TGFB1 and neoplasm: One possible explanation is that high NLR is due to a relatively increased neutrophil count, suggesting that the inflammatory state alters the tumor micro-environment, impairing the patient's immune response to malignancy and thereby promoting tumor progression and metastasis (34); it could also be due to a relatively depleted lymphocyte count, which can act as tumor-promoting leucocytes by producing IL-10 and TGF-β, thereby inducing matrix metalloproteinases and regulatory T-cell pathways in the tumor micro-environment (35).