Prognostic performance of inflammation-based prognostic indices in primary operable non-small cell lung cancer

Abstract

Background:At least 30% of patients with primary resectable non-small cell lung cancer (NSCLC) will experience a relapse in their disease within 5 years following definitive treatment. Clinicopathological predictors have proved to be suboptimal in identifying high-risk patients. We aimed to establish whether inflammation-based scores offer an improved prognostic ability in terms of estimating overall (OS) and recurrence-free survival (RFS) in a cohort of operable, early-stage NSCLC patients.Methods:Clinicopathological, demographic and treatment data were collected prospectively for 220 patients operated for primary NSCLC at the Hammersmith Hospital from 2004 to 2011. Pretreatment modified Glasgow Prognostic Score (mGPS), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were tested together with established prognostic factors in uni- and multivariate Cox regression analyses of OS and RFS.Results:Half of the patients were male, with a median age of 65. A total of 57% were classified as stage I with adenocarcinoma being the most prevalent subtype (60%). Univariate analyses of survival revealed stage (P<0.001), grade (P=0.02), lymphovascular (LVI, P=0.001), visceral pleural invasion (VPI, P=0.003), mGPS (P=0.02) and NLR (P=0.04) as predictors of OS, with stage (P<0.001), VPI (P=0.02) and NLR (P=0.002) being confirmed as independent prognostic factors on multivariate analyses. Patients with more advanced stage (P<0.001) and LVI (P=0.008) had significantly shorter RFS.Conclusions:An elevated NLR identifies operable NSCLC patients with a poor prognostic outlook and an OS difference of almost 2 years compared to those with a normal score at diagnosis. Our study validates the clinical utility of the NLR in early-stage NSCLC.

Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: A meta-analysis of 7,219 patients

“…The characteristics of the 18 studies are summarized in Table I. A total of 7 studies were conducted in Western countries, including the UK (17,26,34), USA (28), Spain (20) and Italy (22,34), 1 study was performed in Turkey (23), and 10 studies were performed in East Asian countries, including Japan (18,19,31,32), Korea (21,25) and China (24,27,30,33). The study published by Mitchell et al (29) included patient data from 33 countries.…”

“…The included studies evaluated 16 populations of patients with NSCLC (17-24,26-29,31-34) and 2 populations of patients with SCLC (25,30). The 2 studies on SCLC reported tumor staging information as limited and extensive disease, so only the staging information from the studies regarding NSCLC were considered Only 1 study by Sarraf et al (17) evaluated all tumor stages, 8 studies evaluated early-stage tumors (23,(26)(27)(28)(29)(31)(32)(33), and 6 studies evaluated late-stage tumors (18,(20)(21)(22)24,34). The study by Tomita et al (19) evaluated stages IA/III/IV.…”

Elevated neutrophil‑to‑lymphocyte ratio is associated with nutritional impairment, immune suppression, resistance to S‑1 plus cisplatin, and poor prognosis in patients with stage?IV gastric cancer

“…Based on these findings, a number of inflammation-based prognostic markers such as the Glasgow Prognostic Score (GPS) and the platelet to lymphocyte ratio (PLR) have been studied (6,7). In addition, Elevated neutrophil-to-lymphocyte ratio is associated with nutritional impairment, immune suppression, resistance to S-1 plus cisplatin, and poor prognosis in patients with stage IV gastric cancer KENJI GONDA 1,2 , MASAHIKO SHIBATA there is increasing evidence that the neutrophil to lymphocyte ratio (NLR) can be an effective prognostic indicator in various types of malignant diseases (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In cancer patients, lymphopenia reflects an impaired cell-mediated immunity, while neutrophilia is acknowledged as a response to systemic inflammation.…”

Increased neutrophil-to-lymphocyte ratio is a novel marker for nutrition, inflammation and chemotherapy outcome in patients with locally advanced and metastatic esophageal squamous cell carcinoma

“…Thus, the prognostic value of inflammation-based prognostic scores, such as the Glasgow Prognostic Score (GPS) and the platelet-to-lymphocyte ratio (6,7), has been studied. In addition, increasing evidence has indicated that the neutrophil-to-lymphocyte ratio (NLR) may be an effective prognostic indicator in various types of malignant diseases (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”