Prognostic value of pretreatment inflammatory biomarkers in advanced lung adenocarcinoma patients receiving first-line pemetrexed/platinum doublet

Abstract

Inflammation is a new hallmark feature of cancer initiation and progression. We aimed to investigate the association between inflammatory response biomarkers and progression-free survival and overall survival in advanced lung adenocarcinoma patients treated with first-line pemetrexed and platinum doublet chemotherapy. Patients hospitalized between April 2012 and March 2015 were enrolled and eliminated according to the inclusion and exclusion criteria. The pretreatment neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, derived neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were calculated. Besides the well-established clinical prognostic factors, the prognostic values of the four markers were evaluated by the Kaplan-Meier method and Cox's proportional hazards regression model. A total of 78 patients were enrolled in this study. Elevated neutrophil-to-lymphocyte ratio and derived neutrophil-to-lymphocyte ratio were correlated with poor treatment response ( p = 0.014, 0.012, respectively). A high pretreatment neutrophil-to-lymphocyte ratio, derived neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio, as well as low lymphocyte-to-monocyte ratio, were associated with worse progression-free survival and overall survival. Multivariate analysis revealed that high neutrophil-to-lymphocyte ratio (hazard ratio = 2.056; 95% confidence interval, 1.281-3.299; p = 0.003) and ≥3 metastasis organs (hazard ratio = 1.989; 95% confidence interval, 1.069-3.702; p = 0.030) were independent prognostic factors for progression-free survival. Meanwhile, high neutrophil-to-lymphocyte ratio (hazard ratio = 5.540; 95% confidence interval, 2.974-10.321; p < 0.001) and habitual smoking (hazard ratio = 2.806; 95% confidence interval, 1.509-5.221; p = 0.001) were independent prognostic factors for overall survival. In conclusion, Pretreatment neutrophil-to-lymphocyte ratio was an independent prognostic factor for advanced lung adenocarcinoma patients treated with first-line pemetrexed/platinum doublet chemotherapy. Elevated pretreatment derived neutrophil-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio might be potential biomarkers for poorer responses to chemotherapy. To verify these findings, larger well-designed prospective studies are needed.

The Utility of Pre-Treatment Inflammation Markers as Associative Factors to the Adverse Outcomes of Vulvar Cancer: A Study on Staging, Nodal Involvement, and Metastasis Models

“…Unlike NLR, multivariate analysis in this study did not reveal any proof of a connection between dNLR and staging, LNM, or DM. NLR and dNLR look identical and have similar effects on cancer-specific mortality [91,92]. Our investigation supported this hypothesis, which found a robust positive correlation between dNLR and NLR (ρ = 0.950, p < 0.001).…”

Prognostic Value of Pretreatment Lymphocyte-to-Monocyte Ratio in Lung Cancer: A Systematic Review and Meta-Analysis

“…A total of 23 studies comprising 8361 lung cancer patients were included. 7 -10,12 -30 Among these patients, 5702 (68%) were males, 4548 were current smokers and 2212 were diagnosed with squamous carcinoma. The main features of the included studies are summarized in Table 1.…”

Prognostic role of pretreatment neutrophil-to-lymphocyte ratio in non-small cell lung cancer patients treated with systemic therapy: a meta-analysis

“…The dNLR had been assessed as a predictor of treatment outcomes in other tumors receiving immunotherapy (62) or chemotherapy (63,64). In lung cancer, dNLR was a prognostic biomarker of the immunotherapy (65) and chemotherapy (22) outcome. Besides dNLR, prognostic tools integrating some items are also under investigation, including tumor immune dysfunction and exclusion (66), lung immune prognostic index (65), and the Glasgow prognostic score (67).…”

“…Neutrophil-to-lymphocyte ratios (NLR), defined as the absolute neutrophil count (ANC) divided by the absolute lymphocyte count (ALC) from whole blood, can be easily and inexpensively accessed from regular blood tests and are associated with the prognosis of various cancers (13,14), including lung cancer (15,16). Our previous study indicated that elevated pretreatment NLR is an independent predictor of inferior survival for NSCLC patients receiving chemotherapy (17), which has been conflicted (18)(19)(20) and supported (21)(22)(23)(24) by other studies. To our knowledge, no consensus on this relationship has been reached and there are a lack of recent meta-analyses (MAs) that comprehensively assess the relationship between pretreatment NLR and systemic treatment outcomes for NSCLC.…”