Abstract:

Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio（NLR） in distant metastasis of various solid tumors. Methods A total of 259 patients diagnosed with solid tumors at the Sixth Affiliated People's Hospital of Shanghai Jiao Tong University were enrolled，which included 94 patients with digestive system tumors，78 patients with respiratory system tumors，37 patients with breast tumors and 50 patients with other types of solid tumors. There were 104 cases in the group without distant metastasis（TNM stage Ⅰ，Ⅱ，Ⅲ） and 155 cases in the group with distant metastasis（TNM stage Ⅳ）. The blood routine indicators，lymphocyte subsets and natural killer（NK） cells were determined，and the NLR，platelet-to-lymphocyte ratio（PLR） and lymphocyte-to-monocyte ratio（LMR）were calculated. Binary Logistic regression analysis was used to evaluate the risk factors of distant metastasis in patients with solid tumors. Multiple Logistic regression analysis was used for stratified analysis. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of each indicator in identifying distant metastasis in patients with solid tumors. Totally，47 patients with solid tumors from January to August 2021 were followed up for 36 months，with the occurrence of distant metastasis as the end event. Disease-free survival（DFS） of solid tumor patients was analyzed by Kaplan-Meier survival curve. Results There was statistical significance on male proportion，white blood cell （WBC） count，red blood cell（RBC） count，hemoglobin（Hb），hematocrit（HCT），the absolute value of neutrophils（NEUT#），the absolute value of lymphocytes（LYMPH#），the absolute value of monocytes （MO#），NLR，PLR and LMR between distant metastasis group and non-distant metastasis group（P<0.05）. There was no statistical significance in the other indicators（P>0.05）. Multivariate Logistic regression analysis showed that NLR was an independent risk factor for distant metastasis in solid tumor patients [odds ratio（OR）=1.488，95% confidence interval（CI） 1.250-1.771，P<0.001]. ROC curve analysis results showed that the area under curve of distant metastasis in solid tumor patients determined by NLR was 0.774. According to the optimal cut-off value of NLR（2.34），solid tumor patients were classified into high NLR（NLR>2.34） group and low NLR（NLR≤2.34） group. C+++ompared with low NLR group，T helper cells，cytotoxic T cells，NK cells and double-negative T cells were decreased in high NLR group（P<0.05），while B cells were increased（P=0.001），and there was no statistical significance in double-positive T cells（P=0.676）. NLR was a risk factor for distant metastasis in different types of solid tumors（P<0.05）. The NLR of TNM stage Ⅳ patients was higher than those of TNM stage Ⅰ，Ⅱ and Ⅲ patients（P<0.001），and there was no statistical significance among TNM stage Ⅰ，Ⅱ and Ⅲ patients（P>0.05）. The DFS in high NLR group was shorter than that in low NLR group（P<0.001），and the incidence of distant metastasis in high NLR group was higher than that in low NLR group（P<0.001）. Conclusions NLR can predict the distant metastasis of different types of solid tumors. The increase of NLR may be related to the enhancement of immunosuppression in patients with solid tumors.

Key words: Neutrophil-to-lymphocyte ratio, Solid tumor, Distant metastasis