Higher aorta dose increased neutrophil‐to‐lymphocyte ratio resulting in poorer outcomes in stage II‐III non‐small cell lung cancer

Abstract

Background This study focused on the relationship between the neutrophil‐to‐lymphocyte ratio (NLR) and the dose of organs at risk in patients with stage II–III non‐small cell lung cancer (NSCLC) receiving intensity‐modulated radiotherapy. Methods The clinical characteristics and dosimetric parameters of 372 patients were collected retrospectively. A high NLR was defined as that ≥1.525. Survival analysis was conducted using the Kaplan–Meier and Cox regression analysis. Least absolute shrinkage and selection operator (LASSO) analysis was conducted to select appropriate dosimetric parameters. The risk factors of NLR were evaluated using univariate and multivariate logistic regression analyses. Results Patients with a high NLR had poorer progression‐free survival (PFS) ( p = 0.011) and overall survival (OS) ( p = 0.061). A low NLR (<1.525) predicted better PFS (hazard ratio [HR] 0.676, 95% confidence interval [CI]: 0.508–0.900, p = 0.007) and OS (HR 0.664, 95% CI: 0.490–0.901, p = 0.009). The aorta dose differed between the low and high NLR groups (all <0.1) in the univariate analysis. An aorta V10 was confirmed as a significant risk factor for a high NLR (odds ratio [OR] 1.029, 95% CI: 1.011–1.048, p = 0.002). Receiving chemotherapy before (OR 0.428, 95% CI: 0.225–0.813, p = 0.010) and during (OR 0.491, 95% CI: 0.296–0.815, p = 0.006) radiotherapy were predictive factors of a low NLR. Conclusion The aorta dose was significantly associated with a high NLR. Patients with stage II–III NSCLC with a high NLR had poorer prognosis. Receiving chemotherapy before and/or during radiotherapy predicted a low NLR.

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

“…Li et al reported that a low NLR predicted better PFS and OS, and aorta V10 was significantly associated with a high NLR. 29 In one study, factors such as baseline counts, heart V20, V40, or mean body dose (MBD) were predictors of NLR or PLR 1 month after RT. 26 In radiation therapy oncology group (RTOG) 0617 it was elucidated that V5, V30, and V40 Gy of the heart correlated with survival.…”

“…There were several studies about the correlation between dose distributions 27 and doses to specific structures 28,29 and radiation‐induced dynamic changes in immune cells. Li et al reported that a low NLR predicted better PFS and OS, and aorta V10 was significantly associated with a high NLR 29 .…”

“…There were several studies about the correlation between dose distributions 27 and doses to specific structures 28,29 and radiation‐induced dynamic changes in immune cells. Li et al reported that a low NLR predicted better PFS and OS, and aorta V10 was significantly associated with a high NLR 29 . In one study, factors such as baseline counts, heart V20, V40, or mean body dose (MBD) were predictors of NLR or PLR 1 month after RT 26 .…”

Prognostic value of neutrophil-to-lymphocyte ratio change in patients with locally advanced non-small cell lung cancer treated with thoracic radiotherapy

“…However, the predictive value of NLR for the prognosis of LA-NSCLC needs further exploration especially in the era of immunotherapy. In NSCLC patients with stage II and stage III who received radical intensity-modulated radiation therapy, prior research has shown that a lower baseline NLR indicates higher rates of PFS and OS 15 . Conversely, baseline NLR was confirmed to have no association with OS in III NSCLC patients, of whom 115 (35%) patients underwent surgical resection, followed by chemotherapy or chemoradiotherapy, and the remaining 217 (65%) patients received synchronous CRT 16 .…”