Prognostic significance of neutrophil/lymphocyte ratio (NLR) and correlation with PET–CT metabolic parameters in small cell lung cancer (SCLC)
- 138 Downloads
The aim of this study is to detect the prognostic significance of neutrophil/lymphocyte ratio (NLR) in SCLC and to evaluate the relation with 18F-FDG PET–CT metabolic parameters (PET–CT MPs).
Demographic parameters, laboratory values including NLR and other clinical variables were analyzed in 112 patients with small cell lung cancer (SCLC) and 54 of these patients had results of metabolic parameters detected with 18 FDG PET–CT [including SUVmax, SUVmean, metabolic tumor volume (MTV), whole body MTV (WBMTV), TLG (total lesion glycolysis), whole body TLG (WBTLG)] were evaluated for survival analyses.
Mean and median overall survival (OS) and progression-free survival (PFS) were found to be significantly longer in cases with NLR < 4 compared with NLR > 4 in totally. Also stage, performance status, response to first-line therapy, LDH, and lymphocyte count were found to be prognostic for OS and PFS. MTV, WBMTV and WBTLG were found to be prognostic for both OS and PFS, while SUVmax found to be significant for OS. Patients with NLR ≥ 4, MTV ≥ 60.1, WBMTV ≥ 120 and WBTLG ≥ 1000 points had lower OS and PFS. A moderate positive correlation was found between NLR and SUVmean (r: 0.36), SUVmax (r: 0.34), TLG (r: 0.39), MTV (r: 0.51), WBMTV (r: 0.40), and WBTLG (r: 0.46).
There is relationship between PET–CT metabolic parameters and NLR in SCLC. Highest correlation was found with NLR and MTV, WBMTV, and WBTLG, and evaluation of NLR together with these parameters predicts survival times and tumor biology more clearly in SCLC.
KeywordsSmall cell lung cancer (SCLC) Neutrophil/lymphocyte ratio (NLR) PET–CT Metabolic tumor volume (MTV) Whole body metabolic tumor volume (WBMTV) Whole body total lesion glycolysis (WBTLG)
This article has been approved of as an Oral Presentation in 7. Turkish Society of Medical Oncology Congress (21–25 March 2018).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E365–E368Google Scholar
- 2.Govindan R, Page N, Morgensztern D et al (2006) Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol 24(28):4539–4544Google Scholar
- 3.Stupp R, Monnerat C, Turrisi AT et al (2004) Small cell lung cancer: state of the art and future perspectives. Lung cancer 45(1):105–117Google Scholar
- 4.Yip D, Harper PG (2000) Predictive and prognostic factors in small cell lung cancer: current status. Lung cancer 28(3):173–185Google Scholar
- 5.Micke P, Faldum A, Metz T et al (2002) Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer—what limits limited disease? Lung Cancer 37(3):271–276Google Scholar
- 6.Edge S, Byrd DR, Compton CC et al (2010) American Joint Committee on Cancer (AJCC). In: Cancer staging handbook, 7th edn. Springer, New York, pp 299–323Google Scholar
- 7.Kalemkerian GP, Schneider BJ (2017) Advances in small cell lung cancer. Hematol Oncol Clin North Am 31(1):143–156Google Scholar
- 8.Jett JR, Schild SE, Kesler KA et all (2013) Treatment of small cell lung cancer: Diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5):e400S–e419SGoogle Scholar
- 9.van Loon J, De Ruysscher D, Wanders R et al (2010) Selective nodal irradiation on basis of 18FDG-PET scans in limited-disease small-cell lung cancer: a prospective study. Int J Radiat Oncol Biol Phys 77(2):329–336Google Scholar
- 10.Sasaki R, Komaki R, Macapinlac H et al (2005) [18F] fluorodeoxyglucose uptake by positron emission tomography predicts outcome of non–small-cell lung cancer. J Clin Oncol 23(6):1136–1143Google Scholar
- 11.Davies A, Tan C, Paschalides C et al (2007) FDG-PET maximum standardised uptake value is associated with variation in survival: analysis of 498 lung cancer patients. Lung Cancer 55(1):75–78Google Scholar
- 12.Guo H, Zhu H, Xi Y et all (2007) Diagnostic and prognostic value of 18F-FDG PET/CT for patients with suspected recurrence from squamous cell carcinoma of the esophagus. J Nucl Med 48(8):1251–1258Google Scholar
- 13.Lund AA, Vilstrup MH, Jochumsen KM et al (2017) Prognostic Evaluation of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in endometrial cancer: a retrospective study. Int J Gynecol Cancer 27(8):1675–1684Google Scholar
- 14.Xie P, Yue JB, Fu Z et al (2009) Prognostic value of 18F-FDG PET-CT before and after radiotherapy for locally advanced nasopharyngeal carcinoma. Ann Oncol 21(5):1078–1082Google Scholar
- 15.Zhang H, Wroblewski K, Liao S et al (2013) Prognostic value of metabolic tumor burden from 18F-FDG PET in surgical patients with non–small-cell lung cancer. Acad Radiol 20(1):32–40Google Scholar
- 16.Tamandl D, Ta J, Schmid R et al (2016) Prognostic value of volumetric PET parameters in unresectable and metastatic esophageal cancer. Eur J Radiol 85(3):540–545Google Scholar
- 17.Satoh Y, Onishi H, Nambu A et al (2014) Volume-based parameters measured by using FDG PET/CT in patients with stage I NSCLC treated with stereotactic body radiation therapy: prognostic value. Radiology 270(1):275–281Google Scholar
- 21.Mantovani A, Allavena P, Sica A et al (2008) Cancer-related inflammation. Nature 454(7203):436–444Google Scholar
- 22.Boissier R, Campagna J, Branger N et al (2017) The prognostic value of the neutrophil-lymphocyte ratio in renal oncology: a review. Urol Oncol 35(4):135–141Google Scholar
- 25.Käsmann L, Bolm L, Schild SE et al (2017) Neutrophil-to-lymphocyte ratio predicts outcome in limited disease small-cell lung cancer. Lung 195(2):217–224Google Scholar
- 29.Suzuki R, Lin SH, Wei X et al (2018) Prognostic significance of pretreatment total lymphocyte count and neutrophil-to-lymphocyte ratio in extensive-stage small-cell lung cancer. Radiother Oncol 126(3):499–505Google Scholar
- 30.Hanahan D, Weinberg RA (2011) Hallmarks of cancer: the next generation. Cell 144(5):646–674Google Scholar
- 31.Powell DR, Huttenlocher A (2016) Neutrophils in the tumor microenvironment. Trends Immunol 37(1):41–52Google Scholar
- 33.Fridlender ZG, Albelda SM (2012) Tumor-associated neutrophils: friend or foe? Carcinogenesis 33(5):949–955Google Scholar
- 34.Zhou SL, Zhou ZJ, Hu ZQ et al (2016) Tumor-associated neutrophils recruit macrophages and T-regulatory cells to promote progression of hepatocellular carcinoma and resistance to sorafenib. Gastroenterology 150(7):1646–1658Google Scholar
- 36.Gumus F, Solak I, Eryilmaz MA (2018) The effects of smoking on neutrophil/lymphocyte, platelet//lymphocyte ratios. Bratisl Lek Listy 119(2):116–119Google Scholar
- 37.Sheikhbahaei S, Mena E, Pattanayak P et al (2017) Molecular imaging and precision medicine: PET/computed tomography and therapy response assessment in oncology. PET Clin 12:105–118Google Scholar
- 38.Lee YJ, Cho A, Cho BC et al (2009) High tumor metabolic activity as measured by fluorodeoxyglucose positron emission tomography is associated with poor prognosis in limited and extensive stage small-cell lung cancer. Clin Cancer Res 15(7):2426–2432Google Scholar
- 39.Zhu D, Ma T, Niu Z et al (2011) Prognostic significance of metabolic parameters measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with small cell lung cancer. Lung Cancer 73(3):332–337Google Scholar
- 40.Oh JR, Seo JH, Chong A et al (2012) Whole-body metabolic tumour volume of 18F-FDG PET-CT improves the prediction of prognosis in small cell lung cancer. Eur J Nucl Med Mol Imaging 39(6):925–935Google Scholar
- 41.Daisne JF, Duprez T, Weynand B et al (2004) Tumor volume in pharyngolaryngeal squamous cell carcinoma: comparison at CT, MR imaging, and FDG PET and validation with surgical specimen. Radiology 233(1):93–100Google Scholar
- 42.Biehl KJ, Kong FM, Dehdashti F et al (2006) 18F-FDG PET definition of gross tumor volume for radiotherapy of non-small cell lung cancer: is a single standardized uptake value threshold approach appropriate? J Nucl Med 47(11):1808–1812Google Scholar
- 43.Kubota R, Yamada S, Kubota K et al (1992) Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 33(11):1972–1980Google Scholar
- 44.Chen HH, Chiu NT, Su WC et al (2012) Prognostic value of whole-body total lesion glycolysis at pretreatment FDG PET-CT in non-small cell lung cancer. Radiology 264(2):559–566Google Scholar
- 45.Sürücü E, Demir Y, Şengöz T (2015) The correlation between the metabolic tumor volume and hematological parameters in patients with esophageal cancer. Ann Nucl Med 29(10):906–910Google Scholar
- 46.Jeong E, Hyun SH, Moon SH et al (2017) Relation between tumor FDG uptake and hematologic prognostic indicators in stage I lung cancer patients following curative resection. Medicine (Baltimore) 96(5):e5935Google Scholar