***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE The preoperative neutrophil-to-lymphocyte ratio was proposed as a prognostic factor for localized clear cell renal cell carcinoma . We evaluated its role in nonclear cell renal cell carcinoma . MATERIAL S AND METHODS We queried 2 prospect i ve kidney cancer data bases . Patients who underwent full resection of localized ( T1 - 3 N0/+ M0 ) nonclear cell renal cell carcinoma by radical or partial nephrectomy were included in analysis . Associations of the continuously coded neutrophil-to-lymphocyte ratio with disease-free survival were assessed with univariable and multivariable Cox regression models . Prognostic accuracy was evaluated with the Harrell concordance index . RESULTS Our final cohort included 281 patients . The 5-year disease-free survival rate was 88.1 % . The neutrophil-to-lymphocyte ratio was significantly associated with disease-free survival . With each 1.0 increase in the ratio the risk of recurrence increased by 15 % ( HR 1.15 , p=0.028 ) . On multivariable analysis TNM group ( HR 2.84 , p=0.025 ) , Fuhrman grade ( HR 3.40 , p<0.001 ) and the neutrophil-to-lymphocyte ratio ( HR 1.17 , p=0.022 ) were independently associated with disease-free survival . Adding the neutrophil-to-lymphocyte ratio improved the accuracy of a base model to predict disease-free survival from 78.8 % to 80.8 % . CONCLUSIONS The neutrophil-to-lymphocyte ratio is an independent prognostic factor for disease-free survival after surgery with curative intent for localized nonclear cell renal cell carcinoma . It significantly increases the accuracy of established prognostic factors . The neutrophil-to-lymphocyte ratio may provide a meaningful adjunct for patient counseling and clinical trial design Background : The host inflammatory response has a vital role in carcinogenesis and tumour progression . We examined the prognostic value of  inflammatory markers ( albumin , white-cell count and its components , and platelets )  in pre-treated patients with advanced renal cell carcinoma ( RCC ) . Methods : Using data from a r and omised trial , multivariable proportional hazards models were generated to examine the impact of inflammatory markers and established prognostic factors ( performance status , calcium , and haemoglobin ) on overall survival ( OS ) . We evaluated a new prognostic classification incorporating additional information from inflammatory markers . Results : Of the 416 patients , 362 were included in the analysis .  Elevated neutrophil counts , elevated platelet counts , and a high neutrophil – lymphocyte ratio were significant independent predictors for shorter OS in a model with established prognostic factors . The addition of inflammatory markers improves the discriminatory value of the prognostic classification as compared with established factors alone ( C-statistic 0.673 vs 0.654 , P=0.002 for the difference ) , with 25.8 % ( P=0.004 ) of patients more appropriately classified using the new classification . Conclusion : Markers of systemic inflammation contribute significantly to prognostic classification in addition to established factors for pre-treated patients with advanced RCC . Upon validation of these data in independent studies , stratification of patients using these markers in future clinical trials is recommended BACKGROUND For many years , the intensivists are search ing for an easily measurable and available parameter which might reflect the intensity of stress and /or systemic inflammation in critically ill patients following shock , multiple trauma , major surgery or sepsis . Recently , some authors have described the onset of significant lymphocytopenia after polytrauma , major surgery , endotoxaemia and sepsis . We investigate whether serial examination of white blood cell counts may reflect and clarify the immune response to stressful events in critically ill patients . GOAL We have design ed a prospect i ve longitudinal observational study to investigate serial changes in circulating neutrophil and lymphocyte counts following major surgery , unscheduled surgery and sepsis . METHODS We have investigated the differential white blood cell counts and the clinical course in 90 oncological ICU patients . We compared three groups : group A consisting of 62 patients who underwent scheduled colorectal surgery , group B consisting of 18 patients who underwent unscheduled surgery for abdominal sepsis , group C consisting of 10 medical ICU patients who were treated for severe sepsis and septic shock . The severity of clinical course was expressed by means of SOFA score ( group A 0.3 - 1 - 1.3 point , group B 2.2 - 2.9 - 2.6 point , group C 7.4 - 8.3 - 7.7 point ) and APACHE II score ( group A 3.7 - 7.6 - 8.1 point , group B 8.6 - 11.1 - 10.5 point , group C 16.3 - 15.2 - 14.3 point ) . Differential white blood cell counts were investigated on blood cell counter SYSMEX SF 3000 in 4 consecutive periods : 1 day one before surgery , 0 the day of surgery or ICU admittance , 1 day one after surgery ( or the 1st ICU day ) , 2nd day following surgery ( or the 2nd ICU day ) . The measured values of neutrophils and lymphocytes were expressed as relative counts ( % ) of the whole all white blood cell population . RESULTS The physiologic response of circulating leukocytes to surgical stress in group A is characterized by the onset of marked neutrophilia ( 62.5 % before surgery up to 84.4 % after surgery ) and significant lymphocytopenia ( 28.1 % before surgery to 10.3 % following surgery ) . We observed a slow decline in neutrophil counts and an increase in lymphocyte counts since the 1st postoperative day . The patients with abdominal infection ( group B ) had elevated counts of neutrophils already before surgery ( 83.2 % ) and low values of lymphocyte counts ( 9.5 % ) . A further increase in neutrophil counts ( 89.9 % ) and marked lymphopenia ( 7 % ) were recorded during the post-surgical period in group B. Critically ill patients with severe sepsis or septic shock ( group C ) had significantly highest values of neutrophil relative counts ( 94%-93.1%-92.5 % , p < 0.05 against group A ) and marked lowest values of lymphocyte counts ( 3.8%-4%-3.7 % , p < 0.05 against group A ) . The severity of clinical course ( according SOFA and APACHE II score ) correlated with the divergence of neutrophil and lymphocyte counts in the white blood picture ( marked neutrophilia and lymphocytopenia ) . CONCLUSION In the population of 90 ICU oncological patients , we observed rapid serial changes in white blood cell population s , as a response of the immune system to surgical stress , systemic inflammation or sepsis . Preliminary results show the correlation between the severity of clinical course and the grade of neutrophilia and lymphocytopenia . The ratio of neutrophil and lymphocyte counts ( in absolute and /or relative % values ) is an easily measurable parameter which may express the severity of affliction . We suggest the term : neutrophil-lymphocyte stress factor , as a ratio of neutrophil to lymphocyte counts , which can be routinely used in clinical ICU practice in intervals of 6 - 12 and 24 hours . The prognostic value of neutrophil-lymphocyte stress factor should be evaluated in further studies . ( Tab . 6 , Fig. 5 , Ref . 12 . CONTEXT R and omized trials of short-term aspirin use for prevention of recurrent colorectal adenoma have provided compelling evidence of a causal relationship between aspirin and colorectal neoplasia . However , data on long-term risk of colorectal cancer according to dose , timing , or duration of therapy with aspirin and other nonsteroidal anti-inflammatory drugs ( NSAIDs ) remain limited . OBJECTIVE To examine the influence of aspirin and NSAIDs in prevention of colorectal cancer . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 82 911 women enrolled in the Nurses ' Health Study providing data on medication use biennially since 1980 and followed up through June 1 , 2000 . MAIN OUTCOME MEASURE Incident colorectal cancer . RESULTS Over a 20-year period , we documented 962 cases of colorectal cancer . Among women who regularly used aspirin ( > or = 2 st and ard [ 325-mg ] tablets per week ) , the multivariate relative risk ( RR ) for colorectal cancer was 0.77 ( 95 % confidence interval [ CI ] , 0.67 - 0.88 ) compared with nonregular users . However , significant risk reduction was not observed until more than 10 years of use ( P < or = .001 for trend ) . The benefit appeared related to dose : compared with women who reported no use , the multivariate RRs for cancer were 1.10 ( 95 % CI , 0.92 - 1.31 ) for women who used 0.5 to 1.5 st and ard aspirin tablets per week , 0.89 ( 95 % CI , 0.73 - 1.10 ) for 2 to 5 aspirin per week , 0.78 ( 95 % CI , 0.62 - 0.97 ) for 6 to 14 aspirin per week , and 0.68 ( 95 % CI , 0.49 - 0.95 ) for more than 14 aspirin per week ( P<.001 for trend ) . Notably , women who used more than 14 aspirin per week for longer than 10 years in the past had a multivariate RR for cancer of 0.47 ( 95 % CI , 0.31 - 0.71 ) . A similar dose-response relationship was found for nonaspirin NSAIDs ( P = .007 for trend ) . The incidence of reported major gastrointestinal bleeding events per 1000 person-years also appeared to be dose-related : 0.77 among women who denied any aspirin use ; 1.07 for 0.5 to 1.5 st and ard aspirin tablets per week ; 1.07 for 2 to 5 aspirin per week ; 1.40 for 6 to 14 aspirin per week ; and 1.57 for more than 14 aspirin per week . CONCLUSIONS Regular , long-term aspirin use reduces risk of colorectal cancer .  Nonaspirin NSAIDs appear to have a similar effect . However , a significant benefit of aspirin is not apparent until more than a decade of use , with maximal risk reduction at doses greater than 14 tablets per week . These results suggest that optimal chemoprevention for colorectal cancer requires long-term use of aspirin doses substantially higher than those recommended for prevention of cardiovascular disease , but the dose-related risk of gastrointestinal bleeding must also be considered Chronic inflammation may play a role in ovarian carcinogenesis . We examined associations between 3 plasma biomarkers of inflammation-C-reactive protein ( CRP ) , interleukin 6 , and tumor necrosis factor α receptor 2- and  risk of invasive epithelial ovarian cancer in prospect ively collected sample s from the Nurses ' Health Study ( NHS ; 1989 - 2010 ) , Nurses ' Health Study II ( NHS II ; 1996 - 2009 ) , and the Women 's Health Study ( WHS ; 1992 - 2011 ) and performed a meta- analysis including data from previous publications . Associations with ovarian cancer risk were calculated using logistic regression ( NHS/NHS II ; n = 217 cases ) or Cox proportional hazards regression ( WHS ; n = 159 cases ) . Study -specific results were combined using r and om-effects meta- analysis . In the NHS/NHS II and WHS , we observed a 53 % increased risk of invasive ovarian cancer when comparing women in the fourth quartile of CRP with women in the first quartile ( 95 % confidence interval ( CI ) : 1.05 , 2.23 ) . A CRP level of > 10 mg/L versus a level of ≤1 mg/L was associated with a 2.16-fold increased risk ( 95 % CI : 1.23 , 3.78 ) . In a meta- analysis of published studies , women in the third tertile of CRP had a 35 % increased risk ( 95 % CI : 1.10 , 1.67 ) compared with women in the first tertile . There were no significant associations between interleukin 6 or tumor necrosis factor α receptor 2 and risk in the NHS/NHS II . Our results support the hypothesis that higher levels of circulating CRP are associated with increased risk of ovarian cancer  , indicating that the role of inflammation in ovarian cancer requires further elucidation BACKGROUND The neutrophil-lymphocyte ratio ( NLR ) , proposed as an indicator of cancer-related inflammation , has known prognostic value in prostate cancer . We examine its association with survival ( OS ) and response in patients treated with second-line chemotherapy .  METHODS We analysed patients with metastatic castration 
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The results showed that all OS , CSS , RFS , PFS , and MFS risks were significantly different between patients with an elevated NLR and those with a low NLR in various urologic tumors .
A high NLR portended poor prognosis .
However , no significance was observed for CSS in patients with renal cell carcinoma ( HR = 1.38 , 95 % CI : 0.96–1.99).Our meta- analysis suggests that NLR could be a prognostic predictor for urologic tumors .
Patients with a high NLR were deemed to have a poor prognosis