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.
We performed an observational study in early breast, kidney, and lung cancers (357, 227, and 255 patients) with uni- and multivariate analyses (Cox model).
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).
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.
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.
- Breast Cancer Patient
- Circulate Tumour Cell
- Locoregional Recurrence
- Kidney Cancer