Background
For selected early stage small cell lung cancer (SCLC), curative intent surgery is often performed. Previous studies, predominantly from East Asia, reported that high neutrophil to lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR) correlate with poor prognosis in several types of tumors including SCLC. Our aim was to investigate the prognostic value of NLR and PLR in Caucasian patients with resected SCLC, as potential tool to select patients for multimodal treatment including surgery.
Methods
Consecutive patients evaluated at three centers between 2000 and 2013 with histologically confirmed and surgically resected SCLC were retrospectively analyzed. NLR and PLR at diagnosis was used to categorize patients into “high” and “low” groups based on receiver operating curve analysis. Univariate and multivariate analyses were used to evaluate the impact of clinical and pathological characteristics on outcome.
Results
There were a total of 189 patients with a median age of 58 years, and the majority had stage I or II disease. We found a significant correlation between NLR and tumor stage (p = 0.007) and age (p = 0.038). Low NLR (LNLR) was associated with significantly longer overall survival, while PLR had no prognostic impact. There were significant associations between NLR and PLR but not with gender, vascular involvement, tumor necrosis, peritumoral inflammation, or tumor grade.
Conclusion
Pre-operative LNLR may be a favorable prognostic factor in stage I–II SCLCs. PLR is not prognostic in this population. LNLR is easy to assess and can be integrated into routine clinical practice. Further prospective studies are needed to confirm these observations.
Рис.3. Средняя концентрация формальдегида в воздухе за год (Qcp-мг/м3, ПДК 0,003 мг/м3) в городах Югры. References 1. Single interagency information-statistical system.
Results: All were male and the average age was 76 years (64-86) at the time of surgery. The average duration between SBRT and the surgery was 20 months (10-105). Pathological diagnosis was adenocarcinoma in 7, squamous cell carcinoma in 4, and others in 2. Lobectomy was performed in 10 patients, segmentectomy in 2 and wedge resection in 1. Because the irradiated area was mainly confined to the peripheral lungs, central pulmonary structures were intact after irradiation. There was almost no pleural adhesion related to the irradiation. There was no perioperative mortality and 4 patients had morbidities. One patient had a conversion from VATS to thoracotomy due to bleeding and 3 patients had prolonged air leak postoperatively. The resected tumor diameter ranged from 12 to 50 mm with a median of 33 mm. Viable tumor cells were found in the specimens of all patients. Two patients were positive on mediastinal lymph nodes and were offered adjuvant chemotherapy. At a mean follow-up of 52 months (range, 13 to 103 months), the 3 and 5 year survival rates were 72% and 41%, respectively. Conclusion: Salvage surgery after SBRT was feasible and provided encouraging outcome.
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