Pretreatment Neutrophil to Lymphocyte Ratio Is Associated with Poor Survival in Patients with Stage I-III Non-Small Cell Lung Cancer

Abstract

BackgroundNeutrophil-to-lymphocyte ratio (NLR) has been shown to be a prognostic indicator in several types of cancer. We aimed to investigate the association between NLR and survival in surgery-treated non-small cell lung cancer (NSCLC) patients.Study DesignThis large retrospective study included 1,245 patients who underwent initial surgery for stage I–III NSCLC at The University of Texas MD Anderson Cancer Center between December 2002 and November 2010. We analyzed the relationship of NLR with clinicopathological variables, local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), recurrence-free survival (RFS), overall survival (OS), and disease-specific survival (DSS) in patients with high or low NLR using Kaplan-Meier method. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to assess the prognostic strength of NLR.ResultsThere was a statistically significant association between the pretreatment NLR and histology type (P = 0.003) and tumor grade (P = 0.028). At a median follow-up time of 50.6 months, high NLR was associated with reduced DRFS (P = 0.011), OS (P < 0.0001) and DSS (P = 0.004); it was not associated with LRFS and RFS. Multivariable Cox analysis further revealed that NLR (P = 0.027), pathologic stage (P < 0.0001) and lymphovascular invasion (P < 0.0001) were strong independent predictors for DRFS. NLR was also an independent marker predicting poor OS (P = 0.002) and DSS (P = 0.017).ConclusionThe pretreatment NLR can serve as a biomarker to predict distant recurrence and death in stage I–III NSCLC patients. Combination of NLR and pathologic stage can better predict the OS and DSS in stage I-II NSCLC patients.

Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines?

“…In these three nomograms, which contain an independent nomogram exclusively for BD‐IPMN, cyst size and existence of a solid component are common predictors of malignant lesions in BD‐IPMN,8, 25, 26 and older age is also a predictor in two nomograms 8, 26. Gemenetzis et al29 included both MD‐IPMN and BD‐IPMN in a nomogram, and one of its factors predicting invasive cancer is the neutrophil‐to‐lymphocyte ratio, which has been reported to be a predictor of invasive cancer and poor prognosis in patients with various types of tumors 30, 31, 32, 33…”

Neutrophil to Lymphocyte Ratio (NLR) in Peripheral Blood: A Novel and Simple Prognostic Predictor of Non-small Cell Lung Cancer (NSCLC)

“…Cumulative evidence has revealed that tumor-promoting in lammation contributes to cancer growth and progression by creating a tumor-promoting microenvironment, stimulates the proliferation of bronchial stem cells, and triggers the carcinogenesis of lung epithelial cell. Additionally, systematic in lammatory can not only cause tumor growth and promote tumor metastasis by activating type 2 T-assisted response, chemokines, vascular regeneration and others [4], but also responsible for reducing the effect of anti-cancer drugs and cancer-related symptoms including anorexia, cancerous pain, debilitation, cachexia [2]. In total, systematic in lammation has been shown to play an important impact on the pathogenesis and progression of NSCLC and is of great value to the aggravation and prognosis of NSCLC.…”

“…Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all cases of lung cancer [1], but fewer than 15% of individuals diagnosed with NSCLC can survive for more than 5 years, which poses a great threat to the patient's life and health [2]. Recently, the incidence of lung cancer keeps dynamically growing, but more than 75% of patients at diagnosis has appeared local development or metastasis, missing the best period of surgery.…”

“…On one hand, CD11b +/Ly6G+ tumor-associated neutrophils are toxic to tumor cells. On the other hand, neutrophils can promote tumor metastasis through Mac-1-mediated pathways, secrete vascular endothelial growth factor, and inhibit the dissolution activity of lymphatic cells, natural killer cells, contributing to tumor proliferation [2]. Most of the neutrophils play a role in promoting tumor growth and immunosuppression [2], while the loss of neutrophils may inhibit tumor growth.…”

“…On the other hand, neutrophils can promote tumor metastasis through Mac-1-mediated pathways, secrete vascular endothelial growth factor, and inhibit the dissolution activity of lymphatic cells, natural killer cells, contributing to tumor proliferation [2]. Most of the neutrophils play a role in promoting tumor growth and immunosuppression [2], while the loss of neutrophils may inhibit tumor growth. As the host's immune response to the tumor is lymphocyte-dependent, lymphocytes can not only induce cytotoxin-mediated apoptosis but also produce a certain cytokine to inhibit tumor cell proliferation and migration.…”