Prognostic value of neutrophil-to-lymphocyte ratio in locally advanced non-small cell lung cancer treated with concurrent chemoradiotherapy

Abstract

Purpose: This study aimed to investigate neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors in patients with locally advanced non-small cell lung cancer (NSCLC) who received concurrent chemoradiotherapy (CCRT). Materials and Methods: We retrospectively analyzed 66 patients with locally advanced NSCLC treated with definitive CCRT. Among these patients, 95% received paclitaxel/carboplatin or docetaxel/cisplatin. The median radiation dose was 66 Gy in 33 fractions. The NLR and PLR before/after CCRT were evaluated. The maximally selected log-rank test was used to obtain the cutoff values related to the overall survival (OS). Results: Patients with high post-CCRT NLR (>3.12) showed worse OS, locoregional progression-free survival (LRPFS), and distant metastasis-free survival (DMFS) than those with low NLR (2-year OS: 25.8% vs. 68.2%, p < 0.001; 2-year LRPFS: 12.9% vs. 33.8%, p = 0.010; 2-year DMFS: 22.6% vs. 38.2%, p = 0.030). Patients with high post-CCRT PLR (>141) showed worse OS and LRPFS than those with low PLR (2-year OS: 37.5% vs. 71.1%, p = 0.004; 2-year LRPFS: 16.5% vs. 40.3%, p = 0.040). Patients with high NLR change (>1.61) showed worse OS and LRPFS than those with low NLR change (2-year OS: 26.0% vs. 59.0%, p < 0.001; 2-year LRPFS: 6.8% vs. 31.8%, p = 0.004). The planning target volume (hazard ration [HR] = 2.05, p = 0.028) and NLR change (HR = 3.17, p = 0.025) were the significant factors for OS in the multivariate analysis. Conclusion: NLR change after CCRT was associated with poor prognosis of survival in patients with locally advanced NSCLC. An elevated NLR after CCRT might be an indicator of an increased treatment failure risk.

Clinical importance of the absolute count of neutrophils, lymphocytes, monocytes, and platelets in newly diagnosed hepatocellular carcinoma

“…Furthermore, reports suggest subcategorization of white blood cells or platelets and their functions associated with tumor progression or suppression 6 – 8 . Numerous studies have confirmed the clinical significance of the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in HCC 9 – 12 . Additionally, our group has also reported the prognostic significance of NLR, LMR, and PLR in newly diagnosed previously untreated patients with HCC using a large single institutional cohort data and validated the results in the same cohort registered at different times 13 .…”

Prognostic impact of immune inflammation biomarkers in predicting survival and radiosensitivity in patients with non‐small‐cell lung cancer treated with chemoradiotherapy

“…Since most of the studies usually lean on surgery and/or chemotherapy as treatment modalities, we focused our attention in the literature on the studies on patients who were subjected to radiotherapy, as our aim is to make a comparison with the results of our study. All series had a retrospective design and included patients with locally advanced NSCLC treated with curative radiotherapy 1,23–28 . The inferences obtained can be listed as follows: First, these indices were often examined individually in published studies.…”

“…Second, some researchers evaluated post treatment values and changes regarding these indices. While the change of indices remained prognostic, pre‐treatment values of indices unexpectedly did not show a survival advantage 24 . Third, the studies examined the prognostic effects of indices on OS and PFS.…”

New developments in locally advanced nonsmall cell lung cancer

“…Concurrent chemoradiotherapy may dynamically alter PD-L1 expression and numbers of CD8 + tumour infiltrating lymphocytes [98,99]. Pre-therapeutic blood-based parameters, or their change during chemoradiotherapy, may predict prognosis [100][101][102].…”