Prognostic role of pretreatment neutrophil-to-lymphocyte ratio in non-small cell lung cancer patients treated with systemic therapy: a meta-analysis

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR) is related to prognosis in non-small cell lung cancer (NSCLC). However, no consensus on the relationship of pretreatment NLR and survival outcomes of systemic therapy in NSCLC exists. This meta-analysis investigated the prognostic role of pretreatment NLR during systemic therapy for NSCLC, including chemotherapy, immunotherapy and targeted therapy. Methods: PubMed, Web of Science and Cochrane Library databases were systematically searched up to April 09, 2019. Hazard ratios (HRs) with their 95% confidence intervals (CIs) were pooled to investigate the association of pretreatment NLR with progression-free survival (PFS) and overall survival (OS). Results: In total, 27 articles with 4,298 participants were selected. The pooled results showed that elevated pretreatment NLR was associated with inferior PFS (HR, 1.45, 95% CI, 1.28-1.66) and OS (HR, 1.63, 95% CI, 1.43-1.84) during systemic therapy. Subgroup analyses according to the treatment strategy suggested that higher pretreatment NLR was significantly associated with shorter survival in all therapies, including

Oligoprogressive Non-Small-Cell Lung Cancer under Treatment with PD-(L)1 Inhibitors

“…Of note, the association of PD-L1 expression with OPD under IO monotherapy does not mean that PD-L1 is an accurate OPD biomarker, because we observed several (7/33 evaluable or 21%) IO-monotherapy-treated OPD cases with low (0-10%) PD-L1 expression (Table S1), and, conversely, many patients with high PD-L1 expression developed diffuse progression instead (Table 1). Furthermore, the blood lymphocyte-to-neutrophil ratio, a biomarker associated with efficacy of immunotherapy and chemotherapy in NSCLC [25,26], did not correlate with the pattern of NSCLC progression in our patients ( Table 1 and Table S2). Overall, our results show that the development of OPD in IO-treated NSCLC cannot be reliably predicted based on commonly available clinical, laboratory, and pathologic parameters, which underlines the importance of radiologic surveillance for its detection.…”

The clinicopathological and prognostic value of the pretreatment neutrophil-to-lymphocyte ratio in small cell lung cancer: A meta-analysis

“…behavior and clinical characteristics. Previous meta-analyses [41,42] have focused on the relationships between NLR and prognosis in patients with non-small cell lung cancer. Additionally, the prior meta-analyses of SCLC [43,44] only included two studies, which have not explored the clinicopathological value of NLR in SCLC.…”

Immune Modulation in Lung Cancer: Current Concepts and Future Strategies

“…One important insight is that conventional modalities, namely surgery, chemotherapy and radiotherapy, also depend heavily on the patient’s immune system for their efficacy. For example, tumor-infiltrating lymphocytes (TILs) and a lower blood NLR predict longer survival after surgery of early-stage NSCLC and SCLC, under chemotherapy in NSCLC and SCLC, and under molecularly targeted treatments in NSCLC [223-229], while the therapeutic effect of ablative radiotherapy depends on the activity of CD8 + T cells [230]. Both radiotherapy and chemotherapy induce immunogenic cell death that boosts cancer immunity by the release of DAMPs, such as calreticulin, and activation of necroptotic pathways [231, 232].…”