Endocrinol Metab.  2024 Apr;39(2):334-343. 10.3803/EnM.2023.1854.

Prognostic Roles of Inflammatory Biomarkers in Radioiodine-Refractory Thyroid Cancer Treated with Lenvatinib

• Kim CA
• Kim M
• Jin M
• Kim HK
• Jeon MJ
• Lim DJ
• Kim BH
• Kang HC
• Kim WB
• Shin DY
• Kim WG

• KMID: 2554638
• DOI: http://doi.org/10.3803/EnM.2023.1854

Abstract

Background
Inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), serve as valuable prognostic indicators in various cancers. This multicenter, retrospective cohort study assessed the treatment outcomes of lenvatinib in 71 patients with radioactive iodine (RAI)-refractory thyroid cancer, considering the baseline inflammatory biomarkers.
Methods
This study retrospectively included patients from five tertiary hospitals in Korea whose complete blood counts were available before lenvatinib treatment. Progression-free survival (PFS) and overall survival (OS) were evaluated based on the median value of inflammatory biomarkers.
Results
No significant differences in baseline characteristics were observed among patients grouped according to the inflammatory biomarkers, except for older patients with a higher-than-median NLR (≥2) compared to their counterparts with a lower NLR (P= 0.01). Patients with a higher-than-median NLR had significantly shorter PFS (P=0.02) and OS (P=0.017) than those with a lower NLR. In multivariate analysis, a higher-than-median NLR was significantly associated with poor OS (hazard ratio, 3.0; 95% confidence interval, 1.24 to 7.29; P=0.015). However, neither the LMR nor the PLR was associated with PFS. A higher-than-median LMR (≥3.9) was significantly associated with prolonged OS compared to a lower LMR (P=0.036). In contrast, a higher-than-median PLR (≥142.1) was associated with shorter OS compared to a lower PLR (P=0.039).
Conclusion
Baseline inflammatory biomarkers can serve as predictive indicators of PFS and OS in patients with RAI-refractory thyroid cancer treated with lenvatinib.

Keyword

Lenvatinib; Thyroid neoplasms; Inflammatory biomarker; Lymphocytes; Monocytes; Neutrophils

Figure

• 

  Fig. 1. Progression-free survival (PFS) of patients who underwent lenvatinib treatment for refractory thyroid cancer based on inflammatory biomarkers. (A) PFS according to the neutrophil-to-lymphocyte ratio (NLR). (B) PFS according to the lymphocyte-to-monocyte ratio (LMR). (C) PFS according to the platelet-to-lymphocyte ratio (PLR).

• 

  Fig. 2. Overall survival (OS) of patients who underwent lenvatinib treatment for refractory thyroid cancer based on inflammatory biomarkers. (A) OS according to the neutrophil-to-lymphocyte ratio (NLR). (B) OS according to the lymphocyte-to-monocyte ratio (LMR). (C) OS according to the platelet-to-lymphocyte ratio (PLR).

• 

  Fig. 3. Clinical course of patients who underwent lenvatinib treatment for refractory thyroid cancer based on the presence of inflammatory risk factors. (A) Progression-free survival of patients in the high- and low-risk groups. (B) Overall survival of patients in the high- and low-risk groups. RF, risk factor.

• 

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