High Neutrophil-to-lymphocyte Ratio Predicts Survival in Thyroid Cancer Patients on Tyrosine Kinase Inhibitor Therapy

  • BACKGROUND: Tyrosine kinase inhibitors (TKI) improve patient survival with progressing thyroid cancer. However, a significant number of patients still fail to benefit from this treatment. This study evaluated the neutrophil-to-lymphocyte ratio (NLR) in advanced thyroid carcinoma patients as a predictor of survival after TKI initiation.

    METHODS: We retrospectively collected data on 72 patients treated with TKI between May 2015 and August 2018. Fifty-two patients had differentiated thyroid carcinoma (DTC), 19 patients had anaplastic carcinoma (ATC) and one had squamous cell carcinoma. NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count.

    RESULTS:  Median NLR for all patients at initiation of TKI and for 39 patients who died at the time of death was 4.21 (range, 0.86-95.0) and 12.29 (range, 0.97-98.0). NLR at initiation of TKI was significantly higher in ATC (median 11.93, range 2.32-95) compared to DTC (3.55, 0.8-58.33). NLR more than 10 at TKI initiation was significantly associated with shorter overall survival compared with NLR less than 10 (P<.0001). In receiver operating characteristic curve analysis, cut-offs for DTC and ATC were 11.43 (P=0.0488, AUC 0.941) and 31.67 (P=0.0034, AUC 0.831) in patients who survived less than 6 weeks after TKI initiation, respectively.

    DISCUSSION & CONCLUSION : We might refer the patients whose NLR is more than 11.43 in DTC and those NLR is over 31.67 in ATC to a palliative care program. Further prospective study is warranted to develop a predictive algorithm to detect the optimal timing for starting and stopping TKI use.


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