Abstract
Background
The immune system has been shown to play an important role in preventing cancer progression. The neutrophil–lymphocyte ratio (NLR) has been proposed to be an indicator of a systemic inflammatory response. We investigated the prognostic significance of NLR in patients with completely resected stage I non-small lung cancer (NSCLC).
Methods
A series of 343 pathological stage I NSCLC patients, completely resected between 2000 and 2008 at a single institution, were evaluated retrospectively. Perioperative clinical and laboratory data were collected, and the cohort was divided into two groups according to preoperative NLR. We examined the correlation between NLR and clinicopathological parameters and determined the prognostic significance.
Results
High NLR was significantly correlated with patients of older age (p = 0.045), preoperative hypoalbuminemia (p = 0.030), and nonadenocarcinoma histology (p = 0.045). Upon univariate analysis, the high NLR group had significantly lower 5-year recurrence-free survival (81.2 vs. 59.9 %, p < 0.001) and 5-year overall survival (89.2 vs. 72.8 %, p < 0.001) than the low NLR group. Multivariate analysis showed that NLR was an independent prognostic factor (hazard ratio 2.141, 95 % confidence interval; 1.306–3.515, p = 0.003). In terms of initial recurrent sites, the proportion of patients who developed distant metastasis was significantly higher in the high NLR group than in the low NLR group (p < 0.001).
Conclusions
Preoperative high NLR is a significant predictor of poor prognosis and is associated with more frequent distant metastasis in patients with completely resected stage I NSCLC. This readily available and simply calculated ratio provides useful information for the clinician to consider in terms of perioperative management.
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Acknowledgment
The authors thank Dr. Keith Kretzmer, Medical Communication Advisor of Department of General Thoracic Surgery of Teikyo University, for their editorial review of the manuscript.
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The authors have no potential conflicts of interest to disclose.
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10434_2015_4735_MOESM1_ESM.ppt
Supplementary Fig. 1 Receiver operating characteristic curve analysis of NLR forrecurrence after surgery. The sensitivity and specificity of NLRpredicting recurrence after resection were 66.7% and 58.5%, respectively, ata cut-off value was 2.498 of NLR, with area under the curve (AUC) of 0.684 (PPT 106 kb)
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Takahashi, Y., Horio, H., Hato, T. et al. Prognostic Significance of Preoperative Neutrophil–Lymphocyte Ratios in Patients with Stage I Non-small Cell Lung Cancer After Complete Resection. Ann Surg Oncol 22 (Suppl 3), 1324–1331 (2015). https://doi.org/10.1245/s10434-015-4735-5
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DOI: https://doi.org/10.1245/s10434-015-4735-5