Table 2.
Associations of total white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR) with cancer incidence.
| Total WBC, Per Quartile Increase | NLR, Per Quartile Increase | |||||||
|---|---|---|---|---|---|---|---|---|
| N | % | HR | (95%CI) | p-trend | HR | (95%CI) | p-trend | |
| All Cancers | 22,747 | 100.0 | 1.05 | (1.03-1.06) | <0.0001 | 1.03 | (1.02-1.04) | <0.0001 |
| Tongue | 143 | 0.6 | 0.91 | (0.77-1.07) | 0.24 | 0.98 | (0.84-1.14) | 0.79 |
| Salivary Gland | 28 | 0.1 | 1.12 | (0.78-1.60) | 0.55 | 0.84 | (0.60-1.19) | 0.34 |
| Floor of Mouth | 23 | 0.1 | 1.17 | (0.73-1.89) | 0.51 | 1.29 | (0.86-1.93) | 0.22 |
| Gum and Other Mouth | 74 | 0.3 | 0.91 | (0.72-1.14) | 0.39 | 1.16 | (0.93-1.43) | 0.19 |
| Nasopharynx | 15 | 0.1 | 1.01 | (0.62-1.66) | 0.96 | 1.30 | (0.80-2.11) | 0.30 |
| Tonsil | 113 | 0.5 | 0.98 | (0.81-1.17) | 0.80 | 1.06 | (0.89-1.25) | 0.54 |
| Oropharynx | 18 | 0.1 | 0.60 | (0.37-0.95) | 0.03 | 1.24 | (0.80-1.92) | 0.34 |
| Hypopharynx | 21 | 0.1 | 0.75 | (0.49-1.15) | 0.19 | 1.19 | (0.79-1.79) | 0.41 |
| Esophagus | 426 | 1.9 | 1.06 | (0.96-1.16) | 0.27 | 1.11 | (1.01-1.21) | 0.02 |
| Stomach | 283 | 1.2 | 1.18 | (1.05-1.32) | 0.01 | 1.07 | (0.96-1.19) | 0.26 |
| Small Intestine | 102 | 0.5 | 1.08 | (0.89-1.31) | 0.43 | 1.13 | (0.94-1.36) | 0.19 |
| Colon excluding Rectum | 1,709 | 7.5 | 1.04 | (0.99-1.09) | 0.09 | 1.06 | (1.01-1.10) | 0.02 |
| Rectum and Rectosigmoid Junction | 888 | 3.9 | 1.07 | (1.00-1.14) | 0.05 | 1.03 | (0.97-1.09) | 0.37 |
| Anus | 76 | 0.3 | 1.13 | (0.90-1.42) | 0.28 | 0.96 | (0.78-1.18) | 0.68 |
| Liver | 146 | 0.6 | 0.76 | (0.65-0.89) | 0.0008 | 0.91 | (0.78-1.06) | 0.22 |
| Intrahepatic Bile Duct | 105 | 0.5 | 1.22 | (1.01-1.47) | 0.04 | 0.98 | (0.82-1.17) | 0.79 |
| Gallbladder | 59 | 0.3 | 1.41 | (1.09-1.84) | 0.01 | 1.01 | (0.79-1.28) | 0.96 |
| Other Biliary | 77 | 0.3 | 0.91 | (0.73-1.13) | 0.41 | 0.90 | (0.73-1.11) | 0.33 |
| Pancreas | 495 | 2.2 | 1.01 | (0.93-1.11) | 0.77 | 1.07 | (0.98-1.16) | 0.11 |
| Retroperitoneum | 12 | 0.1 | 1.19 | (0.69-2.06) | 0.53 | 1.08 | (0.64-1.83) | 0.78 |
| Peritoneum, Omentum and Mesentery | 67 | 0.3 | 0.90 | (0.71-1.14) | 0.38 | 1.01 | (0.81-1.26) | 0.94 |
| Nose, Nasal Cavity and Middle Ear | 23 | 0.1 | 1.02 | (0.68-1.53) | 0.93 | 0.82 | (0.56-1.20) | 0.31 |
| Larynx | 85 | 0.4 | 0.97 | (0.77-1.20) | 0.75 | 1.02 | (0.83-1.24) | 0.87 |
| Lung | 1,657 | 7.3 | 1.14 | (1.08-1.20) | <0.0001 | 1.04 | (1.00-1.09) | 0.06 |
| Bones and Joints | 25 | 0.1 | 1.21 | (0.82-1.79) | 0.34 | 0.98 | (0.68-1.41) | 0.89 |
| Soft Tissue including Heart | 119 | 0.5 | 1.05 | (0.88-1.25) | 0.57 | 1.29 | (1.08-1.53) | 0.005 |
| Melanoma of the Skin | 1,223 | 5.4 | 1.00 | (0.95-1.06) | 0.99 | 1.00 | (0.95-1.06) | 0.95 |
| Non-Melanoma Skin | 41 | 0.2 | 0.96 | (0.71-1.30) | 0.81 | 1.21 | (0.90-1.62) | 0.21 |
| Breast | 4,467 | 19.6 | 1.05 | (1.02-1.08) | 0.0004 | 1.02 | (0.99-1.05) | 0.17 |
| Cervix | 56 | 0.3 | 1.21 | (0.93-1.57) | 0.15 | 1.01 | (0.79-1.29) | 0.94 |
| Uterine Corpus | 694 | 3.1 | 1.07 | (1.00-1.15) | 0.07 | 1.11 | (1.04-1.19) | 0.003 |
| Uterus, Not Otherwise Specified | 13 | 0.1 | 0.91 | (0.54-1.54) | 0.73 | 1.21 | (0.72-2.02) | 0.47 |
| Ovary | 441 | 1.9 | 1.01 | (0.92-1.10) | 0.88 | 1.08 | (0.99-1.18) | 0.09 |
| Vagina | 12 | 0.1 | 1.01 | (0.59-1.74) | 0.96 | 1.37 | (0.80-2.35) | 0.25 |
| Vulva | 52 | 0.2 | 1.07 | (0.83-1.40) | 0.60 | 1.13 | (0.88-1.46) | 0.34 |
| Other Female Genital Organs | 46 | 0.2 | 0.88 | (0.66-1.16) | 0.36 | 0.99 | (0.76-1.30) | 0.96 |
| Prostate | 4,757 | 20.9 | 1.01 | (0.98-1.03) | 0.71 | 1.01 | (0.99-1.04) | 0.36 |
| Testis | 58 | 0.3 | 1.08 | (0.84-1.40) | 0.53 | 1.02 | (0.80-1.30) | 0.86 |
| Penis | 28 | 0.1 | 0.98 | (0.68-1.41) | 0.92 | 1.17 | (0.82-1.67) | 0.39 |
| Urinary Bladder | 495 | 2.2 | 1.02 | (0.93-1.11) | 0.69 | 1.08 | (1.00-1.18) | 0.06 |
| Kidney and Renal Pelvis | 640 | 2.8 | 1.07 | (0.99-1.15) | 0.09 | 1.15 | (1.07-1.24) | 0.0002 |
| Kidney | 593 | 2.6 | 1.09 | (1.01-1.18) | 0.03 | 1.16 | (1.07-1.25) | 0.0002 |
| Renal Pelvis | 47 | 0.2 | 0.82 | (0.62-1.08) | 0.16 | 1.08 | (0.83-1.42) | 0.57 |
| Ureter | 26 | 0.1 | 1.09 | (0.74-1.59) | 0.67 | 1.13 | (0.79-1.63) | 0.50 |
| Eye and Orbit | 52 | 0.2 | 1.06 | (0.81-1.38) | 0.67 | 0.92 | (0.71-1.19) | 0.52 |
| Brain and Other Nervous System | 374 | 1.6 | 0.96 | (0.87-1.06) | 0.40 | 1.05 | (0.95-1.15) | 0.33 |
| Thyroid | 189 | 0.8 | 0.95 | (0.83-1.09) | 0.49 | 1.01 | (0.88-1.16) | 0.88 |
| Other Endocrine including Thymus | 25 | 0.1 | 0.96 | (0.65-1.40) | 0.82 | 0.83 | (0.58-1.21) | 0.34 |
| Hodgkin Lymphoma | 60 | 0.3 | 1.24 | (0.96-1.60) | 0.10 | 0.97 | (0.77-1.23) | 0.80 |
| Non-Hodgkin Lymphoma | 1,199 | 5.3 | 1.26 | (1.20-1.34) | <0.0001 | 0.82 | (0.78-0.86) | <0.0001 |
| Diffuse Large B-cell Lymphoma | 358 | 1.6 | 0.93 | (0.84-1.03) | 0.15 | 1.06 | (0.96-1.17) | 0.24 |
| Chronic Lymphocytic Leukemia/Small Lymphocytic Leukemia | 315 | 1.4 | 2.79 | (2.45-3.18) | <0.0001 | 0.38 | (0.33-0.42) | <0.0001 |
| Follicular | 191 | 0.8 | 0.79 | (0.68-0.90) | 0.0007 | 1.21 | (1.06-1.39) | 0.01 |
| Other Non-Hodgkin Lymphoma | 335 | 1.5 | 1.18 | (1.06-1.31) | 0.002 | 0.98 | (0.89-1.08) | 0.67 |
| Myeloma | 364 | 1.6 | 0.85 | (0.77-0.95) | 0.002 | 0.85 | (0.77-0.94) | 0.001 |
| Acute Lymphocytic Leukemia | 18 | 0.1 | 1.28 | (0.81-2.03) | 0.29 | 1.00 | (0.65-1.53) | 0.99 |
| Other Lymphocytic Leukemia | 32 | 0.1 | 0.93 | (0.66-1.31) | 0.66 | 0.55 | (0.38-0.79) | 0.001 |
| Acute Myeloid Leukemia | 157 | 0.7 | 0.84 | (0.72-0.97) | 0.02 | 0.93 | (0.81-1.08) | 0.35 |
| Chronic Myeloid Leukemia | 40 | 0.2 | 1.15 | (0.84-1.56) | 0.38 | 0.98 | (0.74-1.31) | 0.89 |
| Other Myeloid/Monocytic Leukemia | 26 | 0.1 | 1.15 | (0.78-1.69) | 0.49 | 0.90 | (0.63-1.28) | 0.55 |
| Mesothelioma | 201 | 0.9 | 1.01 | (0.88-1.15) | 0.92 | 0.97 | (0.85-1.10) | 0.63 |
| Miscellaneous | 90 | 0.4 | 1.08 | (0.88-1.32) | 0.47 | 0.89 | (0.74-1.08) | 0.25 |
| Uncertain Cancer Type | 17 | 0.1 | 0.84 | (0.53-1.33) | 0.45 | 1.20 | (0.76-1.88) | 0.44 |
Multivariate models include the following variables: age as 3-knot spline, sex, race/ethnicity (White, Black, Asian, mixed or missing), smoking history (25-level variable incorporating current smoking status, smoking intensity [current and former smokers]; time since quitting [former smokers], and cigar and pipe use [current and former smokers]), alcohol drinking (never, past, current), body mass index (<25, 25-30, ≥30kg/m2), WBC count (quartile), and NLR (quartile). Results are not shown separately for the following cancers where the number of cases was less than 11 (n=65): cancers of the lip (n=9), other oral cavity and pharynx (n=9), other digestive organs (n=7), pleura (n=3), trachea/mediastinum/other respiratory organs (n=7), other urinary organs (n=9), acute monocytic leukemia (n=4), other acute leukemia (n=7), aleukemic/subleukemic/not otherwise specified leukemia (n=7), and Kaposi sarcoma (n=3).
Abbreviations: CI, confidence interval; HR, hazard ratio; NLR, neutrophil-to-lymphocyte ratio; WBC, white blood cell
Bold indicates significant p-values after Bonferroni correction