Pretreatment neutrophilto lynphocyte ratio is a predictor of event free survival in ewing sarcoma family of tumors – an analysis of 330 patients

Abstract

Background/Objectives: Ewing sarcoma family tumour (ESFT) is a systemic disease and inflammatory in nature. Inflammatory biomarkers have been identified as prognostic marker in various malignancies including sarcoma. Here we have evaluated the prognostic implication of pretreatment neutrophil to lymphocyte ratio (NLR) in ESFT. Design/Methods: We have calculated baseline NRL from peripheral blood parameters in 330 patients of ESFT treated with uniform chemotherapy protocol in our institution from June’2003 to Nov’2011. Treatment protocol consists of neoadjuvant chemotherapy followed by surgery and/or radiotherapy as local treatment modality and adjuvant chemotherapy. NLR was dichotomized as high and low with high NLR defined as value over the median. Data was censored on 30th Jan’2016. Results: Median age was 15 years (range: 1-55) with male: female ratio of 239:91. Fortyone percent (n=136) patients had metastasis at presentation. Most common sites of tumour were long bones in 133 (40%), thorax in 66 (20%) and abdomen-pelvis in 57 (17%) patients. Ninety-seven (29%) patients had systemic symptoms at presentation. Median NLR was 1.48 (range: 0.08-7.22). High NLR was associated with older age (p=0.004), female sex (p=0.02), high WBC count (p=0.02), and low serum albumin (p=0.02). In the whole cohort, high NLR (>1.48) emerged as independent prognostic factor predicting inferior EFS (Hazard ratio-1.62, p=0.005) along with metastasis at presentation (p<0.001) and high lactate dehydrogenase level (p=0.001), in multivariate analysis. In the cohort of localized disease, high NLR didn’t predicted EFS whereas in cohort of metastatic disease, high NLR independently predicted inferior EFS (Hazard ratio-1.76, p=0.02), in multivariate analysis. Conclusion: High pretreatment NLR emerged as independent prognostic factor predicting inferior EFS in patients with ESFT, especially in those with metastasis at presentation. It is an easily available and cost effective biomarker. Prognostic nature of NLR should be evaluated in a prospective study and if proven, should be included in prognostic model to tailor therapy.