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Sisi Wang, Tao Xiao, Chunhong Hu, Are preoperative platelet-lymphocyte and neutrophil-lymphocyte ratio prognostic factors for patients with esophageal squamous cell cancer?, Diseases of the Esophagus, Volume 29, Issue 6, 1 September 2016, Page 704, https://doi.org/10.1111/dote.12351
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Dear Editor,
We read with deep interest the recent article titled ‘Prognostic value of preoperative platelet-lymphocyte and neutrophil-lymphocyte ratio in patients undergoing surgery for esophageal squamous cell cancer’.1 In this study, the investigators performed a retrospective analysis to assess the prognostic value of preoperative platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) in patients with resected esophageal squamous cell carcinoma (ESCC). They conclude that preoperative PLR is easily obtained from a routine blood test and may provide additional prognostic information for ESCC patients, especially in the early stage. It is a valuable and interesting article. Nevertheless, there are some comments related to this article we would like to raise.
Firstly, we recommend that the authors should minimize the selection bias. PLR and NLR have been recently suggested to be markers of thrombotic and inflammatory condition. In the literature, it was shown that valvular heart diseases, acute coronary syndromes, hypertension, end-stage renal diseases, and other diseases may potentially affect the PLR and NLR.2,3 In the study of Xie et al.,1 patients with rheumatologic conditions or connective tissue disorders were excluded, while such as heart diseases that are very common in the patients with an average age of 58.1 years (range: 34–76 years) were not mentioned. Thus, it would be more relevant if the authors mentioned these PLR- and NLR-affecting factors.