What is the clinical evidence from this study?

Study design: Cohort. Population: Cancer survivors (n=4974). Intervention: Elevated neutrophil-to-lymphocyte ratio (NLR) vs. Lower neutrophil-to-lymphocyte ratio. Primary outcome: Cardiovascular mortality (HR 1.14, 95% CI 1.08-1.21, p=<0.001).

September 9, 2024Scientific Reports24 citationsOpen Access

Neutrophil-to-lymphocyte ratio as a predictor of cardiovascular mortality in cancer survivors

Q: What are the key findings of this study?

Each unit increase in the neutrophil-to-lymphocyte ratio was significantly associated with a 14% increased risk of cardiovascular mortality (HR 1.14) among cancer survivors.

YHYan He XLXing Liu MWMin Wang

Key Result

Each unit increase in the neutrophil-to-lymphocyte ratio was significantly associated with a 14% increased risk of cardiovascular mortality (HR 1.14) among cancer survivors.

Study Design

Type

Cohort (n=4,974)

Structured PICO

Does an elevated neutrophil-to-lymphocyte ratio predict increased cardiovascular mortality in cancer survivors?

Population

4,974 cancer survivors from the NHANES dataset were followed for a median of 7.66 years to evaluate the prognostic significance of the neutrophil-to-lymphocyte ratio on mortality.

Exposure

Elevated neutrophil-to-lymphocyte ratio (NLR ≥ 2.61)

Comparator

Lower neutrophil-to-lymphocyte ratio (NLR < 2.61)

Outcome

Cardiovascular mortalityhard clinical

An elevated neutrophil-to-lymphocyte ratio (≥2.61) serves as a significant prognostic biomarker for increased cardiovascular and all-cause mortality among cancer survivors.

Main Result

Hazard Ratio: 1.14 (95% CI 1.08–1.21)

p-value: p=<0.001

Limitations

Retrospective design limits the ability to infer causality between elevated NLR levels and increased cardiovascular mortality.
Reliance on self-reported cancer diagnoses may not capture all nuances of disease type, stage, or treatment history.
Lack of detailed information on cancer staging, specific treatment modalities received, and concomitant medication use.
Cross-sectional design of NHANES prevents ascertaining the timing of NLR measurement relative to cancer diagnosis and treatment.
Missing data on other potentially relevant biomarkers like C-reactive protein, N-terminal pro-B-type natriuretic peptide, and troponin.

Abstract

This study aims to evaluate the neutrophil-to-lymphocyte ratio (NLR) as a predictive biomarker for cardiovascular mortality among cancer patients, utilizing data from the National Health and Nutrition Examination Survey (NHANES). From the NHANES dataset (2007-2018), we analyzed 4974 cancer survivors, investigating the prognostic significance of NLR for all-cause, cardiovascular, and cancer-specific mortality. Survival outcomes were analyzed using Cox regression and Kaplan-Meier methods. Optimal NLR cutoffs were identified as 2.61 for differentiating the higher NLR group from lower NLR group. Elevated NLR levels significantly correlated with increased all-cause mortality (HR 1.11, 95% CI 1.07-1.14, P < 0.001) and cardiovascular mortality (HR 1.14, 95% CI 1.08-1.21, P < 0.001) in adjusted models. Subgroup analyses revealed that age, sex, smoking status, and hypertension significantly influence NLR's association with cardiovascular mortality. Specific cancers including breast, prostate, non-melanoma skin, colon and melanoma experience increased all-cause and cardiovascular mortality in the higher NLR group compared to lower NLR group. Elevated NLR is a significant predictor of increased mortality in cancer patients, particularly for cardiovascular outcomes. These findings support that NLR acts as a pivotal prognostic tool with significant implications for clinical practice in the realm of cardio-oncology.

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