Can Simple Parameters such as Neutrophil-to-Lymphocyte Ratio and Neutrophil Count Predict the Nature of Adrenal Masses?

Background: The immune system responds to many diseases by triggering an inflammatory response, which in turn produces changes in the formulation of blood elements in the circulation. Certain parameters derived from the complete blood count, mainly the neutrophil/lymphocyte ratio (NLR), have been used as biomarkers in the diagnosis and prognosis of solid tumors.

Methods: A total of 66 patients who underwent surgery for adrenal lesions were analyzed. Complete blood countderived parameters obtained preoperatively were studied according to the nature of the definitive pathology report.

Results: As a result of ROC analysis, neutrophil and NLR parameters were found to be significant diagnostic biomarkers in differentiating benign from malignant lesions (AUC = 0.853 (0.760 - 0.947); p < 0.001, AUC = 0.702 (0.557 - 0.848); p = 0.025, respectively). Other blood parameters were similar between the groups (p > 0.05). The discrimination power of NLR was significantly more successful than neutrophil count. The cutoff point for the NLR was found to be 4.36. Concerning tumor diameters of all study groups, the malignant group was found to be statistically different from the others (p < 0.001). A positive significant correlation was observed between tumor diameter and NLR (r = 0.435, p < 0.001).

Conclusions: The systemic inflammatory response to adrenal lesions may be evaluated by means of NLR, an elevated NLR value in combination with a large lesion may be predictive of malignancy rather than benignity.