the article.


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