Association between neutrophil-to-lymphocyte ratio and all-cause and cardiovascular mortality among adults with cancer from NHANES 2005-2018: a retrospective cohort study

TL;DR

High neutrophil-to-lymphocyte ratio is linked to increased risk of death in cancer patients, including from cardiovascular causes.

Contribution

This study is one of the first to analyze the association between NLR and mortality in cancer patients using a large U.S. dataset.

Findings

Higher NLR was significantly associated with increased all-cause mortality in cancer patients.

Elevated NLR was also linked to increased cardiovascular disease mortality.

Kaplan-Meier and spline analyses confirmed a positive linear relationship between NLR and mortality risks.

Abstract

Evidence on the association between the neutrophil-to-lymphocyte ratio (NLR) and all-cause and cardiovascular disease (CVD) mortality in adults with cancer is limited.

This study aimed to examine the relationship between NLR and all-cause and CVD mortality in adults with cancer.

A retrospective cohort study included 2,639 cancer patients in the U.S. from the NHANES dataset (2005-2018), collecting demographic, laboratory, and mortality data. Multivariable Cox regression analysis, subgroup analysis and restricted cubic spline analyses assessed the associations between NLR and mortality outcomes.

During a median follow-up of 77 months, 713 (27.0%) deaths occurred, including 149 (5.6%) from CVD. Multivariable Cox regression analysis revealed that a high NLR, treated as a continuous variable, was significantly correlated with increased all-cause mortality (HR, 1.09; 95% CI, 1.05-1.12; p < 0.001) and CVD mortality (HR, 1.12; 95% CI, 1.05-1.19; p < 0.001). Meanwhile, when evaluating NLR as a categorical variable, the adjusted hazard ratios (HR) for NLR and all-cause mortality in quartiles Q2 (1.6-2.2), Q3 (2.2-3), and Q4 (>3) were 1.06 (95% CI: 0.83-1.34, p = 0.062), 1.12 (95% CI: 0.89-1.42, p = 0.334), and 1.30 (95% CI: 1.04-1.63, p = 0.021), respectively, when compared with individuals in the lower quartile Q1 (≤1.6). In terms of CVD mortality, the adjusted HR values for NLR in Q2, Q3, and Q4 were 0.92 (95% CI: 0.50-1.69, p = 0.062), 1.24 (95% CI: 0.71-12.19, p = 0.334), and 1.76 (95% CI: 1.04-2.97, p = 0.034), respectively, compared to those in the lower NLR quartile Q1 (≤1.6). Subgroup analysis showed similar patterns (all p-values for interaction > 0.05). Kaplan-Meier analysis indicated lower survival rates for individuals with higher NLR, and RCS analysis suggested a positive linear relationship between NLR and all-cause and CVD mortality.

Elevated NLR is linked to higher all-cause and CVD mortality risks among adults with cancer.

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