Derived Neutrophil-Lymphocyte Ratio and C-Reactive Protein as Prognostic Factors for Early-Stage Non-Small Cell Lung Cancer Treated with Stereotactic Body Radiation Therapy

Abstract

Objectives: To explore the relationship between peripheral blood inflammation parameters and overall survival (OS) and progression-free survival (PFS) of early-stage non-small cell lung cancer patients who underwent stereotactic body radiotherapy (SBRT). Patients and methods: In this study, eligible patients treated with SBRT from 2013 to 2018, and both serum complete blood count and blood biochemical results were available prior to (within 60 days) radiotherapy were included. Results: A review of hospital registries identified 148 patients, and the 5-year OS and PFS of the entire cohort were 69.8% and 65.6%, respectively, with the median follow-up time was 52.8 months. Multivariable analysis showed that derived neutrophil-lymphocyte ratio (dNLR) ≥1.4 and C-reactive protein (CRP) ≥2.9 were statistically and independently associated with worse OS (HR = 4.62, 95% CI 1.89–11.27, p = 0.001; HR = 2.92, 95% CI 1.49–5.70, p = 0.002, respectively). The 5-year OS for patients with dNLR below and equal to or above the 1.4 were 85.3% and 62.9% (p = 0.002), respectively, and 76.7% for the low CRP group versus 58.5% for the high CRP group (p = 0.030). Higher serum level of post-treatment CRP also independent parameters for inferior PFS (HR = 4.83, 95% CI 1.28–18.25, p = 0.020). Conclusions: Our results demonstrate that dNLR and CRP are associated with the outcomes of early-stage NSCLC patients treated with SBRT, which may assist in selecting optimal nursing care and therapeutic scheme for every individual.

Prognostic utility of blood inflammation biomarkers before and after treatment on the survival of patients with locally advanced non‐small cell lung cancer undergoing stereotactic body radiotherapy

“…Additionally, post‐treatment NLR was significantly increased compared with pre‐treatment one and associated with OS 21 . Dong et al found that higher NLR and CRP were associated with worse OS 18 . Luo et al 22 reported that high PLR (≤199.55) was independent prognostic factor of poor survival.…”

“…The synergy between immunotherapy and RT is gaining increasing interest 4,5,15,16 . Radiation‐induced neutrophilia and thrombocytophilia seemed to indicate active inflammation, which facilitated the escape of the immune cells and invasion of the tumor cells 17–19 . Radiation‐induced lymphopenia (RIL) was an immunosuppression factor.…”

“…More studies investigated a relationship between systemic inflammation and survival in early‐stage NSCLC undergoing SBRT 18,20–22 . Sebastian et al showed that high pre‐treatment NLR was associated with mortality but not with disease control.…”

“… 4 , 5 , 15 , 16 Radiation‐induced neutrophilia and thrombocytophilia seemed to indicate active inflammation, which facilitated the escape of the immune cells and invasion of the tumor cells. 17 , 18 , 19 Radiation‐induced lymphopenia (RIL) was an immunosuppression factor. One mechanism was inhibiting infiltrations of peripheral blood lymphocytes into the tumor microenvironment and inducing the immunological surveillance escape by weakening the recognition of tumor antigens.…”

“…More studies investigated a relationship between systemic inflammation and survival in early‐stage NSCLC undergoing SBRT. 18 , 20 , 21 , 22 Sebastian et al showed that high pre‐treatment NLR was associated with mortality but not with disease control. Additionally, post‐treatment NLR was significantly increased compared with pre‐treatment one and associated with OS.…”