Does neutrophil-to-lymphocyte ratio have a role among the other prognostic factors of nonsmall cell lung cancer?

Abstract

INTRODUCTION: Neutrophil‑to‑lymphocyte ratio (NLR), an index of systemic inflammation, has beenassociated with poor survival for many cancers. The aim of this study was to investigate the clinicalsignificance of blood NLR in nonsmall cell lung cancer (NSCLC) as a prognostic factor.METHODS: We retrospectively reviewed medical records of patients with NSCLC and collected datafrom December 2009 to September 2013. NLRs were calculated at the time of diagnosis before anytype of treatment. Data about NLR, age, sex, smoking, histopathology, Eastern Cooperative OncologyGroup (ECOG) performance score, disease stage, serum albumin, and treatment modalities wereinvestigated. These parameters were tested for its association with the 1‑year, 2‑year, and overallsurvival (OS); OS was calculated by the Kaplan–Meier analysis.RESULTS: A total of 121 patients with a median age of 61.9 (range 34–84), 14 (11.6%) female, and107 (88.4%) males were included in the study. Majority of the patients were at local or advancedstage (Stage IIIA: 14.9%, Stage IIIB 14.9%, and Stage IV: 48.8%). Most common histological tumortype was squamous cell carcinoma (56.2%). Median neutrophil (N) count was 6.400 μl/ml, medianlymphocyte (L) count was 1.570 μl/ml, while median NLR was 3.7. In univariate analysis, survival ratesof patients did not have any differences according to gender, age, tumor histology, albumin level, andtreatment modality (surgery and chemoradiotherapy). 1‑year and 2‑year survival rates of patients withECOG 0 were higher than ECOG 1, 2, 3 patients (P = 0.034). Survival rates of Stage 1 patients (P 3.7. The percentage of patients who survived at the 1‑year and 2‑yearwere higher in the NLR 3.7 groups (14 vs. 9 months, P = 0.036). The multivariate Cox regression analysisrevealed that the independent predictive factors for longer OS were low ECOG performance score (hazardratio [HR] 0.786, 95% confidence interval [CI]: 0.799–0.931, P = 0.001), early disease stage (HR 1.517,95% CI: 0.527–0.886, P < 0.001), and low NLR (HR 0.573, 95% CI: 0.440–0.962, P = 0 .036).