Inflammation scores as prognostic biomarkers in small cell lung cancer: a systematic review and meta-analysis

Abstract

Background Inflammation scores based on general inflammation markers as leucocyte count or C-reactive protein have been evaluated as prognostic markers of inferior survival in several cancers. In small cell lung cancer (SCLC), however, inflammation scores are less studied. In the present study, we set out to perform a systematic review and meta-analysis investigating reported associations between inflammation scores and overall survival (OS) in SCLC. Methods A literature search was performed in PubMed, Embase, Scopus, and Web of Science following the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines. Of the identified publications, only studies in English containing original data evaluating inflammation scores as a prognostic factor in SCLC patients were included. Hazard ratios (HRs) for OS were pooled in a random-effects model. Results In total, 33 articles were included evaluating eight different inflammation scores in 7762 SCLC patients. Seven of the identified scores were based on leucocyte count. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) ratio were the most frequently evaluated scores (NLR: n = 23; PLR: n = 22). For NLR, a meta-analysis including 16 studies demonstrated that patients with a high NLR had a significantly shorter OS compared to patients with a low NLR (pooled HR = 1.39 (95% CI, 1.23–1.56)). For PLR, an association with survival could not be confirmed in a meta-analysis performed based on eight studies (pooled HR = 1.20 (95% CI, 0.96–1.51)). Conclusions This review identifies that inflammation scores based on general inflammation markers have some potential as prognostic biomarkers in SCLC. The meta-analyses indicated that NLR is associated with inferior OS, whereas an association between PLR and OS could not be confirmed. Thus, NLR could be a useful biomarker of OS in SCLC patients. Systematic review registration The protocol for the study was submitted to the PROSPERO database (registration number CRD42020188553).

Inflammation-scores as prognostic markers of overall survival in lung cancer: a register-based study of 6,210 Danish lung cancer patients

“…The nine evaluated inflammation-scores have all previously shown potentials as prognostic biomarkers of OS in lung cancer patients [ 26 – 29 , 32 , 34 – 38 ]. NLR is the most widely studied score and has in meta-analyses demonstrated to hold prognostic value in NSCLC [ 39 – 41 ] as well as in SCLC [ 17 , 19 ]. On the other hand, the ACBS has only once been studied in patients with lung cancer as we previously have evaluated the score in 267 patients with NSCLC.…”

“…In lung cancer, several inflammation-scores have been evaluated. Especially, NLR, PLR and GPS have attracted attention and in meta-analyses demonstrated potentials as prognostic biomarkers independently of stage and histology [ 15 – 19 ]. However, despite many studies on inflammation-scores in the literature, it remains unknown which inflammation-score serves as the best prognostic score.…”

“…Based on a comprehensive literature search, we identified nine inflammation-scores composed of general inflammation markers which have been previously evaluated in lung cancer patients [ 19 ]. Our primary objective was to make a direct comparison of the prognostic potential of these established inflammation-scores in a large Danish lung cancer cohort to identify the inflammation-score with the best prognostication of OS.…”

Mediterranean Diet Implementation to Protect against Advanced Lung Cancer Index (ALI) Rise: Study Design and Preliminary Results of a Randomised Controlled Trial

“…Lower ALB has been associated with a higher incidence of systemic inflammation and a worse overall survival [9,15]. Additionally, a higher CRP concentration and a greater Neutrophil to Lymphocyte Ratio (NLR) have been related to a worse overall survival in LC [9,15,16]. An adequate protein and energy intake represents the first target of a correct nutritional intervention in cancer patients [15].…”

Elevated Pretreatment Fibrinogen-to-Lymphocyte Percentage Ratio Predict Tumor Staging and Poor Survival in Non-Small Cell Lung Cancer Patients with Chemotherapy or Surgery Combined with Chemotherapy

“…11–13 However, conflicting results of monocytes/lymphocytes (MLR), platelets/lymphocytes (PLR), circulating neutrophils/lymphocytes (NLR) and prognosis of lung cancer have been reported. 14–16 Hou et al 17 indicated that fibrinogen (FIB) and D-dimer levels could be used as candidate biomarkers for the prognosis of NSCLC. It can be inferred that the relationship between FIB and LY% can be used to determine the prognosis of NSCLC.…”