Neutrophil-Lymphocyte Ratio as a Prognostic Parameter in NSCLC Patients Receiving EGFR-TKIs: A Systematic Review and Meta-Analysis

Tang, Mingbo; Gao, Xinliang; Sun, He; Tian, Suyan; Dong, Junxue; Liu, Zhao; Liu, Wei

doi:10.1155/2021/6688346

Cited by 16 publications

(10 citation statements)

References 36 publications

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“…Prior studies have looked solely at pretreatment NLR and have found that pretreatment NLR is an independent predictor of PFS and OS [9,32]. We did not observe NLR at the pretreatment stage (i.e., time of therapy initiation) to be an independent predictive factor as prior studies have reported, possibly due to our limited sample size and the strong association between baseline number of disease sites with OS and PFS, and ECOG score with OS and PFS.…”

Section: Discussioncontrasting

confidence: 69%

Neutrophil-to-Lymphocyte Ratio Is a Predictive Biomarker in Patients with Epidermal Growth Factor Receptor (EGFR) Mutated Advanced Non-Small Cell Lung Cancer (NSCLC) Treated with Tyrosine Kinase Inhibitor (TKI) Therapy

Yun

Rouhani

Bestvina

et al. 2021

Cancers

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Background: First-line treatment for patients with non-small cell lung cancer (NSCLC) with a sensitizing epidermal growth factor receptor (EGFR) mutation is a tyrosine kinase inhibitor (TKI). Despite higher response rates and prolonged progression free survival (PFS) compared with platinum doublet chemotherapy, a subset of these patients do not receive prolonged benefit from these agents. We investigate if the neutrophil-to-lymphocyte ratio (NLR) and other markers of cachexia and chronic inflammation correlate with worse outcomes in these patients. Methods: This study is a retrospective review of 137 patients with advanced EGFR-mutated NSCLC treated with TKIs at Rush University Medical Center and University of Chicago Medicine from August 2011 to July 2019, with outcomes followed through July 2020. The predictive value of NLR and body mass index (BMI) was assessed at the start of therapy, and after 6 and 12 weeks of treatment by univariable and multivariable analyses. Results: On univariable analysis, NLR ≥ 5 or higher NLR on a continuous scale were both associated with significantly worse PFS and overall survival (OS) at treatment initiation, and after 6 or 12 weeks of treatment. On multivariable analysis, NLR ≥ 5 was associated with increased risk of death at 12 weeks of therapy (HR 3.002, 95% CI 1.282–7.029, p = 0.011), as was higher NLR on a continuous scale (HR 1.231, 95% CI 1.063–1.425, p = 0.0054). There was no difference in PFS and OS and amongst BMI categories though number of disease sites and Eastern Cooperative Oncology Group (ECOG) performance status was associated with worse PFS and OS. Conclusions: Patients with NLR ≥ 5 have a worse median PFS and median OS than patients with NLR < 5. NLR may have value as a predictive biomarker and may be useful for selecting patients for therapy intensification in the front-line setting either at diagnosis or after 12 weeks on therapy. NLR needs to be validated prospectively.

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Section: Discussioncontrasting

confidence: 69%

Neutrophil-to-Lymphocyte Ratio Is a Predictive Biomarker in Patients with Epidermal Growth Factor Receptor (EGFR) Mutated Advanced Non-Small Cell Lung Cancer (NSCLC) Treated with Tyrosine Kinase Inhibitor (TKI) Therapy

Yun

Rouhani

Bestvina

et al. 2021

Cancers

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“…Decreased lymphocyte values are associated with decreased ability to eradicate tumors. TILs are components of TME that regulate the inflammatory response and have an important role in the eradication of tumor cells [23,24]. This study showed that there was no difference in PFS in the exon 19 mutation group and the exon 21 mutation group (12.00 (9.76-14.23) versus 12.00 (10.18-13.81), p = 0.499).…”

Section: Discussionmentioning

confidence: 69%

“…This meta-analysis used 10 studies with different NLR cut-offs. Patients with low NLR had better PFS (HR 1.67, 95% CI 1.16-2.39, p=0.005) [23]. A study by Phan et al in Vietnam also demonstrated NLR as a prognostic factor for poor PFS.…”

Section: Discussionmentioning

confidence: 92%

Pre-treatment Neutrophil-to-Lymphocyte Ratio significantly affects progression free survival in positive EGFR mutation advanced lung adenocarcinoma with EGFR-TKI treatment in Bali, Indonesia

Widiasari

Ngurah

et al. 2023

Romanian Journal of Internal Medicine

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Introduction: Today, recommendations about initial Response Evaluation Criteria in Solid Tumor (RECIST) and its frequency still vary, while early diagnosis of progression affects patient’s prognosis and subsequent treatment options. Methods: This study aims to examine Progression Free Survival (PFS) of positive EGFR mutations advanced lung adenocarcinoma receiving Tyrosine Kinase Inhibitor (TKI) and factors that influence it. This was an observational study with retrospective cohort design conducted at Prof IGNG Ngoerah Hospital from January to December 2021. Sample was data from Epidermal Growth Factor Receptor (EGFR) positive mutation advanced lung adenocarcinoma patient who were treated with EGFR-TKI at Prof IGNG Ngoerah Hospital, Denpasar, Bali from January 2017 to February 2021. Total sample was 63. Results: Median PFS was 12 months (95% CI 10.28 – 13.71) and minimum PFS was 3 months. In univariate analysis, Hazard Ration (HR) of older age, smoker, distant metastasis, brain metastasis, increased Neutrophil-to-Lymphocyte Ration (NLR), and exon 21 mutation to shorter PFS was 0.99 (95% CI 0.95-1.02); 1.03 (95% CI 0.57-1.85); 1.45 (95% CI 0.85-2.49); 2.14 (95% CI 1.02-4.49); 1.08 (95% CI 1.03-1.13); and 1.21 (95% CI 0.67-2.18). Multivariate analysis showed only increased NLR affected PFS significantly with HR 1.06 (95% CI 1.007-1.13). Conclusion: Median PFS of EGFR positive mutation advanced lung adenocarcinoma patients who received TKI was 12 months and minimum value was 3 months. Increased age, smoking, distant metastases, brain metastases, and exon 21 mutations were not associated with PFS. NLR significantly affected PFS.

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“…e prognostic value of NLR has been proven in various types of cancer [26][27][28][29]. Bagley [26] and Soyano [27] argued that high NLR was significantly associated with poor OS and PFS in NSCLC patients receiving ICIs.…”

Section: Discussionmentioning

confidence: 99%

Correlation between the Immune Checkpoint Inhibitors Prognostic Index and Outcomes in Nonsmall Cell Lung Cancer: A Multicentre Analysis

Zhou

Tian

et al. 2022

Journal of Oncology

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Objective. To evaluate the prognostic value of the immune checkpoint inhibitor prognostic index (ICPI), based on the albumin (ALB) and derived neutrophil-to-lymphocyte ratio (dNLR), for nonsmall cell lung cancer (NSCLC) patients receiving immune checkpoint inhibitors (ICIs). Methods. We conducted a multicentre retrospective study with an ICIs cohort (n = 143) and a chemotherapy control cohort (n = 84). A Cox proportional hazards regression and logistic regression model were used to find the independent risk factor for progression-free survival (PFS) and overall survival (OS) and disease control rate (DCR) in NSCLC patients. The Kaplan–Meier was used to evaluating the PFS and OS. Results. The ALB <35 g/L and dNLR >3 were correlated with worse PFS and OS for NSCLC patients receiving ICIs, respectively. The moderately high-risk ICPI had a significantly increased risk of progression (hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.14–2.91; P = 0.012 ) and of death (HR 2.33, 95% CI 1.12–4.87; P = 0.024 ) and of nondisease control (odds ratio (OR) 3.05, 95% CI 1.19–7.83; P = 0.021 ) and was correlated with worse PFS and 1-year survival rates (4.0 months vs. 7.2 months; P = 0.001 ; 44.3% vs. 76.1%; P = 0.001 ) compared with low-risk ICPI when it was characterized two groups. When ICPI was further divided into three groups, the results showed that the high-risk ICPI was correlated with worse PFS and 1-year survival rates. However, there was no difference in the chemotherapy cohort. Conclusion. The ICPI was correlated with worse outcomes for NSCLC patients receiving ICIs but not for patients with chemotherapy.

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Neutrophil-Lymphocyte Ratio as a Prognostic Parameter in NSCLC Patients Receiving EGFR-TKIs: A Systematic Review and Meta-Analysis

Cited by 16 publications

References 36 publications

Neutrophil-to-Lymphocyte Ratio Is a Predictive Biomarker in Patients with Epidermal Growth Factor Receptor (EGFR) Mutated Advanced Non-Small Cell Lung Cancer (NSCLC) Treated with Tyrosine Kinase Inhibitor (TKI) Therapy

Neutrophil-to-Lymphocyte Ratio Is a Predictive Biomarker in Patients with Epidermal Growth Factor Receptor (EGFR) Mutated Advanced Non-Small Cell Lung Cancer (NSCLC) Treated with Tyrosine Kinase Inhibitor (TKI) Therapy

Pre-treatment Neutrophil-to-Lymphocyte Ratio significantly affects progression free survival in positive EGFR mutation advanced lung adenocarcinoma with EGFR-TKI treatment in Bali, Indonesia

Correlation between the Immune Checkpoint Inhibitors Prognostic Index and Outcomes in Nonsmall Cell Lung Cancer: A Multicentre Analysis

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