Association of Neutrophil to Lymphocyte Ratio with Clinicopathological Features in Breast Cancer

Background: Even with the advances in the diagnosis and treatment of breast malignancy, to date breast cancer is still the number one cause of death in women in Pakistan. Various researches proved that prolonged inflammatory conditions played a part in progression of malignancy, these factors also promote growth leading to poor prognosis. This study shows the analysis of peripheral blood neutrophil to lymphocyte ratio (NLR) in breast malignancy and its association with disease characteristics Methods: The cross-sectional study was done in Liaquat National Hospital and Medical College, Karachi. Pakistan. A total of 2059 female patient population with breast cancer hit the criteria. The patients were asked to undergo a complete blood count with leukocyte differential preoperatively. Patients’ complete data was collected preoperatively including specimen-related histopathology reports. Patients excluded were those with clinical evidence of ongoing active infection/sepsis, any blood disorders, any previous or ongoing inflammatory or autoimmune diseases, and steroid therapy. Results: No association was seen between the NLR with the age, grade, and luminal subtypes. However, NLR had a significant association with the size and stage of the disease. With an increase in NLR, the stage increased. Conclusion: The study identifies the usefulness of the NLR ratio, which in the future can be used as a diagnostic adjunct in the preoperative workup of patients with breast malignancy.

Paediatric Fungal Keratitis：A Case Series of 45 Children Presenting to a Tertiary Referral Centre

Purpose：To analyze the etiology, characteristics, and treatment outcomes of paediatric fungal keratitis in northern China.Methods：The medical records of children (< 18 years old) diagnosed with fungal keratitis at the Shandong Eye Institute from 1996 to 2017 were reviewed for demographic features, risk factors, seasonal variation, clinical characteristics, laboratory findings, and treatment strategies.Results：Forty-five children (46 eyes) were included. Fungal keratitis in children accounted for 16.4% of all of the children with infectious keratitis, which was lower than that in adults (59.4%, p < 0.001). Unexplained fungal keratitis accounted for 26.1%. Plant trauma (23.9%) and wind and sand into the eyes (21.7%) ranked second and third, respectively. Fusarium fungi infection was found in 69.9%, and 31.0% were infected by Aspergillus fungi. The corneal ulcer area was positively correlated with a peripheral blood neutrophil/lymphocyte ratio (NLR) at the first visit (r = 0.310, p = 0.036). Voriconazole had the highest drug sensitivity rate. A total of 67.4% (31 eyes) underwent therapeutic keratoplasty (PKP 21 eyes; LKP 10 eyes). The recurrence rate was 3.2% (due to an Aspergillus infection). The best corrected visual acuity (BCVA) after treatment in children ≤ 8 years (median 20/60) was lower than the BCVA in children > 8 years (median 20/50, p = 0.035).Conclusions：Fungal keratitis are less common in children than in adults. The main infection was due to Fusarium fungi. The preferred antifungal drug was voriconazole. LKP treatment is preferred for Fusarium infection keratitis.

Significance of Preoperative Peripheral Blood Neutrophil-lymphocyte Ratio in Predicting Postoperative Survival in Patients with Multiple Myeloma Bone Disease

Background: By observing the change characteristics of NLR at different stages after operation, to make a preliminary analysis of the effect of operation on the immune status of MM patients and study the prognostic value of peripheral blood NLR in predicting the treatment of multiple myeloma bone disease (MMBD).Method: The clinical data of 82 MMBD patients who underwent operations in our hospital were collected, which to analyze the effect of preoperative peripheral blood NLR on the prognosis of MMBD patients; Peripheral blood lymphocyte percentage was taken as the major observation indicator to analyze the change characteristics of the immune status of MM patients.Results: Data showed that the NLR cut-off values of the NLR≥3 group and NLR≥4 group were significantly correlated with POS. The POS of NLR≥3 patients (14.86±14.28) was significantly shorter than that of NLR＜3 patients (32.68±21.76). The lymphocyte percentage 1 week after operation (19.329±9.083) was significantly lower than that before operation (25.723±11.016). Survival analysis showed that postoperative chemotherapy and preoperative peripheral blood NLR were independent risk factors for POS.Conclusions: NLR was significant for the prediction of the POS of MMBD patients treated with operation, and MMBD patients with high preoperative NLR (NLR≥3) had a poorer prognosis and shorter POS. The immune status of MMBD patients was at a normal low level, and significantly declined after operation.Trial registration: The conducted study contains a retrospective analysis of medical records of our hospital database. Beijing Chao-yang Hospital Human Research Ethics Committee classifies this as a retrospective audit. The ethics approval and consent was given for the conducted retrospective data analysis.

Clinical implications of systemic and local immune responses in human angiosarcoma

Angiosarcomas are a rare subtype of soft-tissue sarcomas which exhibit aggressive clinical phenotypes with limited treatment options and poor outcomes. In this study, we investigated the clinical relevance of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic immune response, as well as its correlation with intra-tumoral immune profiles in a subgroup of cases (n = 35) using the NanoString PanCancer IO360 panel and multiplex immunohistochemistry. In the overall cohort (n = 150), angiosarcomas of the head and neck (AS-HN) comprised most cases (58.7%) and median overall survival (OS) was 1.1 year. NLR, classified as high in 78 of 112 (70%) evaluable patients, was independently correlated with worse OS (HR 1.84, 95%CI 1.18–2.87, p = 0.0073). Peripheral blood NLR was positively correlated with intra-tumoral NLR (tNLR) (Spearman’s rho 0.450, p = 0.0067). Visualization of tumor-infiltrating immune cells confirmed that tNLR scores correlated directly with both neutrophil (CD15+ cells, rho 0.398, p = 0.0198) and macrophage (CD68+ cells, rho 0.515, p = 0.0018) cell counts. Interestingly, tNLR correlated positively with oncogenic pathway scores including angiogenesis, matrix remodeling and metastasis, and cytokine and chemokine signaling, as well as myeloid compartment scores (all p < 0.001). In patients with documented response assessment to first-line chemotherapy, these pathway scores were all significantly higher in non-responders (47%) compared to responders. In conclusion, systemic and local immune responses may inform chemotherapy response and clinical outcomes in angiosarcomas.