title: Neutrophil to lymphocyte ratio associated with prognosis of lung cancer.
abstract: OBJECTIVE
  Many studies recently focus on complicated and expensive genomic tests, but the prognostic values of biochemical markers which are easily obtained in clinics are largely overlooked and without further exploration. This study assesses the association of neutrophil-lymphocyte-ratio (NLR) with prognosis of lung cancer patients.
  
  
  METHODS
  In 1032 patients with histologically confirmed lung cancer, the association of pretreatment NLR values with overall survival (OS) was evaluated using a Cox proportional hazards model and the temporal relationship of longitudinal NLR was assessed using a mixed effects model.
  
  
  RESULTS
  Compared to the patients with a low pretreatment NLR value, those with elevated NLR exhibited a statistically significant worse OS with a hazard ratio (HR) of 1.50 (P < 0.0001) after adjusting for age, gender, race, smoking status, drinking status, tumor stage, tumor grade, histology, and treatments. A significant trend of increasing HRs along with increasing NLR values was observed. The increased risk of death conferred by pretreatment NLR values reached a peak level around 2 years after diagnosis. Moreover, in longitudinal analysis, we observed a trend of dramatically increased NLR values in patients who died during follow-up, but stable NLR values in those who were still alive, with a significant interaction of death-alive status with follow-up time (P < 0.0001).
  
  
  CONCLUSIONS
  Elevated NLR is a potential biomarker to identify lung cancer patients with poor prognosis and should be validated in a future clinical trial.
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 S. 11th St., Philadelphia, PA, 19107, USA. voichita.bar-ad@jefferson.edu.
authors.forename: V
authors.initials: V
authors.lastname: Bar-Ad
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 S. 11th St., Philadelphia, PA, 19107, USA.
authors.forename: J
authors.initials: J
authors.lastname: Palmer
authors.affiliation: Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Lai
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 S. 11th St., Philadelphia, PA, 19107, USA.
authors.forename: B
authors.initials: B
authors.lastname: Lu
authors.affiliation: Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Myers
authors.affiliation: Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Axelrod
authors.affiliation: Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Johnson
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, 111 S. 11th St., Philadelphia, PA, 19107, USA.
authors.forename: M
authors.initials: M
authors.lastname: Werner-Wasik
authors.affiliation: Department of Thoracic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Cowan
authors.affiliation: Department of Thoracic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: N R
authors.initials: NR
authors.lastname: Evans
authors.affiliation: Department of Pulmonology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: B T
authors.initials: BT
authors.lastname: Hehn
authors.affiliation: Department of Pathology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Solomides
authors.affiliation: Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000097:blood* / Q000276:immunology* / Q000401:mortality; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D016016:Proportional Hazards Models
keywords: Lung cancer; Neutrophil/lymphocyte ratio; Prognostic biomarkers