Pretreatment Neutrophil to Lymphocyte Ratio Is Associated with Poor Survival in Patients with Stage I-III Non-Small Cell Lung Cancer.
BACKGROUND
Neutrophil-to-lymphocyte ratio (NLR) has been shown to be a prognostic indicator in several types of cancer. We aimed to investigate the association between NLR and survival in surgery-treated non-small cell lung cancer (NSCLC) patients.


METHODS
This large retrospective study included 1,245 patients who underwent initial surgery for stage I-III NSCLC at The University of Texas MD Anderson Cancer Center between December 2002 and November 2010. We analyzed the relationship of NLR with clinicopathological variables, local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), recurrence-free survival (RFS), overall survival (OS), and disease-specific survival (DSS) in patients with high or low NLR using Kaplan-Meier method. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to assess the prognostic strength of NLR.


RESULTS
There was a statistically significant association between the pretreatment NLR and histology type (P = 0.003) and tumor grade (P = 0.028). At a median follow-up time of 50.6 months, high NLR was associated with reduced DRFS (P = 0.011), OS (P < 0.0001) and DSS (P = 0.004); it was not associated with LRFS and RFS. Multivariable Cox analysis further revealed that NLR (P = 0.027), pathologic stage (P < 0.0001) and lymphovascular invasion (P < 0.0001) were strong independent predictors for DRFS. NLR was also an independent marker predicting poor OS (P = 0.002) and DSS (P = 0.017).


CONCLUSIONS
The pretreatment NLR can serve as a biomarker to predict distant recurrence and death in stage I-III NSCLC patients. Combination of NLR and pathologic stage can better predict the OS and DSS in stage I-II NSCLC patients.
Department of Oncology, General Hospital, Jinan Command of the People's Liberation Army, Jinan, China.|Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
Jun
J
Wang
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
Neda
N
Kalhor
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
Jianhua
J
Hu
Department of Oncology, General Hospital, Jinan Command of the People's Liberation Army, Jinan, China.
Baocheng
B
Wang
Department of Oncology, General Hospital, Jinan Command of the People's Liberation Army, Jinan, China.
Huili
H
Chu
Department of Oncology, Wuhan General Hospital of Guangzhou Command of the People's Liberation Army, Wuhan, China.
Bicheng
B
Zhang
Department of Oncology, General Hospital, Jinan Command of the People's Liberation Army, Jinan, China.
Yaping
Y
Guan
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
Yun
Y
Wu
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000473:pathology; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models
PLoS One. 2011;6(12):e28844
22194927
Cancer Treat Rev. 2013 Aug;39(5):534-40
22995477
J Support Oncol. 2007 Apr;5(4):157-62; discussion 164-6, 183
17500503
Laryngoscope. 2013 Nov;123(11):2690-9
23619955
Eur J Cardiothorac Surg. 2015 Apr;47(4):e140-5
25548132
Gynecol Oncol. 2014 Mar;132(3):542-50
24462730
Asian Pac J Cancer Prev. 2014;15(5):2089-94
24716939
PLoS One. 2012;7(8):e41883
22870258
BMC Cancer. 2013 Mar 27;13:158
23530866
Lung Cancer. 2014 Apr;84(1):79-85
24524817
J Immunol. 1985 Jan;134(1):230-4
3871101
Br J Cancer. 2014 Jul 29;111(3):452-60
24921916
Carcinogenesis. 2012 May;33(5):949-55
22425643
J Thorac Oncol. 2015 Feb;10(2):280-5
25299234
Br J Cancer. 2013 Mar 5;108(4):901-7
23385728
Nature. 2002 Dec 19-26;420(6917):860-7
12490959
Ann Surg Oncol. 2012 Jan;19(1):217-24
21638095
J Thorac Oncol. 2012 Apr;7(4):655-62
22425914
J Immunol. 1988 Dec 15;141(12):4395-402
3264311
J Thorac Oncol. 2012 Mar;7(3):587-94
22307011
Br J Cancer. 2006 Jul 17;95(2):139-45
16786043
J Thorac Oncol. 2011 Apr;6(4):824-33
21173711
PLoS One. 2012;7(12):e51862
23251644
Br J Cancer. 2014 Jan 21;110(2):435-40
24357796
Cancer Biol Ther. 2013 Jun;14(6):469-75
23760488
J Cancer Res Clin Oncol. 2008 Oct;134(10):1143-9
18347812
Br J Cancer. 2013 Apr 30;108(8):1677-83
23558897
PLoS One. 2015 May 07;10(5):e0126496
25950176
Eur J Cancer. 2009 Jul;45(11):1950-8
19231158
Anticancer Res. 2011 Sep;31(9):2995-8
21868550
Clin Genitourin Cancer. 2014 Oct;12 (5):317-24
24806399
PLoS One. 2012;7(12):e52704
23285161
Am J Surg. 2015 Sep;210(3):526-35
26105800
Br J Cancer. 2013 Jul 23;109(2):416-21
23799847
J Med Assoc Thai. 2012 Feb;95 Suppl 2:S199-207
22574550
Asian Pac J Cancer Prev. 2014;15(6):2651-4
24761879
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S1324-31
26198075
CA Cancer J Clin. 2015 Jan-Feb;65(1):5-29
25559415
Br J Cancer. 2014 Jan 21;110(2):369-74
24357794
Immunobiology. 2006;211(6-8):473-86
16920487
Asian Pac J Cancer Prev. 2013;14(9):5237-42
24175807
Clin Transl Oncol. 2012 Nov;14(11):864-9
22855161
J Thorac Cardiovasc Surg. 2002 Sep;124(3):503-10
12202867
PLoS One. 2014 Sep 19;9(9):e106914
25238252
Surg Today. 2014 Nov;44(11):2146-52
24831660
J Thorac Cardiovasc Surg. 2009 Feb;137(2):425-8
19185164
BMJ. 1995 Oct 7;311(7010):899-909
7580546
Int J Biol Markers. 2011 Oct-Dec;26(4):209-15
22139643
Br J Cancer. 2014 Apr 15;110(8):1930-5
24667648
J Thorac Oncol. 2009 Jul;4(7):792-801
19458556
Asia Pac J Clin Oncol. 2014 Oct 31;:null
25359280
J Thorac Oncol. 2010 Dec;5(12):2024-36
21155185
Oncology. 2012;82(5):261-8
22538399