Prognostic Value of Pretreatment Circulating Neutrophils, Monocytes, and Lymphocytes on Outcomes in Lung Stereotactic Body Radiotherapy

Abstract

PurposeIn the present study, we determined the association of pretreatment circulating neutrophils, monocytes, and lymphocytes with clinical outcomes after lung stereotactic body radiotherapy (sbrt).Methods All patients with primary lung cancer and with a complete blood count within 3 months of lung sbrt from 2005 to 2012 were included. Overall survival (os) was calculated using the Kaplan-Meier method. Factors associated with os were investigated using univariable and multivariable Cox proportional hazards regression. Fine-Gray competing risk regression was performed to test the association of the neutrophil:lymphocyte (nlr) and monocyte:lymphocyte (mlr) ratios with two types of failure: disease-related failure and death, and death unrelated to disease. ResultsOf the 299 sbrt patients identified, 122 were eligible for analysis. The median and range of the nlr and mlr were 3.0 (0.3-22.0) and 0.4 (0.1-1.9) respectively. On multivariable analysis, sex (p = 0.02), T stage (p = 0.04), and nlr (p < 0.01) were associated with os. On multivariable analysis, T stage (p < 0.01) and mlr (p < 0.01) were associated with disease-related failure; mlr (p = 0.03), nlr (p < 0.01), and sbrt dose of 48 Gy in 4 fractions (p = 0.03) and 54 Gy or 60 Gy in 3 fractions (p = 0.02) were associated with disease-unrelated death. Median survival was 4.3 years in the nlr≤3 group (95% confidence interval: 3.5 to not reached) and 2.5 years in the nlr>3 group (95% confidence interval: 1.7 to 4.8; p < 0.01). ConclusionsIn lung sbrt patients, nlr and mlr are independently associated with os and disease-unrelated death.If validated, nlr and mlr could help to identify patients who would benefit most from sbrt.

Anemia is a poor prognostic factor for stage I non-small cell lung cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT)

“…A few studies have suggested that such a decline post SBRT for lung cancer could be due to irradiation of the bone marrow in the thoracic vertebral bodies [24], [25] or due to exposure of large pools of blood in the heart or great vessels to low dose radiation [26]. Higher NLR and PLR have been associated with poor outcomes as seen in various studies [16], [27], [28]. Interestingly, our study did not show association of pre-SBRT NLR or PLR with any survival end points on multivariate model which has been seen in another study as well [29].…”

“…However, most of these studies have evaluated patients with advanced stage or medically operable early stage NSCLC who underwent surgery. There are very few studies evaluating their role in stage I NSCLC undergoing SBRT [15] , [16] . Most of these studies have limited their blood values measured within the 3 month period prior to initiating therapy [9] , [10] , [11] , [12] , [13] , [15] , [17] .…”

Systemic Inflammation Biomarkers Predict Survival in Patients of Early Stage Non-Small Cell Lung Cancer Treated With Stereotactic Ablative Radiotherapy - A Single Center Experience

“…Likewise, a retrospective study by Cannon also indicated elevated NLR and PLR were associated with poor survival 24 . Giuliani et al demonstrated that NLR and LMR were independently correlated with OS in early stage NSCLC patients who were treated with SABR 25 . In the present work, we combined the NLR, PLR, and LMR metrics in order to analyze their collective contribution to OS.…”

Prognostic utility of pretreatment neutrophil-lymphocyte ratio in survival outcomes in localized non-small cell lung cancer patients treated with stereotactic body radiotherapy: Selection of an ideal clinical cutoff point

“…For localized NSCLC patients treated with SBRT, we hypothesize that NLR is predictive of competing mortality risk given our data. Giulani et al reported similar findings of no association with lung cancer-specific outcomes when analyzing NLR as a continuous variable [36]. This suggests an underlying propensity for mortality in the elevated NLR cohort.…”