Has the neutrophil/lymphocyte ratio a predictive role in distinguishing neoplastic potential of colonic polyps?

We read with interest the article ‘Relationship between Colonic Polyp Type and the Neutrophil/Lymphocyte Ratio as a Biomarker’ by Karaman et al (2013). In their study, authors aimed to investigate the neutrophil/lymphocyte ratio (NLR) as a biomarker in distinguishing colonic polyps which are neoplastic or non-neoplastic. Finally, they concluded that despite the low sensitivity and specificity, NLR may be used as a biomarker of neoplastic condition of colonic polyps. We would like to thank the authors for their contribution. NLR is a readily available and inexpensive laboratory marker which is used to measure systemic inflammation. In literature, it was shown that valvular heart diseases, acute coronary syndromes, diabetes mellitus, thyroid functional abnormalities, renal and/or hepatic failure, metabolic syndrome, essential hypertension, many inflammatory diseases may potentially affect the NLR (Alkhouri et al., 2012; Balta et al., 2013; Stotz et al., 2013; Tanoglu et al., 2014). Thus, it would be more relevant if Karaman et al. had mentioned these NLR-affecting factors while evaluating the predictive significance of the NLR in patients with UC. Moreover, medication may alter NLR in patients with UC, so it would have been useful if the patients were described in greater detail in terms of mesalazine, antibiotic, steroid use and/or other medications. In addition, it would also have been better if the authors indicated the elapsed time between taking the blood samples and measuring NLR since waiting period prior to analysis may affect NLR. And also, as a limitation of study, it would be more objective if a large number of patients were included in the research. We believe that the findings of Karaman et al. will lead to further studies concerning predictive role of NLR in distinguishing colonic polyps which are neoplastic or non-neoplastic. But, it should be clearly kept in mind that NLR itself alone without other variables may not secure true information about the neoplastic status of colonic polyps. Finally we conclude that, in terms of NLR’s predictive role in distinguishing neoplastic potential of colonic polyps, NLR should be evaluated with other variables as mentioned above.