Background: Neutrophil-lymphocyte ratio (NLR) is a measure of systemic inflammation that appears prognostic in localized and advanced non-small cell lung cancer (NSCLC). Increased systemic inflammation portends a poorer prognosis in cancer patients. We hypothesized that low NLR at diagnosis is associated with improved overall survival (OS) in locally advanced NSCLC (LANSCLC) patients.
Patients and methods: Records from 276 patients with stage IIIA and IIIB NSCLC treated with definitive chemoradiation with or without surgery between 2000 and 2010 with adequate data were retrospectively reviewed. Baseline demographic data and pretreatment peripheral blood absolute neutrophil and lymphocyte counts were collected. Patients were grouped into quartiles based on NLR. OS was estimated using the Kaplan-Meier method. The log-rank test was used to compare mortality between groups. A linear test-for-trend was used for the NLR quartile groups. The Cox proportional hazards model was used for multivariable analysis.
Results: The NLR was prognostic for OS (p < .0001). Median survival in months (95% confidence interval) for the first, second, third, and fourth quartile groups of the population distribution of NLR were 27 (19-36), 28 (22-34), 22 (12-31), and 10 (8-12), respectively. NLR remained prognostic for OS after adjusting for race, sex, stage, performance status, and chemoradiotherapy approach (p = .004).
Conclusion: To our knowledge, our series is the largest to demonstrate that baseline NLR is a significant prognostic indicator in LANSCLC patients who received definitive chemoradiation with or without surgery. As an indicator of inflammatory response, it should be explored as a potential predictive marker in the context of immunotherapy and radiation therapy.
Implications for practice: Neutrophil-lymphocyte ratio measured at the time of diagnosis was associated with improved overall survival in 276 patients with stage IIIA and IIIB non-small cell lung cancer (NSCLC) treated with definitive chemoradiation with or without surgery. To our knowledge, our series is the largest to demonstrate that baseline neutrophil-lymphocyte ratio is a significant prognostic indicator in locally advanced NSCLC patients who received definitive chemoradiation with or without surgery. Neutrophil-lymphocyte ratio is an inexpensive biomarker that may be easily utilized by clinicians at the time of locally advanced NSCLC diagnosis to help predict life expectancy.
摘要
背景. 中性粒细胞‐淋巴细胞比值（NLR）是全身炎症的衡量指标, 而后者在局部晚期非小细胞肺癌（NSCLC）中具有预后作用。癌症患者全身炎症增加意味着预后较差。我们假设局部晚期NSCLC（LANSCLC）患者诊断时NLR较低与总生存期（OS）改善相关。
患者和方法. 我们回顾性分析了2000年至2010年期间接受确定性放化疗联合或不联合手术治疗且具有充分数据的276例IIIA期和IIIB期NSCLC患者的记录。采集基线人口统计学数据和治疗前外周血中性粒细胞和淋巴细胞绝对计数。根据NLR四分位数对患者进行分组。采用Kaplan‐Meier法估计OS。采用时序检验比较各组的死亡率。采用线性趋势检验分析各个NLR四分位数组。使用Cox比例风险模型进行多变量分析。
结果. NLR是OS的预后指标（p<0.0001）。NLR人群分布的第一、二、三和四四分位数组的中位生存期（95%置信区间）分别为27（19‐36）、28（22‐34）、22（12‐31）和10（8‐12）个月。校正人种、性别、分期、体力状态和放化疗方法后, NLR仍然是OS的预后指标（p=0.004）。
结论. 据我们所知, 本研究是规模最大的证明基线NLR是接受过确定性放化疗联合或不联合手术治疗的LANSCLC患者的显著预后指标的研究。NLR是炎症反应的指标, 应将其作为免疫治疗和放射治疗的潜在预测标志物进行探索。The Oncologist 2017;22:737–742
对临床实践的提示：在276例接受过确定性放化疗联合或不联合手术治疗的IIIA期和IIIB期NSCLC患者中, 诊断时测定的中性粒细胞‐淋巴细胞比值与总生存期改善相关。据我们所知, 本研究是规模最大的证明基线中性粒细胞‐淋巴细胞比值是接受过确定性放化疗联合或不联合手术治疗的局部晚期NSCLC患者的显著预后指标的研究。临床医生在诊断局部晚期NSCLC时可使用中性粒细胞‐淋巴细胞比值作为生物标志物, 该方法成本低廉且简单易行, 可帮助预测预期寿命。
Keywords: Locally advanced; Neutrophil‐lymphocyte ratio; Non‐small cell lung cancer; Prognosis.
© AlphaMed Press 2017.