Systemic Inflammation and Lung Cancer: Is It a Real Paradigm? Prognostic Value of Inflammatory Indexes in Patients with Resected Non-Small-Cell Lung Cancer

Abstract

Background (1): Our goal was to investigate if and how pre-operative inflammatory status can influence the long-term prognosis of patients undergoing lung surgery for cancer. Materials and Methods (2): This prospective observational study includes the agreement of all operable patients to the study, who were referred to our department between 1 January 2017 and 30 December 2018. The inflammatory pre-operative status of the patients was investigated by calculating albumin, CPR (c-protein reactive), complete blood count (neutrophils, lymphocytes, platelets, hemoglobin), and some other indexes referring to inflammatory status, namely the HALP amalgamated index, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocytes ratio (NLR), systemic immune-inflammation index (SII), and advanced lung cancer inflammation Index (ALI). The follow-up ended in November 2021. Patient overall survival was assessed using the Kaplan–Meier method. The log-rank test was used to compare survival rates. Variables significantly associated with survival at univariate analysis were entered int Cox multivariate analysis (stepwise mode) to assess their independent character. Hazard ratios and their 95% confidence intervals were calculated. Variables associated with p < 0.05 were considered significative. Results (3): We enrolled 257 patients in our study. The overall survival of the cohort was as follows: 1 year, 96.1%; 3 year, 81.3%; and 4 year, 74.2%. Univariate analysis showed risk factors for overall survival as follows: Thoracoscore ≥ 2 (p = 0.002); histology (p = 0.002); HALP < 32.2 (p = 0.0002); SII ≥ 808.9 (p = 0.0004); ALI < 34.86 (p = 0.0005); NLr ≥ 2.29 (p = 0.01); hemoglobin < 13 g/dl (p = 0.01); PLR ≥ 196.1 (p = 0.005); pN+ (p < 0.0001); pleural invasion (p = 0.0002); and presence of vascular or lymphatic tumor emboli (p = 0.0002). Multivariate Cox analysis (stepwise model) identified Thoracoscore ≥ 2 (p = 0.02); histology, HALP < 32.2 (p = 0.004), and pN (p < 0.0001) as independent predictors of death. Conclusion (4): Pre-operative inflammatory status strongly influences long-term prognosis in patients affected by NSCLC and undergoing surgery.

Systemic immune-inflammation index upon admission correlates to post-stroke cognitive impairment in patients with acute ischemic stroke

“…Meanwhile, SII was also considered to be correlated to unfavorable outcomes of various tumors such as cholangiocarcinoma, lung cancer, gliomas, etc. [ 10 , 21 , 22 ]. Subsequently, there has been an established link between SII and the occurrence and prognosis of chronic heart failure and coronary heart disease [ 23 , 24 ].…”

Application of Monocyte-to-Albumin Ratio and Neutrophil Percentage-to-Hemoglobin Ratio on Distinguishing Non-Small Cell Lung Cancer Patients from Healthy Subjects

“…Meanwhile, high levels of hemoglobin and albumin are positively correlated with the prognosis of NSCLC. 40 Therefore, further investigation has been carried out in this study on whether MAR and NPHR levels could be used as potential biomarkers to predict the disease progression of NSCLC. Interestingly, the results showed that MAR and NPHR were both significantly associated with tumor size, lymph node metastasis, and distant metastasis, which might be a partial suggestion to tumor progression.…”

The Naples Prognostic Score Is a Useful Tool to Assess Surgical Treatment in Non-Small Cell Lung Cancer

“…Based on the above, new prognostic tools such as pre-operative NLR, LMR, and the platelet to lymphocyte ratio (PLR) started to be used, achieving a strong correlation with all lung and other types of cancer prognosis [8,25,26].…”

“…Currently, many hematological markers, which can be easily obtained in daily clinical practice, are increasingly utilized for the prognosis of several cancers, including NSCLC. In particular, systemic inflammation and nutritional status have been proven to be involved in cancer development [8,9], and related biomarkers have been evaluated as possible indicators of outcomes for oncologic patients [10][11][12][13][14].…”