Inverse Association between Platelet–Lymphocyte Ratio and Prognosis in Terminally Ill Cancer Patients: A Preliminary Study

Abstract

Abstract

Background:

An elevated platelet–lymphocyte ratio (PLR) is an indicator for worse outcomes in cancer, but its significance at the end of life remains unclear.

Objective:

This study aimed to investigate the value of PLR as an independent prognostic factor in terminally ill cancer patients.

Methods:

This retrospective cohort study included 312 terminal cancer patients and was conducted in a palliative care unit of a tertiary cancer center. Patient demographic data, clinical information, and laboratory values, including complete blood cell count, were obtained. Survival was analyzed using the Kaplan–Meier method and log-rank test. The Cox proportional hazards model was used to identify independent prognostic factors for survival.

Results:

Median survival was 16 days in patients with PLR ≥200 and 9 days in patients with PLR <200 (p = 0.008). Results of multivariate analysis showed that the following factors predicted worse survival: poor performance status (adjusted hazard ratio [aHR], 2.16; 95% confidence interval [CI], 1.50–3.09), azotemia (aHR, 1.43; 95% CI, 1.01–2.02), hypoalbuminemia (aHR, 1.55; 95% CI, 1.07–2.26), hyperbilirubinemia (aHR, 1.67; 95% CI, 1.23–2.29), elevated lactate dehydrogenase (aHR, 1.58; 95% CI, 1.11–2.26), high neutrophil–lymphocyte ratio (aHR, 1.49; 95% CI, 1.09–2.04), and low PLR (aHR, 1.46; 95% CI, 1.08–1.97).

Conclusion:

Although elevated PLR indicates worse outcomes in patients with solid tumors, decreased PLR was an independent prognostic factor for poor survival in cancer patients at the end of life.