The relation between NLR and cancer outcome is probably to be found in tumour-associated immune changes; an elevated NLR reflects a decreased lymphocyte-mediated immunity (with an alteration in CD4+ helper/CD8+ suppressors ratio) and an increased production of inflammatory agents such as vascular endothelial growth factor (VEGF) that promotes tumour growth [65]; some studies evidence that the highest values of NLR are associated with aggressive tumour profiles [52]. This evidence concerns the gene CD8A and neoplasm.