The Addition of Peripheral Blood Inflammatory Indexes to Nomogram Improves the Predictive Accuracy of Survival in Limited-Stage Small Cell Lung Cancer Patients

Abstract

BackgroundAccumulated evidence for systemic inflammation response in several solid tumors prompts a possibility of prediction of patients’ prognosis in a more accessible and valuable manner. However, the prognostic value of peripheral blood inflammatory markers in limited-stage small cell lung cancer (LS-SCLC) remains unclear. Therefore, we investigated the prognostic values of pretreatment inflammatory indexes in LS-SCLC patients.MethodsWe retrospectively identified 334 patients with LS-SCLC and collected their pretreatment serum levels of neutrophil, platelet, lymphocyte, leukocyte, hemoglobin, and albumin, then neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation index (SII) were calculated. Patients were dichotomized as low-Risk or high-Risk group based on their corresponding cutoff values. Univariate and multivariate analyses were conducted with a Cox proportional hazards model. The least absolute shrinkage and selection operator (LASSO)-Cox regression analysis was performed to construct the inflammation-related prognostic scoring system named Risk for OS. Nomograms were established to provide prognostic information, allowing for more individualized prediction of survival.ResultsHigher pretreatment platelet, lymphocyte, and albumin were indicators of favorable overall survival (OS), whereas higher NLR and SII were accompanied by inferior OS. The prognosis of patients with high Risk was significantly worse than that with low Risk in both the training group and the validation group (both p < 0.001). Comparable area under the curve (AUC) values between the training group and the validation group were observed, yielding 1-, 3-, and 5-year OS rates of 67.3% vs. 69.2%, 66.8% vs. 69.5%, and 66.7% vs. 71.4%, respectively. Multivariate analyses revealed that Risk [hazard ratio (HR) = 0.551, p < 0.001] was an independent negative prognostic indicator for OS, which was further verified in the validation set. The addition of Risk to nomogram (C-index = 0.643) harbored improved predictive accuracy for OS when compared with that of clinical factors alone (C-index = 0.606); the AUC values of 1-, 3-, and 5-year OS rates were 71.7% vs. 66.4%, 73.5% vs. 66.6%, and 71.9% vs. 65.6%, respectively.ConclusionsPretreatment peripheral blood inflammatory indexes may be a noninvasive serum biomarker for poor prognosis in LS-SCLC. The addition of Risk to the nomogram model could serve as a more powerful, economical, and practical method to predict survival for patients with LS-SCLC.

External Application of a Nomogram to Predict Survival and Benefit of Peripheral Blood Inflammatory Indexes in Limited-Stage Small Cell Lung Cancer

“…Qi et al. formulated a prognostic scoring system called Risk by integrating multiple inflammatory factors, which could more genuinely reflect the complex immune state of the human body compared to a single factor ( 10 ). However, due to the different laboratory instruments and reference values applied in the two hospitals, it’s inappropriate to copy the formula in the original article.…”

“…This retrospective observational external application cohort study was carried out in patients pathologically diagnosed as SCLC in Shanxi Cancer Hospital from January 2015 to December 2018. Inclusion criteria were similar to the original study ( 10 ). All patients have been reassessed as LS-SCLC by the Veterans Administration Lung Study Group (VALG) staging standard (2017 NCCN guidelines), and all patients received concurrent or sequential chemoradiotherapy.…”

“…The inflammatory variables included in Risk and relevant clinicopathological characteristics in the nomogram were collected. The calculation formulas of platelet-to-lymphocyte ratio (PLR), NLR, and SII were the same as those in the original study ( 10 ). The nomogram estimated the predicted probability of 1-, 2-, and 3-year OS rates by calculating the total points for each patient.…”

“…Recently Qi et al. proposed a nomogram to estimate the additional benefit of Risk, an inflammation-related prognostic scoring system, in predicting prognosis for LS-SCLC ( 10 ). They found lower pretreatment neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation index (SII) were significantly associated with better prognosis.…”

Risk Prediction Model for Synchronous Oligometastatic Non-Small Cell Lung Cancer: Thoracic Radiotherapy May Not Prolong Survival in High-Risk patients

“…Several hematological and clinical factors have been shown to suggest a bad prognosis for lung cancer including hypoalbuminemia (16)(17)(18); increase of C-reactive protein (18,19), lactate dehydrogenase (20), PLR (17,(21)(22)(23), NLR (17,(21)(22)(23)(24), SII (17,21), and tumor biomarkers (20,25); abnormal coagulation and fibrinolysis (26, 27); high T and N stage; liver metastasis; adrenal metastasis (28,29); absence of SMs; smoking history; male; and loss of weight (30). In the present study, 10 variables were included in the Risk-Total formula, and the level of risk score was associated with reduced survival of patients, which was consistentwith previous studies.…”