Correlation of the Neutrophil-to-lymphocyte and Platelet-to-lymphocyte Ratios with Postoperative Complications and Survival in Surgery for Bone Metastasis of the Appendicular Skeleton

Abstract

Objective To analyze, in cases of long-bone metastases, the incidence of postoperative complications and survival of up to 1 year, correlating them with the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR).

Methods Review of 160 medical records of patients who underwent surgery for bone metastases in the appendicular skeleton. We determined epidemiological characteristics and NLR and PLR values, which were correlated with survival and complications.

Results Women represented 64.5% of the sample, and 62.6% presented primary breast tumor. The proximal femur was the most affected bone. The median survival was of 13.2 months, and the 1-year survival rate, of 34.7%. Tumor resection with endoprosthesis was the most common surgery. The postoperative complication rate was of 10%, and the mean time until occurrence was of 27.9 (range: 0–140) days. We observed a significant association between neutrophil levels and postoperative complications (p = 0.04): for every increase of 100 neutrophils, the risk of postoperative complications increased by 1%. The mean NLR and PLR values were of 5.3 (range: 0.2–30.7) and 199.7 (range: 32.1–676.7) respectively. Patients with NLR ≥ 2 (p < 0,001) showed a decrease in survival from 92,3 to 62,5% in the third month, and from 61,5 to 31,3% in the first year. Those with PLR ≥ 209 (p < 0.001) showed a decrease in survival from 69 to 59.3% in the third month, and from 40.2 to 25.9% in the first year.

Conclusion There was no positive association regarding the NLR and PLR and postoperative complications. However, we noted a strong correlation involving elevated NLR and PLR levels and reduced life expectancy starting from the third postoperative month.

Keywords

blood platelets - lymphocytes - neoplasm metastasis - neutrophils - operative surgical procedures - postoperative complications

Authors' Contributions

Each author contributed individually and significantly to the development of the present article: MST and AVRT: conceptualization and investigation; CAPMR: methodology; FIT: project administration; and all authors: writing – review and editing.

Financial Support

The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.

^* Study developed at Hospital Erasto Gaertner in partnership with Faculdade Evangélica Mackenzie do Paraná, Curitiba, PR, Brazil.

Publication History

Received: 11 September 2024

Accepted: 14 December 2024

Article published online:
11 April 2025

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