Monitoring cancer using the CBC- “complete blood count” lab test, aka Hematology Profile
This cheap and routine blood test can provide valuable feedback on how the patient is doing, filling in gaps between scans and other more direct tests of tumor growth. It can show very soon after starting a new program if it is working as intended. These ratios change quickly, and can be checked as often as every 2 weeks. If both ratios are trending positively, continue, but if both are trending negatively, re-evaluate care or order other tests. If they are just going up and down randomly with no definite trend, ignore the fluctuations. Chemotherapy or other immune suppressive therapies such as steroids may make it harder to interpret, but over all it is of great utility. It helps stratify the patient as low, moderate or high risk, informing care choices.
Neutrophil Lymphocyte Ratio (NLR): A potential screening test for a “non-healing wound”
• Divide the neutrophil count by the lymphocyte count.
• Ideally pre-operative NLR is under 1.88, up to 2.3 is OK.
• Neutrophil count to absolute lymphocyte count rising to greater than 3:1 is at risk.
• Over 5:1 is very high risk.
• Any consistent trend downward in the NLR has prognostic significance, ie shows improvement in cancer control. Results can be skewed in chemotherapy, infections, and other causes.
Lymphocyte to Monocyte ratio (LMR): Monocyte counts may rise before diagnosis or relapse, and may rise further as disease progresses. More reliable than the NLR.
• Divide the lymphocyte count by the monocyte count.
• A lymphocyte to monocyte ratio (LMR) of 6 or greater is ideal.
• Above 4 can be OK.
• 2 to 3 is unfavourable
• Trends up or down in LMR have prognostic value. At least 3 readings are needed to identify true trends. Going up is a sign of improving cancer control.
References for Monitoring Immune Cell Ratios:
Annaballi, Hofhaus Marchesi, et al., The Neutrophil/Lymphocyte Ratio ≥ 3.5 is a Prognostic Marker in Diffuse Large B-Cell Lymphoma: A Retrospective Analysis from the Database of the Italian Regional Network ‘Rete Eematologica del Lazio per I Linfomi’(RELLI), Leuk. Lymphoma 2019; doi: 10.1080/10428194.2019.1633628.
Bartlett, Flynn, Panageas, et al., High Neutrophil-to-Lymphocyte Ratio (NLR) Is Associated With Treatment Failure and Death in Patients Who Have Melanoma Treated With PD-1 Inhibitor Monotherapy, Cancer 2019 Oct 04;[EPub Ahead of Print].
Cupp, Cariolou, Tzoulaki, et al., Neutrophil to Lymphocyte Ratio and Cancer Prognosis: An Umbrella Review of Systematic Reviews and Meta-Analyses of Observational Studies, BMC Med. 2020; 18: 360.
Fest, Ruiter, Koerkamp, et al., The Neutrophil-to-Lymphocyte Ratio is Associated with Mortality in the General Population: The Rotterdam Study, Euro. J. Epidemiol. 2019; 34 (5): 463-470.
Gago-Dominguez, et al., Neutrophil to Lymphocyte Ratio and Breast Cancer Risk: Analysis by Subtype and Potential Interactions, Sci. Rep. 2020; 10: 13203.
Geng, Fu, Fu & Zhang, Neutrophil to Lymphocyte Ratio is a Prognostic Factor for Disease Free Survival in Patients with Breast Cancer Underwent Curative Resection, Medicine 2018; 97: 35 (e11898).
Goto ,Kashiwagi, Aano, et al., Predictive Value of Lymphocyte-to-Monocyte Ratio in the Pre-Operative Setting for Progression of Patients with Breast Cancer, BMC Cancer 2018; 18: 1137.
Kijima, Arigami, Uchikado, et al., Combined Fibrinogen and Neutrophil-Lymphocyte Ratio As A Prognostic Marker of Advanced Esophageal Squamous Cell Carcinoma, Cancer Science 2017; 108: 193-199.
Mallapa, Sinha, Gupta & Chadwick, Preoperative Neutrophil to Lymphocyte Ratio >5 is a Prognostic Factor for Recurrent Colorectal Cancer, Colorectal. Dis. J. Assoc. Coloproctol. GB & Ireland 2013; 15 (3): 323-328.
May, Marques, Reddy & Gangaraju, Three Neglected Numbers in the CBC: The RDW, MPV and NRBC Count,, Clev. Clin. J. Med. 2019; 86 (3): 167-172.
Moon, Noh, Cho, et al., Prediction of Late Recurrence in Patients with Breast Cancer: Elevated Neutrophil to Lymphocyte Ratio (NLR) 5 Years After Diagnosis and Late Recurrence, Breast Cancer (Tokyo) 2020; 27 (19): 54-61.
Mustaq, Ali & Raza, Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Myelodysplastic Syndromes, J. Clin. Oncol. 2016; 34 (15) suppl: 7062.
Pascual-Gonzalez, et al., Defining the Role of Neutrophil-to-Lymphocyte Ratio in COPD: A Systematic Literature Review, Int. J. COPD 2018; 13: 3651-3662.
Salati, Caputo, Cunningham, et al., The A.L.A.N. Score Identifies Prognostic Classes in Advanced Biliary Cancer Patients Receiving First-Line Chemotherapy, Eur. J. Cancer 2019; 117(xx): 84-90.
Song, Graubad, Rabkin & Engels, Neutrophil to Lymphocyte Ratio and Mortality in the United States General Population, Sci. Rep. 2021; 11: 464.
Wu, Zhang, Qin, et al, Mean Platelet Volume/Platelet Count Ratio in Colorectal Cancer: A Retrospective Clinical Study, BMC Cancer 2019; 19: 314.
Neil McKinney, ND © May, 2023