High neutrophil-lymphocyte ratio is not independently associated with worse survival or recurrence in patients with extremity soft tissue sarcoma

Erin A. Strong, Sandra H. Park, Cecilia G. Ethun, Bonnie Chow, David King, Meena Bedi, John Charlson, Harveshp Mogal, Susan Tsai, Kathleen Christians, Thuy B. Tran, George Poultsides, Valerie Grignol, J. Harrison Howard, Jennifer Tseng, Kevin K. Roggin, Konstantinos Chouliaras, Konstantinos Votanopoulos, Darren Cullinan, Ryan C. FieldsT. Clark Gamblin, Kenneth Cardona, Callisia N. Clarke

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Soft tissue sarcomas are a heterogenous group of neoplasms without well-validated biomarkers. Cancer-related inflammation is a known driver of tumor growth and progression. Recent studies have implicated a high circulating neutrophil-lymphocyte ratio as a surrogate marker for the inflammatory tumor microenvironment and a poor prognosticator in multiple solid tumors, including colorectal and pancreatic cancers. The impact of circulating neutrophil-lymphocyte ratio in soft tissue sarcomas has yet to be elucidated. Methods: We performed a retrospective analysis of patients undergoing curative resection for primary or recurrent extremity soft tissue sarcomas at academic centers within the US Sarcoma Collaborative. Neutrophil-lymphocyte ratio was calculated retrospectively in treatment-naïve patients using blood counts at or near diagnosis. Results: A high neutrophil-lymphocyte ratio (≥4.5) was associated with worse survival on univariable analysis in patients with extremity soft tissue sarcomas (hazard ratio 2.07; 95% confidence interval, 1.54–2.8; P < .001). On multivariable analysis, increasing age (hazard ratio 1.03; 95% confidence interval, 1.02–1.04; P < .001), American Joint Committee on Cancer T3 (hazard ratio 1.89; 95% confidence interval, 1.16–3.09; P = .011), American Joint Committee on Cancer T4 (hazard ratio 2.36; 95% confidence interval, 1.42–3.92; P = .001), high tumor grade (hazard ratio 4.56; 95% confidence interval, 2.2–9.45; P < .001), and radiotherapy (hazard ratio 0.58; 95% confidence interval, 0.41–0.82; P = .002) were independently predictive of overall survival, but a high neutrophil-lymphocyte ratio was not predictive of survival (hazard ratio 1.26; 95% confidence interval, 0.87–1.82; P = .22). Conclusion: Tumor inflammation as measured by high pretreatment neutrophil-lymphocyte ratio was not independently associated with overall survival in patients undergoing resection for extremity soft tissue sarcomas.

Original languageEnglish
Pages (from-to)760-767
Number of pages8
JournalSurgery (United States)
Issue number4
StatePublished - Oct 2020


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