Pretreatment Neutrophil-to-Lymphocyte Ratio and Lymphocyte Recovery: Independent Prognostic Factors for Survival in Pediatric Sarcomas

J Pediatr Hematol Oncol. 2017 Oct;39(7):538-546. doi: 10.1097/MPH.0000000000000911.


Background: Pretreatment neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) recovery have been shown to be associated with prognosis in several types of cancer in adults. However, evidence in pediatric cancer is scarce. The aim of our study was to evaluate whether pretreatment NLR and lymphocyte recovery are prognostic factors in pediatric sarcomas.

Materials and methods: Study participants were identified from a retrospective cohort of 100 children with osteosarcoma (n=55), rhabdomyosarcoma (n=22), and Ewing sarcoma (n=23). Data for the hematological variables were obtained from medical records and analyzed with other known prognostic factors in univariate and multivariate analyses.

Results: In multivariate analysis, NLR>2 was an independent prognostic factor for OS in patients with osteosarcoma (hazard ratio [HR], 2.27, 95% confidence interval [CI], 1.07-5.30; P=0.046) along with metastatic disease and poor histologic response; as well as in patients with rhabdomyosarcoma (HR, 4.76, 95% CI, 1.01-22.24; P=0.0237) along with metastatic disease and risk group. ALC recovery correlated for inferior OS in osteosarcoma (HR, 3.34, 95% CI, 1.37-8.12; P=0.008) and rhabdomyosarcoma (HR, 3.89; 95% CI, 1.01-14.89; P=0.0338).

Conclusions: Our study confirms that NLR and ALC recovery are independent prognostic factors for pediatric sarcomas, implying an important role of immune system in survival. Clinical utility of these prognostic biomarkers should be validated in larger pediatric studies.

MeSH terms

  • Biomarkers
  • Child
  • Cohort Studies
  • Female
  • Humans
  • Leukocyte Count
  • Lymphocytes / pathology*
  • Male
  • Neoplasm Metastasis
  • Neutrophils / pathology*
  • Osteosarcoma / drug therapy
  • Osteosarcoma / mortality
  • Prognosis*
  • Retrospective Studies
  • Rhabdomyosarcoma / drug therapy
  • Rhabdomyosarcoma / mortality
  • Sarcoma / blood
  • Sarcoma / diagnosis*
  • Sarcoma / mortality
  • Sarcoma / pathology
  • Sarcoma, Ewing / drug therapy
  • Sarcoma, Ewing / mortality
  • Survival Rate


  • Biomarkers