title: Prognostic performance of inflammation-based prognostic indices in primary operable non-small cell lung cancer.
abstract: BACKGROUND
  At least 30% of patients with primary resectable non-small cell lung cancer (NSCLC) will experience a relapse in their disease within 5 years following definitive treatment. Clinicopathological predictors have proved to be suboptimal in identifying high-risk patients. We aimed to establish whether inflammation-based scores offer an improved prognostic ability in terms of estimating overall (OS) and recurrence-free survival (RFS) in a cohort of operable, early-stage NSCLC patients.
  
  
  METHODS
  Clinicopathological, demographic and treatment data were collected prospectively for 220 patients operated for primary NSCLC at the Hammersmith Hospital from 2004 to 2011. Pretreatment modified Glasgow Prognostic Score (mGPS), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were tested together with established prognostic factors in uni- and multivariate Cox regression analyses of OS and RFS.
  
  
  RESULTS
  Half of the patients were male, with a median age of 65. A total of 57% were classified as stage I with adenocarcinoma being the most prevalent subtype (60%). Univariate analyses of survival revealed stage (P<0.001), grade (P=0.02), lymphovascular (LVI, P=0.001), visceral pleural invasion (VPI, P=0.003), mGPS (P=0.02) and NLR (P=0.04) as predictors of OS, with stage (P<0.001), VPI (P=0.02) and NLR (P=0.002) being confirmed as independent prognostic factors on multivariate analyses. Patients with more advanced stage (P<0.001) and LVI (P=0.008) had significantly shorter RFS.
  
  
  CONCLUSIONS
  An elevated NLR identifies operable NSCLC patients with a poor prognostic outlook and an OS difference of almost 2 years compared to those with a normal score at diagnosis. Our study validates the clinical utility of the NLR in early-stage NSCLC.
authors.affiliation: Division of Experimental Medicine, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Pinato
authors.affiliation: Department of Respiratory Medicine, National Heart and Lung Institute, Hammersmith Hospital, Du Cane Road, W120HS London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Shiner
authors.affiliation: Division of Oncology, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Seckl
authors.affiliation: Division of Oncology, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Stebbing
authors.affiliation: Division of Experimental Medicine, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Pathology, Hammersmith Campus of Imperial College London, Du Cane Road, W120HS London, UK.
authors.forename: F A
authors.initials: FA
authors.lastname: Mauri
mesh_terms: D000368:Aged; D001772:Blood Cell Count; D001792:Blood Platelets / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D009504:Neutrophils / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models