Byline: Daniel. Thompson, Luke. Perry, Jesse. Renouf, Domagoj. Vodanovich, Adele. Hong Lee, Jahan. Dimiri, Gavin. Wright
BACKGROUND/OBJECTIVE: Given the poor overall survival (OR) and progression-free survival (PFS) rates for lung cancers managed with surgical resection, there is a need to identify the prognostic markers that would improve the risk stratification of patients with operable lung cancer to inform treatment decisions. We investigate the prognostic utility of two established inflammation-based scores, the neutrophil-lymphocyte ratio (NLR) and the change in neutrophil-lymphocyte ratio ([DELTA]NLR), throughout the operative period in a prospective cohort of patients with lung cancer who underwent surgical resection. METHODS: Demographic, clinical, and treatment details for 345 patients with lung cancer who underwent surgical resection between 2000 and 2019 at multiple centers across Melbourne, Victoria (Australia), were prospectively collected. Preoperative NLR and [DELTA]NLR were calculated after which Cox univariate and multivariate analyses were conducted for OS and PFS against the known prognostic factors. RESULTS: Both univariate and multivariate analyses showed that preoperative NLR >4.54, as well as day 1 and day 2 postoperative NLR (P < 0.01), was associated with increased risk for postoperative mortality (hazard ratio 1.8; P < 0.01) and PFS (P < 0.05), whereas [DELTA]NLR was not a significant predictor of OS or PFS. CONCLUSION: Elevated NLR among patients with lung cancer who underwent surgical resection was prognostic for poor OS and PFS, whereas [DELTA]NLR was not found to be prognostic for either OS or PFS. Further research may yet reveal a prognostic value for [DELTA]NLR when compared across a greater time period.
Lung cancer is the most common cause of cancer death worldwide, with approximately 1.37 million global deaths per year.,, Although surgical resection constitutes an important treatment option for patients with early-stage disease and suitable patients with advanced disease, the recurrence rates have remained high (from 30% to 75%) depending on the final pathological stage, while 5-year survival rates have varied according to the pathological stage, ranging from 70% for Stage IA disease to 40% for Stage IIB. High recurrence rates and associated mortality warrant the investigation of prognostic factors to improve the risk stratification of patients with lung cancer who are amenable to surgical resection. Recent research has investigated prognostic pathological biomarkers that may identify patients likely to have poorer overall survival (OS) and progression-free survival (PFS). Prognostic biomarkers that allow for the identification of patients at higher risk for recurrence may be used in the future to determine those who may benefit from adjuvant and neoadjuvant therapies and suitability for surgery.
Prognostication of patients with lung cancer commonly relies on the validated tumor-node-metastasis (TNM) system to guide the clinical decisions, categorized by the American Joint Committee on Cancer (AJCC) stages. Multiple other known tumors and biological factors, such as histological grade, patient age, sex, and performance status, can predispose patients to worse PFS/OS., While several novel biomarkers are under investigation for patient prognostication, including plasma exosomal proteins and circulating tumor DNA and RNA,,, testing for such biomarkers is limited by availability and price.