Neutrophil–Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer. Issue 8 (August 2021)

• Record Type: Journal Article
• Authors: Punjabi, A.; Barrett, E.; Cheng, A.; Mulla, A.; Walls, G.; Johnston, D.; McAleese, J.; Moore, K.; Hicks, J.; Blyth, K.; Denholm, M.; Magee, L.; Gilligan, D.; Silverman, S.; Qureshi, M.; Clinch, H.; Hatton, M.; Philipps, L.; Brown, S.; O'Brien, M.; McDonald, F.; Faivre-Finn, C.; Hiley, C.; Evison, M.
• Is Part Of: Clinical oncology. Volume 33:Issue 8(2021)
• Page Start: e331
• Page End: e338
• Publication Date: 2021-08
• Subjects: Curative-intent radiotherapy -- lung cancer -- lymphocyte count -- neutrophil–lymphocyte ratio -- NSCLC; Oncology -- Periodicals; Tumors -- Periodicals; Cancer -- Treatment -- Periodicals; Radiotherapy -- Periodicals; Neoplasms -- Periodicals; Cancer -- Radiotherapy; Cancer -- Treatment; Oncology; Medical radiology; Radiotherapy; Tumors; Electronic journals; Periodicals; 616.994
• DOI: 10.1016/j.clon.2021.03.019
• Languages: English
• ISSNs: 0936-6555

Abstract

Abstract: Aims: The neutrophil–lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival. Materials and methods: A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment. Results: In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06–2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49–3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5–3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76–4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days ( P = 0.34), post-NLR 596 versus 1287 days ( P ≤ 0.001), change in NLR 553 versus 1214 days ( P ≤ 0.001) and post-ALC 594 versus 1287 days ( P ≤ 0.001). Conclusion: NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols. Highlights: Multi-centre UK study of 425 patients undergoing curative intent radiotherapy for NSCLC. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Pre-NLR > 2.5, post-NLR > 5.5, change in NLR > 3.6 and post-ALC < 0.8 optimally predicted poor survival. Median OS high vs low-risk group: pre-NLR 770 vs 1009, post-NLR 596 vs 1287, change in NLR 553 vs 1214 and post-ALC 594 vs 1287 days.