Prognostic Value of Inflammatory Biomarkers in Patients With Stage I Lung Adenocarcinoma Treated With Surgical Dissection

Abstract

ObjectiveInflammation plays a crucial role in tumorigenesis and progression. Our purpose was to investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII), and develop a nomogram to predict the cancer-specific survival (CSS) and disease-free survival (DFS) of stage I lung adenocarcinoma patients.Methods1431 patients undergoing surgical resection with pathologically confirmed stage I lung adenocarcinoma were reviewed. The optimal cut-off values for NLR, SII, and SIRI were defined by the receiver operating characteristic (ROC) curve. Cox proportional hazards regression analyses were performed to recognize factors significantly correlated with CSS and DFS to construct the nomogram. The value of adjuvant chemotherapy on model-defined high-risk and low-risk patients was further explored.ResultsThe cohort had a median follow-up time of 63 months. Multivariate analysis revealed that higher NLR (≥2.606), higher SIRI (≥0.705), higher SII (≥580.671), later T stage, histological pattern with solid or micropapillary components and radiologic features with solid nodules were significantly associated with worse CSS and DFS. The concordance index (C-index) of the nomogram established by all these factors was higher than that of the TNM staging system both in CSS (validation set 0.778 vs 0.652) and DFS (validation set 0.758 vs 0.695). Furthermore, the value of the established nomogram on risk stratification in stage I lung adenocarcinoma patients was validated.ConclusionsHigher NLR, SII and SIRI pretreatment were associated with worse survival outcomes. A practical nomogram based on these three inflammatory biomarkers may help clinicians to precisely stratify stage I lung adenocarcinoma patients into high- and low-risk and implement individualized treatment.

Chest CT Severity Score and Systemic Inflammatory Biomarkers as Predictors of the Need for Invasive Mechanical Ventilation and of COVID-19 Patients’ Mortality

“…Apart from well-known biomarkers of inflammation such as C-reactive protein, interleukin-6 (IL-6), and procalcitonin, hematological indices have gained popularity in recent years in the specialized literature due to their inexpensive cost and performance [ 7 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 38 , 39 , 40 , 41 ]. Moreover, hematological indices such as neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), systemic immune inflammation index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI), have been applied to predict the prognosis in patients with the cardiovascular disease [ 42 , 43 , 44 ], acute limb ischemia [ 45 , 46 ], chronic kidney disease [ 47 , 48 ], peripheral artery disease [ 49 ], malignancy [ 50 , 51 , 52 ], and more recently in the case of COVID-19 patients [ 7 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

Systemic Inflammatory Biomarkers and Chest CT Findings as Predictors of Acute Limb Ischemia Risk, Intensive Care Unit Admission, and Mortality in COVID-19 Patients

“…Cell blood count (CBC) has recently been suggested and investigated in the case of COVID-19 patients as a diagnostic and predictive tool for detecting severe forms [ 31 , 32 , 33 ], the need for ICU admission [ 33 , 34 ], and the necessity for invasive mechanical ventilation (IMV) [ 35 ], as well as mortality [ 36 , 37 ]. Among the CBC parameters, we list the following inflammatory biomarkers: monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelets to lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), whose prognostic role has been demonstrated in the field of cardio-vascular pathology [ 38 , 39 , 40 , 41 , 42 , 43 , 44 ], kidney disease [ 45 , 46 ], oncology [ 47 , 48 ], and in the last two years, in the case of COVID-19 patients [ 31 , 32 , 33 , 34 , 35 ].…”

The prognostic value of the preoperative inflammatory index on the survival of glioblastoma patients

“…Hematological indicators such as neutrophils, lymphocytes, monocytes, and platelets count can reflect the inflammatory condition of the system and have potential value for prognostic prediction of many tumors [ 10 – 13 ]. Different combinations of these markers yielded various inflammatory markers, such as SII, SIRI, NLR, PLR, and MLR, which have been reported as important prognostic factors for malignancies including lung cancer, nasopharyngeal carcinoma, and COVID-19 cancer [ 14 – 16 ].…”