Abstract
Background
Neutrophil to lymphocyte ratio (NLR) has been shown to be a prognosis indicator in different types of cancer. We aimed to investigate the association between NLR and therapy response, progression free survival (PFS) and overall survival (OS) in advanced non-small cell lung cancer (NSCLC) patients treated with first-line platinum-based chemotherapy.
Methods
Patients who were hospitalized between January 2007 and December 2010 were enrolled and eliminated according to the inclusion and exclusion criteria. The NLR was defined as the absolute neutrophil count divided by the absolute lymphocyte count. Logistic regression analysis was applied for response rate and Cox regression analysis was adopted for PFS and OS. A P value of ≤0.05 was considered to be statistically significant.
Results
A total of 182 patients were enrolled in the current study. The median PFS was 164.5 days and median OS was 439.5 days. The statistical analysis data indicated that low pretreatment NLR (≤ 2.63) (OR = 2.043, P = 0.043), decreased posttreatment NLR (OR = 2.368, P = 0.013), well and moderate differentiation (OR = 2.773, P = 0.021) and normal CEA level (≤ 9.6 ng/ml) (OR = 2.090, P = 0.046) were associated with response to first-line platinum-based chemotherapy. A high pretreatment NLR (HR = 1.807, P = 0.018 for PFS, HR = 1.761, P = 0.020 for OS) and distant metastasis (HR = 2.118, P = 0.008 for PFS, HR = 2.753, P = 0.000 for OS) were independent prognostic factors for PFS and OS.
Conclusion
Elevated pretreatment NLR might be a potential biomarker of worse response to first-line platinum-based chemotherapy and shorter PFS and OS for advanced NSCLC patients. To confirm these findings, larger, prospective and randomized studies are needed.
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References
Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90
Gu X, Ma C, Yuan D et al (2012) Circulating soluble intercellular adhesion molecule-1 in lung cancer: a systematic review. Transl Lung Cancer Res 1:36–44
Tanner NT, Sherman CA, Silvestri GA (2012) Biomarkers in the selection of maintenance therapy in nonsmall cell lung cancer. Transl Lung Cancer Res 1:96–98
Donnem T, Bremnes RM, Busund LT et al (2012) Gene expression assays as prognostic and predictive markers in early stage non-small cell lung cancer. J Thorac Dis 4:212–213
Hanahan D, Weinberg RA (2011) Hallmarks of cancer: the next generation. Cell 144:646–674
Lin X, Li W, Lai J et al (2012) Five-year update on the mouse model of orthotopic lung transplantation: scientific uses, tricks of the trade, and tips for success. J Thorac Dis 4:247–258
Schreiber RD, Old LJ, Smyth MJ (2011) Cancer immunoediting: integrating immunity’s roles in cancer suppression and promotion. Science 331:1565–1570
Thavaramara T, Phaloprakarn C, Tangjitgamol S et al (2011) Role of neutrophil to lymphocyte ratio as a prognostic indicator for epithelial ovarian cancer. J Med Assoc Thai 94:871–877
Azab B, Bhatt VR, Phookan J et al (2012) Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 19:217–224
Rashid F, Waraich N, Bhatti I et al (2010) A pre-operative elevated neutrophil: lymphocyte ratio does not predict survival from oesophageal cancer resection. World J Surg Oncol 8:1
An X, Ding PR, Li YH et al (2010) Elevated neutrophil to lymphocyte ratio predicts survival in advanced pancreatic cancer. Biomarkers 15:516–522
Gwak MS, Choi SJ, Kim JA et al (2007) Effects of gender on white blood cell populations and neutrophil-lymphocyte ratio following gastrectomy in patients with stomach cancer. J Korean Med Sci 22(Suppl):S104–S108
Walsh SR, Cook EJ, Goulder F et al (2005) Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91:181–184
Sharaiha RZ, Halazun KJ, Mirza F et al (2011) Elevated preoperative neutrophil:lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol 18:3362–3369
Cho H, Hur HW, Kim SW et al (2009) Pre-treatment neutrophil to lymphocyte ratio is elevated in epithelial ovarian cancer and predicts survival after treatment. Cancer Immunol Immunother 58:15–23
Keizman D, Ish-Shalom M, Huang P et al (2012) The association of pre-treatment neutrophil to lymphocyte ratio with response rate, progression free survival and overall survival of patients treated with sunitinib for metastatic renal cell carcinoma. Eur J Cancer 48:202–208
Yamanaka T, Matsumoto S, Teramukai S et al (2007) The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology 73:215–220
Tomita M, Shimizu T, Ayabe T et al (2011) Preoperative neutrophil to lymphocyte ratio as a prognostic predictor after curative resection for non-small cell lung cancer. Anticancer Res 31:2995–2998
Sarraf KM, Belcher E, Raevsky E et al (2009) Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg 137:425–428
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247
Grivennikov SI, Greten FR, Karin M (2010) Immunity, inflammation, and cancer. Cell 140:883–899
Suzuki K, Kachala SS, Kadota K et al (2011) Prognostic immune markers in non-small cell lung cancer. Clin Cancer Res 17:5247–5256
Sato H, Tsubosa Y, Kawano T (2012) Correlation between the pretherapeutic neutrophil to lymphocyte ratio and the pathologic response to neoadjuvant chemotherapy in patients with advanced esophageal cancer. World J Surg 36:617–622
Kaneko M, Nozawa H, Sasaki K et al (2012) Elevated neutrophil to lymphocyte ratio predicts poor prognosis in advanced colorectal cancer patients receiving oxaliplatin-based chemotherapy. Oncology 82:261–268
Koch A, Fohlin H, Sorenson S (2009) Prognostic significance of C-reactive protein and smoking in patients with advanced non-small cell lung cancer treated with first-line palliative chemotherapy. J Thorac Oncol 4:326–332
Ohashi R, Takahashi K, Miura K et al (2006) Prognostic factors in patients with inoperable non-small cell lung cancer–an analysis of long-term survival patients. Gan To Kagaku Ryoho 33:1595–1602
Albain KS, Crowley JJ, LeBlanc M et al (1991) Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol 9:1618–1626
Acknowledgments
This research was supported by the Natural Science Fund of Jiangsu Province (BK2011658) to Yong Song.
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Yao, Y., Yuan, D., Liu, H. et al. Pretreatment neutrophil to lymphocyte ratio is associated with response to therapy and prognosis of advanced non-small cell lung cancer patients treated with first-line platinum-based chemotherapy. Cancer Immunol Immunother 62, 471–479 (2013). https://doi.org/10.1007/s00262-012-1347-9
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DOI: https://doi.org/10.1007/s00262-012-1347-9