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Lymphocyte - Neutrophil Ratio (NLR) in cancer patients

Bluebear21
  • 2 replies
  • 41 subscribers
  • 494 views

Hello

I am a  56 yr old female bladder cancer patient.  I was treated in 2021 for TCC pTa G1, with TURBT and a single post-op  instillation of Mitomycin C.  I have fortunately since been clear but am aware of the high reoccurrence rate of this cancer.  Due  to blood tests in connection with a minor health issue unconnected to my cancer, I am aware that I have had for several years (possibly longer, low lymphocytes (recently 0.9 - 1.1) and a NLR of 2 - 3.  

I am aware of recent research in peer reviewed medical journals that concludes that a NLR in this range is a statistical indicator of poorer prognosis in cancer patients and yet my doctor seems unconcerned and although the hospital consultant who ordered some of the most recent blood tests, noted my results and suggested to my doctor she may consider referring to me to haematology, she doesn’t feel this is warranted.  

I wanted to ask if NLR is recognised as a relevant indicator for disease (in my case recurrence) in cancer patients and whether, I should be worried. As my cancer was originally diagnosed by chance (scan for unrelated symptoms) and I have never had any of the recognised symptoms associated with it, I have ongoing anxiety about how I will know if it returns, at least until it has progressed as I believe I will not continue to be offered routine cystoscopies.

Thank you for your time.

Blue.

  • Hi Bluebear21,

    Thank you for contacting Macmillan Cancer Support. My name is David, one of the Cancer Information Nurse Specialists on the Macmillan Support Line.

    Sorry to hear about your non-muscle invasive bladder cancer. However, I am glad to know that this was detected early, treated appropriately and you are currently in the clear.

    It is only natural and very common that you have anxiety and continue to worry about cancer coming back. Understanding your uncertainty of the future may help you cope better.

    The important thing to remember is to keep all future appointments and report any symptoms you may have as early as possible.

    There appears to be little evidence to support the recent research you refer to. This may also require further research to validate its findings.

    It is not routinely used as a statistical indicator of poor prognosis either.

    Prognosis has many factors to consider, such as general medical condition, the extent of the cancer, does the person have any underlying conditions and how they respond to treatment.

    However, if you are referred onto a Haematologist, then they may wish to carry out further investigations for unexplained neutropenia as this could be for a number of reasons.

    Statistical information is useful in some instances. However, we must remember that they are averages based on large numbers of patients.

    They can’t predict exactly what will happen to you. No two patients are exactly alike and response to treatment also varies from one person to another.

    You may find the paper on The Median Isn’t the Message a useful insight into statistical information.

    Sometimes people gain strength in talking to others who may be in a similar situation to themselves. Our Bladder Cancer Forum may be a good place to start.

    Alternatively, Action Bladder Cancer UK and Fight Bladder Cancer are also good sources of information and support.

    If there is anything else we can help you with please feel free to get back in touch

     

    Best wishes

    David, Cancer Information Nurse Specialist

     

    You can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or send us an email.

     

    Ref/**

    DT/PG

  • in reply to David T - Macmillan

    Hi David

    Thank you so much for this.  I will certainly have a look at the paper you reference.

    i am a member of the bc forum and have found it very helpful and supportive.

    Thank you again.  Best wishes, Blue

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