الفهرس 
Impact of neutrophil to lymphocyte ratio on response to neoadjuvant chemotherapy in solid tumors
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Abstract
Background:
The neutrophil-to-lymphocyte ratio (NLR) is a promising prognostic factor in solid tumors. The
primary objective of this study was to investigate the ability of NLR to predict disease-free survival
(DFS) radiological response and pathological response in patients with solid tumors treated with
neoadjuvant chemotherapy (NAC) and to assess the relevance of an optimal unified NLR cut-off
value across multiple tumors in the neoadjuvant setting. Peripheral blood-derived
inflammation-based scores such as the Lymphocyte monocyte ratio (LMR) and
platelet–lymphocyte ratio (PLR) have recently also been proposed as prognostic markers in solid
tumors. We aimed to investigate the effect of LMR, and PLR on clinical outcomes in solid tumors
cases receiving neoadjuvant.
Methods
Data from the National cancer institute of Egypt Registry from January 2017 and December 2017
were reviewed. Of the 4327 records reviewed, we included 317 patients who completed
neoadjuvant therapy and underwent radical treatment afterward with an available differential blood
count on record.
Results:
The median age was 50 years ranging from 18 to 75. Breast cancer patients were 59% (N=187) ,
Bladder cancer cases 11% (N=11%), osteosarcoma 8%(N= 26) , Mesothelioma 7.6% (N=24) ,
ovarian cancer 6% (N=19) , lung cancer 6% (N=18) and gastric cancer 2 %(N= 8 ) . There was no
statistically significant effect of pretreatment NLR on DFS (p=0.497) , radiological response
(p=0.336 ) , pathological response (p=0.936 ) and pathological complete remission (pCR)
(p=0.473) . there was no statistically significant effect of pretreatment PLR and LMR on DFS
(p=0.25, p=0.24 respectively ). Similarly PLR and LMR did not affect radiological response
(p=0.126 , p=0.257 respectively) and pathological response (p=0.184 , p= 0.503 respectively ).
Dynamic changes in NLR, PLR, and LMR through neoadjuvant did not predict radiological
response disease response ( p =0.59, 0.215, 0.41 respectively ) , Nor did it predict pathological
response ( p =0.252, 0.0.544, 0.334 respectively ).
Dynamic changes in NLR , PLR, and LMR did not affect 3 year DFS ( p =0.112, 0.4, 0.778
respectively ).
Conclusion:
NLR and CBC-derived blood markers are potentially powerful tools in cancer and oncology Stronger evidence is needed before actual real-life uses are proposed in clinical practice.
Prospective marker studies could help explore the magnitude of NLR and inflammatory markers
and their incorporation in prognostic and predictive scores.