LETTER TO THE EDITOR

The Neutrophil Lymphocyte Ratio in Patients with GlioblastomaMultiforme

Sevket Balta • Sait Demirkol • Cengiz Ozturk

Received: 12 July 2013 / Accepted: 31 December 2013 / Published online: 10 January 2014

� Springer Science+Business Media New York 2014

To the Editor,

We read with great interest the article ‘The association of

pre-treatment neutrophil to lymphocyte (N/L) ratio with

overall survival in patients with glioblastoma multiforme

(GBM)’ by Bambury et al. [1]. They aimed to assess the

prognostic impact of N/L ratio in a clinically annotated

cohort of GBM patients to see if this marker of host sys-

temic immunity independently predicted outcome. They

concluded that NLR may prove to be a useful addition to

predicting prognosis in GBM patients. Thanks to the

authors for their contribution.

A complete blood count is an easy examination tech-

nique that gives us information about the patient’s formed

blood contents: the red and white cells, the platelets, the

count and dimensions of subgroups of cells, and parameters

like the distribution weights, mean platelet volume [2]. In

recent years, N/L ratio has been proposed as a surrogate

marker for endothelial dysfunction and inflammation in

distinct populations and has prognostic and predictive

values [3]. Although white blood cells are in normal range,

subtypes of white blood cells may predict cardiovascular

mortality. However, sometimes acute conditions like bac-

terial or viral infections or drug treatments might effect

neutrophil and lymphocyte counts and so the ratio of these

two parameters might be changed. The acute disease situ-

ation may overlap the chronic ongoing inflammation. In

context, if the authors had mentioned these factors,it would

be useful.

Because hypertension, diabetes mellitus, metabolic

syndrome, left ventricular dysfunction and hypertrophy,

acute coronary syndromes [4], valvular heart disease,

congenital heart disease, abnormal thyroid function tests,

renal or hepatic dysfunction, known malignancy, local or

systemic infection, previous history of infection

(\3 months), inflammatory diseases [5], and any medica-

tion that related to inflammatory condition of patients, the

measurement of N/L ratio can be potentially affected and

fixed run-on in all of above conditions [6]. For these rea-

sons, it would be better, if the authors had mentioned these

factors.

We believe that these findings will elucidate further

studies about N/L ratio as a surrogate marker of prognosis

in GBM patients. Finally, N/L ratio itself alone without

other inflammatory markers may not give information to

clinicians about the chronic endothelial inflammatory

condition of the patient [7]. So, we think that it should be

evaluated together with other serum inflammatory

markers.

Conflict of interest There is no conflict of interests.

References

1. Bambury RM, Teo MY, Power DG, Yusuf A, Murray S, Battley JE

et al (2013) The association of pre-treatment neutrophil to

lymphocyte ratio with overall survival in patients with glioblas-

toma multiforme. J Neurooncol 114(1):149–154

2. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR

et al (2005) Which white blood cell subtypes predict increased

cardiovascular risk? J Am Coll Cardiol 45(10):1638–1643

3. Demirkol S, Balta S, Unlu M, Arslan Z, Cakar M, Kucuk U et al

(2012) Neutrophils/lymphocytes ratio in patients with cardiac

syndrome X and its association with carotid intima-media

S. Balta (&) � S. Demirkol � C. Ozturk

Department of Cardiology, Gulhane School of Medicine,

Gulhane Medical Academy, Tevfik Saglam St.,

06018 Etlik-Ankara, Turkey

e-mail: drsevketb@gmail.com

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J Neurooncol (2014) 117:195–196

DOI 10.1007/s11060-013-1355-4

thickness. Clin Appl Thromb Hemost. doi:10.1177/107602961246

7227

4. Ulusoy R, Yokusoglu M, Kirilmaz A, Nevruz O, Baysan O,

Kilicaslan F et al (2011) Mean platelet volume in ST elevation and

non-ST elevation myocardial infarction. Gulhane Med J 53(2):

114–118

5. Balta S, Demirkol S, Cakar M, Arslan Z, Unlu M, Celik T (2013)

Other inflammatory markers should not be forgetten when

assessing the neutrophil to lymphocyte ratio. Clin Appl Thromb

Hemost 19(6):693–694

6. Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G et al (2013)

Neutrophil to lymphocyte ratio and cardiovascular diseases: a

review. Expert Rev Cardiovasc Ther 11(1):55–59

7. Cingoz F, Iyisoy A, Demirkol S, Sahin MA, Balta S, Celik T et al

(2013) Carotid intima-media thickness in patients with slow

coronary flow and its association with neutrophil to lymphocyte

ratio: a preliminary report. Clin Appl Thromb Hemost. doi:10.

1177/1076029613485283

196 J Neurooncol (2014) 117:195–196

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