The role of neutrophil to lymphocyte ratio in predicting lung metastasis in giant cell tumor of the extremities

M.P. Johan, I.A. Paturusi, H. Yurianto, M.A. Usman, J. Arifin, M.A. Abidin, M.A. Kawilarang, D. Kennedy

Department of Orthopedics and Traumatology, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia. muhpjo@gmail.com

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• Oncology
• Respiratory Medicine

OBJECTIVE: Inflammation has a vital role in tumor development and metastasis. Changes in blood count parameters have been associated with tumor prognosis. We aimed to evaluate the prognostic significance of neutrophil to lymphocyte ratio (NLR) in predicting lung metastasis of giant cell tumors of the bone (GCTB) of the extremities.

PATIENTS AND METHODS: 34 GCTB patients (22 males and 12 females) were included in the study. Patients were divided into two groups. The metastasis group (n = 7) included GCTB patients with lung metastasis, while the non-metastasis group (n = 27) included those without lung metastasis. Descriptive statistics and frequency distribution were calculated [age, white blood cell (WBC), neutrophil, lymphocyte, platelets, neutrophil to lymphocyte ratio (NLR), and platelets to lymphocytes ratio (PLR)]. Continuous normal variables were expressed as mean ± standard deviation and compared using Student’s t-tests. The receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of NLR and PLR to predict lung metastasis. The factors were considered to be statistically significant at p < 0.05.

RESULTS: There were no significant differences between the lymphocyte count (1.81 vs. 2.23 103/mm3), platelet count (436 vs. 364 103/mm3), and PLR values (247 vs. 190) of the two groups (p > 0.05). The WBC count (11.8 vs. 8.95 103/mm3), neutrophil count (8.78 vs. 5.69 103/mm3), and NLR levels (5.45 vs. 2.81) (p < 0.05) were significantly higher in the metastasis group. The presence of an NLR cut-off value of 3.7 significantly predicted the existence of lung metastasis (AUC = 0.857 [95%CI = 0.714-1], p = 0.004) with a sensitivity of 85% and specificity of 82%.

CONCLUSIONS: NLR may serve as a promising prognostic marker for predicting lung metastasis in GCTB patients.

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