Pre-treatment neutrophil-lymphocyte ratio is associated with overall mortality in localized non-small cell lung cancer treated with stereotactic body radiotherapy

Sebastian, Nikhil; Wu, Trudy C.; Bazan, Jose G.; Driscoll, Erin; Willers, Henning; Yegya-Raman, Nikhil; Bond, Laura; Dwivedi, Abhishek; Mo, Xiaokui; Tan, Yubo; Xu‐Welliver, Meng; Haglund, K.E.; Jabbour, Salma K.; Keane, Florence K.; Williams, Terence M.

doi:10.1016/j.radonc.2019.01.032

Cited by 27 publications

(39 citation statements)

References 32 publications

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“…Thus, an elevated 3-month posttreatment NLR after treatment could be used to potentially dictate closer follow up or addition of consolidative therapies. Additionally, we found that NLR increases after radiation, a finding that has been identified in other studies (15)(16)(17) and possibly reflects a sustained inflammatory response to radiotherapy and/or depletion of lymphocytes, which are highly radiosensitive. It is possible that the lack of significant association of posttreatment NLR at 1 month with outcomes is due to a more acute inflammatory or lymphodepleted state not indicative of the chronic immunologic changes that are more likely to influence cancer recurrence.…”

Section: Discussionsupporting

confidence: 85%

Association of Pre- and Posttreatment Neutrophil–Lymphocyte Ratio With Recurrence and Mortality in Locally Advanced Non-Small Cell Lung Cancer

et al. 2020

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Objectives: Neutrophil-lymphocyte ratio (NLR) has been associated with mortality in non-small cell lung cancer (NSCLC), but its association with recurrence in locally advanced NSCLC (LA-NSCLC), specifically, is less established. We hypothesized preand posttreatment NLR would be associated with recurrence and mortality. Methods: We studied the association of pretreatment NLR (pre-NLR) and posttreatment NLR at 1 (post-NLR 1) and 3 months (post-NLR 3) with outcomes in patients with LA-NSCLC treated with chemoradiation. Pre-NLR was dichotomized by 5, an a priori cutoff previously shown to be prognostic in LA-NSCLC. Post-NLR 1 and post-NLR 3 were dichotomized by their medians. Results: We identified 135 patients treated with chemoradiation for LA-NSCLC between 2007 and 2016. Median follow-up for living patients was 61.1 months. On multivariable analysis, pre-NLR ≥ 5 was associated with worse overall survival (

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Section: Discussionsupporting

confidence: 85%

Association of Pre- and Posttreatment Neutrophil–Lymphocyte Ratio With Recurrence and Mortality in Locally Advanced Non-Small Cell Lung Cancer

et al. 2020

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“…The NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count. DFS and OS were stratified by median of NLR (2.3), which was also consisting with previous studies [15][16][17][18] . Epidermal growth factor receptor (EGFR) mutation status was detected by real-time PCR or DNA sequencing as previously described [19].…”

Section: Patientsmentioning

confidence: 58%

Combination of PD-L1 expression and NLR as prognostic marker in patients with surgically resected non-small cell lung cancer

Wang

Cao

et al. 2019

J. Cancer

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Background: In recent years, great improvement has been made in immunotherapies for non-small cell lung cancer (NSCLC). Current data have suggested that Programmed cell death ligand 1 (PD-L1) expression might not be an ideal marker for patient selection in isolation. Evidence has been increasing that alternative markers, such as neutrophil-to-lymphocyte ratio (NLR), a biomarker of systemic inflammation response (SIR) previously associated with outcomes in a variety of cancers including NSCLC, might be a predictor for patient selection and the response to therapy. No reports have examined the prognostic value of combination of PD-L1 expression and inflammatory markers such as NLR in NSCLC. This retrospective study explores the relationship between NLR and PD-L1 expression in NSCLC as well as the prognostic value of combination of PD-L1 expression and NLR. Method: We evaluated tumor PD-L1 expression in 235 surgically resected NSCLC cases by immunohistochemical analysis. Carcinoma cells showing membranous staining for PD-L1 were considered PD-L1-positive cells (Figure 1). Cases with ≥1% tumor membrane staining were considered PD-L1-positive. The association of clinicopathological characteristics with PD-L1 expression was assessed by univariate and multivariate analyses. Moreover, univariate and multivariate analyses were performed to evaluate the predictive impact of PD-L1 expression and other factors on disease-free survival (DFS) and overall survival (OS). Result: PD-L1 protein expression was elevated in 34.0% of patients at cutoff value of 1%. Univariate analyses showed that PD-L1 expression was significantly higher in men (χ 2 =5.226, P=0.030), heavy smokers (χ 2 =18.650, P<0.001), and patients with squamous cell carcinoma (χ 2 =4.036, P=0.045). No correlations were noted between PD-L1 expression and age, EGFR mutation status or clinical stage. No significant correlations between PD-L1 protein expression and NLR were found. Multivariate logistic regression revealed that smoking index ≥400 was independent predictor of PD-L1 expression (odds ratio [OR], 3.375; P < 0.001). The results of univariate survival analyses showed that clinical stage (log-rank χ 2 =7.876, P=0.019) was associated with DFS. Smoking index (log-rank χ 2 =4.832, P=0.028), clinical stage (log-rank χ 2 =7.582, P=0.023) and adjuvant treatment (log-rank χ 2 =5.440, P=0.020) were significantly associated with OS. Neither PD-L1 expression nor NLR was found to be associated with DFS or OS. Of interest, when patients were divided in two groups according to combined PD-L1/NLR: patients with PD-L1+/ high NLR as Group 1, other patients as Group 2, Group 1 had significantly shorter DFS as well as OS than Group 2 (DFS: log-rank χ 2 =5.231, P=0.022, Figure 2A; OS: log-rank χ 2 =4.742, P=0.029, Figure 2B). In the multivariate analysis, Cox proportional hazards regression models showed that, PD-L1+/ high NLR was associated with a significantly shorter DFS and OS (hazard ratio [HR], 1.394, P=0.040; HR, 1.442, P=0.042, respectively). Stratified analysis showed t...

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“…Immune and in ammatory responses attract attention because they are critical for tumor development and are potentially associated with treatment outcomes. Most studies report that an elevated NLR before initial surgery, chemotherapy, or RT, or combined, is associated with poor prognoses of patients with lung cancer, uterine cervical cancer, ovarian cancer, and many other solid tumors [17,18,19,20]. In CCA, an elevated NLR immediately before surgery or chemotherapy potentially predicts shorter PFS and OS [1,[32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

“…However, we lack universally accepted standardized prognostic factors. This situation may be resolved by evaluation of immune and in ammatory factors that serve as prognostic factors for other malignancies [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Makers Including Immune and Inflammatory Factors Predict Outcomes in Patients Receiving Postoperative Radiation Therapy for Cholangiocarcinoma

Mukai

Matsuyama

Sugiura

et al. 2020

Preprint

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Purpose: This study aimed to analyze treatment outcomes and prognostic markers, including immune and inflammatory factors, of postoperative radiation therapy (RT) administered to patients with cholangiocarcinoma (CCA).Methods: We retrospectively selected 59 patients with CCA who underwent surgery and postoperative RT with curative intent from 2004 to 2019. Patients received external irradiation (50 Gy in 25 fractions) using three-dimensional RT. Overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS), and locoregional control (LRC) rates of initial RT were assessed using the Kaplan–Meier method. Univariate and multivariate Cox proportional-hazards regression models were used to identify prognostic factors. We analyzed prognostic factors of inflammation, such as pre-RT platelet count, hemoglobin, lymphocyte count ratio (LCR) of the leukocyte count, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR).Results: Tumor stages were distributed as follows: I (n = 8), II (n = 25), III (n = 15), and IVA (n = 11). The median follow-up was 24 months. Two-year OS, CSS, PFS, and LRC rates were 59.5%, 62.0%, 40.1%, and 66.7%, respectively. Univariate analysis revealed that lower LCR was significantly associated with shorter PFS (P = 0.0446, hazard ratio (HR): 1.90, 95%, confidence interval (CI): 1.02–3.58). There was no significant difference between the median baseline values of PLR and NLR; and age ≥75, positive regional lymph node metastases (N+), and chemotherapy after RT were significantly associated with poor OS. Multivariate analysis revealed a significant association of N+ with OS, PFS and CSS and that lower LCR was significantly associated with PFS (HR: 0.481, CI: 0.252–0.905, p=0.0234). Among late toxicity events, two patients (3.38%) were suspected with therapy-related liver toxicity.Conclusions: LCR before RT was a prognostic factor for postoperative radiation therapy of patients with CCA.

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Pre-treatment neutrophil-lymphocyte ratio is associated with overall mortality in localized non-small cell lung cancer treated with stereotactic body radiotherapy

Cited by 27 publications

References 32 publications

Association of Pre- and Posttreatment Neutrophil–Lymphocyte Ratio With Recurrence and Mortality in Locally Advanced Non-Small Cell Lung Cancer

Association of Pre- and Posttreatment Neutrophil–Lymphocyte Ratio With Recurrence and Mortality in Locally Advanced Non-Small Cell Lung Cancer

Combination of PD-L1 expression and NLR as prognostic marker in patients with surgically resected non-small cell lung cancer

Prognostic Makers Including Immune and Inflammatory Factors Predict Outcomes in Patients Receiving Postoperative Radiation Therapy for Cholangiocarcinoma

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