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Reply: Comment on ‘Elevated preoperative neutrophil/lymphocyte ratio is associated with poor prognosis in soft-tissue sarcoma patients’

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We would like to thank Bhat et al (2013) for their interesting comments and suggestions regarding our manuscript ‘Elevated preoperative neutrophil/lymphocyte (N/L) ratio is associated with poor prognosis in soft-tissue sarcoma patients’. We demonstrated that the N/L ratio is an independent prognostic marker for time to recurrence (TTR) and overall survival (OS) in a large cohort of patients with soft-tissue sarcoma (STS) (Szkandera et al, 2013). The N/L ratio is a cost-effective and easily determinable potential prognostic marker. Previous studies, including cardiovascular diseases and various cancer entities, showed a poor clinical outcome in patients presenting with an elevated pre-treatment N/L ratio (Bhat et al, 2013; Guthrie et al, 2013; Pichler et al, 2013). In general, it is supposed to reflect the systemic inflammatory response that accompanies chronic diseases, but might be influenced by many different factors, including systemic infections, atherosclerosis, hypertension, chronic renal diseases and diabetes and can be even affected by atherosclerotic risk factors and drug treatment (Buyukkaya et al, 2012; Kaya et al, 2013; Lee et al, 2012; Demir, 2013; Okyay et al, 2013). We are aware that these parameters might influence the balance between cells of the white blood cell count, especially neutrophils and lymphocytes, but most of these factors were not available for analysis in our study cohort. However, as the laboratory data, including neutrophil and leucocyte counts, were obtained by exploration within 3 days before surgery, at least acute conditions like bacterial or viral infections that would probably influence the N/L ratio can be excluded. We concur with Balta et al (2013) that the potential confounding factors mentioned above should be considered in further prospective studies investigating inflammatory biomarkers in various diseases to elucidate their true prognostic impact.

Change history

  • 25 June 2013

    This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication


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Correspondence to A Gerger.

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Szkandera, J., Pichler, M., Gerger, A. et al. Reply: Comment on ‘Elevated preoperative neutrophil/lymphocyte ratio is associated with poor prognosis in soft-tissue sarcoma patients’. Br J Cancer 108, 2627 (2013).

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