Neutrophil to iymphocyte ratio: Does it really differentiate between papillary thyroid carcinomas and multinodular goiter

Hakan Bölükbaşı; Serhan Yılmaz

doi:10.19161/etd.888863

EN TR

Neutrophil to iymphocyte ratio: Does it really differentiate between papillary thyroid carcinomas and multinodular goiter

Abstract

Aim: The aim of this study is to reveal the value of preoperative neutrophil lymphocyte ratio in differential diagnosis between papillary thyroid carcinoma, papillary thyroid microcarcinoma and benign multinodular goiter. Materials and methods: Patients with papillary thyroid carcinoma, papillary thyroid microcarcinoma, and multinodular goiter whose histopathological diagnosis was confirmed by postoperative pathology reports were included in the study. Results: The TSH levels were statistically significantly different among the groups (p < 0.001). The intergroup comparison revealed that the TSH levels were significantly lower in the multinodular goiter group compared to the papillary thyroid carcinoma and papillary thyroid microcarcinoma groups (p < 0.001, p0.001). The mean neutrophil count was 4.98 ± 1.19 in the papillary thyroid carcinoma group, 4.68 ± 1.33 in the papillary thyroid microcarcinoma group, and 4.59 ± 1.40 in the multinodular goiter group. The neutrophil counts of the groups were found to be significantly different (p = 0.013). The papillary thyroid carcinoma group had a significantly higher neutrophil count than the multinodular goiter group. The mean Neutrophil lymphocyte ratio value was 2.20 ± 0.71 in the papillary thyroid carcinoma group and 2.02 ± 0.92 in the multinodular goiter group. Neutrophil lymphocyte ratio values were significantly higher in the the papillary thyroid carcinoma group (p = 0.006). Conclucion: We believe that increased neutrophil lymphocyte ratio may be an indicator of underlying malignant disease in patients with thyroid nodules in the preoperative period.

Keywords

Nötrofil lenfosit oranı: Papiller tiroit kanserini multinodüler guatrdan gerçekten ayırt eder mi?

Öz

Amaç: Bu çalışmanın amacı, preoperatif nötrofil lenfosit oranının papiller tiroit karsinomu, papiller tiroit mikrokarsinomu ve benign multinodüler guatr arasında ayırıcı tanıdaki değerini ortaya koymaktır. Metod: Çalışmaya, total tiroidektomi uygulanan ve histopatolojik tanıları postoperatif patoloji raporları ile doğrulanan papiller tiroit karsinomu, papiller tiroit mikrokarsinomu ve multinodüler guatr hastaları dahil edildi. Bulgular: Ortalama TSH düzeyi papiller tiroit karsinomu grubunda 1.85 ± 1.18 mIU / L, papiller tiroit mikrokarsinomu grubunda 1.78 ± 1.04 mIU / L ve multinodüler guatr grubunda 1.15 ± 0.91 mIU / L idi. TSH düzeyleri gruplar arasında istatistiksel olarak anlamlı farklıydı (p <0,001). Gruplar arası karşılaştırma, multinodüler guatr grubunda TSH seviyelerinin papiller tiroit karsinomu ve papiller tiroit mikrokarsinomu gruplarına kıyasla önemli ölçüde daha düşük olduğunu ortaya çıkardı (p <0.001, p0.001). Ortalama nötrofil sayısı papiller tiroit karsinomu grubunda 4,98 ± 1,19, papiller tiroit mikrokarsinomu grubunda 4,68 ± 1,33 ve multinodüler guatr grubunda 4,59 ± 1,40 idi. Grupların nötrofil sayıları anlamlı olarak farklı bulundu (p = 0,013). Papiller tiroit karsinomu grubu, multinodüler guatr grubuna göre önemli ölçüde daha yüksek nötrofil sayısına sahipti Ortalama nötrofil lenfosit oranı, papiller tiroit karsinomu grubunda 2.20 ± 0.71 ve multinodüler guatr grubunda 2.02 ± 0.92 idi. Nötrofil lenfosit oranı papiller tiroit karsinomu grubunda anlamlı olarak yüksekti (p = 0,006). Sonuç: Ameliyat öncesi dönemde tiroit nodülü olan hastalarda nötrofil lenfosit oranı artışının altta yatan kötü huylu hastalığın bir göstergesi olabileceğine inanıyoruz.

Anahtar Kelimeler

References

Polyzos SA, Kita M, Avramidis A Thyroid nodulesstepwise diagnosis and management. Hormones 2007; 6: 101-19.
Luo J, McManus C, Chen H, et al. Are there predictors of malignancy in patients with multinodular goiter? J Surg Res 2012; 174, 207-10.
Dean, D. S. & Gharib H. Epidemiology of thyroid nodules. Best practice & research. Clinical endocrinology & metabolism 2008; 22: 901–11, doi: 10.1016/j.beem.09.019. Erdem H, Gundogdu C, Sipal S Correlation of E-cadherin, VEGF, COX-2 expression to prognostic parameters in papillary thyroid carcinoma. Exp Mol Pathol 2011; 90: 312–17.
Cho JS, Yoon JH, Park MH, et al. Age and prognosis of papillary thyroid carcinoma: Retrospective stratification into three groups. J Korean Surg Soc 2012; 83: 259–66.
Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States 1973-2002. JAMA 295:2164–67.
Yu XM, Wan Y, Sippel RS, et al. Should all papillary thyroid micro- carcinomas be aggressively treated? An analysis of 18,445 cases. Ann Surg 2011; 254: 653–60.
Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation. Nature 2008; 454: 436–44.
Guarino V, Castellone MD, Avilla E, et al. Thyroid cancer and inflammation. Mol Cell Endocrinol 2010; 321: 94–02.

Moore MM, Chua W, Charles KA, et al. Inflammation and cancer: Causes and consequences. Clin Pharmacol Ther 2010; 87: 504–08.
Rashid F, Waraich N, Bhatti I, et al. Pre-operative elevated neutrophil: lymphocyte ratio does not predict survival from oesophageal cancer resection. World J Surg Oncol 2010; 8: 1.
Proctor M. J, McMillan DC, Morrison DS et al., A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. British journal of cancer 2012;107, 695–99, doi: 10.1038/bjc.2012.292
Shimada H, Takiguchi N, Kainuma O, et al. High preoperative neutrophil-lymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer 2010; 13: 170–76. Kisucka J, Butterfield CE, Duda DG, et al. Platelets and platelet adhesion support angiogenesis while preventing excessive hemorrhage. Proc Natl Acad Sci USA 2006; 103, 855-60.
Okuturlar Y, Gunaldi M, Tiken, et al. Utility of peripheral blood parameters in predicting breast cancer risk. Asian Pac J Cancer Prev 2015; 16 (6): 2409–12.
Pujol P, Daures J P, Nsakala N, et al. Degree of thyrotropin suppression as a prognostic determinant in differentiated thyroid cancer. J Clin Endocrinol Metab 1996; 81:4318 –23.
Seretis C, Gourgiotis S, Gemenetzis G, et al. The significance of neutrophil/lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters: a pilot study. American journal of surgery 2013; 205: 691–96, doi: 10.1016/j.amjsurg.2012.08.006.Volume 60 Issue 1, March 2021 / Cilt 60 Sayı 1, Mart 2021 69
18. Liu J. Du J, Fan J, et al. The Neutrophil-to-Lymphocyte Ratio Correlates with Age in Patients with Papillary Thyroid Carcinoma. ORL; journal for oto-rhino-laryngology and its related specialties 2015; 77: 109–16, doi: 10.1159/000375534
Kim SM. Kim EH, Kim BH, et al. Association of the Preoperative Neutrophil-to-lymphocyte Count Ratio and Platelet-to-Lymphocyte Count Ratio with Clinicopathological Characteristics in Patients with Papillary Thyroid Cancer. Endocrinology and metabolism 2015; 30, 494–01, doi: 10.3803/EnM.2015.30.4.494
Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol 2010; 6: 149–63.
Kwon HC, Kim SH, Oh SY, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers 2012; 17: 216-22.
Coussens LM, Werb Z. Inflammation and cancer. Nature 2002; 420: 860–867.
De Visser KE, Eichten A, Coussens LM. Paradoxical roles of the immune system during cancer development. Nat Rev Cancer 2006; 6: 24–37.
Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratis lek listy 2001; 102: 5-14.
Romano F, Uggeri F, Crippa S, et al. Immunodeficiency in different histotypes of radically operable gastrointestinal cancers. J Exp Clin Cancer Res 2004; 23 (2): 195–00.
Templeton AJ, McNamara MG, Seruga B, et al. Prognostic role of neutrophil-to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 2014: 106: dju124.
Kocer D, Karakukcu C, Karaman H et al. May the neutrophil/ lymphocyte ratio be a predictor in the differentiation of different thyroid disorders? Asian Pac J Cancer Prev 2015; 16: 3875-79.
Gong W, Yang S, Yang X, et al. Blood preoperative neutrophil-to-lymphocyte ratio is correlated with TNM stage in patients with papillary thyroid cancer. Clinics (Sao Paulo) 2016; 71: 311–14.
Liu CL, Lee JJ, Liu TP, et al. Blood neutrophilto-lymphocyte ratio correlates with tumor size in patients with differentiated thyroid cancer. J Surg Oncol 2013; 107: 493-97.
Jin J, Machekano R, McHenry CR. The Utility of Preoperative Serum Thyroid-Stimulating Hormone Level for Predicting Malignant Nodular Thyroid Disease. Am J Surg 2010; 199 (3): 294-97; discussion 298. doi: 10.1016/j.amjsurg.2009.08.028.
Kim D, Park JW Clinical implications of preoperative thyrotropin serum concentrations in patients who underwent thyroidectomy for nonfunctioning nodule (s). J Korean Surg Soc 2013; 8515–9.
Klinger MH, Jelkmann W. Role of blood platelets in infection and inflammation. J Interferon Cytokine Res 2002; 22: 91322.

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Hakan Bölükbaşı ^*
0000-0002-4904-9302
Türkiye

Serhan Yılmaz
0000-0002-5612-5932
Türkiye

Publication Date

March 31, 2021

Submission Date

October 20, 2020

Acceptance Date

December 16, 2020

Published in Issue

Year 2021 Volume: 60 Number: 1

DOI

https://doi.org/10.19161/etd.888863

IZ

https://izlik.org/JA24TY22HY

Cite

RIS / Bibtex

Vancouver

1.Hakan Bölükbaşı, Serhan Yılmaz. Neutrophil to iymphocyte ratio: Does it really differentiate between papillary thyroid carcinomas and multinodular goiter. EJM. 2021 Mar. 1;60(1):63-9. doi:10.19161/etd.888863

Cited By

Diagnostic accuracy of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in differentiating thyroid tumors: A systematic review and meta-analysis

PLOS One

https://doi.org/10.1371/journal.pone.0322382