Pretreatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic biomarkers for neuroblastoma risk stratification.

Background: Neuroblastoma (NB) is the most common extracranial solid tumor in children, accounting for approximately 15% of pediatric oncology mortality. While risk-stratified therapy has improved survival, high-risk cases still face poor outcomes. Pretreatment inflammatory markers, including the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), have emerged as potential, cost-effective prognostic biomarkers to refine risk assessment and guide treatment intensity. Objectives: This study aimed to investigate the associations between pretreatment NLR, PLR, and clinicopathological characteristics, and to evaluate their significance in neuroblastoma risk stratification. Methods: We conducted a retrospective study of pediatric patients newly diagnosed with neuroblastoma at the Capital Center for Children's Health, Capital Medical University, between March 2023 and July 2025. Data, including age, International Neuroblastoma Staging System (INSS) classification, and International Neuroblastoma Risk Group Staging System (INRGSS) criteria, were recorded. Pretreatment blood samples were analyzed for neutrophil, lymphocyte, and platelet counts to calculate NLR and PLR. The association between these ratios, clinicopathological characteristics, and risk groups was analyzed using Receiver Operating Characteristic (ROC) curves. Results: ROC curve analysis established optimal cutoff values for NLR and PLR at 0.98 and 104.6, respectively, for differentiating high-risk from low/intermediate-risk patients. The combined NLR-PLR model demonstrated superior predictive performance, yielding an Area Under the Curve (AUC) of 0.833. Both NLR and PLR showed significant positive correlations with neuroblastoma risk stratification. Notably, patients with elevated baseline NLR and PLR values were significantly more likely to present with advanced disease stages compared to their lower-risk counterparts. These data suggest that the integration of NLR and PLR into a dual-index score synergistically enhances the accuracy of risk discrimination. Conclusions: Pretreatment NLR and PLR are potent, cost-effective, and easily accessible biomarkers that correlate significantly with high-risk neuroblastoma and poor prognostic indicators in unadjusted analyses. Incorporating these inflammatory indices into standard staging protocols may improve the precision of initial risk stratification, allowing for more personalized therapeutic interventions.