title: Perioperative neutrophil:lymphocyte ratio and postoperative NSAID use as predictors of survival after lung cancer surgery: a retrospective study.
abstract: The association between neutrophil:lymphocyte ratio (NLR) and poor long-term outcomes in patients with non-small-cell lung cancer (NSCLC) has been demonstrated in numerous studies. The benefit of perioperative administration of anti-inflammatory drugs on these outcomes has not been well established. Our aim in this retrospective study was to investigate the effects of postoperative nonsteroidal anti-inflammatory drug (NSAID) administration and NLR on tumor recurrence and survival in patients' undergoing surgical resection for NSCLC. This retrospective study included perioperative data from 1139 patients who underwent surgical resection for stages I-III NSCLC. Perioperative data such as baseline characteristics, adjuvant or neoadjuvant therapy, pre- and postoperative NLR, and NSAID use (ketorolac, ibuprofen, celecoxib, or in combination) were included. We evaluated the association between preoperative NLR and NSAID use on recurrence-free (RFS) and overall survival (OS). In all, 563 patients received an NSAID as a part of their postoperative management. The majority of patients received ketorolac (n = 374, 67.16%). Ketorolac administration was marginally associated with better OS (P = 0.05) but not with RFS (P = 0.38). Multivariate analysis (n = 1139) showed that preoperative NLR >5 was associated with a reduction in RFS (hazard ratio [HR] = 1.37; 95% confidence interval [CI] = 1.05-1.78; P = 0.02) and OS (HR = 1.69; 95% CI = 1.27-2.23; P = 0.0003). However, after accounting for tumor stage, NLR ≥ 5 was a predictor of RFS and OS only in patients with stage I NSCLC. To conclude, preoperative NLR was demonstrated to be an independent predictor of RFS and OS in a subset of patients with early stage NSCLC. Ketorolac administration was not found to be an independent predictor of survival.
authors.affiliation: University of California, San Diego School of Medicine, California.
authors.forename: Jae Eun
authors.initials: JE
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Villarreal
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Javier
authors.initials: J
authors.lastname: Lasala
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Gottumukkala
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jun
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Outcomes Research Consortium, Cleveland, Ohio.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cata
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods / Q000401:mortality; D007958:Leukocyte Count; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D008214:Lymphocytes / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009504:Neutrophils / Q000502:physiology*; D012189:Retrospective Studies; D059016:Tumor Microenvironment
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Anti-inflammatory agents, nonsteroidal; neoplasms; non-small-cell lung cell, surgery, inflammation