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

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.

Early albumin use improves mortality in difficult to resuscitate burn patients.

BACKGROUND: The optimal resuscitation algorithm remains elusive for patients with a large burn injury. Recent reports from the military support that larger burns that do not respond well to ongoing lactated Ringer's solution resuscitation may improve with the use of 5% albumin and vasopressors. We hypothesized that the use of 5% albumin and vasopressors, as needed, would decrease complications of fluid resuscitation and burn mortality. METHODS: Fluid needs during the first 24 hours after burn injury, complications, and demographics were collected from all patients 12 years and older with burn size 20% or more of total body surface area admitted from 2003 to 2010. In March 2007, we changed our resuscitation to include the use of 5% albumin in the first 24 hours if the estimated fluid needs at 12 hours after burn would lead to a fluid volume of 6 mL/kg per percent burn at 24 hours. The patients treated before this change (Preprotocol) were compared with those treated after the guideline change (Postprotocol). RESULTS: The two groups were well matched for age, burn size, and inhalation injury. Ventilator days and mortality were decreased in the Postprotocol group. There was a trend toward less intravenous fluid use in the Postprotocol group where the use of albumin was higher. There was significantly less vasopressor infusion in the Postprotocol group. There was no statistical difference in the number of escharotomies performed or overall incidence of abdominal compartment syndrome, but no patient required open laparotomy in the Postprotocol group. CONCLUSION: An algorithm incorporating albumin use in the first 24 hours after burn injury was associated with the use of less vasopressor agents and lower mortality. Early albumin use was also associated with a shorter duration of mechanical ventilation in burn patients sustaining burns 20% or more total body surface area. LEVEL OF EVIDENCE: Therapeutic study, level IV.