Clinical significance of preoperative neutrophil‐lymphocyte ratio and platelet‐lymphocyte ratio in the prognosis of resected early‐stage patients with non‐small cell lung cancer: A meta‐analysis

Abstract

Background Poor prognosis is linked to peripheral blood levels of preoperative platelet‐lymphocyte ratio (PLR) and neutrophil‐lymphocyte ratio (NLR) in many advanced cancers. Nevertheless, whether the correlation exists in resected early‐stage cases with non‐small cell lung cancer (NSCLC) stays controversial. Consequently, we performed a meta‐analysis to explore the preoperative NLR and PLR's prognostic significance in early‐stage patients with NSCLC undergoing curative surgery. Methods Relevant studies that validated the link between preoperative NLR or PLR and survival results were found via the proceeding databases: PubMed, Embase, Cochrane Library, and Web of Science. The merged 95% confidence interval (CI) and hazard ratio (HR) was employed to validate the link between the NLR or PLR's index and overall survival (OS) and disease‐free survival (DFS) in resected NSCLC cases. We used sensitivity and subgroup analyses to assess the studies' heterogeneity. Results An overall of 21 studies were attributed to the meta‐analysis. The findings indicated that great preoperative NLR was considerably correlated with poor DFS (HR = 1.58, 95% CI: 1.37–1.82, p < 0.001) and poor OS (HR = 1.51, 95% CI: 1.33–1.72, p < 0.001), respectively. Subgroup analyses were in line with the pooled findings. In aspect of PLR, raised PLR was indicative of inferior DFS (HR = 1.28, 95% CI: 1.04–1.58, p = 0.021) and OS (HR = 1.37, 95% CI: 1.18–1.60, p < 0.001). In the subgroup analyses between PLR and DFS, only subgroups with a sample size <300 (HR = 1.67, 95% CI: 1.15–2.43, p = 0.008) and TNM staging of mixed (I‐II) (HR = 1.47, 95% CI: 1.04–2.07, p = 0.028) showed that the link between high PLR and poor DFS was significant. Conclusions Preoperative elevated NLR and PLR may act as prognostic biomarkers in resected early‐stage NSCLC cases and are therefore valuable for guiding postoperative adjuvant treatment.

What's new in thoracic oncology

“…Improvements in the accuracy and prognostic value of liquid biopsy thanks to AI have been reported in other, nonthoracic malignancies, such as ovarian cancer 38 . Similar investigations are currently underway in lung cancer, analyzing biomarkers which can be drawn from peripheral blood samples to guide diagnosis and individualize treatment recommendations 39,40 …”

“…38 Similar investigations are currently underway in lung cancer, analyzing biomarkers which can be drawn from peripheral blood samples to guide diagnosis and individualize treatment recommendations. 39,40…”

Prognostic significance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in non-small cell lung cancer

“…A recent meta-analysis that examined 21 studies has concluded that preoperative elevated NLR and PLR levels may act as prognostic markers in only early stage NSCLC patients that were operated while our study has the same conclusion in all stages. [28] Likewise another study that has investigated again only the operated NSCLC patients also concluded that both NLR and PLR are related to survival but PLR demonstrates a greater prognostic value than NLR. [29] An interesting study which investigated newly diagnosed stage IV NSCLC patients a relationship was found between depressive symptoms and NLR,PLR increase.…”

The DC–T cell axis is an effective target for the treatment of non‐small cell lung cancer

“…Thus far, more CAR‐T studies have focused primarily on NSCLC 141,142 . The most common target antigens of NSCLC include human EGFRs, mesothelin, mucin 1, PD‐L1, 143 CEAs, 144 and HER2 145 . As a result, these antigens are potentially novel targets for NSCLC treatment 146,147 …”